Grammont reverse total shoulder arthroplasty in patients with rheumatoid arthritis and nonreconstructible rotator cuff lesions

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.