(i) Shoulder arthroplasty for osteoarthritis and rheumatoid arthritis

Abstract

Replacement arthroplasty represents the treatment of choice for most patients with end-stage glenohumeral osteoarthritis or rheumatoid arthritis. Multiple studies have documented reliable improvements in pain, range of motion, function and quality of life after this procedure. Total shoulder arthroplasty seems to be associated with more reliable pain relief and improvements in elevation when compared to hemiarthroplasty. The main surgical principles of shoulder arthroplasty apply equally to patients with osteoarthritis and rheumatoid arthritis; however, the different underlying pathology associated with these two conditions needs to be understood in order to modify the surgical technique accordingly. Most patients with osteoarthritis have an intact rotator cuff and enough glenoid bone stock to allow implantation of a glenoid component. Asymmetric posterior glenoid erosion often needs to be corrected and capsular releases are needed to restore elevation and external rotation. In rheumatoid arthritis, implantation of a glenoid component may not be possible in the presence of severe glenoid bone loss or a massive irreparable cuff tear; in addition, rheumatoid involvement of other joints needs to be taken into consideration. Infection, instability, periprosthetic fractures, and glenoid loosening or erosion are the main failure mechanisms of shoulder arthroplasty. Careful surgical technique and a well-executed physical therapy program translate into successful outcomes in most patients with osteoarthritis and rheumatoid arthritis. Replacement arthroplasty represents the treatment of choice for most patients with end-stage glenohumeral osteoarthritis or rheumatoid arthritis. Multiple studies have documented reliable improvements in pain, range of motion, function and quality of life after this procedure. Total shoulder arthroplasty seems to be associated with more reliable pain relief and improvements in elevation when compared to hemiarthroplasty. The main surgical principles of shoulder arthroplasty apply equally to patients with osteoarthritis and rheumatoid arthritis; however, the different underlying pathology associated with these two conditions needs to be understood in order to modify the surgical technique accordingly. Most patients with osteoarthritis have an intact rotator cuff and enough glenoid bone stock to allow implantation of a glenoid component. Asymmetric posterior glenoid erosion often needs to be corrected and capsular releases are needed to restore elevation and external rotation. In rheumatoid arthritis, implantation of a glenoid component may not be possible in the presence of severe glenoid bone loss or a massive irreparable cuff tear; in addition, rheumatoid involvement of other joints needs to be taken into consideration. Infection, instability, periprosthetic fractures, and glenoid loosening or erosion are the main failure mechanisms of shoulder arthroplasty. Careful surgical technique and a well-executed physical therapy program translate into successful outcomes in most patients with osteoarthritis and rheumatoid arthritis.