Shoulder arthroplasty for sequelae of poliomyelitis

• Published in: Journal of shoulder and elbow surgery 2016-05, Vol.25 (5), p.791-796
• Main Authors: Werthel, Jean-David, MD, Schoch, Bradley, MD, Sperling, John W., MD, Cofield, Robert, MD, Elhassan, Bassem T., MD
• Format: Article
• Language: English
• Subjects: Aged; Arthralgia - etiology; Arthralgia - surgery; Arthritis - etiology; Arthritis - surgery; Arthroplasty, Replacement, Shoulder - adverse effects; Arthroplasty, Replacement, Shoulder - methods; Female; Follow-Up Studies; Hemiarthroplasty - adverse effects; Humans; Joint Instability - diagnostic imaging; Joint Instability - etiology; Joint Instability - surgery; Male; Middle Aged; Muscle Strength; Muscle Weakness - etiology; Muscle Weakness - surgery; Muscle, Skeletal - physiopathology; Orthopedics; poliomyelitis; Poliomyelitis - complications; Radiography; Range of Motion, Articular; Rotation; Shoulder - physiopathology; Shoulder - surgery; Shoulder arthroplasty; Shoulder Joint - diagnostic imaging; Shoulder Joint - physiopathology; Shoulder Joint - surgery; Treatment Outcome
• ISSN: 1058-2746; 1532-6500
• DOI: 10.1016/j.jse.2015.09.032

Background Polio infection can often lead to orthopedic complications such as arthritis, osteoporosis, muscle weakness, skeletal deformation, and chronic instability of the joints. The purpose of this study was to assess the outcomes and associated complications of arthroplasty in shoulders with sequelae of poliomyelitis. Methods Seven patients (average age, 70 years) were treated between 1976 and 2013 with shoulder arthroplasty for the sequelae of polio. One patient underwent reverse shoulder arthroplasty, 2 had a hemiarthroplasty, and 4 had total shoulder arthroplasty. Average follow-up was 87 months. Outcome measures included pain, range of motion, and postoperative modified Neer ratings. Results Overall pain scores improved from 5 to 1.6 points (on a 5-point scale) after shoulder arthroplasty. Six shoulders had no or mild pain at latest follow-up, and 6 shoulders rated the result as much better or better. Mean shoulder elevation improved from 72° to 129°, and external rotation improved from 11° to 56°. Average strength in elevation decreased from 3.9 to 3.4 postoperatively, and external rotation strength decreased from 3.9 to 3.3. This, however, did not reach significance. Evidence of muscle imbalance with radiographic instability was found in 4 shoulders that demonstrated superior subluxation, anterior subluxation, or both. This remained asymptomatic. No shoulder required revision or reoperation. Conclusions Shoulder arthroplasty provides significant pain relief and improved motion in patients with sequelae of poliomyelitis. Muscle weakness may be responsible for postoperative instability, and careful selection of the patient with good upper extremity muscles must be made.