The objective of this study was to investigate whether immobilization following RSA impacts postoperative range of motion (ROM), clinical scores, and complication rates.Our hypothesis is that rehabilitation protocol without immobilization would yield similar clinical results compared with immobilization protocol.
This retrospective case study included 52 shoulders (48 patients) which underwent surgery at our hospital between July 2019 and August 2023, and were available for at least one year of postoperative follow-up. The patients were divided into two groups based on the rehabilitation protocol: postoperative 3-week immobilization group with abduction pillow (Group 1) and non-immobilization group (Group 2).Demographic characteristics, ROM, Constant score (CS), and complications were recorded.
The mean age at the time of surgery was 76.4 years At 1-year follow-up, mean ROM changed from 60.2 to 115.9 degrees of flexion, 48.6 to 103.9 degrees of abduction, 18.4 to 17.3 degrees of external rotation in adduction, and an internal rotation score of 4.5 to 3.4, in Group 1(n = 22). In Group 2(n = 30), mean ROM changed from 77 to 133.5 degrees of flexion, 72 to 120.3 degrees of abduction, 25.8 to 28.7 degrees of external rotation in adduction, and an internal rotation score from 4.3 to 4.5. The CS improved from 28.3 to 55.2 in Group 1 and from 31.9 to 60.2 in Group 2. Pain scores improved from 7.6/15 to 10.5/15 in Group 1 and from 6.2/15 to 12.6/15 in Group 2.Although no significant differences were observed between the groups preoperatively, except for abduction, significant differences were found postoperatively in ROM and pain scores . There were two dislocations in Group 2 postoperatively.
At one year postoperatively, non-immobilized group (Group 2) shows comparable or better clinical outcomes than the conventionally immobilization group (Group 1). In addition, benefits to the patient were observed, such as reduced costs and less stress from immobilization due to the absence of an abduction pillow. In non-immobilization group (Group 2), two postoperative dislocations were observed. However, the impact of fixation remains unclear because these dislocations were caused by factors other than fixation such as falls or weight-bearing activities.The results of this study suggest that early rehabilitation without immobilization after RSA may be an effective and safe approach.
While immobilization is commonly used in postoperative protocols following RSA, the results of this study suggest that the necessity of traditional immobilization should be reconsidered. In the future, it will be important to increase sample size and conduct long-term observation to evaluate the risks associated with non-immobilization and its impact on both the physical and psychological recovery of patients.
immobilization
