The shoulder joint is extremely agile, the unobstructed movement of which depends on the harmonious synergy of the bones, tendons and muscles. A key role in the smooth shoulder movement are played by the tendons that form the so -called shoulder rotation.
However, if these tendons have suffered irreparable damage, the upper extremity support and lifting mechanism is significantly disturbed, resulting in functional restrictions and pain. If this condition is supplemented by the deterioration and degeneration of the articular surfaces, then the issue is further complicated. But here comes, in advanced cases, the reverse total shoulder arthroplasty. This procedure is designed to face these challenges, especially when classic total shoulder arthroplasty is insufficient.
What is the inverted total shoulder arthroplasty?
Inverse overall shoulder arthroplasty is a specialized surgical technique designed to repair serious shoulder joint damage, especially when the rotary petal is inadequate or has undergone irreversible ruptures. In contrast to the anatomical approach, in which the implants are placed according to the normal shoulder structure, the inverted total shoulder arthroplasty reverses the position of their placement.
In traditional total arthroplasty, the head of the arm is replaced by a metal implant and the shoulder with a polyethylene implant to reproduce the normal anatomy and biomechanics of the gluchon joint. However, in the reverse version, the philosophy of the replacement is completely changed: in the shoulder a “sphere” is placed and at the upper end of the arm a hollow surface (reception). This reversal aims to enhance the stability of the joint and allows for efficient activation of the deltoid muscle to raise the upper extremity, even when the rotational muscles are unable to fulfill their role. This technique was developed in the 1980s and today it is the most common shoulder arthroplasty technique, especially in patients over 70 years.
When is this technique selected?
This method is recommended in cases where the patient suffers from:
- Shoulder degenerative arthritis with concomitant spinning cake ruptures.
- Chronic, non -reconstructive ruptures of the rotational petal.
- Serious intra -articular fractures in the elderly, where anatomical recovery is impossible.
- Failed previous arthroplasty (revisions).
- Infections or relaxation of previous intentions.
Operation and biomechanical advantages
With the reversal of the articular surfaces, the center of rotation of the joint shifts inward and down. This allows the deltoid muscle to “lift the weight” of the movement, offering the ability to lift and abduct the upper extremity without the need for the rotational pedal.
The main advantages of this technique include:
- Significant relief from chronic pain.
- Improving shoulder mobility.
- Ability to restore even in complex cases.
Surgical procedure
The procedure is performed under general anesthesia and lasts about 60 to 90 minutes. Depending on the general condition of the patient and the complexity of the case, the time of surgery may be changed. Regional anesthesia is usually used for better post -operative pain control.
Implant materials
The intentions used are made of high strength materials such as titanium, cobalt, polyethylene and ceramic. Ceramics are considered one of the most advanced materials with excellent life and durability.
Postoperative hospitalization and rehabilitation
The patient stays in the hospital usually for 1 day. From the third post -operative day it is usually able to self -serve, and within the first week it can gradually return to simple daily activities.
Long -term results and success
The long-term success of reverse arthroplasty is impressive, with percentages reaching 90-95% over a fifteen-year depth. Annual X -ray re -examinations are essential to monitoring the intent.
In general, the reverse total shoulder arthroplasty It is the appropriate option for patients who have not only extensive damage to the articular surfaces of the shoulder, but also the tendon and muscles of the rotational pedal. With high success rates, immediate pain relief and impressive restoration of joint functionality, it is a highly beneficial treatment technique of treatment of complex shoulder pathologies, especially when conventional methods are not particularly promising.
Writes Panagiotis PandosOrthopedic surgeon, manager Upper extremity, Athens Medical Center
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