Abstract
The aim of this study was to assess the medium-term results of the Copeland cementless surface replacement of the shoulder for rheumatoid arthritis.
Between 1986 and 1998, 75 patients with rheumatoid arthritis had a cementless surface replacement. They were 58 females and 17 males with a mean age 60 years (range: 24 to 88 years). The mean follow-up was 6 years (range: 2 to 14 years). The functional outcome was assessed using the Constant score and a patient satisfaction scale. The mean Constant score was 53.4 points for total shoulder replacements (76 age/ sex adjusted) and 47.9 points for hemiarthroplasty (71 age/ sex adjusted). Forward elevation improved from 50 degrees to 104 degrees for total shoulder replacements and from 47 degrees to 101 degrees for hemiarthroplasty. Seventytwo patients (96%) considered the shoulder to be better or much better. 3 patients (4%) felt the shoulder was the same.
The deltopectoral approach was used in 38 while the antero-superior (Mackenzie) approach was used in 37 shoulders. The rotator cuff was intact in 24 shoulders, thin but intact in 21 shoulders, had a full thickness tear in 26 shoulders and a massive tear in four shoulders.
Sixty-eight patients were available for radiological review. Fifty-six (82.4%) humeral components showed no lucent lines. Eleven (16.2%) showed localised lucent lines < 1mm and one was loose. Of the 39 glenoid components, 19 (48.7%) showed no lucent lines, 19 (48.7%) showed lucent lines < 1mm and one was loose. No lucencies were observed in the hydroxyapatite coated implants.
Two patients in the total shoulder group with massive cuff tears required revision for component loosening. One patient in the hemiarthroplasty group was revised to a total due to pain, with complete pain relief.
The results of CSRA are at least comparable to stemmed prosthesis in rheumatoid arthritis. However, CSRA preserves bone stock and allows easier revision in this relatively young group of patients. It also reduces the risk of humeral shaft fractures compared to a stemmed implant, especially when an elbow replacement is needed.
The abstracts were prepared by Mr Roger Emery. Correspondence should be addressed to him at the British Orthopaedic Association, Royal College of Surgeons, 35-43 Lincoln’s Inn Fields, London WC2A 3PN
