INSTABILITY OF THE SHOULDER AFTER ARTHROPLASTY

被引:151
作者
MOECKEL, BH [1 ]
ALTCHEK, DW [1 ]
WARREN, RF [1 ]
WICKIEWICZ, TL [1 ]
DINES, DM [1 ]
机构
[1] HOSP SPECIAL SURG,SHOULDER SERV,NEW YORK,NY 10021
关键词
D O I
10.2106/00004623-199304000-00003
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
A replacement arthroplasty was performed in 236 shoulders at The Hospital for Special Surgery from 1984 through 1989. Ten patients (eight women and two men) from that group were identified as having instability of the shoulder at the time of follow-up, and the results for these patients were reviewed retrospectively. The ages of the patients ranged from fifty-six to seventy-nine years. The instability was anterior in seven of the patients and posterior in three. The anterior instability was caused by a rupture of the repaired subscapularis tendon. The operative treatment of the anterior instability consisted of mobilization and repair of the tendon, but three of the seven patients continued to have instability. A static stabilizer, consisting of an allograft of Achilles tendon, was inserted in these three patients, and the result was a success. The etiology of the posterior instability (three patients) was multifactorial. Treatment consisted of correction of any soft-tissue imbalance and revision of the prosthetic components as necessary. All ten patients were followed clinically and radiographically for at least two years. All of the patients had some loss of motion of the shoulder as compared with the motion before the dislocation. There were no neurovascular complications, problems related to the allografts, or any other complications. We concluded that proper balancing of the soft tissues and positioning of the prosthetic components are essential to a successful arthroplasty of the shoulder. The postoperative rehabilitation should include a physical therapy program in which the range of motion of the arm that was achieved in the operating room is not exceeded. Early recognition and treatment of tendon disruption is important when acute injuries are being treated. Instability after an arthroplasty was treated successfully with reconstruction of the soft-tissue envelope or revision of the prosthetic components, or both, and sometimes with the use of an allograft to replace deficient soft tissues.
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页码:492 / 497
页数:6
相关论文
共 8 条
[1]   THE DANA TOTAL SHOULDER ARTHROPLASTY [J].
AMSTUTZ, HC ;
THOMAS, BJ ;
KABO, JM ;
JINNAH, RH ;
DOREY, FJ .
JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, 1988, 70A (08) :1174-1282
[2]   TOTAL SHOULDER ARTHROPLASTY [J].
BARRETT, WP ;
FRANKLIN, JL ;
JACKINS, SE ;
WYSS, CR ;
MATSEN, FA .
JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, 1987, 69A (06) :865-872
[3]   TOTAL SHOULDER ARTHROPLASTY WITH THE NEER PROSTHESIS [J].
COFIELD, RH .
JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, 1984, 66A (06) :899-906
[4]  
COOFIELD RH, 1990, INSTRUCTIONAL COURSE, V39, P449
[5]  
GALINAT BJ, 1988, ORTHOP T, V12, P143
[6]   RECENT EXPERIENCE IN TOTAL SHOULDER REPLACEMENT [J].
NEER, CS ;
WATSON, KC ;
STANTON, FJ .
JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, 1982, 64 (03) :319-337
[7]  
NEER CS, 1974, J BONE JOINT SURG AM, VA 56, P1
[8]  
OBRIEN SJ, 1988, ORTHOP T, V12, P143