Early mobilisation versus delayed protocols after reverse total shoulder arthroplasty for nonfracture indications: A systematic review and meta-analysis

Abstract

Purpose: This study aimed to compare clinical outcomes, range of motion, pain scores and complication rates between early and delayed mobilisation following reverse total shoulder arthroplasty (RTSA). Methods: A systematic review and meta-analysis were conducted according to 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Ovid Medline and Scopus databases were searched from inception through May 2025. Comparative studies evaluating early versus delayed mobilisation after RTSA were included. Methodological quality was assessed using the modified Coleman Methodology Score, while risk of bias was evaluated using the Newcastle-Ottawa Scale for cohort studies and the Risk of Bias 2 tool for randomised controlled trials. Pooled outcomes included patient-reported outcome scores, range of motion and postoperative complications. Results: Six studies with a total of 1763 patients were included. All included studies in this review investigated RTSA for nonfracture indications. Methodological quality ranged from fair to excellent across included studies. Meta-analysis showed that early mobilisation was associated with statistically significantly greater improvements in forward flexion (mean difference [MD] of 4.36°), abduction (MD of 4.95°) and pain visual analogue scale scores (MD of –0.40) compared to delayed mobilisation. No statistically significant differences were found between groups in Constant scores, American Shoulder and Elbow Surgeons scores, external rotation, dislocation rates, or revision surgery. Notably, early mobilisation was associated with a lower incidence of postoperative fractures. Conclusion: Early mobilisation after RTSA may yield modest improvements in pain and shoulder motion, though below established MCID thresholds. Importantly, it was associated with a lower risk of postoperative fractures and did not increase other complications. These findings support the safety of early rehabilitation, while highlighting the limited clinical magnitude of benefit. Level of Evidence: Level III.