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I'm looking for information on the kinds of problems I might run into having a reverse shoulder replacement for rheumatoid arthritis. I understand these implants are used most often for people with osteoarthritis. Can they be used for people like me? I guess I should tell you I have one shoulder almost totally destroyed by RA, a torn rotator cuff on that side, and the same problem starting on the other side.
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The mechanics and design of the reverse shoulder replacement are the exact opposite of a traditional shoulder replacement. In the reverse implant, the ball portion of the shoulder is placed where the socket use to be and the socket is where the ball or humeral head occurs naturally in the normal shoulder joint. This new design has made it possible to create a much more stable shoulder joint that can function without a rotator cuff.
The loss of the support and function of the rotator cuff muscle is the key ingredient here. Without this important muscle group, patients with severe rheumatoid arthritis do not do well with the traditional shoulder replacement. But concerns about bone loss and a lack of information on how patients with rheumatoid arthritis would do with this type of implant have kept surgeons from using the reverse shoulder replacement.
There has been one study (from the Mayo Clinics in Arizona and Minnesota) that showed encouraging results for patients with severe shoulder destruction from rheumatoid arthritis and rotator cuff tears. They successfully replaced the shoulder joints of 19 patients with a reverse shoulder replacement. Early results (after three years) were good but there were some complications.
Compared with preoperative measurements, the postoperative results were excellent for 12 of the 19 patients. Five others had satisfactory results. Only two had an unsatisfactory outcome. There were a few complications but most were not directly related to the surgery. Falls leading to bone fractures were the biggest postoperative problem but these were not directly related to (or caused by) the shoulder replacement surgery. No one in the study needed revision surgery.
The Mayo surgeons concluded that patients with severe shoulder joint destruction from rheumatoid (inflammatory) arthritis have some new options with this procedure. The main indication for the use of reverse shoulder replacements has always been severe rotator cuff damage. It looks like a reverse prosthesis can also successfully reduce pain and significantly improve function previously affected by limited motion.
The authors say they will continue using this procedure with their patients when appropriate. That last word is very important -- patient selection is done carefully with the goal of the best results with the fewest complications. As with all major surgical procedures, complications can occur.
Some of the most common complications following reverse artificial shoulder replacement are infection, fracture, dislocation, loosening, and nerve or blood vessel injury. For more information on the specific surgical complications that can arise, see our patient handout: A Patient's Guide to Reverse Arthroplasty.
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