Wondering what are the most important indications for conducting a shoulder joint endoprostheses? In this article, you will discover why this procedure is necessary in cases of advanced degeneration of the shoulder joint and the health benefits it brings to patients. You'll learn about the main reasons for performing endoprosthesis, the different types of implants used in this procedure and the steps to be taken during post-operative rehabilitation. Are you ready to learn all about this surgical solution? We invite you to read more!
Shoulder joint endoprosthesis - Causes
Shoulder endoprosthesis, also known as alloplasty, is a well-established surgical procedure recommended in cases of severe pain combined with significant limitation of strength and mobility of the shoulder complex. The main reasons why patients may need this type of intervention include:
- Advanced degenerative changes of the shoulder joint,
- rheumatoid arthritis,
- fractures,
- rotator cone damage,
- sterile bone necrosis,
- unsuccessful previous joint surface replacement surgery.
The procedure involves removing the damaged parts of the joint and replacing them with artificial components - prostheses, thereby relieving pain and restoring motor function. About a thousand surgical procedures of shoulder endoprosthesis are performed annually in Poland. Shoulder endoprosthesis is most often recommended when other forms of treatment, such as rehabilitation or pharmacotherapy, prove ineffective.
Degenerative Joint Disease of the Shoulder.
Osteoarthritis of the shoulder is one of the most common causes leading to the need for shoulder endoprosthesis. With the aging of the population, the incidence of this disease is increasing, and it is estimated that it can affect ⅓ of people over the age of 60.
The gradual degeneration of cartilage tissue, which develops over years of use, leads to excessive friction caused by direct contact between the surfaces of the bones that make up the joint. As a result of the described changes, there is a restriction of the joint's mobility and complaints of pain that appear even at rest. Many patients also complain of sleep problems due to pain. The risk group includes not only the elderly, but also active people who primarily use motor tasks based on upper limb movements, such as tennis and weightlifting.
In advanced cases, when lesions are irreversible and other treatments fail, surgical intervention becomes necessary. The endoprosthesis procedure allows for a significant reduction in pain and improvement in quality of life.
Injuries and Other Indications
Serious injuries, such as fractures of the head of the humerus or damage to the rotator cone, are another possible indication for "joint replacement" surgery. If the damaged bone cannot be adequately fused, or as a result of major osteoporotic changes that may lead to another break in the bone tissue, the orthopedic surgeon may recommend direct alloplasty. As for the rotator cone, by definition it is a structure consisting of 4 muscles and more specifically their tendons, which is designed to stabilize the head of the humerus and provide mobility. In patients with massive, long-term damage to the rotator cone as a result of the failure of the muscles comprising it, there is a lack of adequate stability of the shoulder complex, the consequence of which, in addition to pain, may also be cartilage damage.
Another indication for this type of procedure is any inflammatory lesions that remain resistant to the conservative treatment used. These lesions are most often of an autoimmune nature, the cause of which has not yet been completely defined. One form of such a condition and the most common of its kind is rheumatoid arthritis (RA). The primary effect of this disease is inflammation and thickening of the synovial membrane, which, if sustained over the long term, can lead to secondary cartilage damage.
Re-endoprosthesis of the shoulder joint is relatively rare, and it is accepted that regardless of the chosen method of surgery, approximately 10% patients require re-endoprosthesis as a result of complications. The most common causes include:
- Implant loosening or displacement,
- wear and tear on parts of the implant,
- Lack of or inadequate rehabilitation,
- infection.
Diagnosis of these conditions plays a key role in deciding whether to operate. Diagnosis includes imaging studies, such as MRIs and CT scans, which provide an accurate picture of the joint structure and extent of damage. The results of these tests, combined with clinical symptoms such as pain, swelling and reduced mobility, help doctors determine the most appropriate treatment plan, including possible endoprosthesis.
Shoulder Joint Endoprosthesis - Treatment Methods.
