Shoulder arthroplasty in the paraplegic patient

Introduction: Shoulder arthroplasty in the paraplegic patient is a challenging procedure, because of the patients' unique demands on the shoulder. Previous information on the outcomes of this surgery in the literature is quite limited. Our experience in the prosthetic reconstruction of the arthritic shoulder in patients with pre-existing paraplegia was reviewed to define the results and identify any complications or the need for revision surgery. Method: Six patients were identified as eligible for inclusion. One patient had a humeral head replacement (HHR) and the remaining patients total shoulder arthroplasty (TSA). The average age at time of surgery was 68.7 years. The most common cause of the paraplegia was poliomyelitis, which was present in 3 patients. The other etiologies were transverse myelitis, spina bifida, and familial spastic paraparesis. Patients were followed for an average of 84 months, ranging from a minimum of 24 months up to 200 months. Results were graded according to a modified Neer classification. Results: The results were excellent in 1 shoulder, satisfactory in 4, and unsatisfactory in only 1. One patient continued to have severe pain post-operatively, but good pain relief was achieved in the remaining shoulders. Average postoperative elevation was 122 degrees, ranging from 90 degrees to 150 degrees. Complications included pressure ulceration, pneumonia, brachial plexopathy, and humeral fracture. Conclusions: Satisfactory outcomes in pain relief and range of motion can be accomplished with shoulder arthroplasty in the paraplegic patient. Complications are frequent and careful management of the patient necessary to minimize their occurrence. Level of evidence: Level IV; Case Series; Treatment Study (C) 2010 Journal of Shoulder and Elbow Surgery Board of Trustees.