Abstract
BACKGROUND: As shoulder arthroplasty volume rises globally, evidence on optimal perioperative rehabilitation and analgesia remains limited. This systematic review evaluated enhanced recovery after surgery postoperative strategies on patient-reported outcomes and satisfaction. METHODS: PubMed, Embase, MEDLINE, Global Health, and Cochrane Library were searched per Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. Studies undergoing total shoulder arthroplasty or reverse total shoulder arthroplasty (RTSA) were included. Interventions: rehabilitation timing and analgesic protocols. Outcomes: American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST), Single Assessment Numeric Evaluation (SANE), range of motion, Quality of Recovery-15, and satisfaction. RESULTS: Eighteen studies including 1,722 patients (total shoulder arthroplasty: n = 7; RTSA: n = 2; mixed: n = 9) were analyzed. Delayed rehabilitation after RTSA improved early pain scores (ASES pain 26.3 ± 16.3 vs. 16.7 ± 11.6 at 6 months; P = .01) and overall function (ASES total 40.2 ± 20.1 vs. 30.0 ± 18.8; P = .04), without affecting long-term outcomes (ASES 88-90, SST 9.8-9.9, SANE 85-88 at 12 months). Opioid-sparing and opioid-free protocols achieved equivalent functional recovery (ASES 74-89, SST 6-9, SANE 24-28 change-from-baseline) and consistently higher patient satisfaction (86-97%) at 2-6 weeks. Continuous interscalene blocks and liposomal bupivacaine provided effective analgesia (Quality of Recovery-15 postoperative day 3: 124.5-132.0), with trends toward improved early recovery. Across studies, range of motion outcomes (forward flexion 126-146° and external rotation 57-62°) were comparable, indicating multiple enhanced recovery after surgery strategies can deliver similar functional and patient-reported outcomes while enhancing early recovery and satisfaction. CONCLUSION: Functional recovery following shoulder arthroplasty appeared robust across diverse rehabilitation and analgesic strategies. Delayed rehabilitation offered early pain advantages, and opioid-sparing approaches enhanced patient satisfaction without compromising outcomes. These findings supported a personalized, patient-centered approach to postoperative care and highlight the need for further high-quality comparative trials.