Paper 24: Self-removal of sling following reverse shoulder arthroplasty results in no difference in outcomes and complication rates: short-term results of a prospective, single-blinded, randomized controlled trial

Objectives: The purpose of this study was to compare short-term range of motion (ROM), patient-reported outcomes (PROs), and early complication rates in patients instructed to wear a sling for six weeks versus those allowed to remove the sling at their discretion. We hypothesized that outcomes and complication rates would be similar between groups in the three months following reverse shoulder arthroplasty (RSA).
Methods: This is prospective, single-blinded, randomized controlled trial which evaluates RSA patients. Patients were randomized into two groups: the Sling Group (SG), instructed to wear a sling for six weeks postoperatively, and the Sling-for-Comfort Group (SCG), allowed to discontinue sling use once their regional nerve block resolved. Planned enrollment includes 50 patients randomized into each group, with the surgeon blinded to the treatment arm. This interim analysis includes patients with at least three months follow-up. Patients were matched based on age, gender, and surgical indication. Pre- and post-operative ROM, including forward flexion (FF), external rotation (ER), and internal rotation (IR) using the Constant-Murley scoring system, as well as PROs, including subjective shoulder value (SSV), and visual analog score (VAS) were collected using electronic medical records. Finally, post-operative complications including clinical complications and radiographic complications were included. Student's t-test was used for continuous variables, and the chi-square test was used for categorical variables.
Results: 52 patients met inclusion criteria, with 26 patients in each group. There were no significant differences in baseline demographics: age (SG: 72.3+-6.4 years, SCG: 74.1+-7.0 years, p=0.3), gender (SG: 42.3% male, SCG: 34.6% male, p=0.6), or surgical indication (SG: 61.5% osteoarthritis, SCG: 61.54% osteoarthritis, p=1.0). No significant differences were found in pre-operative and post-operative FF (p=0.3, p=0.3), ER (p=0.7, p=0.4), and IR (p=0.9, p=0.4). Similarly, pre-operative and post-operative SSV (p=0.9, p=0.2) and VAS (p=0.1, p=0.9) showed no statistical difference. No early clinical or radiographic complications were identified in either group.
Conclusions: Early, short-term data found in this study supports our hypothesis that ROM, PROs, and complication rates are similar between patients who wear a post-operative sling strictly for six weeks and those who discontinue the sling right away following RSA. We did not observe an increase in complication rates of instability, wound healing issues, or early fixation failure in patients who discontinued their sling immediately. The lack of any observable benefits from a strict sling protocol may be particularly beneficial for elderly patients who live alone, as it allows them to remove the sling at their discretion to maintain their independence for ADLs in the immediate postoperative period.