Shoulder arthroplasty: surgical progress and rehabilitation

Shoulder arthroplasty is an operation in which hopelessly damaged parts of the shoulder joint are removed and artificial components (endoprosthesis) are installed in their place.

Shoulder replacement is an effective and often the only way to restore lost arm movement. There are many diseases that are accompanied by dysfunction of the shoulder joint - these are fractures of the humerus, scapula, damage to the soft tissue structures of the shoulder joint (labrum, tendons and muscles), arthrosis and arthritis of the shoulder joint, neurological deficiency of the brachial plexus and others. With them, a pain syndrome always appears, in which a person begins to spare the shoulder, deliberately reducing the range of movements, which in turn leads to improper functioning of the muscles and their gradual fatty degeneration - a “vicious circle” closes.

Often injuries and diseases can be successfully treated surgically; for example, a displaced comminuted fracture can be “assembled” and fixed with a plate with screws; A torn labrum can often be removed and the torn rotator cuff tendons can be sewn back on. But these injuries are not always treated correctly and on time, and changes in the shoulder joint can go so far that the only way to solve the problem is to undergo shoulder replacement, while all the movements characteristic of the shoulder joint can be performed in the artificially created joint.

Preparing for surgery

First, a consultation with an orthopedic traumatologist is necessary, during which the doctor assesses the clinical situation, the condition of the joint, the general physical health of the patient, examines X-ray images and, together with the patient, decides on the need and possibility of shoulder replacement.
The list of preoperative examinations usually includes:

• X-ray of the shoulder joint in 2 projections
• CT scan
• Electroneuromyography (according to indications)
• Fluorography of the chest organs
• ECG
• General clinical examinations of blood and urine
• Biochemical blood test with liver tests, assessment of kidney function, coagulogram
• Testing for standard infections (syphilis, HIV and viral hepatitis)
• Determination of blood group and Rh factor

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Types of endoprosthetics

Based on the information obtained during the examination, the orthopedic surgeon plans the operation. The doctor determines the type of endoprosthetics and selects a prosthesis.

Superficial – used when the bone tissue of the head of the humerus is well preserved, but the cartilage in the joint is destroyed. An implant is installed on the ground bone to replace this cartilage.

Single pole. If the condition of the joint allows, only one of its components (the pole) is replaced with an artificial hemiprosthesis - either the head of the humerus or the scapular cavity.

Total - if the joint is irreversibly destroyed, all its structures in contact with each other are replaced - both the glenoid cavity of the scapula and the head of the humerus. That is, a joint prosthesis is installed.

Reversible. In the last decade, reverse shoulder arthroplasty has become widespread. During its implementation, the components of the endoprosthesis change places. A metal head is installed on the articular surface of the scapula, and a concave polyethylene liner is installed in the humerus. This type of prosthetics allows you to restore the range of motion in the shoulder joint earlier and to a greater extent.

Support and consolidation of results.

In addition to regularly performing exercises aimed at maintaining the achieved results, it is important to comply with a number of conditions:

1. Do not lift heavy objects, and monitor the load on the joint.
2. Exclude active sports such as football, basketball, volleyball, running, skiing.
3. Replace them with calmer ones - swimming, tennis, Nordic walking.
4. For independent maintenance of physical fitness, exercise equipment is ideal, in particular, an exercise bike, step, and arthromot.

The prosthesis imposes a number of other restrictions:

• If there is metal in the implant, magnetic resonance imaging cannot be used for diagnosis.
• In the first months, you need to avoid exposure to high temperatures, including saunas.
• You cannot perform sudden movements, strikes, or swings with the operated leg.
• Control body weight.
• Check with your doctor regularly. Especially in case of pain, swelling, hematomas in the implant area, or any infectious diseases.

Operation stages

The operation is performed under general endotracheal anesthesia.

After cutting the skin, the joint capsule is removed and the joint is exposed.

All damaged fragments of bone tissue and scar tissue are excised.

