Reverse Shoulder Arthroplasty in Weight-Bearing Shoulders of Wheelchair-Dependent Patients: Outcomes and Complications at 2 to 5 years.

Autor: Alentorn-Geli E; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.; Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905., Wanderman NR; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.; Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905., Assenmacher AT; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.; Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905., Sánchez-Sotelo J; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.; Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905., Cofield RH; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.; Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905., Sperling JW; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.; Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
Jazyk: angličtina
Zdroj: PM & R : the journal of injury, function, and rehabilitation [PM R] 2018 Jun; Vol. 10 (6), pp. 607-615. Date of Electronic Publication: 2017 Oct 27.
DOI: 10.1016/j.pmrj.2017.10.010
Abstrakt: Background: Wheelchair-dependent patients rely on their upper extremities for mobility and transfers. This entails the heavy use of upper extremities as weight-bearing joints, leading to shoulder overuse with increased prevalence of rotator cuff-related disorders and ultimately to challenging cases for shoulder surgeons when a joint replacement is needed.
Objective: To report the outcomes of reverse shoulder arthroplasty (RSA) in wheelchair-dependent patients with arthritis and rotator cuff tears.
Design: Retrospective case series/cross-sectional study.
Setting: Tertiary university hospital.
Patient (participants): All wheelchair-dependent patients undergoing RSA between 2004 and 2013.
Methods/interventions: Of the 22 wheelchair-dependent patients undergoing RSA, 18 of them had a minimum follow-up of 2 years. There were 9 men and 9 women, with a mean (standard deviation) age and length of follow-up of 68 (8.5) years and 36 (24-63) months. A retrospective chart review and cross-sectional phone calls were conducted to obtain all data.
Outcomes: Pain, range of motion, functional scores (Neer scale, simple shoulder test, and American Shoulder and Elbow Society), satisfaction, complications/reoperations, radiographic loosening, and 90-day mortality/morbidity.
Results: RSA resulted in a significant improvement in pain (P = .02) and nonsignificant improvements in forward flexion (P = .3) and external rotation (P = .07). There were 3 (16%) excellent, 12 (63%) satisfactory, and 4 (21%) unsatisfactory results. The mean (standard deviation) postoperative American Shoulder and Elbow Society score was 56.5 (16.5). All patients stated that they would undergo RSA again. There were no surgically related complications or reoperations. The 90-day mortality and morbidity rates were 0% and 26%, respectively.
Conclusions: RSA is a safe and effective procedure in wheelchair-dependent patients who use their shoulders for weight-bearing purposes. Although functional scores are not optimal and medical complications are not uncommon, 79% of patients had an excellent or satisfactory result.
Level of Evidence: III.
(Copyright © 2018 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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