Can Reverse Shoulder Arthroplasty be Used with Few Complications in Rheumatoid Arthritis?

Abstract

Background Many patients with rheumatoid arthritis develop superior migration of the humeral head because of massive cuff tears, causing loss of active motion. Reverse shoulder arthroplasty could potentially restore biomechanical balance but a high incidence of glenoid failure has been reported. These studies do not, however, typically include many patients with rheumatoid arthritis (RA) and it is unclear whether the failure rates are similar. Questions/purposes We therefore (1) evaluated pain relief and shoulder function after reverse arthroplasty in RA; (2) compared results between primary and revision procedures; (3) determined the incidence of scapular notching; and (4) determined the complication rate. Methods We identified 29 patients with RA who had 33 reverse arthroplasties from among 412 patients having the surgery. Six patients were lost to followup. Twenty three patients (27 shoulders) were evaluated after a minimum followup of 18 months (mean, 56 months; range, 18-143 months), including 18 primary and nine revision arthroplasties. All patients were evaluated preoperatively and 23 shoulders postoperatively by an independent physiotherapist and four were assessed postoperatively by phone. Level of pain, range of motion, and ConstantMurley score were recorded and new radiographs taken.

Complications with reverse total shoulder arthroplasty and recent evolutions

“…Indications for RTSA include degenerative arthritis associated with irreparable cuff tears (cuff tear arthropathy) and irreparable cuff tears with loss of function in the elderly (pseudoparalytic shoulder) [3][4][5][6][7][8][9], aseptic necrosis of the humeral head in the elderly [1], shoulder reconstruction in rheumatoid arthritis [5,10], chronic shoulder dislocations in the elderly [11], reconstruction surgery for tumour [12,13], revision surgery after failed anatomical or resurfacing arthroplasty [14][15][16][17][18][19], failed rotator cuff repair with superior escape and reconstruction for comminuted fractures of the proximal humerus in the elderly [20,21]. Any procedure addressing shoulder reconstruction with RTSA demands the existence of a functional deltoid muscle that makes shoulder mobility possible with this type of implant [20].…”

Pain and function in eight hundred and fifty nine patients comparing shoulder hemiprostheses, resurfacing prostheses, reversed total and conventional total prostheses

“…Among RA patients in our study, RTPs were used much more frequently than TPs, and RTPs performed very well in this patient group. Good functional results and pain relief have previously been demonstrated for RTPs and in patients with RA [21][22][23][24], although no comparison of RTPs to HPs has previously been published. The frequent incidence of damaged rotator cuff in RA patients suggests the use of RTPs rather than TPs; randomised studies are needed to further investigate this.…”

Surgical Treatment for the Shoulder Joint in Rheumatoid Patients

“…20) As such, the Lévigne classification system reflects the morphological changes of the glenohumeral joint, offering useful information for surgical decisions. 21,22) Surgical Indication…”

“…Recently, satisfactory results have been reported with reverse shoulder arthroplasty (RSA), which can overcome the problems of conventional arthroplasty in RA patients. 21,22) This procedure might be an alternative treatment option. The biomechanical features of RSA is that this procedure confers high stability and improves the lever arm for the deltoid muscle, potentially resulting in the improvement of range and strength of abduction, even in the presence of rotator cuff dysfunction.…”