Thursday, July 28, 2016

Shoulder joint replacement arthroplasty and polio

Shoulder arthroplasty for sequelae of poliomyelitis.

These authors reviewed 7 patients with sequelae of polio having shoulder arthroplasty (1 reverse shoulder arthroplasty, 2 hemiarthroplasties, 4 total shoulders).

At an average of 87 months, the pain scores improved from 5 to 1.6 points.  6 shoulders were rated as much better or better. Mean shoulder elevation improved from 72° to 129°, and external rotation improved from 11° to 56°. Average strength in elevation decreased from 3.9 to 3.4 postoperatively, and external rotation strength decreased from 3.9 to 3.3. 
Evidence of radiographic instability was found in 4 shoulders (superior subluxation, anterior subluxation, or both). No shoulders were revised.

This report demonstrates that the surgical care of the polio shoulder is complex and needs to be customized to the individual patient. These patients often have multiple musculoskeletal problems and often require their upper extremities for ambulation and transfers. Of note is that radiographic followup was available for 4 of the 7 patients and all 4 had evidence of instability. The basis for selection of a hemiarthroplasty, total shoulder or reverse total shoulder requires further study.