Alloplasty of the humeral joint

Background. Since 1980's, shoulder arthroplasty has become more oftenly performed procedure, and for severe comminuted fractures of proximal humerus (fou r- fragmented fractures, according to Neer's classification) has become first - line therapeutic option. At the beginnig of 90's, contemporary prinicples of shoulder arthroplasty were introduced. It is assumed that 4 mechanical parameters, i.e. range of motion, joint stability, strengh and smoothness of prosthesis components contribute to shoulder function, and we sholud reach toward their reconstruction during surgical procedure. Material and Methods. In our Department from 1995 to1999 we performed 14 shoulder hemiarthroplasties using Bio-Modular prosthesis (12 women and 2 men). Patients' age ranged from 41 to 75 years (average 61.8 years). Indications included: acute comminuted proximal humerus fractures, proximal humerus malunions, and either degenerative arthritis or rheumatoid arthrits of the shoulder. Aftertreatment consisted of passive motions introduced on the first day after an operation, followed by assisted active excercises 4- 6 weeks later, and motions against resistance, allowed 2 months postoperatively. Results. The outcomes were evaluated three years after surgery, and were measured as the score in the Constant scale and as subjective patients' assesments. Improvement was seen as an increase from average 28.3 preoperative Constant score, to 60.3 postoperatively. Subjectively, excellent outcome was reported by 4 patients, good - by 7, and fair by 2 patients. Conclusions. Our experience shows that whereas indications to shoulder artrhroplasty are not frequent in cases of fractures or orthopedic conditions of the affected region, in properly selected group of patients this procedure is effective treatment option, alleviating pain and allowing for regaining well - functioning joint, but long-lasting, at leats one-year long rehabilitation programm after surgery is mandatory.