OBJECTIVE: To compare range of motion (ROM) and patient-reported outcomes (PROs) between a structured home exercise program (HEP) and active, supervised physiotherapy (PT) after primary RTSA by performing a multi-center randomized clinical trial. METHODS: Patients undergoing primary RTSA at two centers were randomized to either a HEP group, in which they were given a handout and a rope pulley, or a PT group, in which they were given a standardized prescription. Surgical technique and implants were standardized. At baseline, six weeks, three months, and one year postoperatively, we obtained American Shoulder and Elbow Surgeons (ASES) scores, Western Ontario Osteoarthritis Scores (WOOS), visual analogue scale for pain (VAS) scores, and measured ROM via videotape. On video, ROM was then measured by blinded observers. At all study visits, patients were asked how many days per week they were in PT and how many days a week they completed HEP to determine compliance and cross-over. An a priori power analysis suggested 29 patients per group, 56 patients total to detect a difference of 30degree in active forward elevation with a power of 0.8 at a two-sided alpha of 0.05. RESULTS: 89 patients were randomized, 43 to PT, and 46 to HEP. We obtained one year PRO follow-up on 83 patients (93%) and ROM follow-up on 73 patients (82%). Nine patients (20%) crossed over from HEP to PT and 2 patients (4%) crossed over from PT to HEP. Complications occurred in 13% of HEP and 17% of PT patients (p = 0.629). Using mixed models that account for baseline values, there were no significant differences between groups in PROs or ROM at final follow-up. CONCLUSION: In this two-center, randomized clinical trial, there were no significant differences in patient outcomes or range of motion between HEP and PT after RTSA. These findings suggest that it may not be necessary to recommend PT as a protocol for all patients after RTSA.

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