Beneficial and harmful effects of shoulder arthroplasty in patients with rheumatoid arthritis: results from a Cochrane review

Objective To assess beneficial and harmful effects of arthroplasty in the shoulder joint in patients with RA. Methods A systematic review within the framework of the Cochrane Collaboration identified randomized controlled trials (RCTs), controlled clinical trials and case series (included for assessment of complications) published between 1995 and 2008. Articles considered potentially relevant were retrieved in full text and assessed independently by two authors. Risk of bias and level of evidence were assessed according to the established criteria. Results One RCT (26 shoulders) compared cemented and uncemented humeral stem fixation during arthroplasty, reporting no significant differences between groups at 2-year follow-up (low-quality evidence). Nineteen case series (1155 shoulders) reported component loosening requiring revision at 5%, infections at 2% and minor complications at 7% (very low-quality evidence). The retrospective case series had several limitations related to methodological quality and standards of reporting. Conclusion At present, there is very little research evidence supporting decisions about shoulder joint arthroplasty in patients with RA.