- 作者：Jason O. Holcomb ; Daniel J. Hebert ; Mark A. Mighell ; Page E. Dunning ; Derek R. Pupello ; Michele D. Pliner ; Mark A. Frankle
- 关键词：Reverse shoulder arthroplasty ; rheumatoid arthritis ; rotator cuff arthropathy
- 刊名：Journal of Shoulder and Elbow Surgery
- 出版年：2010
- 出版时间：October 2010
- 年：2010
- 卷：19
- 期：7
- 页码：1076-1084
- 全文大小：549 K
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.