Abstract
Various surgical treatment were reported on rheumatoid shoulder. However, there were no recommended surgeries in the Japanese 2nd basic published text of rheumatoid disease. We had performed total shoulder arthroplasty(TSA) and humeral head replacement (HHR) in patient with Rheumatoid shoulder from 1992.
The aim of this study was to compare the outcome of humeral head replacement, 2nd generation TSA and 3rd generation TSA in patients followed more than 5 years with rheumatoid shoulder.
Material & Method
From 1992–2007, we performed shoulder arthroplasty in 42 shoulders in 40 patients. Six cases were not able to follow due to die and lost. All 36 shoulders in 34 patients could be followed with x-ray examinations more than 5 years. Averaged follow-up period was 8.6 years (range 5–14.5). HHR with intact cuff performed in 10 shoulders, 2nd generation TSA with intact cuff in 10, 3rd generation TSA in intact cuff in 10 and HHR with muscle tendon transfer in 6 shoulders. The shoulder score of Japanese Orthopaedic Association)JOA score. Modified Neer classification, ROM, lucent lines in X-ray and complications were investigated.
Results
In JOA score, 3rd generation TSA revealed highest score (84 points). Also, in Modified Neer classification, excellent results were obtained 50% of cases in 3rd generation TSA. On the other hand, HHR with muscle tendon transfer group has no cases of excellent results. In flexion & external rotation, 3rd generation TSA had achieved satisfactory results. In X-ray, all glenoid component had a lucent line around the keel type glenoid in 2nd generation TSA. However, only 1.6 points in Lazarus claasification revealed in peg type component in 3rd generation TSA. No nerve injuries and instability were found after surgery. However, two infections and two glenoid resurfacing need after surgery.
Discussion
In this mid-term results, 3rd generation type of TSA system could get favorable results in RA shoulders with intact cuff. However, the treatment for rheumatoid shoulder cases which has masssive rotator cuff defect is still remained as difficult problem.
