Reverse Total Shoulder Replacement in Patients with ‘Weight-Bearing’ Shoulders on Wheelchair or Walking Aids

Reverse shoulder arthroplasty (RSA) has been gaining popularity in recent years. Currently it is indicated for a wide variety of shoulder pathologies. However, use of RSA in patients with ‘weight-bearing’ shoulders by means of using wheelchair or crutches have higher risks.

Aim: The aim of this study was to assess the results of RSA in this group of patients.

Materials and Methods: Between 2005 and 2014, 24 patients (30 shoulders) with ‘weight-bearing’ shoulders were treated at our unit with RSA. 21 patients had cuff arthropathy, 3 rheumatoid arthritis, 1 osteoarthritis, 3 acute fracture and 2 fracture sequela. Postoperatively patients were advised not to push themselves out of their chair for 6 weeks.

Results: 21 patients (27 shoulders) mean follow up was 4.3 years (range 2 – 10y) were available for follow-up. The mean age at surgery was 78 years (range 54- 90y). Constant score improved from 9.4 (range 2 - 26) points preoperatively to 59.8 (range 29 - 80) points at final follow up (p=0.001).

Pain improved from 2 (range 0 - 8) to 13.8/15 (range 9 - 15) (p=0.001). Patient satisfaction from 0.6 to 8.7/10 (p=0.001) at final follow up.

Significant improvement in mean range of motion from 46° to 130° of elevation, 13° to 35° of external rotation and 29° to 78° internal rotation was recorded (p=0.001). Final mean ADLEIR score (Activities of Daily Living External and Internal Rotation score) was 32.4/36 (range 16 - 36). No dislocations or instability occurred.

There were 3 Sirveaux-Nerot grade 1 (10%) and 3 grade 2 (10%) glenoid notching.

Conclusion: RSA can be used for the treatment of patients with ‘weight-bearing’ shoulders. Patients return to good and pain free movement, resume daily activities and have high satisfaction rate.