RESUMO
Modular total shoulder systems offer many advantages over nonmodular designs. Modularity facilitates precise placement of the humeral head with respect to the rotator cuff and tuberosities, allows for soft tissue tensioning and balance with variable neck lengths, and simplifies revision surgery by allowing removal of the humeral head while maintaining a well-fixed humeral stem. This review includes 47 total shoulder arthroplasties performed in 40 patients from 1986 to 1991. The average patient age was 62.3 years, with followup averaging 54 months. Seventeen patients had rheumatoid arthritis, and 22 had osteoarthritis. In the remaining 8 patients, 5 had posttraumatic arthritis, 2 had avascular necrosis, and 1 had cuff tear arthropathy. Glenoid revision was required in 3 patients, and symptomatic loosening occurred in only 1. Pain relief was achieved in 93.5% of patients. Range of motion improved 34.9 degrees in forward flexion, 18.1 degrees in external rotation, and 4 vertebral levels of internal rotation. Lucent lines were evaluated on the anteroposterior (AP) and axillary radiographs. On the AP radiograph, 16 shoulders demonstrated lucency about the glenoid component. Progression beyond 2 mm occurred in 5 shoulders, and symptoms requiring revision developed in one patient. Twenty-two patients demonstrated a lucency on the axillary radiograph, and 9 patients progressed beyond 2 mm. None required revision. The authors present the results and discuss surgical and design considerations of modular total shoulder arthroplasty.
Assuntos
Prótese Articular , Articulação do Ombro/cirurgia , Atividades Cotidianas , Adulto , Idoso , Idoso de 80 Anos ou mais , Artrite Reumatoide/cirurgia , Artroplastia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/cirurgia , Complicações Pós-Operatórias/etiologia , Desenho de Prótese , Radiografia , Amplitude de Movimento Articular , Articulação do Ombro/diagnóstico por imagemRESUMO
This article reviews the anatomy, pathophysiology, and treatment of rotator cuff disease. A plan is presented to assist the clinician in making the appropriate diagnosis and proceed with adequate workup and treatment of a patient with shoulder pain.
Assuntos
Manguito Rotador/patologia , Adulto , Algoritmos , Diagnóstico Diferencial , Humanos , Artropatias/diagnóstico , Artropatias/fisiopatologia , Artropatias/terapia , Dor/fisiopatologia , Radiografia , Manguito Rotador/fisiopatologia , Lesões do Manguito Rotador , Articulação do Ombro/diagnóstico por imagemRESUMO
All design considerations in shoulder arthroplasty are based on reconstructing normal anatomy and enhancing prosthetic fixation, particularly on the glenoid side. These goals are further enhanced by meticulous attention to detail in placement of the component parts relative to the bony anatomy. In addition, great attention must be paid to management of the soft tissue tensions and placement of the component parts relative to soft tissue origins and insertions so that asymmetric overloading of the components can be avoided and loosening and wear can be minimized. The problem of management of prosthetic replacement with associated massive rotator cuff tears continues to be a dilemma. Use of an oversized humeral head articulating with the acromion can offer a compromise solution to the problem. This technique can be combined with altered glenoid component placement or reshaping of the bony glenoid to accommodate its altered relationship with the humeral articular surface. Future design changes are needed to deal with this complex problem.