Article

Wheelchair-dependent patients rely on their upper extremities for
mobility and transfers. This entails the heavy use of upper extremities as
weight-bearing joints, leading to shoulder overuse with increased prevalence of
rotator cuff-related disorders and ultimately to challenging cases for shoulder
surgeons when a joint replacement is needed. OBJECTIVE: To report the outcomes of
reverse shoulder arthroplasty (RSA) in wheelchair-dependent patients with
arthritis and rotator cuff tears. DESIGN: Retrospective case
series/cross-sectional study. SETTING: Tertiary university hospital. PATIENT
(PARTICIPANTS): All wheelchair-dependent patients undergoing RSA between 2004 and
2013. METHODS/INTERVENTIONS: Of the 22 wheelchair-dependent patients undergoing
RSA, 18 of them had a minimum follow-up of 2 years. There were 9 men and 9 women,
with a mean (standard deviation) age and length of follow-up of 68 (8.5) years
and 36 (24-63) months. A retrospective chart review and cross-sectional phone
calls were conducted to obtain all data. OUTCOMES: Pain, range of motion,
functional scores (Neer scale, simple shoulder test, and American Shoulder and
Elbow Society), satisfaction, complications/reoperations, radiographic loosening,
and 90-day mortality/morbidity. RESULTS: RSA resulted in a significant
improvement in pain (P = .02) and nonsignificant improvements in forward flexion
(P = .3) and external rotation (P = .07). There were 3 (16%) excellent, 12 (63%)
satisfactory, and 4 (21%) unsatisfactory results. The mean (standard deviation)
postoperative American Shoulder and Elbow Society score was 56.5 (16.5). All
patients stated that they would undergo RSA again. There were no surgically
related complications or reoperations. The 90-day mortality and morbidity rates
were 0% and 26%, respectively. CONCLUSIONS: RSA is a safe and effective procedure
in wheelchair-dependent patients who use their shoulders for weight-bearing
purposes. Although functional scores are not optimal and medical complications
are not uncommon, 79% of patients had an excellent or satisfactory result. LEVEL
OF EVIDENCE: III.
CI - Copyright (c) 2018 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS