Reverse total shoulder arthroplasty in wheelchair-dependent patients

Area of Science:

• Orthopedic Surgery
• Reconstructive Surgery
• Biomechanics

Background:

• Wheelchair-dependent individuals frequently experience shoulder pathology, leading to significant functional limitations.
• Symptomatic shoulder arthritis or severe rotator cuff pathology impacts independence in this population.

Purpose of the Study:

• To evaluate the outcomes of reverse total shoulder arthroplasty (RTSA) in wheelchair-dependent patients with shoulder arthritis or rotator cuff pathology.
• To assess if RTSA can withstand the increased biomechanical loads from transfers in this patient group.

Main Methods:

• Retrospective analysis of 16 wheelchair-dependent patients undergoing RTSA for shoulder arthritis or rotator cuff pathology.
• Functional outcomes assessed using multiple validated scores (e.g., Simple Shoulder Test, UCLA, SPADI, ASES, Constant, SF-12).
• Objective measures included active elevation and rotation; radiographic evaluation for complications like loosening and notching.

Main Results:

• Significant improvements observed in most functional outcome scores and active range of motion post-RTSA.
• High patient satisfaction rate (83%); however, a notable complication rate (25%) and notching rate (42%) were recorded.
• Early complications included baseplate failure and dislocation; late complications involved periprosthetic fracture due to infection.

Conclusions:

• RTSA offers significant benefits for shoulder pain and dysfunction in wheelchair-dependent patients, potentially restoring independence.
• Patients must be aware of a higher complication rate and potential for temporary increased impairment compared to the general population.
• RTSA is a viable option for this specific patient group, but careful patient selection and management are crucial.