The components of the prosthesis are attached to the humerus and to the articular surface of the scapula. Fixation of the endoprosthesis is possible using special bone cement, or by tightly installing it into the bone (press-fit method). In the latter case, screws are additionally used for fastening to the blade.

Next, all soft tissues are sutured in layers. A bandage is applied.

A drainage is left in the wound for 1-2 days - a thin tube through which blood and discharge from the surgical wound drain.

An x-ray is taken to monitor the correct installation of the endoprosthesis.

Joint replacement surgery

Joint endoprosthetics is a complex operation in which a prosthesis is inserted in place of a damaged joint. For this purpose, a metal, ceramic or high-quality plastic implant is used. The endoprosthesis is fixed, depending on the indications, using a cemented or cementless method.

Prosthetics may be prescribed in the following cases:

1. Arthritis or arthrosis in the final stages.
2. Injuries for which other methods of restoring mobility are not applicable.
3. For dysplasia - congenital or acquired abnormalities of the joints.
4. Tumors in the head and neck of the femur.
5. With necrosis of cartilage and bone tissue, due to impaired blood supply in the area of ​​deformation.
6. Complications of joints due to obesity.

The operation can be performed on the knee, hip, shoulder, ankle, or elbow joints.

Please note that in the presence of the following diseases, surgery is contraindicated:

• Vein thrombosis;
• Blood clotting disorder;
• Tuberculosis;
• Infectious skin lesions;
• Diabetes;
• Kidney failure, etc.

In some cases, arthroscopy is performed before implantation - an operation with minimal intervention (through two or three punctures), which allows you to clarify the diagnosis and also prepare the joint for endoprosthetics. You can read more about arthroscopy here -. The success of the surgical procedures depends on postoperative rehabilitation. Therefore, it is very important to take this seriously and responsibly to return all functions.

Rehabilitation after shoulder arthroplasty

After the operation, the arm is fixed with a special soft bandage.

To prevent infectious complications, a course of antibiotic therapy is carried out.

To prevent thrombotic complications, administer anticoagulants (first by injection, then in tablet form).

To relieve pain, analgesics are prescribed (at the patient's request).

Rehabilitation after shoulder arthroplasty includes early activation under the guidance of a specialist - physical therapy, massage and physiotherapy.

For each stage, strictly its own intensity and amplitude of influences and exercises are allowed.

In the first days, gymnastics for the shoulder joint after endoprosthetics is reduced to minimal movements in the operated limb, and massage to light stroking. Expansion of the motor regime is possible only on the recommendation of a doctor. But physical therapy in the amount recommended for this stage should be mandatory and daily.

The patient spends 5-7 days in the hospital. Then he proceeds to the outpatient stage of rehabilitation under the supervision of an orthopedic traumatologist.

The sutures are removed 2 weeks after surgery.

After 3 months, mobility in the joint is almost restored. You can go back to work. But it is not recommended to lift heavy loads and perform strenuous physical exertion.

Rehabilitation continues up to six months after surgery.

X-ray control is carried out 3, 6 and 12 months after surgery.

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Main program.

The main stage can begin a week or two after endoprosthetics, depending on the age and well-being of the patient. To achieve the maximum effect, an individual comprehensive program is required, carried out under the supervision of specialists, taking into account the characteristics of the body, the operation performed - unipolar biopolar or total prosthetics, and adjustments during the recovery process.

The rehabilitation course after implantation most often includes:

1. Physiotherapy.
2. Physiotherapy
3. Massage
4. Drug therapy

Physiotherapy.

In our clinic, when drawing up a physical therapy program, the following methods are used:

• Classes at TechnoGym multi-stations. New generation multifunctional exercise machines that allow you to perform exercises in three planes with precise load adjustment.
• Rehabilitation activities according to the Neurac system are exercises performed on slings and allow you to combine complete unloading of some muscles with simultaneous targeted training of others.
• Myofascial release is kinesiotherapy performed using special myofascial rollers.
• Mechanotherapy. Joint gymnastics performed on the Arthromot apparatus.
• Therapeutic physical education using sports equipment: fitness balls, dumbbells, expanders, etc.

