Ipsilateral total shoulder and elbow arthroplasties in patients who have rheumatoid arthritis

Background: The data on seventeen patients with rheumatoid arthritis who ha d been managed with ipsilateral total shoulder and elbow arthroplasties wer e analyzed to determine whether the operative technique, the presence of to tal shoulder and total elbow prostheses in the same upper extremity, or com plications of the arthroplasties affected the result in each joint or the o verall functional outcome of the upper extremity. Methods: Seventeen patients with rheumatoid arthritis who were managed with a total of eighteen ipsilateral total shoulder and elbow arthroplasties we re evaluated. The most recent physical examination was at an average of six years and six months (range, two years and one month to fourteen years) po stoperatively. Radiographs, including 40-degree oblique and axillary radiog raphs of the shoulder as well as anteroposterior and lateral radiographs of the elbow, were made at an average of six years and eleven months (range, two years and two months to twenty-two years and eleven months) postoperati vely. The radiographs of the shoulder were examined for loosening of the gl enoid component, glenohumeral subluxation, and radiolucency at the bone-cem ent or bone-implant interface. The functional results of the total shoulder arthroplastics were evaluated with use of the rating systems of Neer ct al. and Cofield. The Mayo elbow-p erformance score was used to evaluate elbow function. A rating system was a lso developed to assess the overall function of the upper extremity, includ ing pain and motion of both the elbow and the shoulder. With this system, t he overall function of the upper extremity was rated as excellent, good, fa ir, or poor. Results: Evaluation of the shoulders revealed substantial relief of pain an d an increase in active elevation. On radiographic evaluation, eight glenoi d and five humeral components were considered to be loose. There were no re operations. According to the rating system of Neer et al., eight shoulders had a satisfactory result and eight had an unsatisfactory result with limit ed active abduction. Limited-goals rehabilitation was successful after one shoulder arthroplasty and unsuccessful after another There were two type-B periprosthetic humeral fractures. There was also substantial relief of pain in the elbows as well as an incre ase in the extension-flexion are; the. pronation-supination are was suffici ent for tasks of daily living. There was no radiographic loosening. Two elb ows had an avulsion of the triceps, and two had aseptic loosening (one of w hich also had a worn bushing); all four needed a reoperation. One other elb ow had persistent ulnar neuritis. The average interval between the arthroplasties was two years and eight mon ths when the shoulder was replaced first and three years and five months wh en the elbow was replaced first. The interval between the joint replacement s and the sequence of the joint replacements were not found to influence th e outcome. Function of the extremity was improved by replacement of either the shoulder or the elbow alone; however, it improved significantly only wh en both joints were replaced (p = 0.03). According to combined clinical out comes scores, there were nine excellent outcomes, four good outcomes, four fair outcomes, and one poor outcome after ipsilateral total shoulder and el bow arthroplasties. Conclusions: When there is severe arthritis of both the shoulder and the el bow, consideration should be given to replacing both joints in order to obt ain optimum functional and clinical outcomes. The possibility of fracture o f the humeral shaft necessitates an alteration of the technique for ipsilat eral total shoulder and elbow arthroplasties.