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Shoulder arthroplasty refers to the complete or partial replacement of damaged areas of such a joint with endoprostheses, that is, its artificial substitutes. Endoprosthetics in the case of this part of the body is highly effective and often the only possible operation to restore the functionality and mobility of the entire arm.
The functionality of the shoulder joint can be impaired as a result of fractures, bruises, other injuries, various diseases, such as arthrosis, arthritis, neurological deficiency of the brachial plexus, and others. A characteristic feature of all anomalies in this area is the occurrence of severe pain in the shoulder. At the same time, the patient subconsciously limits motor activity, and this is reflected in muscle work, which can result in complete atrophy of the shoulder.
Various pathological conditions of the shoulder joint can be treated with traditional and surgical methods, however, if therapy is not started in time, the moment will be missed and only endoprosthetics will be needed to restore the full functioning of the arm.
Anatomical features of the shoulder joint
The most mobile joint of the human skeleton is precisely the shoulder joint, formed by the ends of three bones – the humerus, glenoid scapular cavity and clavicle. In this case, the clavicle, although not directly in contact with the shoulder joint, but its influence on this area is very significant.
The upper part of the humerus is a hemispherical head, as well as large and small tubercles with descending ridges, intertubercular groove, anatomical and surgical necks. In this case, the head coincides in shape with the articular scapular cavity, slightly exceeding it in size.
At the edge of the articular cavity is an elastic articular arch. The dense capsule of this joint is securely attached to the bone in the region of the anatomical neck. Also, the muscles that form the cuff and have the ability to move in the area of the shoulder joint in any plane are also attached to the bone. These are the supraspinatus, infraspinatus, subscapularis and small round muscles. However, the teres major, pectoralis major, and latissimus dorsi muscles are also involved in the processes of providing motor activity.
Above and below in the articular cavity there are special tubercles that serve as attachment points for muscles. The head of the biceps brachialis muscle is attached from above, and one of the three heads of the triceps muscle is attached to the lower tubercle in the body.
The most complex anatomical features of the structure of the shoulder joint provide its multi-level all-round mobility. At the same time, such a structure requires careful planning of treatment and surgical intervention, since during therapeutic or surgical procedures it is important to maintain the health of all components included in the functional.
When is arthroplasty necessary and types of prostheses
Among the main indications for shoulder arthroplasty are:
- Hass disease, in which the cells of the head of the humerus gradually die and are absorbed;
- fractures of the proximal segment, characterized by multifragmentation;
- scapular fractures of the articular cavity, characterized by comminutedness;
- rupture arthropathy in the rotator cuff;
- rheumatoid arthritis of the shoulder joints.
All of the above problems cause irreversible processes in the area of the shoulder joint, leading to its atrophy. It is not possible to solve such problems by traditional non-invasive treatment, therefore, in this case, doctors insist on arthroplasty. It is necessary to do this according to the indications as early as possible so as not to start the processes of atrophy.
Shoulder arthroplasty can be of four main types:
- Superficial, during which it is necessary to replace only the articular surface. The head of the joint remains in place, the surgeon removes the cartilaginous cover of the head, in place of which the prosthesis is subsequently placed.
- Unipolar, in which it is necessary to replace only one articular part of the two included in the shoulder joint. Usually, either the scapular articular cavity or the head of the humerus is to be replaced.
- Total, during which the entire joint is completely replaced with an endoprosthesis. At the same time, 2 varieties are also distinguished – the replacement of joint surfaces and the use of “legged” endoprostheses.
- Revision, which includes the replacement of not a joint, but a previously installed endoprosthesis that has already lost its functionality.
It is important to understand that in unipolar and total arthroplasty, implants with a stem are fixed by it inside the canal of the humerus.
What you need before and after arthroplasty
On the eve of the scheduled operation, the patient must undergo appropriate diagnostic procedures, including urine and blood tests, electrocardiography, and radiography. There are cases when specialists, in addition to all of the above, are required to prepare an operation plan and the results of computed or magnetic resonance imaging.
After studying all the tests, the doctor chooses the type of prosthetics that a particular patient needs, based on his age, the course of the pathology and the amount of motor activity that needs to be achieved during surgery.
On the day after the operation, the arm must be fixed with a specialized sling bandage. To alleviate pain and prevent the development of infectious diseases, patients are prescribed painkillers and antibiotics.
Already on the second day, doctors recommend starting to load and develop the shoulder joint. Movements must be carried out little by little, slightly overcoming pain, but not forcing yourself to experience unbearable sensations.
Each subsequent time the amplitude of hand movements must be slightly increased. After the third day, the joint can be developed using special devices. Postoperative sutures during this operation are removed after 14 days.
Since shoulder arthroplasty is a high-precision surgical intervention, the development of the delivered prosthesis can and should be started as early as possible. The rehabilitation period can be different in duration, depending on the age of the patient, the type of prosthesis and the individual characteristics of the organism. During the entire rehabilitation period, the doctor must control the development and healing process.
There are situations when, after severe injuries, the functions of the shoulder joint are not fully restored.
However, competent specialists most often see this feature even before the operation, therefore, rehabilitation procedures are aimed at achieving a specific range of motor activity, which the doctor suggests.
Complications in arthroplasty
As with any other operation, complications cannot be ruled out during shoulder arthroplasty. Common complications doctors usually include the occurrence of an allergy to anesthetics or the occurrence of a heart attack.
Infectious complications are also likely, which will not necessarily be caused by the surgical intervention itself.
Often, even if you go to the dentist after arthroplasty, for example, you can introduce an infection into the bloodstream, after which the inserted prosthesis can become infected. This situation may even lead to the need for urgent operations.
Doctors advise every time before visiting dental offices or other specialists who can conduct not just examinations, but also any manipulations of an invasive nature, take courses of antibacterial drugs to avoid such complications.
Sometimes a variant of jumping out or dislocation of endoprostheses in the shoulder joints is possible. This happens in the first months of wearing prostheses. This complication can be avoided by following all the prescriptions of doctors, which take into account the necessary and permissible volumes of loads on the endoprosthesis.
Also, as a result of injury, you can break the bone near the prosthesis. The nature of the elimination of this problem always depends on the nature of the resulting fracture.
The prosthesis itself should serve its owner for a long time (about 20 years), but you need to understand that it is not eternal and someday its service life will end. The prosthesis can begin to loosen, cause pain, and hinder activity. All this is a prescription for revision arthroplasty.