Outcome Of A Metaphyseal Reverse Total Shoulder Replacement In Rheumatoid Arthritis

Aim to assess clinical and radiological results of metaphyseal reverse total shoulder arthroplasty (rTSA) in patients with rheumatoid arthritis (RA).

Between 2005 and 2015, 44 shoulders in 37 consecutive RA patients underwent rTSA with a bone impaction technique. 13 of them revisions. Constant Score (CS), Subjective Shoulder Value (SSV), Satisfaction were used and patients prospectively assessed both clinically and radiographically preoperatively, at 3weeks, 3months, 6months, 1-year and yearly postoperatively. Three patients died for unrelated causes.

28 females (32 shoulders) and 9 males (12 shoulders) with mean follow-up of 39 months (range 1y-11y) were available for follow-up. Mean age at surgery was 68.5 years (range 39-86). CS improved from 19.1 (adjusted 26.3) preoperatively to 58.3 (adjusted 81.6) at last follow-up (P<0.001). CS 1-year postoperatively were not significantly different from CS at final follow-up (p=0.603). Pain improved significantly from 11.4/15 to 2.3/15 (p<0.001). Patient satisfaction increased from 1.2/10 to 8.8/10 (p<0.001). Mean range of movement improved to 133°flexion, 120°abduction, 34° active external and 70° active internal rotations. Two intraoperative undisplaced metaphyseal and one glenoid cracks occurred and healed with conservative treatment. One early dislocation occurred in a revision case which was re-operated for exchange to a retentive liner. Two late traumatic periprosthetic fractures were revised to a stemmed implant. 37 implants showed no glenoid notching. There were two grade-1, three grade-2 and two grade-3 Sirveaux-Nerot glenoid notching. No lucencies, subsidence, stress-shielding or implant loosening were evident radiographically. The complication rate was like rTSA performed for a mixed aetiology.

Short metaphyseal rTSA shows to be successful and safe in RA. Impaction grafting technique improves humeral component stability. Patients restore good function, resume daily activities and have high satisfaction rates.