Background. Reverse arthroplasty is an effective method of treating severe injuries and diseases of the shoulder joint. In cases of severe osteoporosis, defects and deformities of the glenoid, there are risks of incorrect installation and instability of the components of the endoprosthesis. In the literature data, the problem of osteoporosis in the endoprosthetics of the shoulder joint and methods of its solution are rather poorly reflected, which was the reason for this study.The aim: to develop algorithms for diagnosing the state of the bone tissue of the articular cavity of the scapula and methods for solving its deviations during reverse shoulder arthroplasty.Materials and methods. Forty-eight patients who underwent reversible shoulder joint replacement were examined in the Department of Adult Orthopedics of the N.N. Priorov National Medical Research Center of Traumatology and Orthopedics. A standard preoperative examination of patients developed in the department was performed, as well as additional calculations of bone density in Hounsfield units and according to X-ray densitometry were performed. The parameters of bone density of the glenoid (in HU) were compared with the data of densitometry.Results. According to the results of densitometry, the patients were divided into groups. A direct dependence of the bone density of the glenoid and the indicators of densitometry was revealed. Algorithms of treatment and preoperative preparation of patients with bone density deficiency for reverse shoulder arthroplasty have been developed.Conclusions. In the studied groups, 100 % of patients with indicators below 139 HU were diagnosed with osteoporosis or osteopenia, and patients with more than 257 HU had normal bone mineral density.
The problem of reverse shoulder arthroplasty with various deformities of the glenoid is relevant for modern traumatology and orthopedics. In addition to various defects, the methods of solving which can be eccentric reaming of the glenoid by milling cutters, bone autoplasty, augmentation, the use of individual implants, orthopedic traumatologists have to deal with a decrease in the mineral density of the bone tissue of the scapula.The aim of this study is to demonstrate the possibility of using hydroxyapatite paste together with bone autoplasty in revision shoulder arthroplasty in conditions of a massive defect and reduced glenoid bone density.Discussion. The article presents a case of surgical treatment of a patient with the consequences of a fracture of the proximal metaepiphysis of the humerus and local osteoporosis of the glenoid by the method of reverse shoulder arthroplasty in combination with the use of hydroxyapatite paste. A detailed description of the operation technique is given.Conclusion. The described clinical case demonstrates the effectiveness of the technique of using hydroxyapatite preparations for shoulder joint replacement.
BACKGROUND: Reverse shoulder arthroplasty is one of the surgical treatment methods of the shoulder joint injuries and diseases accompanied by pronounced changes in the anatomy of the articular structures. Considering the positive aspects of reverse shoulder arthroplasty, the indications for this operation are expanding over time. However, during this operation, errors are possible that lead to early dislocation of the endoprosthesis, compression of the metaglene to the scapula, screw instability and migration of the scapular component. Given the lack of a generally recognized clear algorithm of actions in these complex cases, the problem of reversible shoulder arthroplasty in case of defects in the articular surface of the scapula are relevant. AIM: To develop and evaluate the effectiveness of the method of compensating for the lack of bone tissue of the scapula in the reverse shoulder arthroplasty MATERIALS AND METHODS: In the Department of Adult Orthopaedics of the N.N. Priorov National Research Medical Center, reverse shoulder arthroplasty was performed in patients with scapular bone mass deficiency, who needed to fill in both marginal defects for the installation of metaglene with the correct angle of inclination, and the replacement of extensive defects with the necessary level of glenosphere lateralization. RESULTS: Follow-up of patients who underwent glenoid remodeling using bone autoplasty and subsequent shoulder reverse artroplasty within a period of 6 to 24 months. Remodeling and osseointegration of the grafts were determined, without signs of metaglene instability by the end of the 3rd month after the operation. The complex of rehabilitation measures and the time of recovery of movements in the operated joint did not differ from those of conventional reverse arthroplasty. CONCLUSION: Given the high efficiency of the proposed algorithm, the method used to compensate for the lack of bone tissue of the scapula in shoulder reverse arthroplasty can be recommended for implementation in a wide clinical practice.
The reverse shoulder arthroplasty in the conditions of the modified anatomy of the glenoid is complex and often excludes the possibility of using the standard tactics of installing the glenoid component. There are no identical glenoids, each articular cavity of the scapula differs in height, width, angle of inclination, density of bone tissue, absence or presence of various defects of bone tissue. Given the variety of options for changing the structure and quality of the glenoid bone tissue in injuries and diseases of the shoulder joint, each case of endoprosthetics should be considered individually. In order to perform an adequate metaglen installation, these parameters must be normalized or standardized. The purpose of this work is to review the domestic and foreign literature devoted to the features of reversible shoulder joint replacement during deformation of the articular cavity of the scapula. Based on the analysis of literature data, the percentage of complications associated with unsatisfactory treatment results due to the instability of the glenosphere is quite large, which indicates the lack of elaboration of this topic and its relevance for practical traumatology and orthopedics. The paper considers eccentric non-standard methods of rimming the articular cavity of the scapula, methods of its bone grafting, the use of metaglens made taking into account the deformation of the glenoid, as well as indications for the use of technology for the individual manufacture of scapular components. The study and analysis of indications for the use of various types of techniques for solution glenoid deformities made it possible to systematize and differentially approach the issue of preoperative planning and choosing the correct, right treatment tactics in complex cases of reversible shoulder joint replacement.
BACKGROUND: Severe injuries of the elbow joint and their consequences are a serious problem in modern traumatology and orthopedics due to the large number of unsatisfactory treatment results, in particular, due to the lack of a differentiated approach to the choice of tactics and the method of surgery. AIM: To evaluate the results of a differentiated approach to the choice of tactics and the method of surgical intervention in the treatment of patients with injuries and consequences of injuries of the elbow joint. MATERIALS AND METHODS: The results of treatment of 245 patients with injuries and consequences of damage to the elbow joint were assessed within 11 years from the date of surgery. Six groups of patients were identified: group 1 osteosynthesis of fractures of the elbow joint; 2nd open arthrolysis without the imposition of Oganesyans hinged distraction apparatus (HDA); 3rd open arthrolysis with the imposition of HDA; 4th arthroscopic arthrolysis without HDA imposition; 5th arthroscopic arthrolysis with the imposition of HDA; 6th elbow arthroplasty. RESULTS: In 93% of patients after osteosynthesis (1st group of patients), a good result was obtained (the deficit in the range of motion was not more than 10, the average score on the DASH scale was 8). In patients after arthrolysis, there is a twofold increase in the range of motion (on average from 4250 to 114120), and regardless of the method of arthrolysis (arthroscopic or open) and whether HDA was used or not. On the DASH scale, 89% of patients showed a decrease in points on average from 77 to 36. In the 6th group, an increase in the range of motion was noted on average from 4548 to 126135, on the DASH scale a decrease in points from 7982 to 3944 on average. Revision intervention was required in 28.4%. CONCLUSION: The choice of the method of surgical treatment of injuries and the consequences of severe injuries of the elbow joint directly depends on the degree and nature of destruction of the bone-articular and soft tissue structures, the deficit in the range of motion in the joint.
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