J Orthop Sports Phys Ther. 2019 May;49(5):337-346. doi: 10.2519/jospt.2019.8616. Epub 2019 Apr 25.
Total shoulder arthroplasty (TSA) is indicated for patients with glenohumeral arthritis. In this procedure, the humeral head and glenoid surface are replaced with prosthetic components. Reverse total shoulder arthroplasty (RTSA) is indicated for patients with glenohumeral arthritis and a poorly functioning rotator cuff. In this procedure, a glenosphere articulates with a humerosocket. While those surgeries are commonly performed, a thorough review of the literature is required to determine the areas of agreement and variations in postoperative rehabilitation.
To describe the literature on rehabilitation protocols following anatomic TSA and RTSA.
For this systematic review, a computerized search was conducted in medical databases from inception to May 21, 2018 for relevant descriptive studies on TSA and RTSA rehabilitation protocols. The methodological index for nonrandomized studies tool and the modified Downs and Black tool for randomized controlled trials were used for assessment of the individual studies.
Sixteen studies met the inclusion criteria, of which 1 provided level I evidence, 1 provided level III evidence, 2 provided level IV evidence, and 12 provided level V evidence. Ten of the studies described rehabilitation guidelines for TSA and 6 described those for RTSA. Following TSA, the use of a sling was recommended for a duration that varied from 3 to 8 weeks, and 4 of the 10 published protocols included resisted exercise during the initial stage of healing (the first 6 weeks after surgery). Seven of 10 published protocols recommended limiting shoulder external rotation to 30° and that passive range of motion be fully restored by 12 weeks post surgery. Suggested use of a sling post RTSA varied from "for comfort only" to 6 weeks, motion parameters varied from no passive range of motion to precautionary range limits, and all protocols agreed on performing deltoid isometric exercises early post surgery. There was a high level of heterogeneity for the rehabilitation guidelines and associated precautions for both TSA and RTSA.
The majority of published protocols were descriptive in nature. Published rehabilitation strategies following TSA and RTSA are based on biomechanical principles, healing time frames, and exercise loading principles, with little consistency among protocols. There is a need to determine optimal rehabilitation approaches post TSA and RTSA based on clinical outcomes.
Therapy, level 5. .
全肩关节置换术（TSA）适用于肩关节炎患者。在该手术中，肱骨头和肩胛盂表面用假体替换。反向全肩关节置换术（RTSA）适用于肩关节炎和功能不佳的肩袖患者。在该手术中，一个球形关节与一个肱骨干关节连接。虽然这些手术很常见，但需要对文献进行全面回顾，以确定在术后康复方面的共识和差异。
描述解剖学 TSA 和 RTSA 术后康复方案的文献。
为了进行这项系统综述，我们在医学数据库中进行了计算机检索，检索范围从建立数据库至 2018 年 5 月 21 日，以获取有关 TSA 和 RTSA 康复方案的描述性研究。我们使用非随机研究方法指数和改良 Downs 和 Black 工具评估了个别研究。
符合纳入标准的研究有 16 项，其中 1 项为 I 级证据，1 项为 III 级证据，2 项为 IV 级证据，12 项为 V 级证据。其中 10 项研究描述了 TSA 的康复指南，6 项研究描述了 RTSA 的康复指南。在 TSA 后，建议使用吊带的时间从 3 周到 8 周不等，10 个已发表的方案中有 4 个在愈合的初始阶段（术后 6 周内）包括阻力运动。10 个已发表的方案中有 7 个建议限制肩部外旋至 30°，并在术后 12 周内完全恢复被动活动范围。RTSA 后使用吊带的建议从“仅为舒适”到 6 周不等，运动参数从无被动活动范围到预防范围限制不等，所有方案都同意在手术后早期进行三角肌等长运动。TSA 和 RTSA 的康复指南和相关注意事项存在高度异质性。
大多数已发表的方案本质上都是描述性的。基于生物力学原理、愈合时间框架和运动负荷原则，发表的 TSA 和 RTSA 术后康复策略各不相同，方案之间几乎没有一致性。需要根据临床结果确定 TSA 和 RTSA 术后的最佳康复方法。
治疗，5 级。
