Nguyen Huu F.1, Collin P.2, Matsukawa T.3, Denard P.J.4, Gain S.2, Lädermann A.5
1Physiothérapie de Cornavin, Physiotherapy, Geneva, Switzerland, 2Centre Hospitalier Privé Saint-Grégoire, Saint-Grégoire, France, 3Nagoya University School of Medicine, Department of Orthopedic Surgery, Nagoya, Japan, 4Oregon Health & Science University, Department of Orthopaedics and Rehabilitation, Portland, United States, 5La Tour Hospital, Division of Orthopaedics and Trauma Surgery, Meyrin, Switzerland
Background: Recently reverse shoulder arthroplasty (RSA) has gained increasing popularity because of a clinical perception of an improved functional outcome. However, some patients show/experiment poor recovery of active forward flexion (AFF) after surgery. It has already been demonstrated that it could be related to initial diagnosis, pre- and intraoperative range of motion (ROM) or deltoid impairment, and arm lengthening.
Purpose: The aim of this study was to determine if other predicting factors of AFF after RSA exist.
Methods: Between January 2011 to January 2012, all RSA performed by one of the author were prospectively enrolled in this study. The collective was divided into 2 groups regarding AFF after surgery and a regression analysis was performed to define independent predictive factors of postoperative AFF. The following baseline characteristics were assessed: age, sex, dominant arm, patient activity, body mass index (BMI), preoperative diagnosis, deltoid status, pain and Constant scores, subjective shoulder value (SSV), simple shoulder test (SST) and radiographic findings. Patients were reviewed at 6 weeks, and 3 , 6, 12 and 24 months.
Results: During the study period, 127 RSA were performed. Twenty-three patients were excluded from the study because of preoperative diagnosis. Two patients declined to participate and 1 patient died leaving a cohort of 101 RSA in 101 patients for the final analysis. Poor postoperative AFF was significantly related at 6 weeks to poor postoperative deltoid strength (MRC grade) and at 1 year follow[gg1] -up to surgery of non-dominant arm, preoperative poor AFF, preoperative activity, poor subjective shoulder value, and contralateral poor Constant score.
Conclusion(s): This study revealed that RSA of non-dominant side, preoperative poor AFF, poor subjective shoulder value and poor contralateral Constant score are risk factors of poor recovering AFF. For function to be improved, it may be important to work on own patient perception of upper limb, and to educate pre- and post operatively how to elevate the arm.
Implications: This study allows to adapt more quickly and more precisely the post-operative physiotherapy treatment of patients with risk factors of a bad AFF after RSA.
Funding acknowledgements: none
Topic: Orthopaedics
Ethics approval: Ethics approval of Centre Hospitalier Privé Saint-Grégoire (vivalto santé), boulevard Boutière 6, 35768 Saint-Grégoire Cedex, France.
All authors, affiliations and abstracts have been published as submitted.
