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Abstract

Introduction: The purpose of this study was to review our experience with total shoulder arthroplasty and hemiarthroplasty in patients with RA to determine the results, the risk factors for an unsatisfactory outcome, and the rates of revision. Methods: Between 1976 and 1991, 195 TSA and 108 HHR were performed by the senior author in patients with rheumatoid arthritis. One hundred eighty-seven TSA and 95 HHR with complete preoperative evaluation, operative records, and minimum 2-year follow-up (mean 11.6 years) or follow-up until revision were included in the clinical analysis. Twenty patients died and one was lost to follow-up. All 303 shoulders were included in the survival analysis. Results: There was significant long term pain relief, improvement in active abduction, and external rotation with both HHR and TSA (P<.0001). There was not a significant difference in improvement in pain and motion comparing HHR and TSA for patients with a thin or torn rotator cuff. However, among patients with an intact rotator cuff, improvement in pain and abduction were significantly greater with TSA. Additionally, among patients with an intact rotator cuff, the risk for revision was significantly lower for TSA (p=0.04). The overall rate of revision for glenoid component related problems was 11/195 (5.6%) compared to 8/108 (7.4%) for painful glenoid arthritis. Conclusion: The data from this study indicate there is marked long term pain relief and improvement in motion with shoulder arthroplasty for rheumatoid arthritis. Among patients with an intact rotator cuff, total shoulder arthroplasty appears to be the preferred procedure for pain relief, improvement in abduction, and lower risk of revision surgery. If noted, the author indicates something of value received. The codes are identified as follows: a, research or institutional support; b, miscellaneous funding; c, royalties; d, stock options; e, consultant or employee. *The Food and Drug Administration has not cleared the drug and/or medical device for the use described in this presentation (ie, the drug or medical device is being discussed for an “off-label” use). If noted, the author indicates something of value received. The codes are identified as follows: a, research or institutional support; b, miscellaneous funding; c, royalties; d, stock options; e, consultant or employee. *The Food and Drug Administration has not cleared the drug and/or medical device for the use described in this presentation (ie, the drug or medical device is being discussed for an “off-label” use).