PURPOSE: To compare early rehabilitation (motion ≤ 14 days) with delayed programs (motion ≥ 28 days) after primary rTSA. METHODS: PubMed, Embase, CENTRAL and EBSCOhost were searched, between 1 January 2015 and 17 March 2026, for randomized controlled trials (RCTs) and comparative cohorts evaluating postoperative rehabilitation. Three reviewers screened records, extracted data, and assessed bias (CLEAR-NPT; MINORS) and certainty (GRADE). RESULTS: Seven studies (2 RCTs, 5 comparative cohorts) involving 1,606 shoulders (early = 978; delayed = 628) met eligibility. In these seven studies, the early protocol resulted in increased forward flexion at six weeks postoperatively. By 6-12 months, range of motion and patient reported outcomes (ASES or Constant scores) were functionally equivalent between groups. Dislocation incidence remained low and comparable (1.4% early vs 1.4% delayed), as did overall complications (15.1% vs 23.9%). Evidence certainty was low-to-moderate for early functional benefit and complications, and very low for rare acromion and scapular spine fractures. CONCLUSION: Starting passive or active motion within two weeks after uncomplicated primary rTSA modestly accelerates early range of motion without raising complication risk. Given limited certainty, rehabilitation timing should be individualized until larger, high-quality randomized trials define best practice.
Alkhouri et al. (Wed,) studied this question.
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