Anatomically-designed shoulder hemiarthroplasty made after 3-D models and implanted in a child with rheumatoid arthritis. A case report

The first known report of shoulder arthroplasty is that by Pean, a French surgeon who replaced a joint destroyed by tuberculosis with a prosthesis made of platinum and plastics. In 1951, and mostly in 1974, Neer became the strongest advocate of this practice by designing his own systems. In the 1990s, knowledge on the kinematics and recognizing the significance of adjacent soft tissues involved in shoulder function, led to technique improvements having a significant impact on the outcome.
Shoulder arthroplasty is unusual at an early age. Diseases such as juvenile rheumatoid arthritis (JRA), however, warrant this treatment modality as shoulder pain and a limited range of motion significantly compromise function. The main problem is that this disease leads to bone loss that usually occurstogether with soft tissue incompetence and muscular atrophy.
The purpose of this paper is to present the case of a patient who underwent shoulder hemiarthroplasty due to JRA sequelae, and to review the literature about it.

Case Report
Male, 14-year-old patient, with a 6-year history of juvenile rheumatoid arthritis (JRA), who received several therapies beginning with anti-inflammatory agents and followed by multiple infiltrations. Multiple musculoskeletal conditions occurred due to the disease, including bilateral hip and wrist lesions, which had previously undergone arthrodesis. Both shoulders showed severe functional limitation with 15° of abduction, 10° of flexion, 10° of extension, and 15° of external rotation. According to the UCLA classification score, the patient had a score of 7, indicating poor function. The pain visual analog scale (VAS) indicated 9/10 (severe pain). Xrays revealed a severe panarticular destruction pattern and evidenced closure of the physis (Figure 1), which was confirmed by MRI.
The decision was made to place a hemiprosthesis in the left shoulder. The prosthesis was designed after the natural anatomy of the patient under the supervision of the bioengineering department of the orthopedics group in our hospital. A three-dimensional model was used for the surgery planning and optimum prosthesis manufacturing.

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