medwireNews: Shoulder replacement surgery can relieve pain and improve range of motion in most patients with rheumatoid arthritis (RA) who have failed to respond to medication and physical therapy, say researchers.
Despite elements of RA, such as osteopenia, rotator cuff tears, and immunosuppressing medications, making shoulder arthroplasty potentially challenging, the team found that pain severity decreased from moderate to severe pain before surgery to no or slight pain after.
Specifically, for patients undergoing total shoulder arthroplasty (TSA), the average postoperative score was 1.9 out of a possible 5, compared with a preoperative pain score of 4.8, while for those receiving hemiarthroplasty (HA), the pain score fell from an average 4.8 to 2.4.
Range of motion also improved significantly in both groups of patients, with elevation and external rotation increasing by an average of 35° and 17° following TSA and a respective 32° and 16° following HA. Internal rotation did not change significantly in either case.
In patients with an intact rotator cuff, pain scores decreased significantly more with TSA than with HA, and there was a greater improvement in elevation, albeit not significantly so, note the researchers, led by Robert Cofield (Mayo Clinic, Rochester, Minnesota, USA).
Of the 303 RA patients who participated in the study, 195 underwent TSA and the rate of survivorship in this group was 92.9% without the need for further revision. Among the 108 who received HA, the survivorship rate without further revision was 87.9%.
Co-researcher John Sperling (Mayo Clinic) told the press: “What we’ve learned from this study is that if people do develop significant pain in their shoulder due to arthritis associated with RA, shoulder arthroplasty really is a predictable and reliable operation to help them improve their function and relieve pain.”
The researchers note in the Journal of Shoulder and Elbow Surgery that glenoid component lucencies were common in the patients, but there were very few revisions for glenoid component loosening, at 5%, and no revisions for isolated humeral component loosening. There was a 7% revision rate of HA to TSA for symptomatic glenoid arthrosis, however.
“Overall, both HA and TSA provide reliable options for pain relief and improved elevation and external rotation in patients with RA,” they conclude.
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