Shoulder arthroplasty in patients with juvenile idiopathic arthritis: long-term outcomes

Autor: Joaquin Sanchez-Sotelo, Jean-David Werthel, Erick M. Marigi, Bradley S. Schoch, Dustin R Lee, Jonathan D. Barlow, John W. Sperling, Ian Marigi
Rok vydání: 2021
Předmět:
Zdroj: Journal of Shoulder and Elbow Surgery. 30:2703-2710
ISSN: 1058-2746
DOI: 10.1016/j.jse.2021.06.014
Popis: Background Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatologic disease that occurs in the pediatric population. Often, JIA continues throughout life leading to progressive polyarticular arthritis and significant joint destruction and disability, oftentimes requiring replacement surgery. This study aimed to determine the outcomes of primary shoulder arthroplasty (SA) in patients with JIA. Methods Over a 42-year time period (1977 - 2019), 67 primary SA (20 hemiarthroplasty (HA), 38 anatomic total shoulder arthroplasty (TSA), and 9 reverse shoulder arthroplasty (RSA)) with a prior diagnosis of JIA formally established in a multi-disciplinary rheumatologic clinic met inclusion criteria. Further assessment was performed with inclusion of the visual analog scale (VAS) pain score, active shoulder range of motion (ROM), imaging studies, complications, and implant survivorship free from reoperation and revision. Results SA led to substantial improvements in pain and ROM across the entire cohort at an average follow-up period of 12.2 years (range, 2- 34 years). TSA was associated with the lowest pain scores (0.8; p = 0.02) and the highest ASES scores (77.4; p = 0.04) at most recent follow-up when compared to HA and RSA. There were 14 (21%) complications across the cohort with rotator cuff failure (n=4; 5.9%) as the most common complication followed by infection (n=3; 4.5%). Revision surgery was performed in 5 shoulders (7.5%), with five-year implant survival rates of 95.1% at five years, 93% at ten years, 89.4% at twenty years, and 79.5% at thirty years. At 30 years, TSA was associated with better survival (90.1%) when compared with HA (71.8%). Conclusions Primary shoulder arthroplasty in the form of HA, TSA, and RSA offers a reliable surgical option for JIA patients with respect to pain reduction and ROM improvements. Unique challenges still exist in this cohort, in particular younger patients with an elevated propensity for glenoid bone erosion and a complication rate of 20.9%. As such, HA may not be ideal in this patient population. However, despite rotator cuff and glenoid concerns, TSA seems to be associated with better pain relief and patient reported outcomes with the most durability in the long term when compared to HA. Level of evidence Level III; Retrospective Cohort Comparison; Treatment Study.
Databáze: OpenAIRE
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