Total shoulder replacement in rheumatoid arthritis: Proximal migration and loosening

Surgical Treatment for the Shoulder Joint in Rheumatoid Patients

“…They found that proximal migration of the humeral prosthesis, attributing to rotator cuff failure, was a common complication (21 shoulders, 56.8%), and it was highly associated with a high incidence of progressive lucencies around both the glenoid and humeral components (10 shoulder, 27.0%). Sneppen et al 32) performed TSA in 51 RA patients (62 shoulders) and also reported that 40.3% of patients (25 shoulders) had glenoid loosening and that 54.8% of the patients (34 shoulders) had proximal migration of the humerus after a mean follow-up of 92 months (range, 52-139 months). Although glenoid loosening and proximal migration were noted, good pain relief was achieved in 88.7% of patients (55 shoulders).…”

“…5). 32,36) Superior subluxation shows predisposition to the impingement of greater tuberosity on the acromion during elevation, thus reducing the range of motion at the glenohumeral joint, whether the cuff is functional or not. 37) In RA patients, the coracoacromial arch should preferably be kept intact, because it is an important structure to counteract the tendency for anterosuperior subluxation of the humeral head during TSA or hemiarthroplasty.…”

“…Many studies have recommend the use of cemented humeral components rather than the use of uncemented humeral components due to the high rate of loosening with the latter as a result of poor bone quality in RA patients. 29,32,38) A previous randomized controlled trial with a follow-up of 2 years made a comparison between the cemented and uncemented humeral stem fixation during arthroplasty in RA patients and reported no significant differences between the two groups. 39) However, other studies with longer follow-up durations-7.7 years in one and 9.5 years in the other-have shown loosening in more than 40% of the press-fit humeral components.…”

“…39) However, other studies with longer follow-up durations-7.7 years in one and 9.5 years in the other-have shown loosening in more than 40% of the press-fit humeral components. 31,32) From a long-term perspective, the use of cemented humeral components is considered to be safer than the use of uncemented humeral components in RA patients.…”

Management of Shoulder Hemiarthroplasty in a Patient With Rheumatoid Arthritis

“…3,35 The advantages of TSA include a more consistent pattern of pain relief and a better mechanical fulcrum for active shoulder movement. 3,5,19,36,35,38 Yet, TSA is a more difficult surgical procedure that may involve loosening or premature wearing of the glenoid component. 3,5,10,15,19,35,38 Rotator cuff tears are often encountered when patients with rheumatoid arthritis (RA) are treated with shoulder arthroplasty.…”