The Rheumatoid Shoulder: Current Surgical Treatments

Abstract

Background: Rheumatoid arthritis (RA) is an inflammatory disease resulting in pain and decreased functional outcome. Even though most of large joints are widely discussed in literature, shoulder's surgical treatment options, indications and superiorities to each other were not compared entirely. Materials and methods: Treatment options, such as synovectomy and bursectomy, resection interposition arthroplasty (RIAP), hemiarthroplasty, humeral resurfacing arthroplasty, anatomical total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA) are examined and compared according to timing, advantages and disadvantages. Results: Age is the primary criteria for decision making. Young-aged patients demand high functionality, alas need for revision in the future must be planned. First step is preservation of bone stock as much as possible. For young patient, disabling pain can be candidate for synovectomy and bursectomy or RIAP and also for hemiarthroplasty. As age progresses, priorities change towards rotator cuff status and glenoid bone stock. Conclusions: Age, functional demand, rotator cuff status, adequacy of glenoid bone stock and future planning for possible complications are defined as major criteria for optimal treatment. RA patients will require systemic evaluations with help of rheumatologists. Patient, rheumatologist and orthopaedist should discuss the possible surgical intervention together to achieve high quality of life.