The shoulder joint is composed of three bones: the humerus, scapula and clavicle which form 2 distinct joints: acromion-clavicular and glenohumeral (Fig.1).
The joint surfaces are covered with cartilage, a smooth substance that protects the bones and allows them to move with ease.
Today, about 53,000 people in the United States undergo shoulder replacement surgery each year, according to the Agency for Healthcare Research and Quality.[1]Surgery involves replacing damaged parts of the shoulder that are removed and replaced with artificial components, called prostheses. Treatment options are replacement of the head of the humerus or replacement of the head of the humerus and the concave cavity that houses it, called the glenoid.
Several conditions can cause shoulder pain and disability at the punto such that prosthetic replacement is needed: arthrosis (degenerative joint disease)(Fig.2), rheumatoid arthritis, post-traumatic arthritis, avascular necrosis or severe fractures (Fig.3).[2]
Symptoms most frequently encountered are shoulder pain that interferes with daily activities, loss of motion, and/or shoulder weakness.
Diagnosis will be made based on clinical and radiographic evaluation (x-rays, nuclear magnetic resonance imaging (MRI) for soft tissue evaluation or a computed tomography (CT) scan to determine the condition of the bone).
the Resurfacing Shoulder Prosthesis, a procedure called resurfacing, involves replacing the humeral head alone with a metal prosthetic component (Fig. 4);
the Anatomic Total Shoulder Prosthesis, which involves replacing the joint surfaces with metal and polyethylene prosthetic elements(Fig.5);
the Reverse Shoulder Prosthesis indicated in individuals with severely injured rotator cuffs.In the reverse shoulder prosthesis, the joint convexities and concavities are reversed. It is still a “total” prosthesis, but it means that a metal ball is attached to the glenoid and a concave surface replaces the humeral head (Fig.6). It is the most commonly used prosthesis currently, to treat non-synthesizable fractures, in prosthetic revisions performed for mechanical failure or as a re-implant after previous prosthetic infections [3,4]
Once the surgery is performed, the hospital stay will be about 4-5 days. Once out of the hospital, the arm will be received in a brace that will serve as support and protection for the shoulder for the first 2-4 weeks after surgery.
Most patients are able to perform simple activities such as eating, dressing and washing within 2-4 weeks after surgery. The postoperative rehabilitation period is about 2-3 months.
Bibliography
- Bayona CEA1, Somerson JS2, Matsen FA 3rd3.The utility of international shoulder joint replacement registries and databases: a comparative analytic review of two hundred and sixty one thousand, four hundred and eighty four cases. Int Orthop. 2018 Feb.
- Singh JA1, Sperling J, Buchbinder R, McMaken K. Surgery for shoulder osteoarthritis. Cochrane Database Syst Rev. 2010 Oct.
- Marcheggiani Muccioli GM, Huri G, Grassi A, Roberti di Sarsina T, Carbone G, Guerra E, McFarland EG, Doral MN, Marcacci M, Zaffagnini S. Surgical treatment of infected shoulder arthroplasty. A systematic review. Int Orthop. 2017 Apr.
- Flurin PH, Roche CP, Wright TW, Marczuk Y, Zuckerman JD. A Comparison and Correlation of Clinical Outcome Metrics in Anatomic and Reverse Total Shoulder Arthroplasty. Bull Hosp Jt Dis. 2015 Dec.
- Papadonikolakis A1, Neradilek MB2, Matsen FA 3rd1. Failure of the glenoid component in anatomic total shoulder arthroplasty: a systematic review of the English-language literature between 2006 and 2012. J Bone Joint Surg Am. 2013 Dec.
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