Reverse Shoulder Arthroplasty in the Treatment of End-Stage Rheumatoid Arthritis of the Shoulder

Rheumatoid arthritis (RA) of the shoulder affects both bony and soft-tissue structures around the glenohumeral joint and destroys the rotator cuff, and leads to loss of function, instability, and chronic incongruency of the joint. Lehtinen et al. [1] 2000 reported a natural history of 148 RA shoulders with a 15-year follow-up. The result was upward migration, medialization, and flattening of the humeral head. Accordingly, Rozing & Brad [2] and Kelly [3] detected a massive rotator cuff rupture at the time of surgery in 53%, and 30% of RA patients, respectively. Furthermore, in cases with RA and intact rotator cuff, Betts et al. [4] found a significant incongruence and postoperative upward migration of the humeral head in all cases of anatomic total shoulder Arthroplasty (TSA).