Shoulder Arthroplasty in Rheumatoid Arthritis



Involvement of the shoulder is a common source of disability in rheumatoid arthritis (RA). Almost one fifth of the patients still experience an inadequate response to pharmacological therapy and therefore need sufficient surgical reconstructive treatment. Nevertheless, age at time of surgery could be increased significantly. Especially in cases with a destroyed shoulder joint, several challenges are remaining: erosions and osteopenia/osteoporosis resulting in loss of bone stock and a higher risk for periprosthetic fractures as well as component loosening and a high risk of periprosthetic infections because of immunosuppressive medication. In addition, insufficiency of the rotator cuff (RC) plays a fundamental role in the diseases preoperative as well as postoperative course after arthroplasty. Several inserts could be used, ranging from humeral resurfacing and stemless arthroplasty to reverse arthroplasty with and without bony reconstruction. Regarding the literature, total shoulder arthroplasty (TSA) results in better functional results compared to hemiarthroplasty (HA) but with higher incidence of radiolucent lines, especially of the glenoid component. However summing up, limited research evidence exists to give an established guidance for clinical decisions about shoulder arthroplasty in RA. Therefore, shoulder arthroplasty in RA remains highly ambitious and requires a patient-related individual and sophisticated approach.


Rheumatoid arthritis Shoulder joint Shoulder replacement Shoulder arthroplasty 


  1. 1.
    Olofsson Y, Book C, Jacobsson LT. Shoulder joint involvement in patients with newly diagnosed rheumatoid arthritis. Prevalence and associations. Scand J Rheumatol. 2003;32:25–32.CrossRefGoogle Scholar
  2. 2.
    Petersson CJ. The acromioclavicular joint in rheumatoid arthritis. Clin Orthop Relat Res. 1987;223:86–93.Google Scholar
  3. 3.
    van de Sande MA, Brand R, Rozing PM. Indications, complications, and results of shoulder arthroplasty. Scand J Rheumatol. 2006;35:426–34.CrossRefGoogle Scholar
  4. 4.
    Mertelsmann-Voss C, Lyman S, Pan JT, et al. US trends in rates of arthroplasty for inflammatory arthritis including rheumatoid arthritis, juvenile idiopathic arthritis, and spondylarthritis. Arthritis Rheumatol. 2014;66:1432–9.CrossRefGoogle Scholar
  5. 5.
    Barlow JD, Yuan BJ, Schleck CD, et al. Shoulder arthroplasty for rheumatoid arthritis: 303 consecutive cases with minimum 5-year follow-up. J Shoulder Elb Surg. 2014;23:791–9.CrossRefGoogle Scholar
  6. 6.
    Betts HM, Abu-Rajab R, Nunn T, et al. Total shoulder replacement in rheumatoid disease: a 16- to 23-year follow-up. J Bone Joint Surg Br. 2009;91:1197–2005.CrossRefGoogle Scholar
  7. 7.
    Rozing PM, Brand R. Rotator cuff repair during shoulder arthroplasty in rheumatoid arthritis. J Arthroplast. 1998;13:311–9.CrossRefGoogle Scholar
  8. 8.
    Neer CS. Surgery of rheumatoid arthritis. In: Textbook of rheumatology. Amsterdam: Elsevier; 1993.Google Scholar
  9. 9.
    Hyun YS, Huri G, Garbis NG, et al. Uncommon indications for reverse total shoulder arthroplasty. Clin Orthop Surg. 2013;5:243–55.CrossRefGoogle Scholar
  10. 10.
    Lehtinen JT, Belt EA, Lyback CO, et al. Subacromial space in the rheumatoid shoulder: a radiographic 15-year follow-up study of 148 shoulders. J Shoulder Elb Surg. 2000;9:183–7.CrossRefGoogle Scholar
  11. 11.
    Aswad R, Franceschi JP, Levigne C. Rheumatoid arthritis: epidemiology and preoperative radiographic assessment. Montpellier: Sauramps Medical; 2001.Google Scholar
  12. 12.
    Khan A, Bunker TD, Kitson JB. Clinical and radiological followup of the Aequalis third-generation cemented total shoulder replacement. A minimum ten-year study. J Bone Joint Surg Br. 2009;91:1594–600.CrossRefGoogle Scholar
  13. 13.
    Sperling JW, Cofield RH, Schleck CD, et al. Total shoulder arthroplasty versus hemiarthroplasty for rheumatoid arthritis of the shoulder: results of 303 consecutive cases. J Shoulder Elb Surg. 2007;16:683–90.CrossRefGoogle Scholar
  14. 14.
    Larsen A, Dale K, Eek M. Radiographic evaluation of rheumatoid arthritis and related conditions by standard reference. Ims. Acta Radiol Diagn. 1977;18:481–92.CrossRefGoogle Scholar
  15. 15.
