Outcome of a metaphyseal reverse total shoulder replacement in rheumatoid arthritis

Abstract

To assess the clinical and radiological results of a metaphyseal reverse total shoulder arthroplasty (rTSA) without diaphyseal stem, in rheumatoid arthritis (RA) patients. Forty-five shoulders in 36 consecutive RA patients (2005–2015) underwent rTSA with a bone impaction technique. Patients were assessed clinically and radiographically preoperatively, at 3 weeks, 3 months, 6 months, 12 months post-operatively, and yearly thereafter, using constant score (CS), pain score, subjective shoulder value (SSV) and patient satisfaction score. Forty-four shoulders with mean follow-up of 67 months (range 24 m-146 m (12y)) were available for follow-up. Mean age at surgery was 68.7 years (range 39–86). CS improved from 17.5\u2009±\u200910.5(SD) (age/sex adjusted 23.9\u2009±\u200914.5(SD)) preoperatively to 60.9\u2009±\u200917.4 (SD) (age/sex adjusted 86.5\u2009±\u200924.5 (SD)) at last follow-up (P\u2009<\u20090.001). Pain score and SSV also significantly improved (p\u2009<\u20090.001). Mean range of movement improved to 140°active forward flexion, 134°active abduction, 47°active external rotation (AER) and 70°active internal rotation (AIR). The results were maintained over time. Combined early and late complication rate was 15.6%, which is lower than described in the literature for RA. No lucencies, loosening, subsidence or stress shielding were evident radiographically. Metaphyseal rTSA without a diaphyseal stem is successful and safe in RA patients. Patients achieve good function and have high satisfaction rates. Case series: Level IV