M. Rittmeister et F. Kerschbaumer, Grammont reverse total shoulder arthroplasty in patients with rheumatoid arthritis and nonreconstructible rotator cuff lesions, J SHOUL ELB, 10(1), 2001, pp. 17-22
This study was undertaken to determine whether patients with severe rheumat
oid arthritis and irreparable rotator cuff rupture can be treated successfu
lly with the Grammont shoulder arthroplasty. Seven patients with rheumatoid
arthritis (8 shoulders) with nonreconstructible rotator cuff lesions and L
arsen stage-V radiographic changes of the glenoid and the humeral head unde
rwent a Grammont reverse shoulder arthroplasty. The Constant score improved
from a mean of 17 points (range 4 to 25) preoperatively to a mean of 63 po
ints (range 41 to 79) at a mean of 54 months (range 48 to 73) after shoulde
r arthroplasty The mean strength at 90 degrees of abduction measured 3.6 kg
(range 1 to 6). Shoulder instability was not observed. Complications inclu
ded septic implant loosening (I shoulder), aseptic glenoid loosening (2), a
nd failed acromion osteosynthesis following the transacromial approach (3).
These data of Grammont arthroplasty are encouraging with respect to restor
ation of stability and satisfactory function in rheumatoid, cuff-deficient
shoulders. However, glenoid loosening remained a serious problem, and trans
acromial approaches were complicated by failure of acromial fixation.