[Total shoulder arthroplasty vs. hemiarthroplasty].
Shoulder arthroplasty remains problematic despite the dramatic development of the new implant systems, due to the anatomical characteristics of the shoulder joint. The development of the modern third and fourth generation of shoulder prostheses enables the surgeon by its the three dimensional modularity to adjust the inclination and dorsomedial offset and to reconstruct the anatomic center of rotation. The fixation of the glenoid component is one of the most complicated aspects in the total shoulder arthroplasty. The main criteria regarding hemi- or total arthroplasty are based on morphological changes in the glenoid, the condition of the rotator cuff muscles, disorder etiology, age and activity level of the patient. The cup arthroplasty has proven itself as an alternative to standard humeral shaft arthroplasty. The main advantages of this new system are the elimination of the obligatory humeral head resection and the possibility of converting to the classical humeral shaft prosthesis method. First experiences with the cup system have been evaluated in the department of accident and reconstructive surgery of the UKBF in Berlin as part of a clinical trial. Between March 1998 and June 1999 15 shoulder prostheses in 14 patients were implanted in this hospital. The implants were inserted 8 times in a rheumatic shoulder, 4 times in posttraumatic arthrosis and in 3 humeral head necroses. 13 patients with 14 prostheses were available for follow up. An improvement from 23 to 55 average score points (Constant-Score) was attained by implantation of the cup system within a mean postoperative observation period of 6.1 months.
Arman
F
F
Abteilung für Chirurgie, St. Marien Hospital, Lüdinghausen. farhadarman@aol.com
D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000601:surgery; D007595:Joint Prosthesis; D008297:Male; D010003:Osteoarthritis / Q000000981:diagnostic imaging / Q000601:surgery*; D010020:Osteonecrosis / Q000000981:diagnostic imaging / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery; D011474:Prosthesis Design; D011859:Radiography; D012086:Reoperation; D019534:Shoulder Impingement Syndrome / Q000000981:diagnostic imaging / Q000601:surgery; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000601:surgery*