[Alloplasty of the shoulder joint - introduction to the problem.].
The authors present a review of contemporary views on the problem of alloplasty of the shoulder joint. In the historical introduction they mention the development of surgery of the shoulder joint with the gradual transition from resection or interposition arthroplasties to endoprostheses of varying design which according to the principle of internal constraint can be divided into three groups, i. e. not compressed, semi-constrained and fully-constrained implants. Development revealed that the best results with the least number of complications are achieved with non-constrained implants which predominate nowadays in the production of most firms. The authors describe separately indications for hemiarthroplasties (which implies always implantation of the humeral component) and total replacement of the shoulder joint. Both indication groups overlap to a considerable extent. The spectrum of indications was extended considerably, from the original oncological indications, in particular by degenerative diseases (osteoarthritis, rheumatoid arthritis, systemic diseases etc.) and with regard to the rising number and complexity of fractures of the proximal end of the humerus (or scapula) also by traumatological indications (comminuted dislocated and luxation fractures, poorly healed fractures and fractures of severely osteoporotic bones etc.). Contraindications include nervous lesions with paralysis of the deltoid muscle or the rotator muscles, previous infection, an irreparable defect of bone tissue and a mentally labile, not collaborating patient. During the rehabilitation period a three-stage programme elaborated by Hughes and Neer proved useful. The authors emphasize early positioning of the operated extremity in maximal elevation. In the subsequent part the authors analyze complications associated with surgery of endoprostheses of the shoulder joint. In general it may be stated that the number of complications increases with the degree of constraint of the implant and fully-constrained implants are practically no longer used because of the large number of complications. The most frequent complications are a restricted mobility of the shoulder joint, instability - luxation of the endoprosthesis, impingement syndrome, lack of incorporation of protuberances, pseudoarthroses, infections, loosening of the implants, fractures, nervous and vascular lesions, heterotopic ossifications and permanent postoperative pain. In the conclusion the authors emphasize that replacement of the shoulder joint is not a simple operation and should be carried out by surgeons with great experience with surgery of the shoulder in departments adequately equipped for surgery and rehabilitation. Key words: alloplasty, endoprosthesis, shoulder joint.
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Ortopedická klinika 1. lékarské fakulty KU, Praha.
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