The present study reports a retrospective case series detailing our experience of the use of Copeland surface replacement hemiarthroplasty (CSRA) for the treatment of rheumatoid arthritis (RA) of the shoulder.
Methods
Fifty-three CSRAs were performed in 45 patients between 1994 and 2004. Forty-six shoulders were followed up at a mean of 62.5 months (range 24 months to 150 months). Assessment included a Constant score, patient satisfaction score, and plain radiographs.
Results
The Constant score improved in all shoulders, from a pre-operative mean of 15.2 to 46.3. Mean abduction improved from 27° to 78°, mean flexion from 47° to 92°, and mean external rotation from 9° to 34°. Fifty-two percent of shoulders showed superior subluxation on plain radiographs. Seven shoulders had over 2 mm of glenoid erosion, of which one underwent reoperation. No implants were loose or required revision. One humeral neck fracture was successfully treated non-operatively. Four shoulders required arthroscopic subacromial decompression.
Discussion
CSRA provides satisfactory results in RA compared to more conventional stemmed implants and total shoulder arthroplasty.
ThomasT, NoelE, GoupilleP, DuquesnoyB, CombeB. The rheumatoid shoulder: current consensus on diagnosis and treatment. J Bone Spine2006; 73: 139–43.
2.
LarsenA, DaleK, EekM. Radiographic evaluation of rheumatoid arthritis and related conditions by standard reference films. Acta Radiol Diagn (Stockh)1977; 18: 481–91.
3.
LehtinenJT, BeltEA, KauppiMJ,. Bone destruction, upward migration, and medialisation of rheumatoid shoulder: a 15 year follow up study. Ann Rheum Dis2001; 60: 322–6.
4.
ChenAL, JosephTN, ZuckermanJD. Rheumatoid arthritis of the shoulder. J Am Acad Orthop Surg2003; 11: 12–24.
5.
GadoK, EmeryP. Modified suprascapular nerve block with bupivacaine alone effectively controls chronic shoulder pain in patients with rheumatoid arthritis. Ann Rheum Dis1993; 52: 215–8.
6.
GobelD, GratzS, von RothkirchT, BeckerW, WillertHG. Radiosynoviorthesis with rhenium-186 in rheumatoid arthritis: a prospective study of three treatment regimens. Rheumatol Int1997; 17: 105–8.
7.
BenjaminA. Double osteotomy of the shoulder. Scand J Rheumatol1974; 3: 65.
8.
FinkB, SallenV, GuderianH, TillmannK, RutherW. Resection interposition arthroplasty of the shoulder affected by inflammatory arthritis. J Shoulder Elbow Surg2001; 10: 365–71.
9.
MilbrinkJ, WigrenA. Resection arthroplasty of the shoulder. Scand J Rheumatol1990; 19: 432–6.
10.
RybkaV, RaunioP, VainioK. Arthrodesis of the shoulder in rheumatoid arthritis: a review of forty-one cases. J Bone Joint Surg Br1979; 61B: 155–8.
11.
SmithAM, SperlingJW, O'DriscollSW, CofieldRH. Arthroscopic shoulder synovectomy in patients with rheumatoid arthritis. Arthroscopy2006; 22: 50–6.
12.
SpencerR, SkirvingAP. Silastic interposition arthroplasty of the shoulder. J Bone Joint Surg Br1986; 68: 375–7.
13.
JohnM, PapG, AngstF,. Short-term results after reversed shoulder arthroplasty (Delta III) in patients with rheumatoid arthritis and irreparable rotator cuff tear. Int Orthop2010; 34: 71–7.
14.
BettsHM, Abu-RajabR, NunnT, BrooksbankAJ. Total shoulder replacement in rheumatoid disease: a 16- to 23-year follow-up. J Bone Joint Surg Br2009; 91: 1197–200.
15.
FuerstM, FinkB, RutherW. The DUROM cup humeral surface replacement in patients with rheumatoid arthritis. Surgical technique. J Bone Joint Surg Am2008; 90(Suppl 2): 287–98.
16.
WoodruffMJ, CohenAP, BradleyJG. Arthroplasty of the shoulder in rheumatoid arthritis with rotator cuff dysfunction. Int Orthop2003; 27: 7–10.
17.
KoorevaarRC, MerkiesND, de Waal MalefijtMC, TeeuwenM, van den HoogenFH. Shoulder hemiarthroplasty in rheumatoid arthritis. 19 cases reexamined after 1–17 years. Acta Orthop Scand1997; 68: 243–5.
18.
WalchG, BoileauP. Prosthetic adaptability: a new concept for shoulder arthroplasty. J Shoulder Elbow Surg1999; 8: 443–51.
19.
LevyO, FunkL, SforzaG, CopelandSA. Copeland surface replacement arthroplasty of the shoulder in rheumatoid arthritis. J Bone Joint Surg Am2004; 86A: 512–8.
