I know this is going to sound funny but I just came back from filing taxes with my tax accountant. She told me she had a reverse shoulder replacement for a bad shoulder from RA. This is exactly what I have but I didn't think it was possible to get a shoulder replacement because I also have a badly torn rotator cuff on that side. She said she had the same thing and that's why they used this type of implant. Should I ask my doctor about this?
A recent study from the Mayo Clinics (Arizona and Minnesota clinics) showed encouraging results for patients with rheumatoid arthritis, severe shoulder destruction, 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.
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.
That's why this study is so important. For the first time, we have some early results that support this type of treatment for patients with rheumatoid arthritis affecting the shoulder(s). Results of the reverse procedure were measured using pain levels, shoulder motion, and function of the arm that depended on use of the shoulder. X-rays were used to show position and condition of the implant.
Compared with preoperative measurements, the postoperative results were good to excellent for most of the patients. There were a few complications but most were not directly related to the surgery.
The conclusion of the study was that patients like yourself with severe shoulder joint destruction from rheumatoid (inflammatory) arthritis are not without some options. According to the early results of this Mayo clinic study, the use of reverse shoulder arthroplasty can be beneficial in cases of RA and rotator cuff tears.
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. You can certainly bring this up to your surgeon and see if you might be a good candidate. Not all surgeons perform this procedure so you may have to be referred to a clinic where reverse shoulder replacements are being done.
Steven J. Hattrup, MD, et al. Reverse Shoulder Replacement for Patients with Inflammatory Arthritis. In The Journal of Hand Surgery. September 2012. Vol. 37A. No. 9. Pp. 1888-1894.
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