Mid-term outcomes following total shoulder arthroplasty for rheumatoid arthritis

Background

Rheumatoid arthritis (RA) can lead to debilitating pain, decreased bone stock, and poor rotator cuff quality in afflicted patients. Patients with chronic pain from RA may necessitate surgical intervention, including shoulder arthroplasty, at a younger age than their osteoarthritic counterparts. For several decades, anatomic total shoulder arthroplasty (TSA) or hemiarthroplasty remained the dominant treatments for RA patients. The objective of this abstract is to report on mid-term to long-term outcomes following TSA for RA.

Materials and Methods

This study retrospectively analyzed patients who necessitated TSA for RA. Range of motion scores (forward elevation, external rotation, and internal rotation) and patient-reported outcomes (American Shoulder and Elbow Surgeons, Simple Shoulder Test, and Visual Analog Scale scores) were compared preoperatively and postoperatively. Preoperative and postoperative radiographic measures (lateral humeral offset, acromiohumeral interval, and subluxation) were reviewed by 2 fellowship-trained orthopedic surgeons and the averages were used for analysis.

Results

Included in the analysis were 13 patients (17 shoulders) with an average follow-up time of 8.1 ± 3.6 years. The mean age was 65.3 ± 10.5 years. Forward flexion (Preop: 112^o ± 43^o, Postop: 145^o ± 35^o; P = .03), external rotation (Preop: 31^o ± 20^o, Postop: 46^o ± 15^o; P = .04), and internal rotation (Preop: L2, Postop: T11; P = .02) all improved significantly when preoperative and postoperative values were compared. Furthermore, American Shoulder and Elbow Surgeons (Preop: 33 ± 20, Postop: 74 ± 19; P = .0002), Simple Shoulder Test (Preop: 4 ± 2, Postop: 8 ± 4; P = .003), and Visual Analog Scale pain (Preop: 7 ± 3, Postop: 2 ± 2; P = .002) scores all significantly improved. Analysis of preoperative and postoperative radiographs showed a significant difference in lateral humeral offset (Preop: 14 ± 3, Final: 8 ± 9; P = .02) and acromiohumeral interval (Preop: 11 ± 3, Postop: 7 ± 3; P = .01) measurements; glenoid radiolucency was seen in 10/17 patients at follow-up.

Conclusion

This study contributes to the available literature on TSA for RA at mid-term to long-term follow-up. We show that improvements are obtainable at mid-term evaluation, showing significant pain reduction and increased shoulder function and range of motion. Ultimately, this study demonstrates that TSA is an option for RA patients who require shoulder replacement.