La prothèse inversée de l'épaule dans la polyarthrite rhumatoïde

In the shoulder, rheumatoid arthritis is characterized by a severe joint involvement that combines bony destruction and rotator cuff lesions. These reasons ultimately explain the failures of shoulder hemiarthroplasties or total shoulder anatomical arthroplasties, the results of which degrade over time. The reversed total shoulder arthroplasty can be effective in these situations, with good results over time in term of both pain and joint function. The surgical intervention remains difficult, considering the severity of the joint destruction and general status of patients, weakened by polyarticular involvement and long-term treatments. While initially high, the rate of perioperative and postoperative complications is currently better controlled, becoming comparable to the rate encountered in reverse arthroplasties for rotator cuff arthropathies. The infection and the periprosthetic fracture, in part due to corticosteroids treatments, are the most represented complications. The indication of reversed total shoulder arthroplasty must be the result of close consultation between the rheumatologist and the orthopaedic surgeon.