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Shoulder Replacement May Help for Severe RA

Study found that surgery to relieve pain and stiffness held up for a decade

WebMD News from HealthDay

By Maureen Salamon

HealthDay Reporter

THURSDAY, Jan. 30, 2014 (HealthDay News) -- Although hip and knee replacements are common, a similar surgery to replace diseased shoulder joints also appears worthwhile for rheumatoid arthritis patients whose severe shoulder pain and stiffness can't be eased by medication or physical therapy, new research suggests.

Scientists from the Mayo Clinic found that 93 percent of rheumatoid arthritis patients who underwent a total shoulder replacement -- in which both sides of a shoulder joint are replaced -- needed no further surgery on the joint a decade later. The same was true for 88 percent of those undergoing a partial shoulder replacement.

"We were most happy to see the consistency of pain relief and improvement of function among patients," said study author Dr. John Sperling, an orthopedic surgeon at the clinic in Rochester, Minn. "Shoulder replacement has come a long way over the past 20 to 25 years. It's a one-hour surgery that requires one night in the hospital, and patients have a 90 percent chance of achieving excellent pain relief."

The study, published in the February issue of the Journal of Shoulder and Elbow Surgery, disclosed that two of the researchers receive royalties from medical-device makers.

Shoulder-replacement surgery is performed far less often than hip- or knee-joint replacements, but is done for the same reasons -- to minimize pain and improve movement and function in diseased joints, according to the study.

According to the Agency for Healthcare Research and Quality, about 53,000 Americans underwent shoulder-replacement surgery in 2011. In contrast, more than 900,000 U.S. patients each year have hips or knees replaced, according to the American Academy of Orthopaedic Surgeons.

Shoulder pain is prevalent among those with rheumatoid arthritis, an inflammatory disorder in which the immune system attacks the body's own tissues, causing joint pain and other problems. Shoulder-replacement surgery is also used for those with more common osteoarthritis and for patients with complicated shoulder fractures, Sperling said.

The procedure requires a 4- to 6-inch incision in the upper shoulder region, where the diseased joint is removed and replaced with a plastic or metal joint, Sperling said.

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