What is the expected range of motion after reverse total shoulder arthroplasty (RTSA)?

Expected Range of Motion After Reverse Total Shoulder Arthroplasty

Patients undergoing reverse total shoulder arthroplasty can expect forward elevation to improve to approximately 130-135°, external rotation to 35-40°, and internal rotation to the L1 vertebral level, with most functional gains achieved by 6-12 months postoperatively. 1

Specific Range of Motion Outcomes

Forward Elevation (Flexion)

• Mean postoperative forward elevation reaches 109-133°, representing improvements of 37-51° from preoperative baselines 2, 1
• Patients typically achieve forward elevation of approximately 133° at mid-term follow-up (mean 6.8 years), improving from preoperative values of 82° 1
• In activities of daily living studies, forward elevation improved from 66° to 109° at one year 2

Abduction

• Postoperative abduction typically reaches 69-94°, with improvements of 17-37° from baseline 2, 3, 1
• The range varies depending on whether the procedure is primary versus revision surgery, with primary cases achieving better outcomes 3

External Rotation

• External rotation improves modestly to 35-40° postoperatively, representing gains of approximately 13° from preoperative values 1
• This represents one of the more limited improvements compared to elevation and abduction 4

Internal Rotation

• Internal rotation typically improves to the L1 vertebral level, though improvements are less consistent and may not reach statistical significance in all studies 2, 1
• Some studies show no significant improvement in internal rotation after RTSA 2

Timeline for Recovery

Early Recovery (3-6 Months)

• Pain relief occurs rapidly after RTSA, with most improvement achieved within the first 3 months 4
• By 6 months, patients achieve approximately 72-91% of their total functional improvement 4
• This contrasts with anatomic total shoulder arthroplasty, where patients reach 90-100% of improvement by 6 months 4

Plateau Phase (6-12 Months)

• RTSA patients demonstrate variable recovery patterns with multiple false plateau points, unlike the more consistent recovery seen with anatomic arthroplasty 4
• Maximum range of motion values continue to improve through the first year postoperatively 2

Long-Term Outcomes (Beyond 1 Year)

• Range of motion improvements are sustained at mid-term follow-up (mean 6.8 years), with continued significant improvements maintained from postoperative baselines 1
• The 5-year survival estimate is 98%, and 10-year survival is 83% 1

Functional Translation to Activities of Daily Living

Important Caveat About ROM Gains

• While maximum range of motion improves significantly, patients may not fully utilize these gains in activities of daily living 2, 3
• In primary RTSA for cuff tear arthropathy, ROM improved significantly in all ADLs for flexion/extension and in 3 of 4 ADLs for abduction/adduction 2
• However, in revision cases, patients could perform only 3 additional ADL tasks postoperatively (out of 13/24 preoperatively), and ROM improved significantly in only 1 of 4 ADLs 3

Specific ADL Limitations

• Internal and external rotation show minimal functional improvement in ADLs, with no significant changes observed in most daily activities 2, 3
• This limitation reflects the biomechanical design of RTSA, which relies on the deltoid muscle rather than the rotator cuff for shoulder motion 5, 6

Comparison to Anatomic Total Shoulder Arthroplasty

The effectiveness of anatomic TSA is greater than RTSA for all measures except elevation and abduction 4. Specifically:

• RTSA provides superior improvements in forward elevation and abduction compared to anatomic arthroplasty 4
• Anatomic TSA achieves better outcomes for shoulder rotation (internal and external) 4
• RTSA patients experience a more variable and prolonged recovery compared to the consistent recovery pattern of anatomic TSA 4

Clinical Pitfalls and Considerations

Rehabilitation Expectations

• Structured physical therapy does not improve outcomes compared to home exercise programs after RTSA 7
• This finding suggests that routine prescription of formal physical therapy may not be necessary for all patients 7

Complications Affecting ROM

• The American College of Radiology reports that the most common complications of RTSA include scapular notching, dislocation, periprosthetic fractures, glenoid baseplate failure, and acromial fractures, all of which can limit range of motion 5, 6
• Decreased range of motion is a common symptom of postoperative complications 5

Age Considerations

• The American Academy of Orthopaedic Surgeons notes concerns about performing shoulder arthroplasty in patients under 50 years due to potential risks of increased prosthetic loosening and decreased survivorship 8, 6