When the surface of the joint (shoulder, hip, knee, ankle, etc.) is severely compromised, the minimum resection of the joint surfaces and their coating with prosthetic material, using toolkits dedicated, allows the patient’s recovery, with abolition of pain and restoration of joint function and good quality of life in the vast majority of cases: this is prosthetic surgery (total or partial, of the surface or not, cemented or not) of a joint.
Arthrosis of the shoulder is the degeneration of the joint for traumatic reasons (fractures involving the articular surfaces), degeneration (concentric arthritis) or rotator cuff chronical massive retracted painful pseudoparalitic lesions (‘cuff arthropathy’).
In post-traumatic osteoarthritis chronic shoulder degenerative arthritis, with bone resections of a few millimeters on the joint surfaces joint prostheses can be implanted both on the scapular glenoid surface and on humeral head, implants with and without stem (stemless), with immediate stability, with or without acrylic cement: the presence of a good residual rotator cuff allows better quality and earlier functional recovery while keeping unchanged the mechanical center of the joint.
On the contrary in arthritis of the shoulder caused by chronic insufficiency of the rotator cuff we implant the so-called reverse shoulder prosthesis, which puts more medially the center of rotation of the shoulder, thus obtaining the result of using the deltoid muscle in order to replace the absence of the rotator cuff. In these cases, the resumption of movements (ie the ‘articulation’) of the shoulder is generally very satisfactory, although with modest muscular strength.
The re-education of the shoulder prosthesis is extremely important to obtain the final functional result, which depends on it at least for 50%.
In severe osteoarthritis of the hip I implant cemented and uncemented total prosthesis (with long or short femoral stem, and cemented or cementless acetabular cup), and, where necessary, with metal plates (Muller) or metal rings (Schneider) reinforcement, sometimes with the use of bone bank allograft. In hip arthroscopy nowadays we can also treat capsular and ligamentous pathologies that sometimes constitute the true first causes of articular progressive arthritic degenerations, when the severity of hip pain and functional limitation do not match the scarcity of radiological signs.
Functional rehabilitation of the hip, though less complex than in other joints (shoulder and knee), is still crucial to enable the patient to regain his own range of motion with safe patterns, avoiding dangerous movements, especially in the first two months of postoperative care, when the new capsular tissue is not yet well formed.
The early rehabilitation in swimming pool of the patient operated with hip replacement, performed using waterproof medications, is a good solution for early resumption of proprioception and stereognosis of the hip.
In the knee, analogously to what already described for the shoulder and for the hip, in the event of severe post-traumatic deformities, serious misalignments, or osteoarthritis of the knee advanced, the intervention of total knee prostheses, or, in the case of the unicompartmental osteoarthritis partial knee replacement, with or without the patellofemoral prosthesis, is the solution of the problems of knee pain and severe functional limitations.
As in previous cases, the possibility of an early functional rehabilitation of the patient undergoing knee prosthesis favors so important to the end result at a distance.
Both in the prosthetic hip, or in that of the knee and shoulder, the increased life expectancy of the population leads to the not infrequent cases of need for prosthetic replacement for its mechanical loosening or tank, or to wear of its components: in such cases, in general and local conditions that allow, we perform interventions riprotesizzazione, early or late, in ‘one step’ or ‘two steps’ (in cases septic system with temporary cement spacer preformed, and with subsequent replanting prosthetic ).