The Journal of Bone and Joint Surgery, Vol 71, Issue 4 494-498, Copyright © 1989 by Journal of Bone and Joint Surgery, Inc
Non-constrained total shoulder replacement in patients who have rheumatoid arthritis and class-IV function
RJ Friedman, TS Thornhill, WH Thomas and CB Sledge
Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts 02115.
The results of twenty-four non-constrained total shoulder replacements that
were done in twenty patients who had treatment of rheumatoid arthritis were
retrospectively reviewed to determine how those results were affected by
the severity of the disease. All of the patients had Class-IV functional
capacity, and 92 per cent had Stage-III or IV rheumatoid progression. Nine
(38 per cent) of the shoulders had a tear of the rotator cuff. The mean
length of clinical follow-up was 4.5 years (range, two to ten years).
Preoperatively, all of the patients had disabling pain and limited
function. Postoperatively, twenty-two (92 per cent) of the patients had no
appreciable pain, and eighteen (75 per cent) had no significant functional
limitation (p less than 0.001). Active elevation improved by 88 per cent,
and external and internal rotation also improved significantly. Motion,
relief of pain, and functional improvement were not significantly greater
in the patients who had an intact rotator cuff. Radiolucent lines developed
around ten (42 per cent) of the glenoid prostheses, but only two of the
prostheses were surrounded by a complete line and were thought to be loose.
No revisions were done. We believe that a non-constrained total shoulder
replacement affords excellent relief of pain, satisfactorily improves range
of motion, and improves function in patients who have severe rheumatoid
involvement of the shoulder. However, because motion and function are
severely restricted preoperatively, the end-results are not comparable with
those that have been reported for patients who have less severe rheumatoid
disease.
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