Saturday, October 22, 2011

Reverse Total Shoulder for Rheumatoid Arthritis - Journal of Bone and Joint Surgery

In the Oct 19 issue of JBJS published an article on the use of the reverse total shoulder in the treatment of the shoulder with advanced rheumatoid arthritis. In this case series of 18 patients with an average age of 70 years, there was improvement in comfort and function in all but one after to to seven years of post-surgical follow-up. Four of the 18 experienced fractures, one had a transient axillary nerve palsy and 10 had scapular notching.

The authors point out that bone quality is a particular concern in this patient group. They used bone grafting in eight to enhance the glenoid bone stock and had no cases of glenoid failure.

These gratifying results are a testimony to the surgical judgment and skill of the senior author, Giles Walch, one of the pioneers of reverse shoulder arthroplasty.

It is of note that this series of reverse total shoulders was performed with a prosthesis of the original Grammont design used in the Delta and Aequalis prostheses. Shoulder fellows Saltzman and Mercer investigated the difference in the position of the center of rotation with different prosthesis designs. These positional considerations may have relevance to the tension placed on the acromion with the associated fracture risk and the propensity for notching in reverse total shoulder arthroplasty.


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