Arthroplasty for weight-bearing shoulders

Area of Science:

• Orthopedic Surgery
• Rehabilitation Medicine
• Biomedical Engineering

Background:

• Wheelchair users with lower limb neurological deficits experience mechanical overload on their upper limbs, particularly shoulders.
• This overload leads to significant stress on shoulder arthroplasty implants, a controversial indication for joint replacement.
• Understanding the outcomes of shoulder arthroplasty in this specific patient population is crucial for clinical decision-making.

Purpose of the Study:

• To evaluate the efficacy of shoulder joint replacement in weight-bearing shoulders for patients with neurological deficits.
• To assess improvements in pain, range of motion, function, and autonomy post-surgery.
• To determine if complication rates increase compared to the able-bodied population.

Main Methods:

• Retrospective study of 13 shoulder implants in 11 long-term wheelchair users.
• Clinical assessment included range of motion, pain (VAS), Constant score, and Wheelchair User's Shoulder Pain Index (WUSPI).
• Radiographic evaluation for loosening and scapular notching; functional independence measure (FIM) assessed autonomy.

Main Results:

• Significant decrease in pain (VAS: 8 to 4) and WUSPI score (80 to 21).
• Mean Constant score increased by 90% (22 to 42).
• Improved range of motion noted in functional shoulder subgroup; no significant change in daily transfers; two revisions required (rotator cuff rupture, infection).

Conclusions:

• Shoulder joint replacement is an effective medium-term solution for pain relief in weight-bearing shoulders due to cuff tear arthropathy and glenohumeral OA.
• Improvements in range of motion are pathology-dependent; lifestyle adaptations (e.g., electric wheelchair use) may be necessary.
• The study highlights the benefits for pain and function, with manageable complication rates in this specific population.