# Anatomic Total Shoulder Arthroplasty Outcomes Were Not Negatively Affected by the COVID-19 Pandemic

## TL;DR

The study found that patients who had shoulder surgery during the early months of the COVID-19 pandemic had similar recovery outcomes to those treated in 2019, despite less physical therapy.

## Contribution

This study is novel in showing that reduced physical therapy access during the pandemic did not negatively impact shoulder surgery outcomes.

## Key findings

- Patients in 2020 had significant improvements in range of motion and strength comparable to 2019 patients.
- 2020 patients completed fewer physical therapy sessions and ended therapy earlier than 2019 patients.
- Despite less therapy, 2020 patients reported low average pain scores at final follow-up.

## Abstract

Objective
 To investigate whether patients undergoing anatomic total shoulder arthroplasty (ATSA) between January and March 2020 experienced different postoperative outcomes than patients in 2019. We hypothesized that patients in 2020 would have less access to physical therapy (PT) and experience different postoperative outcomes.

Methods
 Records from patients who received ATSA between January 1st, 2019, and March 17th, 2019, and January 1st, 2020, to March 17th, 2020, were analyzed. Patient data, including demographic information, range of motion (ROM), strength, and PT was collected and compared between the two groups. The 2020 patients were contacted by phone during October 2022 and patient-reported metrics were gathered.

Results
 The present study identified 24 patients in 2019 and 27 patients in 2020 who underwent ATSA during the specified time frame and had a minimum 1-year follow-up. Patients in 2019 experienced improvements in forward elevation (FE) ROM (125.4° to 146.7°;
p
 = 0.008), external rotation (ER; 33.0° to 47.7°;
p
 < 0.001), and internal rotation (IR; S1 to L4;
p
 = 0.019). Patients in 2020 also experienced significant improvements in FE (120.2° to 141.1°;
p
 = 0.009), ER (32.9° to 42.0°;
p
 = 0.037), and IR (S1 to L3;
p
 = 0.002). Patients in 2020 terminated PT earlier (2019: 125.8 days; 2020: 91.1 days;
p
 = 0.046) and completed fewer sessions (2019: 21.4 sessions; 2020: 13.1 sessions;
p
 = 0.003). At the final follow-up, patients in 2020 reported an average Visual Analogue Scale (VAS) pain score of 1.67 ± 1.1.

Conclusion
 Despite decreased PT, patients who underwent ATSA in 2020 had significant improvements in ROM and strength and were comparable to patients in 2019.

Objetivo
 Investigar se os pacientes submetidos à artroplastia total anatômica do ombro (ATAO) entre janeiro e março de 2020 tiveram resultados pós-operatórios diferentes dos pacientes operados em 2019. Nossa hipótese é a de que os pacientes de 2020 teriam menos acesso à fisioterapia (FT) e apresentariam desfechos pós-operatórios diferentes.

Métodos
 Foram analisados os prontuários de pacientes submetidos à ATAO de 1° de janeiro de 2019 a 17 de março de 2019 e de 1° de janeiro de 2020 a 17 de março de 2020. Os dados dos pacientes, incluindo informações demográficas, amplitude de movimento (ADM), força e FT foram coletados e comparados entre os dois grupos. Os pacientes de 2020 foram contatados por telefone durante outubro de 2022, e as métricas relatadas por eles pacientes foram coletadas.

Resultados
 Este estudo identificou 24 pacientes em 2019 e 27 pacientes em 2020 que foram submetidos à ATAO durante o período especificado e tiveram acompanhamento mínimo de 1 ano. Os pacientes em 2019 apresentaram melhoras na ADM de elevação anterior (EA; 125,4° a 146,7°;
p
 = 0,008), rotação externa (RE; 33,0° a 47,7°;
p
 < 0,001) e rotação interna (RI; S1 a L4;
p
 = 0,019). Os pacientes em 2020 também apresentaram melhoras significativas de EA (120,2° a 141,1°;
p
 = 0,009), RE (32,9° a 42,0°;
p
 = 0,037) e RI (S1 a L3;
p
 = 0,002). Os pacientes de 2020 terminaram a FT mais cedo (2019: 125,8 dias; 2020: 91,1 dias;
p
 = 0,046) e fizeram menos sessões (2019: 21,4 sessões; 2020: 13,1 sessões;
p
 = 0,003). No acompanhamento final, os pacientes de 2020 relataram uma pontuação média de dor na Escala Visual Analógica (EVA) de 1,67 ± 1,1.

Conclusão
 Apesar da menor realização de FT, os pacientes submetidos à ATAO em 2020 apresentaram melhoras significativas na ADM e na força e foram comparáveis aos pacientes de 2019.