Reverse shoulder arthroplasty in Rheumatoid Arthritis: Survival and Outcomes.

Abstract

BACKGROUND\nDespite its potential biomechanical advantages, reverse shoulder arthroplasty (RSA) is still considered to be particularly high risk in rheumatoid patients who are osteoporotic and immunodeficient. Our purpose was to report prosthesis survival, complications, and outcomes of RSA in patients with rheumatoid arthritis (RA) at minimum 5-year follow-up.\n\n\nMETHODS\nWe conducted a retrospective multicenter study including 65 consecutive primary RSAs performed in 59 patients with RA between 1991 and 2010. We excluded rheumatoid patients with previous failed anatomic shoulder arthroplasty. Age at surgery averaged 69 years (range, 46-86 years). A structural bone grafting was performed in 18 cases (45%), using the humeral head in 15 cases (BIO-RSA technique), the iliac crest in 2 cases (Norris technique), and an allograft in 1 case. The mean follow-up was 92 months (range, 60-147 months) or until revision surgery.\n\n\nRESULTS\nRevision-free survivorship, using Kaplan-Meyer curves, was 96% at 7 years. Two patients were revised for infections, with associated glenoid loosening in 1 case. No humeral loosening was recorded. The mean adjusted Constant score improved from 36 ±23% preoperatively to 90 ±26% postoperatively, and mean SSV improved from 21 ±13% to 85 ±12%, respectively (p<0.001). Active anterior elevation increased from 65° ±43 to 132° ±27, active external rotation increased from 10° ±26 to 22° ±27, and internal rotation improved from buttocks to waist (p<0.001). Stable fixation of the baseplate was achieved in all cases (including the 6 patients with end stage RA) and we did not observe bone graft non-union or resorption. Preoperative radiologic pattern (centered, ascending, or destructive), presence of acromial fractures or tilt (4 cases, 10%), and scapular notching (55%) on final radiographs were not found to influence outcomes or complication rate. Patients with absent/atrophied teres minor had lower functional results. Overall, 95% of the patients were satisfied with the procedure.\n\n\nCONCLUSION\nRSA is a safe and effective procedure for the treatment of RA patients, with a low risk of complications and low rate of revision, regardless of the radiological presentation and stage of the disease. Rheumatoid patients undergoing primary RSA, with or without or glenoid bone grafting, can expect a revision-free survival rate of 96% at 7-year follow-up. RSA offers the benefits of solving two key problems encountered in rheumatoid shoulders: glenoid bone destruction and rotator cuff deficiency.