Article

Theoretically, patients with only one functional arm secondary to
contralateral amputation or paralysis will subject their only functional upper
extremity to increased loads. This could become an issue after reverse shoulder
arthroplasty (RSA). However, there are no reported data on the implant survival
or function for patients with a nonfunctional contralateral upper extremity.
OBJECTIVE: To report the outcomes of RSA in patients with contralateral upper
extremity amputation or paralysis. DESIGN: Retrospective case series. SETTING:
Tertiary university hospital. PATIENTS: All patients who underwent RSA between
January 2004 and December 2013. METHODS: Of 1335 RSA procedures performed, 5
patients had a minimum 2-year follow-up and nonfunctional contralateral upper
extremity. There were 3 men and 2 women, with a mean (standard deviation) age and
length of follow-up of 72.4 (7.5) years and 56.4 (24-132) months. Two of the
patients had a contralateral upper extremity amputation, and the other 3 had
contralateral upper extremity paralysis as a result of stroke, traumatic brain
injury, and traumatic brachial plexus injury at birth. MAIN OUTCOMES: Pain, range
of motion, functional scores (Simple Shoulder Test, American Shoulder and Elbow
Society and Quick-Disability of the Arm, Shoulder and Hand), satisfaction,
complications/reoperations, and radiographic loosening. RESULTS: RSA resulted in
substantial improvement in pain (P = .008), forward flexion (P = .02), and
external range of motion (P = .01). The mean (standard deviation) Simple Shoulder
Test, American Shoulder and Elbow Society, and Quick-Disability of the Arm,
Shoulder, and Hand scores were 9.8 (1.3), 82 (13), and 17.8 (13.4), respectively.
The results were excellent in 3, satisfactory in 1, and unsatisfactory in 1
patient (due only to external rotation limited to 10 degrees ). Subjectively, all
5 patients felt greatly improved and stated they would undergo RSA again. There
were no complications or reoperations. There were no shoulders with component
loosening. CONCLUSIONS: RSA seems to be a safe, effective, and successful
surgical procedure for patients with a nonfunctional contralateral upper
extremity. Studies with larger sample sizes and longer follow-up will hopefully
validate the present findings. LEVEL OF EVIDENCE: IV.
CI - Copyright (c) 2017 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS