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Fast track rehabilitation after reversed total shoulder arthroplasty: a protocol for an international multicentre prospective cohort study.

ABSTRACT: INTRODUCTION:The use of reversed total shoulder arthroplasty (rTSA) has increased because of an increasing number of indications for this procedure and by ageing of the population. Usual postoperative care consists of immobilisation of the shoulder for a period of 2-6 weeks to allow healing of the subscapularis tendon and protection of the joint. However, new literature proved that reattachment of the subscapularis tendon is unnecessary. Therefore we hypothesised that immobilisation of the shoulder is not necessary and patients can start safely with mobilisation on the first postoperative day. We expect this fast track protocol to be safe and result in better short-term and long-term functional outcomes. METHODS AND ANALYSIS:In our prospective cohort, we will include at least 75 patients aged 50 years and older indicated for rTSA, with acute fracture treatment as an exclusion criterion. Patients will be selected and operated in three hospitals: two in the Netherlands and one in Curacao.Patients will visit the outpatient clinic preoperative, at 6 weeks, 3 months and 1 year postoperative. The data that will be collected includes baseline characteristics, reason for surgery, complications and adverse events, patient reported outcomes (Oxford Shoulder Score, EuroQol-5D and Numeric Rating Scale for pain) and range of motion of the shoulder.All patients will be instructed to use a sling only for 1 day and to follow a progressive physiotherapy schedule for 12 weeks. The primary outcome is the occurrence of complications and adverse events. ETHICS AND DISSEMINATION:The Medical Ethics Committee from the VUmc and Curacao reviewed this study protocol and granted exemption from ethical approval (METC VUmc 2019.111, METC Curacao 2019-02). Study results will be presented at (inter)national conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER:Netherlands Trial Register (NL7656).

SUBMITTER: van Essen T

PROVIDER: S-EPMC7440714 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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Fast track rehabilitation after reversed total shoulder arthroplasty: a protocol for an international multicentre prospective cohort study.

van Essen Tom T Kornuijt Anke A de Vries Lieke Maria Anna LMA Stokman Remco R van der Weegen Walter W Bogie Rob R Hillen Robert Jan RJ van Kampen D A DA

BMJ open 20200820 8

<h4>Introduction</h4>The use of reversed total shoulder arthroplasty (rTSA) has increased because of an increasing number of indications for this procedure and by ageing of the population. Usual postoperative care consists of immobilisation of the shoulder for a period of 2-6 weeks to allow healing of the subscapularis tendon and protection of the joint. However, new literature proved that reattachment of the subscapularis tendon is unnecessary. Therefore we hypothesised that immobilisation of t ...[more]

PMID: 32819933

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Project description:Despite the growing evidence in the literature there is still a lack of consensus regarding the use of minimally invasive surgical technique (MIS) in total knee arthroplasty (TKA).A prospective, randomized, international multicentre trial including 69 patients was performed to compare computer-assisted TKA (CAS-TKA) using either mini-midvastus (MIS group) or standard medial parapatellar approach (conventional group). Patients from 3 centers (Maastricht, Zwickau, Adelaide) with end-stage osteoarthritis of the knee were randomized to either an MIS group with dedicated instrumentation or a conventional group to receive cruciate retaining CAS-TKA without patella resurfacing. The primary outcome was to compare post operative pain and range of motion (ROM). The secondary outcome was to measure the duration of surgery, blood loss, chair rise test, quadriceps strength, anterior knee pain, Knee Society Score (KSS),WOMAC scores, mechanical leg axis and component alignment.Patients in the MIS group (3.97?±?2.16) had significant more pain at 2 weeks than patients in the conventional group (2.77?±?1.43) p?=?0.003. There was no significant difference in any of the other primary outcome parameters. Surgery time was significantly longer (p?<?0.001) and there were significantly higher blood loss (p?=?0.002) in the MIS group as compared to the conventional group. The difference of the mean mechanical leg alignment between the groups was not statistically significant (-0.43° (95% CI -1.50-0.64); p?=?0.43). There was no significant difference of component alignment between the two surgical groups with respect to flexion/extension (p?=?0.269), varus/valgus (p?=?0.653) or rotational alignment (p?=?0.485) of the femur component and varus valgus alignment (p?=?0.778) or posterior slope (p?=?0.164) of the tibial component.There was no advantage of the MIS approach compared to a conventional approach CAS-TKA in any of the primary outcome measurements assessed, however the MIS approach was associated with longer surgical time and greater blood loss. MIS-TKA in combination with computer navigation is safe in terms of implant positioning.ClinicalTrials.gov NCT02625311 8 December 2015.

Dataset Information

Fast track rehabilitation after reversed total shoulder arthroplasty: a protocol for an international multicentre prospective cohort study.

Publications

Fast track rehabilitation after reversed total shoulder arthroplasty: a protocol for an international multicentre prospective cohort study.

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