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Panminerva Medica 1999 December;41(4):341-9

lingua: Inglese

Shoulder arthro­plas­ty. Indications, con­tra­in­di­ca­tions and com­pli­ca­tions

Caniggia M., Fornara P., Franci M., Maniscalco P., Picinotti A.

From the Department of Orthopedics and Traumatology University of Siena, Siena, Italy


Prosthetic sub­sti­tu­tion of the glenohumeral ­joint, begun at the end of the ­last cen­tu­ry, has devel­oped great­ly in re­cent ­years. Today the ­most wide­ly ­used shoul­der pros­the­ses are ­defined as “mod­ular” ­because of ­their exten­sive adapt­abil­ity. The capac­ity to ­adapt to ana­tom­ic vari­a­tions ­must be incor­po­rat­ed with­in ­their struc­ture, and nor­mal artic­u­lar bio­me­chan­ics ­must be respect­ed. The ­choice of pros­the­sis ­must be ­based on the con­di­tion of the ­joint sur­fac­es, on the ana­tom­ic and func­tion­al con­di­tion of the rota­tor ­cuff. So endo­pros­the­sis of the shoul­der is indi­cat­ed for avas­cu­lar necro­sis of the ­head of the humer­us, frac­tures and pseu­do­ar­thro­sis of the ­extreme prox­i­mal end of the humer­us, arthrop­a­thy fol­low­ing rota­tor ­cuff rup­ture. Total shoul­der pros­thet­iza­tion is indi­cat­ed for gleno­hu­mer­al oste­oar­thritis, rheu­ma­toid ­arthritis and out­comes of endo­pros­the­sis. The prin­ci­pal con­tra­in­di­ca­tions for shoul­der replace­ment ­include an infec­tion in ­progress, Charcot’s arthrop­a­thy and ­severe neu­ro­log­i­cal pathol­o­gies. The com­pli­ca­tions of shoul­der pros­the­ses ­include infec­tion, dis­lo­ca­tion, loos­en­ing of a com­po­nent, per­i­pros­thet­ic humer­al and glen­oid frac­tures, ­nerve inju­ries, frac­tures of a pros­thet­ic com­po­nent and ectop­ic ossifi­ca­tion. At ­present pros­thet­ic sub­sti­tu­tion of the glen­o­hu­mer­al ­joint ­offers ­good ­results. Indispensable con­di­tions for ­these ­results ­include ana­tom­ic and func­tion­al integ­rity of the mus­cu­la­ture, ­good ­bone qual­ity, cor­rect posi­tion­ing of the pros­thet­ic com­po­nents and a prop­er reha­bil­i­ta­tion pro­gram.

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