Reverse shoulder arthroplasty in patients with rheumatoid arthritis.

BACKGROUND: The purpose of this study was to describe the pathoanatomy of patients diagnosed with rheumatoid arthritis and rotator cuff deficiency and report their outcomes following reverse shoulder arthroplasty. METHODS: Twenty-one shoulders were evaluated prospectively. Nine had no prior surgery, 9 had a failed rotator cuff repair, and 3 had a failed arthroplasty. Patients were followed for a minimum of 2 years (average, 36 months). All patients had preoperative radiographs and 19 shoulders had an MRI or CT available for evaluation of muscular and bony deficiency. Radiographs at most recent follow-up were evaluated for loosening and scapular notching. RESULTS: All outcome measures improved significantly: ASES scores improved from 28 preoperatively to 82 postoperatively (P < .0001); SST scores improved from 1 to 7 (P < .0001); VAS pain scores improved from 7 to 1 (P < .0001); VAS function scores improved from 3 to 6 (P=.0058); elevation improved from 52° to 126° (P < .0001); abduction improved from 55° to 116° (P=.0002); external rotation improved from 19° to 33° (P=.02); and internal rotation improved from S1 to L4 (P=.02). Twelve patients rated their outcome as excellent, 6 as good, 2 as satisfactory, and 1 as unsatisfactory. Severe glenoid erosion was seen in 10 of the shoulders and 5 of the defects required structural grafting. Three patients (14%) sustained a complication that required reoperation: 2 for infection and 1 for periprosthetic fracture. CONCLUSIONS: In patients with rheumatoid arthritis and rotator cuff deficiency, reverse shoulder arthroplasty can provide improvement in function and decreased pain.

Orthopedic injuries during carrier battle group deployments.

Orthopedic injuries account for a large number of sick call visits during carrier battle group (CBG) deployments. The purpose of this study was to profile the orthopedic injuries during two CBG deployments to help both the line and medical communities better prepare their personnel and supplies. The current study confirmed that orthopedic injuries resulted in the greatest number of sick call visits to the CBG medical departments. Injury analysis revealed a significant number of hand/wrist and back/neck injuries during both carrier deployments. The groups with the highest number of injuries were the air squadrons and aircrews. These findings support the need for continued increased training and supplies for the care of orthopedic injuries. Emphasis should be placed on the care of hand/wrist and back/neck injuries. In addition, all CBG personnel should continue to improve their safety standards, especially in high-risk areas such as the aviation departments.