This case series examines Grammont reverse total shoulder arthroplasty in 7 rheumatoid patients (8 shoulders) with irreparable rotator cuff tears and Larsen stage-V glenoid destruction. It asks whether reverse arthroplasty can restore meaningful function when anatomy is too destroyed for conventional replacement. Mean follow-up was 54 months.
When a rheumatoid patient presents with an irreparable rotator cuff and Larsen stage-V glenoid destruction, anatomic replacement is not a viable option — active forward flexion averages only 34° in cuff-deficient anatomic replacements, and instability is the rule rather than the exception.
This paper established that reverse arthroplasty can rescue these shoulders, with Constant scores tripling from 17 to 63 points at 4+ years and zero dislocations, even when the deltoid is the only functioning muscle.
The critical technical lesson: never use the transacromial approach in a rheumatoid shoulder. Osteoporotic acromial bone cannot hold osteosynthesis hardware. Every case in this series failed and required early revision.
Counsel patients that glenoid loosening remains a significant midterm risk, and set realistic expectations: shoulder function will improve meaningfully, but systemic disease progression will continue to limit overall independence.
This case series examines Grammont reverse total shoulder arthroplasty in 7 rheumatoid patients (8 shoulders) with irreparable rotator cuff tears and Larsen stage-V glenoid destruction. It asks whether reverse arthroplasty can restore meaningful function when anatomy is too destroyed for conventional replacement. Mean follow-up was 54 months.
When a rheumatoid patient presents with an irreparable rotator cuff and Larsen stage-V glenoid destruction, anatomic replacement is not a viable option — active forward flexion averages only 34° in cuff-deficient anatomic replacements, and instability is the rule rather than the exception.
This paper established that reverse arthroplasty can rescue these shoulders, with Constant scores tripling from 17 to 63 points at 4+ years and zero dislocations, even when the deltoid is the only functioning muscle.
The critical technical lesson: never use the transacromial approach in a rheumatoid shoulder. Osteoporotic acromial bone cannot hold osteosynthesis hardware. Every case in this series failed and required early revision.
Counsel patients that glenoid loosening remains a significant midterm risk, and set realistic expectations: shoulder function will improve meaningfully, but systemic disease progression will continue to limit overall independence.