[Arthroplastic borderline cases in pediatric and adolescent rheumatology].

Abstract

Shoulder joint involvement in juvenile idiopathic arthritis (JIA) is common; however, it is first clinically manifested only after a delay. Initially, the aim should be to preserve the joint for as long as possible by means of adequate drug treatment and arthroscopic synovectomy. If definitive joint destruction nevertheless occurs hemiarthroplasty, anatomical and reverse shoulder arthroplasty are available. Hemiarthroplasty can result in pain amelioration and was the gold standard for a long time but it remains inferior to total shoulder arthroplasty in terms of pain reduction, improvement of the range of motion and durability. Reverse shoulder arthroplasty can also be used even in young patients with JIA, particularly when rotator cuffs are also involved. A metaphyseal fixation of the short stem and a modular design of the prosthesis make these attractive, even with respect to the inevitable necessity for revisions.