Reverse shoulder arthroplasty in rheumatoid arthritis: survival and outcomes

BackgroundDespite 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 report prosthesis survival, complications, outcomes of RSA with arthritis (RA) at minimum 5-year follow-up.MethodsWe conducted a retrospective multicenter study including 65 consecutive primary RSAs performed 59 RA between 1991 2010. We excluded previous failed anatomic arthroplasty. Age surgery averaged 69 years (range, 46-86 years). A structural bone grafting 18 cases (45%), using the humeral head 15 (BIO-RSA technique), iliac crest 2 (Norris an allograft 1 case. The mean follow-up 92 months 60-147 months) or until revision surgery.ResultsRevision-free survivorship, Kaplan-Meier curves, 96% 7 years. Two had surgeries for infections, associated glenoid loosening No recorded. adjusted Constant score improved from 36% ± 23% preoperatively 90% 26% postoperatively, Subjective Shoulder Value 21% 13% 85% 12%, respectively (P < .001). Active anterior elevation increased 65° 43° 132° 27°, active external rotation 10° 26° 22° internal buttocks waist Stable fixation baseplate achieved all (including 6 end-stage RA), we did not observe graft nonunion resorption. Preoperative radiologic pattern (centered, ascending, destructive), presence acromial fractures tilt (4 cases, 10%), scapular notching (55%) on final radiographs were found influence complication rate. Patients absent/atrophied teres minor lower functional results. Overall, 95% satisfied procedure.ConclusionRSA safe effective procedure treatment patients, low complications rate revision, regardless presentation stage disease. Rheumatoid undergoing RSA, without grafting, can expect revision-free survival 7-year follow-up. offers benefit solving key problems encountered shoulders: destruction rotator cuff deficiency. Despite surgery. Revision-free procedure.