    Lehtinen JT, Lehto MU, Kaarela K, et al. Radiographic joint space in rheumatoid glenohumeral joints. A 15-year prospective follow-up study in 74 patients. Rheumatology. 2000;39:288–92.CrossRefGoogle Scholar
  16. 16.
    Lévigne C, Franceschi JP. Rheumatoid arthritis of the shoulder: radiological presentation and results of arthroplasty. In: Walch G, Boileau P, editors. Shoulder arthroplasty. Berlin: Springer; 1999. p. 221–30.CrossRefGoogle Scholar
  17. 17.
    Hambright D, Henderson RA, Cook C, et al. A comparison of perioperative outcome in patients with and without rheumatoid arthritis after receiving a total shoulder replacement arthroplasty. J Shoulder Elb Surg. 2011;20:77–85.CrossRefGoogle Scholar
  18. 18.
    Christie A, Dagfinrud H, Ringen HO, et al. Beneficial and harmful effects of shoulder arthroplasty in patients with rheumatoid arthritis: results from a Cochrane Review. Rheumatology. 2011;50:598–602.CrossRefGoogle Scholar
  19. 19.
    Trail IA, Nutall D. The results of shoulder arthroplasty in patients with rheumatoid arthritis. J Bone Joint Surg Br. 2002;84:1121–5.CrossRefGoogle Scholar
  20. 20.
    Collins DN, Harryman DT 2nd, Wirth MA. Shoulder arthroplasty for the treatment of inflammatory arthritis. J Bone Joint Surg Am. 2004;86:2489–96.CrossRefGoogle Scholar
  21. 21.
    Ten Voorde PC, Rasmussen JV, Olson BS, et al. Resurfacing shoulder arthroplasty for the treatment of severe rheumatoid arthritis. Acta Orthop. 2015;86:293–7.CrossRefGoogle Scholar
  22. 22.
    Sojbjerg JO, Frich LH, Johannsen HV, et al. Late results of total shoulder replacement in patients with rheumatoid arthritis. Clin Orthop Relat Res. 1999;366:39–45.CrossRefGoogle Scholar
  23. 23.
    Krishnan SG, Nowinski RJ, Harrison D, et al. Humeral hemiarthroplasty with biologic resurfacing of the glenoid for glenohumeral arthritis. Two to fifteen-year outcomes. J Bone Joint Surg Am. 2007;89:727–34.CrossRefGoogle Scholar
  24. 24.
    Levy O, Funk L, Sforza G, et al. Copeland surface replacement arthroplasty of the shoulder in rheumatoid arthritis. J Bone Joint Surg Am. 2004;86:512–8.CrossRefGoogle Scholar
  25. 25.
    Cho CH, Kim DH, Song KS. Reverse shoulder arthroplasty in patients with rheumatoid arthritis: a systematic review. Clin Orthop Surg. 2017;9:325–31.CrossRefGoogle Scholar
  26. 26.
    Gee GCH, Hanson EK, Saithna A. Reverse shoulder arthroplasty in rheumatoid arthritis: a systematic review. Open Orthop J. 2015;9:237–45.CrossRefGoogle Scholar
  27. 27.
    Boileau P, Morin-Salvo N, Gauci MO, et al. Angled BIO-RSA (bony-increased offset-reverse shoulder arthroplasty): a solution for the management of glenoid bone loss and erosion. J Shoulder Elb Surg. 2017;26:2133–42.CrossRefGoogle Scholar
  28. 28.
    Lapner PLC, Wood KS, Zhang T, et al. The return of subscapularis strength after shoulder arthroplasty. J Shoulder Elb Surg. 2015;24:223–8.CrossRefGoogle Scholar
  29. 29.
    Scalise JJ, Ciccone J, Iannotti JP. Clinical, radiographic, and ultrasonographic comparison of subscapularis tenotomy and lesser tuberosity osteotomy for total shoulder arthroplasty. J Bone Joint Surg Am. 2010;92:1627–34.CrossRefGoogle Scholar
  30. 30.
    Lapner PL, Sabri E, Rakhra K, et al. Comparison of lesser tuberosity osteotomy to subscapularis peel in shoulder arthroplasty: a randomized controlled trial. J Bone Joint Surg Am. 2012;94:2239–46.CrossRefGoogle Scholar
  31. 31.
    Lapner PL, Sabri E, Rakhra K, et al. Healing rates and subscapularis fatty infiltration after lesser tuberosity osteotomy versus subscapularis peel for exposure during shoulder arthroplasty. J Shoulder Elb Surg. 2013;22:396–402.CrossRefGoogle Scholar
  32. 32.
    Gerber C, Yian EH, Pfirrmann CA, et al. Subscapularis muscle function and structure after total shoulder replacement with lesser tuberosity osteotomy and repair. J Bone Joint Surg Am. 2005;87:1739–45.PubMedGoogle Scholar
  33. 33.
    Edwards TB, Boulahia A, Kempf JF, et al. The influence of rotator cuff disease on the results of shoulder arthroplasty for primary osteoarthritis: results of a multicenter study. J Bone Joint Surg Am. 2002;84:2240–8.CrossRefGoogle Scholar

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© ISAKOS 2019

Authors and Affiliations

  1. 1.Department of Orthopaedics, Trauma Surgery and Sports Traumatology, St. Elizabeth-HospitalAcademic Training Hospital of Westphalian-Wilhelms-University MünsterDorstenGermany

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