Is the use of abduction pillows crucial for post-operative rehabilitation following reverse total shoulder arthroplasty?

Background: Surgeons often use abduction pillows after reverse total shoulder arthroplasty (rTSA), but evidence for their benefits is limited. This study compares outcomes for patients using a sling with or without an abduction pillow post-operatively.

Methods: A retrospective review was conducted on patients undergoing primary rTSA. Patients were grouped based on post-operative use of an abduction pillow or not. Data was collected at 6 weeks, 3 months, 6 months, 1 year, and final follow-up. Primary outcomes included rates of post-operative dislocation, range of motion, and patient-reported outcomes.

Results: Patients using an abduction pillow showed reduced forward flexion at 3 months (120° vs. 139°, p = 0.002) and 6 months (135° vs. 147°, p = 0.049). At 6 weeks, abduction was lower in the pillow group (90° vs. 124°, p = 0.01). There were no significant differences in other range-of-motion metrics or patient-reported outcomes. Using no pillow did not increase dislocation risk (OR: 1.67, p = 0.60), infection, readmission, revision, or repeat surgery rates.

Conclusions: Post-operative sling use without an abduction pillow after rTSA appears safe, with no increase in complications and similar patient satisfaction and outcomes.

Level of evidence: Therapeutic Level III.