Shoulder arthroplasty in rheumatoid arthritis

Abstract

The long-term survival rate of shoulder arthroplasties is comparable to that of hip arthroplasties, at about 85% after 15 years. The diagnosis of rheumatoid arthritis is the most important predictive factor for the end-result, with a stronger influence than the condition of the rotator cuff or whether a hemiarthroplasty or a total arthroplasty is performed. Unlike the situation in rheumatoid arthritis, in osteoarthritis wear and tear on the glenoid is caused mainly by medial erosion with cranial migration. The functional results are slightly better with total shoulder replacements than with hemiarthroplasties. Arthroplasty in rheumatoid patients is adversely influenced by the poor quality of the rotator cuff, which is either primarily defective or develops secondary insufficiency as a result of the underlying illness. Secondary cranial migration, i.e. secondary rotator cuff failure, occurs in up to half these patients in the long term. It is frequently followed by glenoid loosening after total shoulder arthroplasty. Nevertheless, glenoid loosening is frequently not progressive over long periods and is well tolerated by the majority of patients. Thus, the rate of glenoid revision operations in rheumatoid patients seldom exceeds 5% in mid- and long-term studies. Owing to poor bone quality, glenoid erosion after hemiarthroplasty is more frequent than in patients with osteoarthritis. In contrast to glenoid loosening, glenoid erosion is almost always painful and leads to poor results requiring surgical revision. In shoulder joints that are centred in the coronal plane and in which the rotator cuff is still intact or only moderately worn, with no more than one defective tendon, total arthroplasty should be given preference. The results achieved with humeral head surface replacement are as good as those yielded by conventional hemiarthroplasty; combination with the implantation of a glenoid is technically demanding but leads to even better results. Reverse arthroplasties should be reserved for patients over 70 years of age with complete or almost complete rotator cuff destruction. In younger patients bipolar implants should be used in preference; the functional results attained with these are admittedly limited, but unlike the reverse implants they do not involve the risk of loosening of the metaglenoid.

Problems, complications, reoperations, and revisions in reverse total shoulder arthroplasty: A systematic review

“…25,26 Also excluded were abstracts 24,31 case reports, 86,87 and articles and reviews without original patient data. * The studies by Baulot and Grammont,4,39,40 Middernacht et al, 65 Walch et al, 94 Boileau et al 7,8 Mottier et al, 66 Neyton et al, 67 and Wall and Walch, 96 were not included in the analysis because parts of them ) References 6,11,13,16,18,30,32,36,[42][43][44][45][46][48][49][50][52][53][54][59][60][61][62][63][68][69][70]74,75,78,85,90,91,93. were the same cohort as in other published studies. 3,…”

Reverse shoulder prosthesis in patients with rheumatoid arthritis: a systematic review

“…Of the latter, 33 were excluded. In 19 reporting on patients who had undergone RSA or TSA, there were no rheumatoid patients with RSA [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]; nine studies on patients who had had an RSA for various aetiologies included one or more rheumatoid patients, but no or insufficient information was provided on their outcomes [26][27][28][29][30][31][32][33][34]; three review articles on RSA in patients with various conditions gave very little information, contained in a short paragraph [35,36], or limited information [37], for the RA group; there were also two articles of general information on shoulder arthroplasty reporting no own case series [38,39]. Two additional studies reported enough pertinent and useful information on several [40] or many [41] RA patients undergoing RSA, but they were excluded because the mean follow-up was less than 36 months and the longest did not reach five years.…”

Wear and damage of articular cartilage with friction against orthopedic implant materials

“…Hemiarthroplasties are less invasive, require less surgical time and result in lower blood loss than total arthroplasties (Blomfeldt et al, 2007; Gartsman et al, 2000). However, patient outcomes are sometimes shown to be less successful than with total arthroplasties, and often require revision, due in part to erosion of the articular surface (Champion and McNally, 2004; Haidukewych et al, 2002; Hasan et al, 2002; Hedtmann and Werner, 2007; Parsons et al, 2004; Sperling et al, 2002). There is a general uncertainty about the cause of seemingly accelerated cartilage wear in hemiarthroplasties.…”