Modern shoulder endoprosthesis is performed using a variety of techniques and modern technology. Prior to surgery, the patient undergoes a thorough diagnostic evaluation, which includes, among other things, symptom evaluations, physical examination, X-rays and CT scans. This detailed analysis allows the precise adjustment of the method of surgery and the type of implant, which is crucial for a positive surgical outcome.
Modern technologies and the variety of available prostheses significantly increase the effectiveness of joint replacement procedures, ensuring that patients can return to normal activities and daily living.
Types of Joint Prostheses
Various types of prostheses are available for shoulder joint endoprosthesis, which are selected individually depending on: the type of injury, concomitant injuries, specific needs (e.g. physical activity) and the patient's condition (e.g. osteoporosis). Despite the wide availability of possible types of implants, the unchanged elements that the shoulder joint must certainly consist of are the head and acetabulum. There are 3 main types of shoulder joint endoprosthesis:
- anatomical endoprosthesis,
- half endoprosthesis,
- 'Reverse' endoprosthesis.
Anatomic endoprosthesis is the most common method of reconstruction involving replacement of both the head and acetabulum of the shoulder joint. In this way, the natural shape of the joint is preserved. The prosthesis consists of a polyethylene (high-density plastic) acetabulum and a metal head. Each of these components is available in different sizes. This type of prosthesis is mainly recommended for patients with osteoarthritis, who do not have any bone damage to the joint and their rotator cone remains intact.
The 'inverted' prosthesis is the optimal choice for patients with a damaged or completely broken rotator cuff or significant joint degradation. In this method, the head of the humerus and the acetabulum of the joint are 'inverted', which means that the head of the joint is moved to the original acetabulum and the acetabulum is stabilized on the humerus. The reason for this procedure is the insufficient stability and mobility of the joint among patients after anatomic endoprosthesis who were also burdened by rotator cuff damage.
A half-arm prosthesis, as the name suggests, involves replacing only one part of the shoulder joint - usually the head of the humerus. It is used for patients in whom only one part of the joint has deteriorated, thus preserving the natural, healthy parts of the joint.
Choosing the right type of prosthesis is crucial for optimal postoperative results and depends on accurate diagnosis and the individual needs of the patient.
Treatment - Course and Techniques
Shoulder endoprosthesis surgery is a complex surgical procedure usually performed under general anesthesia along with the administration of a blockade to the shoulder plexus, so that greater control of pain upon awakening is maintained. The endoprosthesis procedure usually takes about 2h. During the operation, the patient is usually in a semi-recumbent position. The surgical process begins with an incision in the shoulder and thoracic groove, which allows access to the damaged joint. The surgeon then frees the joint capsule from the humerus, the subscapularis muscle from the lesser cusp and the coracohumeral ligament, among others, and removes the degenerated parts of the joint - usually the head of the humerus. He then prepares the site for implantation of the endoprosthesis. Depending on the type of prosthesis chosen, the acetabulum of the joint may also need to be replaced. The size of the prosthesis is selected individually intraoperatively. The prosthesis is precisely placed to ensure a proper fit and minimize the risk of future complications.
Physiotherapy After Shoulder Joint Endoprosthesis
Rehabilitation after shoulder joint replacement is a key part of the recovery process. After surgery to restore joint function, patients often experience movement limitations and pain, which significantly affects their quality of life. Therefore, physiotherapy treatments immediately after surgery are designed to reduce these symptoms and then improve range of motion, muscle strength and overall function, allowing patients to return to daily activities. Proper physiotherapy after endoprosthesis usually begins in the first days after surgery and continues for several months to achieve the best possible results. The key is regular physiotherapy sessions that are tailored to the individual patient's needs and designed to gradually increase the intensity of the exercises based on a balance between protecting the healing tissues and preventing excessive stiffness of the joint.
