Shoulder Joint Replacement
Shoulder joint replacement is a treatment method for the massive destruction of joint structures. The damaged tissues are removed and replaced by a prosthesis that performs the function of the joint. Today, it is the only radical method of treatment, with the help of which doctors return patients to the motion activity of the joint, their ability to work, and their usual sensations.
What are the indications for surgical intervention?
The installation of a prosthesis in place of the damaged joint is required for conditions such as:
- Hass disease. The pathology consists of a necrotic lesion of the head of the bone. The bone tissue of the shoulder gradually lyses (resorbs) and a significant defect appears. The process is called osteonecrosis.
- Fracture of the humerus. Endoprosthetics are required for some subspecies of fracture at this location. It refers to the lesion of the upper part, it can be both types of fracture-dislocation of the bone, fracture in the head area, impingement fracture. The problem is especially acute for the older age groups because their tissues lose the ability to repair. If you compare fractures with the same number of fragments and identical lines of juxtaposition, at a younger age there is a chance that fusion will occur, but older patients are much less likely to have this outcome.
- Osteoarthritis of the shoulder joint. There are many types of arthritis, depending on the cause and stage of the process. Endoprosthesis is most often used for arthritis that occurred on the background of a fracture. This occurs when there is improper fusion or in the absence of adequate therapeutic measures.
- Fracture of the scapula. When the depression where the scapula contacts the humerus is damaged, the head of the shoulder dislocates and the joint becomes unstable.
- Degenerative-dystrophic processes of the shoulder.
Arthritis with involvement of the shoulder joint in the pathological process.
- Congenital features of the shoulder, which lead to habitual dislocation and impaired joint function.
Many of these pathologies trigger the so-called vicious circle: tissue destruction leads to deterioration of the microcirculation of the joint, and the lack of nutrients and oxygen, which is associated with insufficient blood supply, worsens the condition of the joint structures.
Also, these pathologies reach the point where changes are beyond repair. Joint replacement is the only radical method of help, which will return the anatomical structure and natural performance of functions. It is desirable to perform the intervention when ligaments, soft tissues, and muscles are not involved in the process. Surgical treatment has the best effect when it is done in time – it facilitates the rehabilitation period, and minimizes the risk of complications.
Surgical shoulder arthroplasty and its peculiarities
There are several main types of surgical intervention that are used to perform shoulder arthroplasty:
- Superficial joint replacement. Involves replacement of the superficial tissues. This is called resurfacing. Most often, the surface of the head of the humerus, which is represented by a layer of cartilage, is replaced. The head is left in place and performs its function with a new coating after surgery.
- Partial arthroplasty. This is a unilateral arthroplasty that involves replacing one part of the joint. This can be the head of the shoulder or the articular surface of the scapula, depending on the localization of the pathological process.
- Radical joint replacement. This type consists of removing part of the humerus, as well as the articular socket of the scapular surface. The superficial part of both structures may be replaced, or they may be completely replaced with prostheses on a stem.
- Replacement of an existing endoprosthesis or its parts. If a previously installed endoprosthesis has been in use for a long time, its revision or the replacement of individual sections is required.
Surgical intervention is performed under anesthesia. An incision is made in the projection area of the joint in the skin and soft tissues. The damaged part of the humerus is removed through the incision. All damaged tissues are also resected, the articular surfaces are treated and the bone canal is opened. This is necessary for inserting the prosthesis. First its stem is installed, and then the head.
The insertion can take place with special anatomical cement. With cementless insertion, the prosthesis is simply pushed into the bone. The tactics depend on the degree of bone damage, the age and condition of the patient, and the background pathology.
Rehabilitation after surgery
The peculiarity of the rehabilitation regime (it is necessary for any type of surgery, whether it is the replacement of a single articular surface or a full prosthesis) is that from the first day the patient must undergo rehabilitation that has been developed for him individually.
A special set of procedures is aimed at strengthening the muscle group that controls the movements in the prosthetic axis. It is desirable to combine gymnastics with physical therapy. The first exercises are done with the help of a doctor and the movements are performed passively.
In addition to restorative procedures, a set of preventive measures are performed that minimize the risk of complications. The preventive program includes:
- rational antibiotic therapy;
- wound care;
- prevention of thrombosis;
- immobilization of the limb, the use of bandages or dressings;
- breathing exercises.
In the early period of rehabilitation, the procedures are sparing in nature, but the further condition of muscles, ligaments and the entire joint apparatus depends on them. The first exercises, in spite of the low level of load, allow you to gradually move on to serious exercises. Qualitative fulfillment of the attending physician’s recommendations and regular performance of rehabilitation activities will allow you to return your arm to its usual motor activity.