SHOULDER ENDOPROSTHESIS

Zglob ramena najmobilniji je zglob u tijelu i ima pokrete kroz sve ravnine. Za takvu mobilnost zaslužna je smanjena kongruentnost zglobnih tijela, obilna i elastična kapsula, manji broj ligamenata i veći broj mišića koji ga stabiliziraju i pokreću. Zbog takve smanjene kongruentnosti lakše dolazi do ozljeda u zglobu. Veliku važnost ima i rotatorna manšeta koja stabilizira zglob te ozljedom samo jednog mišića može doći do komplikacija. Indikacije za endoproteze su različite vrste artritisa, kompliciraniji prijelomi humerusa, ozljede i rupture rotatorne manšete, avaskularna nekorza itd. Tri su vrste proteza: parcijalna, koja zamjenjuje samo dio humerusa, totalna endoproteza kao zamjena oba zglobna tijela i reverzna endoproteza koja zamjenjuje zglobna tijela, a i njihove konkavno-konveksne površine. Za totalnu endoprotezu i funkcionalnost u ramenu potrebna je funkcija rotatorne manšete, a kod reverzne endoproteze potrebna je funkcija m. deltoideusa. Najčešće komplikacije nakon operacija su dislokacije, infekcije i razlabavljenje komponenti. Rehabilitacija je vrlo bitna stavka, počinje odmah nakon operacije, traje u fazama i odrađuje se dok se ne dobije poželjan opseg pokreta u zglobu.Shoulder joint is the most mobile joint in the body, it has movements in every direction. This mobility is possible because of decreased ongruence between articular bodies, a small amount of ligaments and several muscles that stabilize the joint and move it. Because of the weak congurence this joint can be easily injured. Rotator cuff that stabilizes the joint has a big role in the whole process and the injury of one muscle can lead to complications. Indications for endprosthesis re different types of arthritis, complicated fractures of humerus, injurys and rupture of rotator cuff muscle, avascular necrosis, etc. There are three types of endprosthesis hemiarthroplasty that replaces only one part of humerus; total arthroplasty or endoprothesis that replaces both articular bodies; and the reverse arthroplasty or reverse endprosthesis that replaces the articular bodies and their concave – convexe surfaces. Rotator cuff is necessery for the total endoprothesis and the function of the shoulder and in the reverse endoprothesis it is neccesery for deltoideus to work. The most common complications after operations are dislocations, infection and loosening of the segment. Rehabilitation is very important and it begins right after surgurey, is divided in phases and it lasts until the range of motion in the joint is restored