ConstantCR, GerberC, EmeryRJ,. A review of the constant score: modifications and guidelines for its use. J Shoulder Elbow Surg2008; 17: 355–61.
22.
ConstantCR, MurleyAH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res1987; 214: 160–4.
23.
FinkB, SingerJ, LamlaU, RutherW. Surface replacement of the humeral head in rheumatoid arthritis. Arch Orthop Trauma Surg2004; 124: 366–73.
24.
FuerstM, FinkB, RutherW. The DUROM cup humeral surface replacement in patients with rheumatoid arthritis. J Bone Joint Surg Am2007; 89: 1756–62.
25.
SojbjergJO, FrichLH, JohannsenHV, SneppenO. Late results of total shoulder replacement in patients with rheumatoid arthritis. Clin Orthop Relat Res1999; 366: 39–45.
26.
AlundM, Hoe-HansenC, TillanderB, HedenBA, NorlinR. Outcome after cup hemiarthroplasty in the rheumatoid shoulder: a retrospective evaluation of 39 patients followed for 2–6 years. Acta Orthop Scand2000; 71: 180–4.
27.
TrailIA, NuttallD. The results of shoulder arthroplasty in patients with rheumatoid arthritis. J Bone Joint Surg Br2002; 84: 1121–5.
28.
SneppenO, FruensgaardS, JohannsenHV,. Total shoulder replacement in rheumatoid arthritis: proximal migration and loosening. J Shoulder Elbow Surg1996; 5: 47–52.
29.
SperlingJW, CofieldRH, SchleckCD, HarmsenWS. Total shoulder arthroplasty versus hemiarthroplasty for rheumatoid arthritis of the shoulder: results of 303 consecutive cases. J Shoulder Elbow Surg2007; 16: 683–90.
30.
StewartMP, KellyIG. Total shoulder replacement in rheumatoid disease: 7- to 13-year follow-up of 37 joints. J Bone Joint Surg Br1997; 79: 68–72.
FranklinJL, BarrettWP, JackinsSE, MatsenFAIIIGlenoid loosening in total shoulder arthroplasty. Association with rotator cuff deficiency. J Arthroplasty1988; 3: 39–46.
33.
CollinsDN, HarrymanDTII, WirthMA. Shoulder arthroplasty for the treatment of inflammatory arthritis. J Bone Joint Surg Am2004; 86A: 2489–96.
34.
KellyIG, FosterRS, FisherWD. Neer total shoulder replacement in rheumatoid arthritis. J Bone Joint Surg Br1987; 69: 723–6.
35.
RozingPM, BrandR. Rotator cuff repair during shoulder arthroplasty in rheumatoid arthritis. J Arthroplasty1998; 13: 311–9.
36.
SmithAM, SperlingJW, CofieldRH. Rotator cuff repair in patients with rheumatoid arthritis. J Bone Joint Surg Am2005; 87: 1782–7.
37.
RittmeisterM, KerschbaumerF. Grammont reverse total shoulder arthroplasty in patients with rheumatoid arthritis and nonreconstructible rotator cuff lesions. J Shoulder Elbow Surg2001; 10: 17–22.
38.
GueryJ, FavardL, SirveauxF,. Reverse total shoulder arthroplasty. Survivorship analysis of eighty replacements followed for five to ten years. J Bone Joint Surg Am2006; 88: 1742–7.
39.
RydholmU, SjogrenJ. Surface replacement of the humeral head in the rheumatoid shoulder. J Shoulder Elbow Surg1993; 2: 286–95.
40.
LevyO, CopelandSA. Cementless surface replacement arthroplasty of the shoulder. 5- to 10-year results with the Copeland mark-2 prosthesis. J Bone Joint Surg Br2001; 83: 213–21.
41.
LevyO, CopelandSA. Cementless surface replacement arthroplasty (Copeland CSRA) for osteoarthritis of the shoulder. J Shoulder Elbow Surg2004; 13: 266–71.
42.
CopelandS. The continuing development of shoulder replacement: ‘reaching the surface’. J Bone Joint Surg Am2006; 88: 900–5.
43.
GillDR, CofieldRH, MorreyBF. Ipsilateral total shoulder and elbow arthroplasties in patients who have rheumatoid arthritis. J Bone Joint Surg Am1999; 81: 1128–37.
44.
SteinmannSP, CheungEV. Treatment of periprosthetic humerus fractures associated with shoulder arthroplasty. J Am Acad Orthop Surg2008; 16: 199–207.
45.
McDonoughEB, CrosbyLA. Periprosthetic fractures of the humerus. Am J Orthop2005; 34: 586–91.
46.
KumarS, SperlingJW, HaidukewychGH, CofieldRH. Periprosthetic humeral fractures after shoulder arthroplasty. J Bone Joint Surg Am2004; 86-A: 680–9.
47.
BoileauP, SinnertonRJ, ChuinardC, WalchG. Arthroplasty of the shoulder. J Bone Joint Surg Br2006; 88B: 562–75.
