Reverse shoulder arthroplasty in patients with rheumatoid arthritis

Jason O. Holcomb, MD^a, Daniel J. Hebert, MD^b, Mark A. Mighell, MD^c, Page E. Dunning^d, Derek R. Pupello, MBA^d, Michele D. Pliner^d, Mark A. Frankle, MD^c

^A Henry Ford Wyandotte Hospital, Wyandotte, MI
^b National Naval Medical Center, Orthopaedic Surgery Service, Bethesda, MD
^c  Florida Orthopaedic Institute, Tampa, FL
^d Foundation for Orthopaedic Research and Education, Tampa, FL

Journal of Shoulder and Elbow Surgery, volume 19, issue 7

Background The purpose of this study was to describe the pathoanatomy of patients diagnosed with rheumatoid arthritis and rotator cuff deficiency and report their outcomes following reverse shoulder arthroplasty.

Methods Twenty-one shoulders were evaluated prospectively. Nine had no prior surgery, 9 had a failed rotator cuff repair, and 3 had a failed arthroplasty. Patients were followed for a minimum of 2 years (average, 36 months). All patients had preoperative radiographs and 19 shoulders had an MRI or CT available for evaluation of muscular and bony deficiency. Radiographs at most recent follow-up were evaluated for loosening and scapular notching.

Results All outcome measures improved significantly: ASES scores improved from 28 preoperatively to 82 postoperatively (P < .0001); SST scores improved from 1 to 7 (P< .0001); VAS pain scores improved from 7 to 1 (P < .0001); VAS function scores improved from 3 to 6 (P = .0058); elevation improved from 52° to 126° (P < .0001); abduction improved from 55° to 116° (P = .0002); external rotation improved from 19° to 33° (P = .02); and internal rotation improved from S1 to L4 (P = .02). Twelve patients rated their outcome as excellent, 6 as good, 2 as satisfactory, and 1 as unsatisfactory. Severe glenoid erosion was seen in 10 of the shoulders and 5 of the defects required structural grafting. Three patients (14%) sustained a complication that required reoperation: 2 for infection and 1 for periprosthetic fracture.

Conclusions In patients with rheumatoid arthritis and rotator cuff deficiency, reverse shoulder arthroplasty can provide improvement in function and decreased pain.