Principles of Rehabilitation
The general principles of rehabilitation after shoulder endoprosthesis include several key steps. The first step is to minimize symptoms associated with the surgery, such as pain and swelling. Therefore, the use of pharmacological agents prescribed by the surgeon and also the use of home physical treatments such as cold compresses is recommended during this period. In order to reduce swelling, elevation of the limb and the use of physiotherapy treatments like lymphatic drainage are also recommended. At the same time, this is the point at which it is recommended to start rehabilitation focusing on regaining passive range of motion. It is very important to protect the healing structures as a primary goal at this stage. Therefore, several precautions are recommended. One of them is to limit the range of motion of external rotation to 30^ or to limit overstretching by relieving the arm during sleep by using appropriate support in the form of rollers or pillows.
In the next phase, the greatest emphasis is placed on the gradual recovery of full passive range of motion and it is also the stage when work begins on improving the active mobility of the joint. A new element in this period is also the use of exercises to improve muscle strength. Over time, the intensity of the exercises is gradually increased, helping to strengthen the muscles and improve the stability of the joint. It is crucial that patients strictly follow the physiotherapist's recommendations and regularly attend rehabilitation sessions. The progressive nature of the exercises should be tailored to the patient's individual capabilities, ensuring optimal results without risking damage to the joint.
The criterion for moving to the next stage of improvement requires an improvement in both passive and active range of motion, as well as an increase in joint stability due to improved muscle strength. At this stage, the patient should also be independent when it comes to activities of daily living. In the next phase, strength training is continued, and at this stage it is possible to return to recreational sports. Preventive measures in the form of analgesic and anti-inflammatory measures should no longer be necessary. It is important to remember that pain at this point of improvement may come from structures other than the joint. At this point of improvement, the correct progression of strength training should be experienced by the patient only as muscle fatigue, not as increasing pain.
Postoperative Recommendations and Exercises
Key information immediately after surgery includes proper dressing care. First and foremost, it is important to keep the wound clean and dry to prevent infection. Daily dressings, avoidance of excessive moisture and also proper dressing protection during bathing are key. Another valuable piece of information is the options for reducing pain symptoms at home, as described above. At this stage, one of the most important elements of treatment is proper patient education by a physical therapist on:
- use of an orthosis- for the first 4-6 weeks after surgery, it is recommended to use a sling or an abduction orthosis as recommended by the surgeon,
- appropriate exercise instruction at home-most often passive range of motion exercises with a fixed maximum angle of work and frequency of execution,
- to move from lying to standing independently,
- correct sleeping position-the adopted position should relieve pressure on the operated joint,
- changing clothes-each time putting on clothes should start from the operated limb,
- possibilities to return to work- depending on the type of work performed, for office workers it is 4 weeks after the procedure, for manual workers even 4 months,
- The ability to drive-it is recommended to abstain for 6 weeks after the procedure,
- avoid lifting heavy objects-holding a glass of water on the treatment side is as possible,
- Avoiding smoking-smoking reduces the body's self-healing capacity.
All these measures are aimed at speeding up the return to full fitness and minimizing the risk of complications.
Summary
Shoulder joint endoprosthesis is most commonly used in cases of advanced degenerative changes, rheumatoid arthritis and serious injuries. It is a surgical procedure that relieves pain and restores motor function when other treatments fail. About a thousand procedures of this type are performed annually in Poland. Complications requiring a repeat procedure involve about 10% patients.
Contemporary surgical techniques and modern technologies, such as computed tomography with 3D reconstruction, enable precise fitting of the endoprosthesis, which increases the effectiveness of the procedure and minimizes the risk of complications. Choosing the right type of prosthesis is crucial for optimal postoperative results and depends on accurate diagnostics and individual patient needs.
Physiotherapy after surgery is a key part of returning to full fitness. Rehabilitation exercises, started as early as the first days after surgery, help improve range of motion, muscle strength and overall fitness, which is essential for returning to daily activities. Post-operative recommendations include not only appropriate rehabilitation, but also education of the patient on activities of daily living and the timeframe in which a return to work or driving is possible. It should be remembered that any period presented applies to patients who have undergone the rehabilitation process immediately after surgery and followed the recommendations provided.
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