Is a formal physical therapy program necessary after total shoulder arthroplasty for osteoarthritis?

Philip J. Mulieri, MD, PhD^a, Jason O. Holcom^b, MDb, Page Dunning, BA^c, Michele Pliner, BA^c, R. Kent Bogle, MD^c, Derek Pupello, BS, MBA^c, Mark A. Frankle, MD^a

^a  Shoulder & Elbow Division, Florida Orthopaedic Institute, Tampa, FL, USA
^b Henry Ford Wyandotte Hospital, Wyandotte, MI, USA
^c Foundation for Orthopaedic Research and Education, Tampa, FL, USA

Journal of Shoulder and Elbow Surgery, volume 19, issue 4

Hypothesis A retrospective analysis was conducted of 2 consecutive groups of patients undergoing total shoulder arthroplasty (TSA) for primary osteoarthritis. One group was treated with formal physical therapy (PT), and one group was treated with home-based, physician-guided PT. We hypothesized that patients with a formal postoperative PT protocol would have significantly better postoperative clinical outcomes than patients with no formal PT.

Methods Group A (43 patients) had a standard PT program. Group B (38 patients) had a home-based, physician-guided PT program. Clinical outcomes (preoperatively, 3, 6, and 12 months and most recent follow-up) were analyzed. A minimum sample size of 31 patients gives power to detect a 10-point American Shoulder and Elbow Surgeons (ASES) score (α = 0.05, β = 0.80).

Results ASES and Simple Shoulder Test (SST) scores significantly improved in both groups at all follow-up periods. Forward flexion and abduction were significantly improved in group B at all time points, whereas an initial improvement in forward flexion and abduction in group A was lost at final follow-up. There were no significant differences in final ASES or SST scores between groups at final follow-up. However, forward flexion, abduction, and the Short Form-36 physical component summary in group B were significantly better than group A at final follow-up. No significant improvements in internal rotation or SF-36 mental component summary were seen within or between the groups at final follow-up. Overall, there was no difference in patient satisfaction, with 88% satisfaction in group A and 95% satisfaction in group B (χ2 = 0.471, P = .4924).

Conclusions A home-based, physician-guided therapy program may provide adequate rehabilitation after TSA, allowing for a reduction in cost for the overall procedure.