Thursday, January 14, 2021

The problems of reverse total shoulder in patients with rheumatoid arthritis

Comparison of outcomes after reverse shoulder arthroplasty in patients with rheumatoid arthritis and cuff tear arthropathy

These authors compared the outcomes of reverse total shoulder (RSA) for 24 patients with rheumatoid arthritis (RA) with those of 35 patients with cuff tear arthropathy (CTA) after and average  follow-up period of 31 months (range, 24-64 months). 


The Aequalis Reverse prosthesis (standard stem) was used in 27 cases and the Aequalis

Ascend Flex prosthesis (short stem) in 34 cases.


There was no statistically significant difference between the RA group and the CTA group in the clinical outcomes.


However glenoid component superior tilt was more likely in the RA group (12 of 24) than in the CTA group (4 of 35).


Complications occurred in 7 of 26 patients (27%) with RA and 3 of 35 patients (9%) with CTA. 

Within the RA group, complications included greater tuberosity fractures in 4, lesser tuberosity in 1, glenoid fracture in 1, and transient musculocutaneous nerve palsy in 1. 

Within the CTA group, complications included lesser tuberosity fracture in 1, acromial fracture in 1, and periprosthetic humeral fracture in 1. 


Comment: The relatively high rate of fracture in both groups is noteworthy. The paper does not reveal whether these fractures occurred with the standard stem system

or the short stem system, which relies on a tight metaphyseal fit. A press fit in soft rheumatoid bone may carry the risk of fracture

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