Exercise therapy is carried out under the strict supervision of a specialist, and is aimed not only at developing the limb, but also at restoring neural connections in the operated area. Why does the instructor use verbal, visual and kinesthetic cues? It is very important to calculate the duration and intensity of exercise, since insufficient load will not give a positive effect, and overload can even be harmful. Of great importance when developing a set of procedures and exercises is the reason for which the implant was installed, the age of the patient and the period of injury or illness before surgical treatment.

Physiotherapy.

Based on the indications, the following may be prescribed as part of rehabilitation after joint replacement surgery:

• Myostimulation. Stimulation of muscle contractions using electrical current. This procedure allows you to work certain muscle groups without affecting others.
• Ultrasound. The targeted impact of sound waves, as a result of which blood supply and metabolism improves in the affected area, swelling, inflammation and pain are reduced.
• Magnetotherapy. Physiotherapy based on magnetic fields. Depending on the pole, the following results are achieved: With the northern pole, performance increases, brain function improves, but at the same time the growth of bacteria is stimulated. Therefore, the northern field is contraindicated in the presence of infectious and inflammatory processes. For postoperative recovery, the south magnetic pole is used to reduce pain, reduce inflammation, swelling, calm the nervous system, etc.
• Shock wave therapy. SWT has a targeted effect on the inflammatory focus without affecting the surrounding tissue. Stops inflammation and inflammation, stimulates metabolic processes, reduces pain and swelling in the treatment area.

Massotherapy.

In addition to the above, manual therapy, therapeutic and lymphatic drainage massage are actively used for regeneration and stimulation of metabolism. This develops a limb or eases muscle tension, improves blood circulation, disperses lymph and removes excess fluid from the body.

Drug therapy to prevent instability of the endoprosthesis.

With reduced bone density (even osteoporosis), postoperative complications associated with loosening of the implant are possible, which can lead to re-operation, and quite quickly. To eliminate these consequences, two weeks after prosthetics, the doctor recommends special drug therapy.

A set of procedures for joint rehabilitation should, first of all, be aimed at performing the following tasks:

1. Relieving pain and discomfort.
2. Normalization of blood circulation.
3. Relief of inflammation that occurs after surgery.
4. Returning joint mobility.
5. Prevention of physical inactivity and prevention of contracture.
6. Strengthening the muscular frame.
7. Complete restoration of range of motion, both passive and active.

In the video: a SportClinic patient undergoes rehabilitation after knee surgery.

If the instructions are followed, the return to functionality occurs within 1.5 to 3 months after the operation. As a rule, after three months the patient returns to a normal lifestyle, but physical activity that could cause overload should be avoided. At the end of the course, the rehabilitator gives recommendations for rehabilitation at home. And you need to remember that only a responsible and conscientious attitude to all the doctor’s recommendations will eliminate complications and make recovery as effective as possible.

One recovery session includes:

• Manual therapy, massage.
• Individual exercise therapy and kinesiotherapy.
• Hardware physiotherapy (if necessary).

Shoulder replacement cost

You can find out how much shoulder arthroplasty costs at the Yauza Clinical Hospital by calling the phone number listed on our website, as well as in the “ Prices ” section in the “Traumatology and Orthopedics” block.

Shoulder endoprosthesis replacement is not performed according to quota at the clinic on Yauza.

When choosing the best place to undergo shoulder arthroplasty, price should not be the determining criterion. Much more important is the level of equipment of the clinic and the qualifications of the operating surgeons.

Phases of the rehabilitation period

In general, rehabilitation medicine doctors distinguish three main phases of rehabilitation after shoulder replacement:

• Stretching
• Restoring muscle strength
• Recovery.

Stretching

This period lasts up to two months. Its main task is to stretch the muscles, lightly strain them and tone them, as well as passively strain the arm to prevent loss of prosthetic mobility. Basic exercises that are necessary for stretching: pendulum; flexion, extension and abduction of a limb, walking on a crossbar, stretching muscles with engagement on a support, etc.).