Although hip and knee replacements are common, a similar surgery to replace diseased shoulder joints also appears worthwhile for rheumatoid arthritis patients whose severe shoulder pain and stiffness can't be eased by medication or physical therapy, new research suggests.
Scientists from the Mayo Clinic found that 93% of rheumatoid arthritis patients who underwent a total shoulder replacement in which both sides of a shoulder joint are replaced, needed no further surgery on the joint a decade later. The same was true for 88% of those undergoing a partial shoulder replacement.
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"We were most happy to see the consistency of pain relief and improvement of function among patients," said study author Dr John Sperling, an orthopaedic surgeon at the clinic in Rochester, Minnesota. "Shoulder replacement has come a long way over the past 20 to 25 years. It's a one-hour surgery that requires one night in the hospital, and patients have a 90% chance of achieving excellent pain relief."
To minimise pain
The study, published in the Journal of Shoulder and Elbow Surgery, disclosed that two of the researchers receive royalties from medical-device makers.
Shoulder-replacement surgery is performed far less often than hip- or knee-joint replacements, but is done for the same reasons – to minimise pain and improve movement and function in diseased joints, according to the study.
According to the Agency for Healthcare Research and Quality, about 53 000 Americans underwent shoulder-replacement surgery in 2011. In contrast, more than 900 000 US patients each year have hips or knees replaced, according to the American Academy of Orthopaedic Surgeons.
Shoulder pain is prevalent among those with rheumatoid arthritis, an inflammatory disorder in which the immune system attacks the body's own tissues, causing joint pain and other problems. Shoulder-replacement surgery is also used for those with more common osteoarthritis and for patients with complicated shoulder fractures, Sperling said.
The procedure requires a 4- to 6-inch incision in the upper shoulder region, where the diseased joint is removed and replaced with a plastic or metal joint, Sperling said.
Reliable and effective operation
Analysing more than 300 patients with rheumatoid arthritis who had shoulder replacement surgery at the Mayo Clinic, Sperling and his team observed comparable surgical success rates both five years and 10 years after the procedure. Only small percentages required additional shoulder surgery during those time spans.
Dr Anthony Romeo, a professor of orthopaedics and director of shoulder and elbow surgery at Rush University Medical Centre in Chicago, said the new study provides "tremendous insight" into the results of shoulder replacement.
"Shoulder replacement has really found its place on par with hip replacement and knee replacement," said Romeo, who wasn't involved in the new research. "I hear very frequently in my office of patients saying they're very nervous about having a shoulder replacement because they've either never heard of it or it's so rare they're wondering how it can be a good option."
"I try to reassure my patients that this operation is as effective as hip or knee replacement," he said. "Shoulder replacement has moved ... to become a very predictable, reliable operation."
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