Reverse shoulder arthroplasty in patients with rheumatoid arthritis.

BACKGROUND: The purpose of this study was to describe the pathoanatomy of patients diagnosed with rheumatoid arthritis and rotator cuff deficiency and report their outcomes following reverse shoulder arthroplasty. METHODS: Twenty-one shoulders were evaluated prospectively. Nine had no prior surgery, 9 had a failed rotator cuff repair, and 3 had a failed arthroplasty. Patients were followed for a minimum of 2 years (average, 36 months). All patients had preoperative radiographs and 19 shoulders had an MRI or CT available for evaluation of muscular and bony deficiency. Radiographs at most recent follow-up were evaluated for loosening and scapular notching. RESULTS: All outcome measures improved significantly: ASES scores improved from 28 preoperatively to 82 postoperatively (P < .0001); SST scores improved from 1 to 7 (P < .0001); VAS pain scores improved from 7 to 1 (P < .0001); VAS function scores improved from 3 to 6 (P=.0058); elevation improved from 52° to 126° (P < .0001); abduction improved from 55° to 116° (P=.0002); external rotation improved from 19° to 33° (P=.02); and internal rotation improved from S1 to L4 (P=.02). Twelve patients rated their outcome as excellent, 6 as good, 2 as satisfactory, and 1 as unsatisfactory. Severe glenoid erosion was seen in 10 of the shoulders and 5 of the defects required structural grafting. Three patients (14%) sustained a complication that required reoperation: 2 for infection and 1 for periprosthetic fracture. CONCLUSIONS: In patients with rheumatoid arthritis and rotator cuff deficiency, reverse shoulder arthroplasty can provide improvement in function and decreased pain.

Is a formal physical therapy program necessary after total shoulder arthroplasty for osteoarthritis?

HYPOTHESIS: A retrospective analysis was conducted of 2 consecutive groups of patients undergoing total shoulder arthroplasty (TSA) for primary osteoarthritis. One group was treated with formal physical therapy (PT), and one group was treated with home-based, physician-guided PT. We hypothesized that patients with a formal postoperative PT protocol would have significantly better postoperative clinical outcomes than patients with no formal PT. METHODS: Group A (43 patients) had a standard PT program. Group B (38 patients) had a home-based, physician-guided PT program. Clinical outcomes (preoperatively, 3, 6, and 12 months and most recent follow-up) were analyzed. A minimum sample size of 31 patients gives power to detect a 10-point American Shoulder and Elbow Surgeons (ASES) score (alpha=0.05, beta=0.80). RESULTS: ASES and Simple Shoulder Test (SST) scores significantly improved in both groups at all follow-up periods. Forward flexion and abduction were significantly improved in group B at all time points, whereas an initial improvement in forward flexion and abduction in group A was lost at final follow-up. There were no significant differences in final ASES or SST scores between groups at final follow-up. However, forward flexion, abduction, and the Short Form-36 physical component summary in group B were significantly better than group A at final follow-up. No significant improvements in internal rotation or SF-36 mental component summary were seen within or between the groups at final follow-up. Overall, there was no difference in patient satisfaction, with 88% satisfaction in group A and 95% satisfaction in group B (chi(2)=0.471, P=.4924). CONCLUSIONS: A home-based, physician-guided therapy program may provide adequate rehabilitation after TSA, allowing for a reduction in cost for the overall procedure.

Revision reverse shoulder arthroplasty for glenoid baseplate failure after primary reverse shoulder arthroplasty.

BACKGROUND: The aim of this study is to document a single surgeon's experience performing revision reverse shoulder arthroplasty after baseplate failure. METHODS: Revision reverse shoulder arthroplasty (RSA) for mechanical failure of the glenoid baseplate after RSA was performed in 14 patients. Clinical and radiographic data were collected preoperatively, prior to baseplate failure, after baseplate failure, and at latest follow-up after revision (average, 33 months). RESULTS: When comparing the pre-operative values to post-revision, ASES, forward elevation, and abduction were significantly improved. There was no significant difference in any of the outcome measures when comparing the prefailure data to the post-revision data. The post-revision prosthesis-scapular neck angle (PSNA) showed a significant increase in inferior tilt of the baseplate when compared to pre-failure PSNA (P < .001). Two patients (14%) required a second revision RSA for glenoid baseplate failure (1) and dislocation (1); 1 additional patient developed a postoperative hematoma which resolved without surgery. CONCLUSION: Revision RSA for the treatment of glenoid baseplate mechanical failure can restore pain relief and function to the levels gained after the index RSA.