Does immobilization of patients who underwent a reverse total shoulder arthroplasty for proximal humerus fracture affect postoperative outcomes?

Hypothesis And Background: Reverse total shoulder arthroplasty (rTSA) has become an increasingly popular treatment option for proximal humerus fractures (PHFs) in older patients. However, postoperatively, there lacks a universal protocol for the duration of arm immobilization in a sling. This retrospective review aims to determine whether the clinical outcomes of patients treated at our institution varied depending on their immobilization status following rTSA for PHF.

Methods: All patients aged >50 years with a diagnosis of PHF who were treated with rTSA at a level 1 trauma center between August 2016 and August 2023 with a minimum of 1-year follow-up were included. Patients were grouped into 2 cohorts based on postoperative immobilization. The early range of motion (EROM) cohort was allowed to use the sling for comfort and perform activities of daily living (ADLs) immediately postoperatively, whereas the immobilization cohort consisted of patients instructed to remain immobilized in the sling for 4-6 weeks. The duration of mobilization was recorded. Additional variables collected include demographics, preoperative comorbidities, Neer classification, range of motion (ROM), patient-reported outcomes, postoperative complications, tuberosity healing, and time to tuberosity healing.

Results: Of the 104 patients included in this study, 75 patients (72%) were immobilized in a sling and 29 patients (28%) were prescribed EROM postoperatively. Compared with the immobilization cohort, EROM patients had significantly better active abduction at 6 weeks (P = .011) and 12 weeks (P = .015) and active external rotation at 12 weeks (P = .013). There were no differences in ROM at the 6-month or 1-year follow-up and no differences in rates of tuberosity healing, patient-reported outcomes, or postoperative complications.

Conclusion: Patients prescribed EROM following rTSA for PHF were found to have a faster recovery of ROM but no difference in any outcome at 1 year postoperatively. Complication and reoperation rates as well as tuberosity healing also did not differ between the 2 cohorts, further supporting EROM as a safe and effective option following rTSA. EROM allows patients to resume ADLs sooner, enabling a sense of independence in early recovery.