Monday, March 27, 2023

Inverse total shoulder arthroplasty – for whom?

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The shoulder is one of the most important joints in the human body as it allows for a wide range of motion, giving the arm the ability to function in any direction.

It is heavily involved in every person’s daily activities at home, at work, in entertainment, in amateur and even more so in professional sports: swimming, basketball, tennis, volleyball, throwing, etc.

Which people are affected by shoulder diseases?

“Shoulder disorders cause pain and limit range of motion, leading to difficulties in everything from simple daily activities to work and lifestyle. They affect all ages. Elderly patients have arthritis, degenerative tendon ruptures, fractures, etc., while young patients and athletes find dislocations, traumatic tendon ruptures, severe fractures (arm, collarbone, shoulder blade), frozen shoulder, etc.,” he points out dr Ioannis X Ferousis MD, PhD, Director of the Specialty Clinic for Orthopedic Shoulder Surgery Metropolitan Hospital and added. “The rehabilitation of shoulder disorders is a complex process and its surgical repair is particularly challenging and requires experience.”

Reverse total shoulder arthroplasty

Until recently, patients with severe osteoarthritis of the shoulder were treated with the classic and proven total shoulder arthroplasty, in which the anatomical elements of the joint (head and humerus) were replaced with a metal implant or “The normal anatomy and its biomechanics.

However, this surgery, which is indicated for severe shoulder osteoarthritis, can only be performed when the rotator cuff (a set of tendons that serve to stabilize the shoulder during movement) is functioning normally, which is not always the case. Several patients have massive tears in the rotator cuff tendons due to poor tissue quality, shrinkage, and degeneration due to the chronicity of the damage, among other things.

“Reverse total arthroplasty is also indicated in situations where there is concomitant bone loss, which is particularly common in shoulder arthritis, and in revisions of old shoulder arthroplasty that do not produce results as expected, particularly in old or new fractures. Reverse total shoulder arthroplasty is used in these patients. This is a newer “non-anatomical philosophy” prosthesis that can be used in people with severe osteoarthritis combined with poor rotator cuff function, but also as a replacement for total arthroplasty after complications: loosening, infection, complex periprosthetic fractures, often in elderly patients that cannot be treated with the osteosynthesis method,” explains the specialist.

How does inversion differ from classic total shoulder arthroplasty?

In general, reverse total shoulder arthroplasty does what the name suggests, an anatomical reversal of the procedure.
“That is, the head (ball) is replaced with a hollow polyethylene surface, while the humerus (socket) is replaced with a metal ball. This creates a stable pivot point that allows the patient to raise their arm without involving a problematic or damaged rotator cuff. Of course, these changes are not visible from the outside and do not cause a cosmetic problem.

This operation is the biggest development in shoulder surgery in recent years and one of the biggest in orthopedic surgery in general. It has a predictable outcome: significant recovery of shoulder mobility, with usually complete freedom from pain, requires a short hospital stay (1-2 days), while with appropriate monitoring/guidance the patient begins to mobilize the joint one week after surgery and achieved after one very good mobility for the month,” concludes Dr. Ferousis.

The Metropolitan Hospital’s Specialist Orthopedic Shoulder Surgery Clinic

The first and to this day unique NHS Shoulder Surgery Unit was founded by
dr Ioannis X Ferousi,

which, under his leadership, has become a reference center in shoulder surgery and has been treating complex shoulder diseases on a daily basis for over 30 years. The new model clinic of the Special Orthopedic Shoulder Surgery Clinic was created through cooperation with the Metropolitan Hospital. Thanks to the combination of an excellent medical team and the logistical infrastructure that the Metropolitan Hospital provides at all levels, in addition to orthopedic diseases in general, it is ready to deal with all complex and complicated diseases of the Ohmic zone, be they related to trauma or chronic, degenerative diseases and have the rare qualification of being a point of reference in shoulder surgery in Greece since its inception. And of course, one of the most modern techniques used in the clinic is reverse total shoulder arthroplasty.


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