Can patients manage toileting after reverse total shoulder arthroplasty? A systematic review
A major concern for patients undergoing reverse total shoulder arthroplasty (RTSA) is managing toileting after surgery. The goals of this systematic review of RTSA studies were to determine the following: (1) the percentage of patients who can manage toileting, (2) their degree of difficulty with toileting, and (3) the percentage of patients who can manage toileting after bilateral versus unilateral RTSA.
Medline, EMBASE, Google Scholar, and the Cochrane Central Register of Controlled Trials were searched for studies reporting the ability to manage toileting after RTSA. Six studies with at least 12 months of follow-up were included, yielding 183 patients (105 unilateral RTSA, 78 bilateral RTSA). We pooled patient data and calculated the weighted mean proportion of patients able to manage toileting, those who reported difficulty, and those able to manage toileting after unilateral versus bilateral RTSA. Statistical significance was set at P < 0.05.
Most patients (92%; 95% confidence interval, 87–95%) were able to manage toileting after RTSA. Some degree of difficulty with toileting was reported for 20% of all shoulders. Almost all patients with bilateral RTSA were able to manage toileting with at least one arm (weighted mean proportion 97%; 95% confidence interval, 88–99%). There was no significant difference in the proportion of patients able to manage toileting after unilateral versus bilateral RTSA (P = 0.08). Only 3% of all papers published on the clinical results of RTSA by June 2017 reported upon toileting after the procedure.
With the available evidence, most patients were able to manage toileting after RTSA, although one-fifth reported some degree of difficulty. Ability to manage toileting was similar after unilateral versus bilateral RTSA. In the future, this variable should be a standard question after shoulder arthroplasty.
Level of evidence
KeywordsActivities of daily living Internal rotation Patient satisfaction Range of motion Reverse total shoulder arthroplasty Toileting
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
For this type of study, formal consent is not required.
- 1.Boileau P, Watkinson D, Hatzidakis AM, Hovorka I (2006) Neer Award 2005: the Grammont reverse shoulder prosthesis: results in cuff tear arthritis, fracture sequelae, and revision arthroplasty. Journal of Shoulder and Elbow Surgery/American Shoulder and Elbow Surgeons [et al] 15 5:527–540. doi: https://doi.org/10.1016/j.jse.2006.01.003
- 2.Favard L, Katz D, Colmar M, Benkalfate T, Thomazeau H, Emily S (2012) Total shoulder arthroplasty—arthroplasty for glenohumeral arthropathies: results and complications after a minimum follow-up of 8 years according to the type of arthroplasty and etiology. Orthopaedics & Traumatology, Surgery & Research: OTSR 98 4 Suppl:S41–47. doi: https://doi.org/10.1016/j.otsr.2012.04.003
- 6.Chen AL, Bain EB, Horan MP, Hawkins RJ (2007) Determinants of patient satisfaction with outcome after shoulder arthroplasty. Journal of Shoulder and Elbow Surgery/American Shoulder and Elbow Surgeons [et al] 16 1:25–30. doi: https://doi.org/10.1016/j.jse.2006.04.013
- 18.Michener LA, McClure PW, Sennett BJ (2002) American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, patient self-report section: reliability, validity, and responsiveness. Journal of Shoulder and Elbow Surgery/American Shoulder and Elbow Surgeons [et al] 11 6:587–594. doi: https://doi.org/10.1067/mse.2002.127096
- 20.Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6(7):e1000100. https://doi.org/10.1371/journal.pmed.1000100 CrossRefPubMedPubMedCentralGoogle Scholar
- 22.Maier MW, Zeifang F, Caspers M, Dreher T, Klotz MC, Rettig O, Wolf SI, Kasten P (2015) Can reverse shoulder arthroplasty in post-traumatic revision surgery restore the ability to perform activities of daily living? Orthopaedics & Traumatology, Surgery & Research: OTSR 101(2):191–196. https://doi.org/10.1016/j.otsr.2014.12.007 CrossRefGoogle Scholar
- 25.Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, Norris S, Falck-Ytter Y, Glasziou P, DeBeer H, Jaeschke R, Rind D, Meerpohl J, Dahm P, Schunemann HJ (2011) GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol 64(4):383–394. https://doi.org/10.1016/j.jclinepi.2010.04.026 CrossRefPubMedGoogle Scholar