The shoulder joint is considered the most mobile in an individual. Endoprosthetics of the shoulder joint is an operation during which its completely non-working part is replaced by an artificial element - an endoprosthesis. In some cases, this is the only opportunity with which you can restore lost motor functions of the upper limb.
Brief anatomy of the shoulder joint
The joint of the person who most of all performs different movements has a very complex structure. It consists of the head of the humerus, resembling the shape of a ball and the articular cavity of the scapula, which represents a flattened saucer. Moreover, the surface area of the humerus significantly exceeds the surface of the articular cavity. This structure explains the frequent dislocations and subluxations in the joint of the shoulder. To ensure stability, there are:
- Jointed lips located at the edges of the articular cavity.
- Deep muscles in the area of the shoulder joint. They stabilize and prevent the head of the humerus from moving.
Bone surfaces are covered with articular cartilage, which serves to protect bone tissue and promotes better mobility. A synovial fluid is produced in the synovial membrane around the joint, which lubricates the cartilage, eliminating friction. Complex anatomy contributes to the performance of a large range of movements in the shoulder joint. Arthroplasty of the shoulder joint is an operation that requires careful planning and respect for the muscles during joint reconstruction.
Arthroplasty operation
Sometimes, under the influence of certain factors, the working surfaces of the joints of the shoulder wear out and become deformed. The individual suffers from pain and loses mobility in the shoulder. Installation of the endoprosthesis relieves him of unpleasant sensations and returns to him the motor function of the upper limb. For the first time, a shoulder prosthesis was installed in 1960. In modern conditions, surgery is not uncommon. It is conducted by a trained team of trauma surgeons, having the necessary equipment and instruments available. Manipulation is done under general anesthesia, which lasts from an hour to two. Depending on the replaced part of the shoulder joint, joint replacement is done by the following endoprostheses:
- Total - completely replaces the entire joint, i.e., the head and cavity.
- Unipolar - implants intended to replace one element of a joint, most often all heads.
An artificial implant, with proper rehabilitation, carries out all its characteristic functions: the ability to hold a spoon, fasten buttons, write, drive a car. Only an orthopedic surgeon is able to choose the right prosthesis, taking into account all the individual characteristics of the patient.
Indications for surgery
The main indication for shoulder joint replacement is significant joint damage resulting from a disease or injury. These include:
- Congenital defects of joint development.
- Progressive stage of rheumatoid arthritis.
- Post-traumatic arthrosis.
- Fracture of the glenoid cavity with comminuted phenomenon.
- Hass disease, when the spongy bone, which makes up the head of the bone, gradually dies.
- Defects in the healing of fractures.
All these conditions indicate the irreversibility of the processes that occurred in the shoulder joint and the inability to solve the problem in a way other than endoprosthetics. No need to delay the operation and hope for a miracle that will not happen.
Preparation for shoulder joint replacement surgery
In preparation for surgery for the replacement of the shoulder joint, one must undergo the following examinations:
- General examination of blood and urine.
- ECG to exclude pathologies of the heart muscle.
- Tests for HIV infection, syphilis and hepatitis.
- X-ray of the shoulder joint.
- CT and MRI are performed in extreme cases according to special indications.
It is recommended that you report any health problems to the doctor. They must be resolved between the dates of the appointment of the operation and its conduct. And also the physician should be informed about the constant intake of medicines. The selection of the implant is carried out individually for each patient, taking into account the age of the patient, the characteristics of the pathology, chronic diseases, the expected activity after surgery.
Types of prosthetics of the shoulder joint
In orthopedics, the following types of surgical intervention are used:
- Total shoulder joint replacement - the shoulder prosthesis completely replaces the head and joint cavity. There are two options: only articular surfaces or use prostheses on the legs.
- Superficial - leave the head of the joint, and a worn cartilage cover is replaced with an artificial one.
- Partial - either the head or the cavity is replaced.
- Revision or reuse - a worn or loose prosthesis changes to a new one.
Rehabilitation
In the postoperative period, the motor functions of the shoulder are restored according to the following method:
- The shoulder joint is fixed using a headscarf or sling bandage.
- Therapy of postoperative pain.
- Antibacterial agents are prescribed to prevent infection.
- Light statistical exercises are allowed on the second day after surgical manipulation.
For complete recovery, the patient undergoes a special course of exercise therapy. Rehabilitation after arthroplasty of the shoulder joint is divided into two periods:
- Early - the patient performs exercises that help him restore the range of motion: leading the upper limbs to the sides and forwards, flexion and extension in the elbow and wrist, pendulum movements.
- Late - occurs a month and a half after the operation. Gymnastic exercises are aimed at gaining strength: squeezes from the wall and floor, stretching the tourniquet.
The functions of each person are restored individually. Some completely return to their usual lives, others - perform only the simplest movements necessary to care for themselves.
Possible complications of shoulder joint replacement
Rehabilitation in the postoperative period is sometimes complicated by the deterioration of the patient. The joint prosthesis is a foreign body for the body, so there is a likelihood of an inflammatory process. Complications are possible after any chiurgical manipulation. These include: an allergy to anesthesia, a malfunction of the cardiovascular system.
Although the occurrence of a bacterial infection is observed infrequently, the onset of tissue inflammation near the joint and the spread of infection can lead to additional surgical intervention. The focus of infection may be dental caries, organs of the genitourinary system, and injuries to the skin. In addition, in the early recovery period, a dislocation of the prosthesis is possible. A set of exercises that help strengthen muscles helps prevent this complication.
Obtaining quotas for shoulder replacement surgery
In order to get help for endoprosthetics of the shoulder joint according to the quota, it is necessary:
- Visit your doctor at your place of residence.
- Undergo a full examination and receive a document confirming the presence of pathology of the shoulder joint, which allows you to find a quota for free treatment.
- Make photocopies of the following documents: identity cards (passport); SNILS; MHI policy; certificate confirming disability (if any).
- The collected package of documents, together with the patient’s consent to the processing of individual data, the medical institution is sent to a federal clinic.
- The patient waits for a specific call time about the date of hospitalization.
- After receiving it, he goes to the clinic to the attending physician, where he receives a referral for treatment.
- By the appointed time, the patient arrives at the clinic with a passport, a direction from the attending doctor.
Manipulation of the replacement of the shoulder joint and the implant itself according to the quota in a federal clinic is a free procedure.
Conclusion
Shoulder joint replacement - shoulder joint replacement is the most effective method that will restore the motor functions of the upper limb. The proven methodology allows the individual to fully live and continue to work for many years.