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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
Minerva Ortopedica e Traumatologica 2009 February;60(1):83-92
Shoulder replacement in osteoarthritis of the shoulder joint
Department of Shoulder Surgery ARCUS Clinic, Pforzheim, Germany
Primary glenohumeral arthritis is one of the main indications for implantation of a shoulder endoprosthesis. Actually modular shoulder implants which allow an exact adaptation to the individual geometry of the proximal hummerus are preffered. These implants of the 4th generation can restore physiological tensions and the centre of rotation. Preoperatively conventional x-ray exposures in a-p and axial projections and a magnetic resonance imaging (MRI) investigation are recommended as a standard tool of the diagnostic procedure. Computed tomography (CT) examination is performed when bony defects are present. The delto-pectoral approach is recommended for implantation of the prosthesis. In most cases the glenoid is included in the arthritic process, which means that a total prosthesis is indicated. Results with total prostheses are superior to those obtained with hemi-endoprostheses. In the older patient the stem of the prosthesis is mostly cemented in, while cement free fixation is also possible in the younger patient with good bone quality. The rates of loosening in 10-year follow-up studies of patients with cemented prostheses are well under 1%. The weak point of a shoulder endoprosthesis is still the replacement of the glenoid. The implantation is technically challenging. Cemented glenoid replacements are regarded as standard. Clinically significant loosening has been found to occur in up to 10% of the cases in 10-year follow-up studies, and in up to 80% of cases in which there are radiologically demonstrable lytic borders. The newest development are humeral head implants that are anchored in the metaphysic without cement. These implants can be expected to be implanted in increasing number of patients with good bone quality in the future.