Prognostic factors in arthroplasty in the rheumatoid shoulder

Abstract

Total shoulder arthroplasty is commonly considered a good option for treatment of the rheumatoid shoulder. However, when the rotator cuff and glenoid bone stock are not preserved, the clinical outcome of arthroplasty in the rheumatoid patients remains unclear. Aim of the study is to explore the prognostic value of multiple preoperative and peroperative variables in total shoulder arthroplasty and shoulder hemiarthroplasty in rheumatoid patients. Clinical Hospital for Special Surgery Shoulder score was determined at different time points over a mean period of 6.5 years in 66 rheumatoid patients with total shoulder arthroplasty and 75 rheumatoid patients with shoulder hemiarthroplasty. Moreover, radiographic analysis was performed to assess the progression of humeral head migration and glenoid loosening. Advanced age and erosions or cysts at the AC joint at time of surgery were associated with a lower postoperative Clinical Hospital for Special Surgery Shoulder score. In total shoulder arthroplasty, status of the rotator cuff and its repair at surgery were predictive of postoperative improvement. Progression of proximal migration during the period after surgery was associated with a lower clinical score over time. However, in hemiarthroplasty, no relation was observed between the progression of proximal or medial migration during follow-up and the clinical score over time. Status of the AC joint and age at the time of surgery should be taken into account when considering shoulder arthroplasty in rheumatoid patients. Total shoulder arthroplasty in combination with good cuff repair yields comparable clinical results as total shoulder arthroplasty when the cuff is intact.

Keywords: glenoid component; hemiarthroplasty; humeral head prosthesis; loosening; outcome measurement; prosthesis; rheumatoid arthritis; rheumatoid shoulder; rotator cuff; shoulder arthroplasty; shoulder joint; shoulder prosthesis; total shoulder prosthesis.

Fig. 1

The relationship between age and clinical outcome after shoulder replacement is shown. (White bar: preoperative HSS score; transverse striated bar: postoperative improvement; oblique striated bar: HSS score at 2 years follow-up). Data are presented as mean HSS score with standard error of the mean

Fig. 2

The relationship between change of proximal migration and HSS score, preoperatively and at 2, 5, and 10 years follow-up in shoulders with TSA is demonstrated. Data are presented as mean HSS scores with standard error of the mean. Number of shoulders for different postoperative intervals are: for 0 years, 27 improved/16 progression; 2 years, 23/17; 5 years, 23/16; and 10 years, 13/11

Fig. 3

The relationship between change of medial migration and HSS score preoperatively and at 2.5 and 10 years follow-up in shoulders with HHR. Data are presented as mean HSS scores with standard errors of the mean. The numbers of shoulders for different postoperative intervals are: for 0 years, 72 shoulders (44 unchanged/28 progression); 2 years, 64 (39/25); 5 years, 38 (19/19); 10 years, 16 (7/9)