Reverse shoulder arthroplasty in dialysis amyloidosis: a case report

Abstract

A 65-year-old male with end-stage renal disease (ESRD) on hemodialysis (HD) for 32 years presented with chronic intractable pain and progressive loss of motion in his right shoulder. The patient underwent a reverse total shoulder arthroplasty (RTSA) based on his glenohumeral arthritis, rotator cuff pathology, and debilitating symptoms. Intraoperative inspection revealed a large soft tissue mass in the area of the supraspinatus footprint and abnormal appearances of the humeral head, soft tissues, glenoid rim, and labrum. Histological specimens confirmed the diagnosis of amyloidosis and showed focal calcium pyrophosphate deposition. The patient reported improvement in pain and shoulder range of motion following the procedure in follow-up. We conclude that in the setting of long-term HD, amyloid can deposit into periarticular bone and soft tissue to contribute to patient pathology.