Reverse total shoulder replacement for patients with "weight-bearing" shoulders.

BACKGROUND: Reverse total shoulder arthroplasty (rTSA) has gained popularity in recent years and is indicated for a wide variety of shoulder pathologies. However, use of rTSA in patients with "weight-bearing" shoulders that support wheelchair use or crutches has higher risk. The aim of this study was to assess the results of rTSA in such patients.

METHODS: Between 2005 and 2014, 24 patients (30 shoulders) with weight-bearing shoulders were treated with rTSA at our unit. Patients had cuff arthropathy (n=21), rheumatoid arthritis (n=3), osteoarthritis (n=1), acute fracture (n=3), or fracture sequela (n=2). Postoperatively, patients were advised not to push themselves up and out of their wheelchair for 6 weeks. The study surgeries were performed in 2016, and 21 patients (27 shoulders) who were available for a mean follow-up of 5.6 years (range, 2-10 years). The mean age on surgery day was 78 years (range, 54-90 years). Constant-Murley score improved from 9.4 (range, 2-26) preoperatively to 59.8 (range, 29-80) at the final follow-up (P=0.001).

RESULTS: Pain improved from 2/15 (range, 0-8) to 13.8/15 (range, 9-15) (P=0.001). Patient satisfaction (Subjective Shoulder Value) improved from 0.6/10 to 8.7/10 (P=0.001) at final follow-up. Significant improvement in mean range of motion from 46° to 130° of elevation, 13° to 35° of external rotation, and 29° to 78° internal rotation was recorded (P=0.001). Final mean Activities of Daily Living External and Internal Rotation was 32.4/36 (range, 16-36). There were three patients with Sirveaux-Nerot grade-1 (10%) glenoid notching and three with grade 2 (10%).

CONCLUSIONS: rTSA can be used for treatment of patients with weight-bearing shoulders. Such patients reported pain free movement, resumed daily activities, and high satisfaction rates.