Shoulder arthroplasty - Indications, contraindications and complications

Prosthetic substitution of the glenohumeral joint, begun at the end of the last century, has developed greatly in recent years, Today the most widely used shoulder prostheses are defined as "modular" because of their extensiv e adaptability, The capacity to adapt to anatomic variations must be incorp orated within their structure, and normal articular biomechanics must be re spected. The choice of prosthesis must be based on the condition of the joi nt surfaces, on the anatomic and functional condition of the rotator cuff. So endoprosthesis of the shoulder is indicated for avascular necrosis of th e head of the humerus, fractures and pseudoarthrosis of the extreme proxima l end of the humerus, arthropathy following rotator cuff rupture, Total sho ulder prosthetization is indicated for glenohumeral osteoarthritis, rheumat oid arthritis and outcomes of endoprosthesis, The principal contraindicatio ns for shoulder replacement include an infection in progress, Charcot's art hropathy and severe neurological pathologies. The complications of shoulder prostheses include infection, dislocation, loosening of a component, perip rosthetic humeral and glenoid fractures, nerve injuries, fractures of a pro sthetic component and ectopic ossification. At present prosthetic substitut ion of the glenohumeral joint offers good results. Indispensable conditions for these results include anatomic and functional integrity of the muscula ture, good bone quality, correct positioning of the prosthetic components a nd a proper rehabilitation program.