Shoulder Replacement and Abduction Pillow

Abduction Pillows and Reverse Shoulder Replacements

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

Mark, Warren, Hurley, Goltz, Lorentz, Crook, Adu-Kwarteng, Levin , Klifto, Anakwenze

https://journals.sagepub.com/doi/10.1177/17585732241309019

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 following reverse shoulder replacement.

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 after reverse shoulder replacement. 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 related to reverse shoulder replacement. 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 is safe, showing no increased complications and similar patient outcomes with reverse shoulder replacement.

My Opinion

Abduction pillows have traditionally been used for patient comfort and shoulder stabilization. The deltoid and rotator cuff are less under tension when the pillow is used, which may help healing and recovery. In high BMI patients with medialized rTSAs, the pillow may have utility to prevent adduction based impingement instability. Therefore, considering a reverse shoulder replacement could be crucial.