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Reverse Shoulder Arthroplasty in Rheumatoid Arthritis: A Systematic Review.

Gee EC, Hanson EK, Saithna A - Open Orthop J (2015)

Bottom Line: Previous concerns regarding high pre- and peri-operative complication and revision rates in RA patients were not shown to be valid by the results of this review.Although associated cuff tears are common and glenoid bone loss can increase the technical complexity of surgery, RSA provides consistent and predictable improvements in key outcome measures and the revision and complication rates do not appear to be higher than reported in a large population of mixed aetiologies.The contemporary literature shows that RSA is a safe, effective and reliable treatment option in RA patients.

View Article: PubMed Central - PubMed

Affiliation: Southport and Ormskirk Hospital NHS Trust, Town Lane, Southport, Merseyside, PR8 6PN, UK.

ABSTRACT

Background: Anatomical shoulder replacement for rheumatoid arthritis (RA) is complicated by a high incidence of rotator cuff tears and glenoid erosion. This can lead to poor function and early failure. Reverse shoulder arthroplasty (RSA) has gained popularity as an alternative. This systematic review attempts to further define the role of RSA in RA.

Methods: A systematic review identified seven studies reporting outcomes of RSA in RA patients. Studies were critically appraised, and data on outcomes, complications and technical considerations were extracted and analysed.

Results: One hundred and twenty one shoulders were included (mean follow up 46.9 months). Consistent improvements in the main outcome measures were noted between studies. Ninety five percent of patients described excellent to satisfactory outcomes. The minimum mean forward elevation reported in each study was 115 degrees. Symptomatic glenoid loosening (1.7%), deep infection (3.3%) and revision surgery (5%) rates were no higher than for a population of mixed aetiologies.

Discussion: Previous concerns regarding high pre- and peri-operative complication and revision rates in RA patients were not shown to be valid by the results of this review. Although associated cuff tears are common and glenoid bone loss can increase the technical complexity of surgery, RSA provides consistent and predictable improvements in key outcome measures and the revision and complication rates do not appear to be higher than reported in a large population of mixed aetiologies.

Conclusion: The contemporary literature shows that RSA is a safe, effective and reliable treatment option in RA patients.

No MeSH data available.


Related in: MedlinePlus

Flow of studies.
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Related In: Results  -  Collection

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Figure 1: Flow of studies.

Mentions: After application of the search strategy and eligibility criteria seven studies were included for critical appraisal and data extraction [3, 16, 30-34]. The flow of studies is shown in Fig. (1).


Reverse Shoulder Arthroplasty in Rheumatoid Arthritis: A Systematic Review.

Gee EC, Hanson EK, Saithna A - Open Orthop J (2015)

Flow of studies.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4591906&req=5

Figure 1: Flow of studies.
Mentions: After application of the search strategy and eligibility criteria seven studies were included for critical appraisal and data extraction [3, 16, 30-34]. The flow of studies is shown in Fig. (1).

Bottom Line: Previous concerns regarding high pre- and peri-operative complication and revision rates in RA patients were not shown to be valid by the results of this review.Although associated cuff tears are common and glenoid bone loss can increase the technical complexity of surgery, RSA provides consistent and predictable improvements in key outcome measures and the revision and complication rates do not appear to be higher than reported in a large population of mixed aetiologies.The contemporary literature shows that RSA is a safe, effective and reliable treatment option in RA patients.

View Article: PubMed Central - PubMed

Affiliation: Southport and Ormskirk Hospital NHS Trust, Town Lane, Southport, Merseyside, PR8 6PN, UK.

ABSTRACT

Background: Anatomical shoulder replacement for rheumatoid arthritis (RA) is complicated by a high incidence of rotator cuff tears and glenoid erosion. This can lead to poor function and early failure. Reverse shoulder arthroplasty (RSA) has gained popularity as an alternative. This systematic review attempts to further define the role of RSA in RA.

Methods: A systematic review identified seven studies reporting outcomes of RSA in RA patients. Studies were critically appraised, and data on outcomes, complications and technical considerations were extracted and analysed.

Results: One hundred and twenty one shoulders were included (mean follow up 46.9 months). Consistent improvements in the main outcome measures were noted between studies. Ninety five percent of patients described excellent to satisfactory outcomes. The minimum mean forward elevation reported in each study was 115 degrees. Symptomatic glenoid loosening (1.7%), deep infection (3.3%) and revision surgery (5%) rates were no higher than for a population of mixed aetiologies.

Discussion: Previous concerns regarding high pre- and peri-operative complication and revision rates in RA patients were not shown to be valid by the results of this review. Although associated cuff tears are common and glenoid bone loss can increase the technical complexity of surgery, RSA provides consistent and predictable improvements in key outcome measures and the revision and complication rates do not appear to be higher than reported in a large population of mixed aetiologies.

Conclusion: The contemporary literature shows that RSA is a safe, effective and reliable treatment option in RA patients.

No MeSH data available.


Related in: MedlinePlus