Ream and Run non-prosthetic glenoid arthroplasty for shoulder arthritis: Regenerative cementless surgery designed for individuals desiring higher levels of activity than recommended for traditional total joint replacement.

Edited By: Winston J. Warme, MD, Frederick A. Matsen III, M.D.
Last updated Monday, June 23, 2008

Rehabilitation

Physical therapy

Early motion after shoulder hemiarthroplasty with non-prosthetic glenoid arthroplasty is critical for achieving optimal shoulder function.

Arthritic shoulders are stiff. Although a major goal of the surgery is to relieve this stiffness by release of scar tissue, it may recur during the recovery process if range of motion exercises are not instituted immediately. For the first 6 weeks of the recovery phase, the focus of rehabilitation is on maintaining the motion that was recovered at surgery. Strengthening exercises are avoided during the first 6 weeks so as not to stress the tendon repair before it heals back to the bone. Later on, once the shoulder is comfortable and flexible, strengthening exercises and additional activities are started.

Rehabilitation options

It is often most effective for the patient to carry out their own exercises so that they are done frequently, effectively and comfortably. Usually, a physical therapist or the surgeon instructs the patient in the exercise program and advances it at a rate that is comfortable for the patient.

Structured outpatient physical therapy is usually not necessary during the initial phase of recovery as the gentle stretching exercises are more effectively performed by the patient. When strengthening exercises are added to the program--often at around 6 weeks--outpatient physical therapy for rotator cuff strengthening may be beneficial. However, motivated patients may also perform these exercises at home with equal effectiveness. Occasional visits to the surgeon or therapist may be useful to check the progress and to review the program.

Usual response

Patients are almost always satisfied with the increases in range of motion, comfort and function that they achieve with the exercise program. If the exercises are uncomfortable, difficult, or painful, the patient should contact the therapist or surgeon promptly.

Risks

Duration of rehabilitation

Returning to ordinary daily activities

In general, patients are able to perform gentle activities of daily living using the operated arm from two to six weeks after surgery. Walking is strongly encouraged. Driving should wait until the patient can perform the necessary functions comfortably and confidently. Recovery of driving ability may take six weeks if the surgery has been performed on the right shoulder, because of the increased demands on the right shoulder for shifting gears.

With the consent of their surgeon, patients can often return to activities such as swimming, golf and tennis at six months after their surgery.

Long-term patient limitations

One of the primary goals of shoulder hemiarthroplasty with non-prosthetic glenoid arthroplasty is to allow physically demanding individuals to return to activities that would otherwise have been prohibited with the implantation of a plastic socket. While there are no strict limitations on participation, those activities that involve impact (chopping wood, contact sports) and those that involve heavy loads (weightlifting) may predispose the rotator cuff tendons to injury and tear. Thus patients should take caution in these types of activities to minimize the risk of damage to the operated shoulder.

Costs

The surgeon and therapist should provide the information on the usual cost of the rehabilitation program. The program is quite cost-effective, because it is based heavily on home exercises.

Surgery for Arthritis of the Shoulder at the University of Washington

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