Reverse Shoulder Arthroplasty in Rheumatoid Arthritis: A Systematic Review

Abstract

Abstract:Background: Anatomical shoulder replacement for rheumatoid arthritis (RA) is complicated by a high incidence of rotator cuff tears and glenoid erosion. This can lead to poor function and early failure. Reverse shoulder arthroplasty (RSA) has gained popularity as an alternative. This systematic review attempts to further define the role of RSA in RA.Methods: A systematic review identified seven studies reporting outcomes of RSA in RA patients. Studies were critically appraised, and data on outcomes, complications and technical considerations were extracted and analysed.Results: One hundred and twenty one shoulders were included (mean follow up 46.9 months). Consistent improvements in the main outcome measures were noted between studies. Ninety five percent of patients described excellent to satisfactory outcomes. The minimum mean forward elevation reported in each study was 115 degrees. Symptomatic glenoid loosening (1.7%), deep infection (3.3%) and revision surgery (5%) rates were no higher than for a population of mixed aetiologies.Discussion: Previous concerns regarding high pre-and peri-operative complication and revision rates in RA patients were not shown to be valid by the results of this review. Although associated cuff tears are common and glenoid bone loss can increase the technical complexity of surgery, RSA provides consistent and predictable improvements in key outcome measures and the revision and complication rates do not appear to be higher than reported in a large population of mixed aetiologies. Conclusion:The contemporary literature shows that RSA is a safe, effective and reliable treatment option in RA patients.

Surgical Treatment for the Shoulder Joint in Rheumatoid Patients

“…The biomechanical features of RSA is that this procedure confers high stability and improves the lever arm for the deltoid muscle, potentially resulting in the improvement of range and strength of abduction, even in the presence of rotator cuff dysfunction. 40) Gee et al 41) systematically reviewed 7 case series of RSA performed in RA patients and reported that the minimum mean forward flexion was 115 degrees after a mean follow-up of 46.9 months for 121 shoulders. Studies have shown that TSA and hemiarthroplasty performed in RA patients resulted in a mean forward flexion of 90 degrees or less, and that RA patients with a compromised cuff had favorable outcomes regarding forward flexion when RSA was performed.…”

“…42) According to a previous systematic review, the incidence of scapular notching after RSA is 34% in RA patients. 41) However, there is a lack of clinical evidence showing that notching is related to fracture, loosening, or revision surgery. The occurrences of symptomatic glenoid loosening (1.7%), deep infection (3.3%), and revision surgery (5%) in RA patients after RSA are not much different when compared with other non-RA patients after RSA; however, the occurrence of fracture (10.7%) was high in RA patients.…”

“…The occurrences of symptomatic glenoid loosening (1.7%), deep infection (3.3%), and revision surgery (5%) in RA patients after RSA are not much different when compared with other non-RA patients after RSA; however, the occurrence of fracture (10.7%) was high in RA patients. 41) Because RA patients have a high incidence of osteopenia or osteoporosis, and the tension in the deltoid muscle and remnant cuff tissue increases during glenohumeral joint reduction, the risk of fracture during RSA is high for RA patients.…”