Arthritis of dislocation.
Arthritis of dislocation is a unique form of degenerative joint disease involving the shoulder. It seems that a larger number of patients who develop arthritis of dislocation have had prior instability repairs. In studying large numbers of patients, several factors seem to recur. Careful, repeated examinations of both symptomatic and asymptomatic shoulders may uncover subtle subluxations; examination of other peripheral joints may reveal evidence of hyperlaxity and multidirectional instability. With understanding of the nature, direction, and extent of the instability patterns, more appropriate stabilization procedures may diminish the incidence of arthritis of dislocation. Today's techniques and the surgical management of instabilities obviate the need for hardware, which has been shown to have a significant impact on the occurrence of this arthritis. Surgeons should realize the potentials and risks of arthroscopic stabilization procedures, and only after satisfactory analysis should these procedures be done by orthopedic surgeons in general. Many new techniques for shoulder stabilization are now in the armementarium of the arthroscopist, but more time is needed to see if they will influence the development of arthritis of instability. When arthritis of dislocation does develop, shoulder arthroplasty is reasonable, despite the young age of patients. In the technique of joint replacement for this condition, specific surgical principles must be kept in mind. Preservation of deltoid function is paramount. Restoration of muscle length and tension relationships are critical for successful functional outcomes. Component positioning and orientation must account for the bone loss and alterations in soft tissue tension and quality. No shoulder replacement, no matter how well performed, will be successful without adequate physician-directed rehabilitation.
Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Ohio, USA.
J J
JJ
Brems
D000367:Age Factors; D001168:Arthritis / Q000209:etiology / Q000534:rehabilitation / Q000601:surgery*; D019643:Arthroplasty, Replacement / Q000379:methods / Q000534:rehabilitation; D001182:Arthroscopy; D004724:Endoscopy; D006801:Humans; D004204:Joint Dislocations / Q000150:complications / Q000601:surgery*; D007593:Joint Instability / Q000150:complications / Q000601:surgery; D009119:Muscle Contraction / Q000502:physiology; D018482:Muscle, Skeletal / Q000473:pathology / Q000503:physiopathology; D012008:Recurrence; D012307:Risk Factors; D012782:Shoulder / Q000473:pathology / Q000503:physiopathology; D012785:Shoulder Joint / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome