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Shoulder Arthroplasty in Rheumatoid Arthritis

  • Mike H. BaumsEmail author
Chapter

Abstract

Involvement of the shoulder is a common source of disability in rheumatoid arthritis (RA). Almost one fifth of the patients still experience an inadequate response to pharmacological therapy and therefore need sufficient surgical reconstructive treatment. Nevertheless, age at time of surgery could be increased significantly. Especially in cases with a destroyed shoulder joint, several challenges are remaining: erosions and osteopenia/osteoporosis resulting in loss of bone stock and a higher risk for periprosthetic fractures as well as component loosening and a high risk of periprosthetic infections because of immunosuppressive medication. In addition, insufficiency of the rotator cuff (RC) plays a fundamental role in the diseases preoperative as well as postoperative course after arthroplasty. Several inserts could be used, ranging from humeral resurfacing and stemless arthroplasty to reverse arthroplasty with and without bony reconstruction. Regarding the literature, total shoulder arthroplasty (TSA) results in better functional results compared to hemiarthroplasty (HA) but with higher incidence of radiolucent lines, especially of the glenoid component. However summing up, limited research evidence exists to give an established guidance for clinical decisions about shoulder arthroplasty in RA. Therefore, shoulder arthroplasty in RA remains highly ambitious and requires a patient-related individual and sophisticated approach.

Keywords

Rheumatoid arthritis Shoulder joint Shoulder replacement Shoulder arthroplasty 

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Copyright information

© ISAKOS 2019

Authors and Affiliations

  1. 1.Department of Orthopaedics, Trauma Surgery and Sports Traumatology, St. Elizabeth-HospitalAcademic Training Hospital of Westphalian-Wilhelms-University MünsterDorstenGermany

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