Outcome of a metaphyseal reverse total shoulder replacement in rheumatoid arthritis


Aim To assess the clinical and radiological results of a metaphyseal reverse total shoulder arthroplasty (rTSA) without diaphyseal stem, in rheumatoid arthritis (RA) patients.

Forty-five shoulders in 36 consecutive RA patients (2005–2015) underwent rTSA with a bone impaction technique.

Patients were assessed clinically and radiographically preoperatively, at 3 weeks, 3 months, 6 months, 12 months post-operatively, and yearly thereafter, using constant score (CS), pain score, subjective shoulder value (SSV) and patient satisfaction score.

Forty-four shoulders with mean follow-up of 67 months (range 24 m-146 m (12y)) were available for follow-up.

Mean age at surgery was 68.7 years (range 39–86). CS improved from 17.5 ± 10.5(SD) (age/sex adjusted 23.9 ± 14.5(SD)) preoperatively to 60.9 ± 17.4 (SD) (age/sex adjusted 86.5 ± 24.5 (SD)) at last follow-up (P < 0.001). Pain score and SSV also significantly improved (p < 0.001). Mean range of movement improved to 140°active forward flexion, 134°active abduction,

47°active external rotation (AER) and 70°active internal rotation (AIR). The results were maintained over time. Combined early and late complication rate was 15.6%, which is lower than described in the literature for RA. No lucencies, loosening, subsidence or stress shielding were evident radiographically.

Metaphyseal rTSA without a diaphyseal stem is successful and safe in RA patients. Patients achieve good function and have high satisfaction rates.

Level of evidence Case series: Level IV

(MUSCULOSKELETAL SURGERY https://doi.org/10.1007/s12306-021-00706-x 30/3/2021)