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At least 199 records · Page 11Linked to original sources
PubMed1978

Long-term clinical and hemodynamic evaluation of the Ionescu-Schiley pericardial xenograft and the Braunwald-Cutter and Björk-Shiley prostheses in the mitral position.

Single mitral valve replacement was undertaken in 220 patients between March, 1971, and October, 1977. Bjork-Shiley prostheses (BS) were inserted in 42 patients, Braunwald-Cutter prostheses (BC) in 52, and Ionescu-Shiley pericardial xenografts (PX) in 126. No attempt was made at randomization. The actuarial survival rate was 81.9 +/- 12.8 percent at 7 years for patients with BS prostheses, 41.7 +/- 22.9 percent at 6 years for patients with BC prostheses, and 89.0 +/- 9.3 percent for patients with PX valves 7 years following valve replacement. Of the late deaths in patients with BC prostheses, 62.5 percent were valve related. The incidence of thromboembolism was 4.7, 1.8, and 1.5 episodes per 100 patient-years in the BS, BC, and PX groups, respectively. Long-term anticoagulation was used only in patients with BS and BC prostheses. Late postoperative hemodynamic studies were performed in six patients each with BS and BC prostheses and in 29 patients with PX valves. The mean diastolic gradients at rest were 6.2, 8.3, and 6.4 mm. Hg in the respective groups. The corresponding figures for calculated valve area were 1.8, 1.6, and 2.0 sq. cm. There was no statistically significant difference between the data recorded from the three groups of patients except for the survival rate of the BC prosthesis and the PX valve. The BS prosthesis and the PX valve have similar durability and hemodynamic performance for an almost identical duration of follow-up. Because of the improved quality of life and reduced morbidity without anticoagulants, we are using the PX valve exclusively for heart valve replacement.

Bioprosthesis↗
PubMed1993

Long-term results of tissue development and cell differentiation on Dacron prostheses seeded with microvascular cells in dogs.

PURPOSE: The purpose of this study was to investigate in vivo the long-term development, differentiation, and proliferation of the subendothelial tissue on Dacron prostheses seeded with microvascular cells (MVC). METHODS: Autologous MVC from omental adipose tissue were seeded on 4 mm Dacron prostheses and the prostheses interposed in the carotid arteries of mongrel dogs for 5, 13, and 26 weeks. RESULTS: Light and electron microscopic evaluation of patent seeded prostheses demonstrated an almost complete monolayer of endothelial cells and well-organized subendothelial tissue, whereas patent control prostheses were mainly covered by red and white thrombi, which were partially replaced by organized tissue with increased implantation time. The measurements of the thickness of the luminal cell layer in seeded and control grafts showed no statistically significant increase between 5 and 26 weeks of implantation. The subendothelial tissue of seeded prostheses demonstrated a time-dependent maturation of highly synthesizing myofibroblasts embedded in a collagen matrix to cells with features of smooth muscle cells located in a collagen-elastin matrix. In control grafts examined after 26 weeks the spontaneous endothelialization was accompanied by a delayed or incomplete maturation of subendothelial tissue. CONCLUSIONS: Our study indicates that MVC seeded onto Dacron prostheses are able to generate a vascular wall that does not continue to proliferate after prolonged implantation and that increasingly resembles the wall of a normal artery in cell differentiation and intercellular matrix.

Animals↗
PubMedDate not supplied

In vivo measurements of precision of fit involving implant-supported prostheses in the edentulous jaw.

The objective of this study was to measure and compare the precision of fit of implant-supported prostheses in the edentulous jaw by using both the master cast replicas and the intraoral implants as references. Seven maxillary and 10 mandibular prostheses were randomly selected and measured by means of a three-dimensional (3-D) photogrammetric technique. The results indicated that prostheses routinely connected to osseointegrated implants could demonstrate distortion between the framework and individual implants of up to several hundred microns. When master casts were used as a reference, the mean 3-D distortion of the center point of gold cylinders was 37 microns (SD 18) and 75 microns (SD 40) for mandibular and maxillary prostheses, respectively. The corresponding mean displacement was 90 microns (SD 51) and 111 microns (SD 59), respectively, when the intraoral implants were used as references. The mean 3-D distortion was significantly higher for the intraoral measurements in both arches (P < .001 and P < .05). Furthermore, the overall distortion was significantly higher for the maxillary prostheses when the master casts were used as the reference (P < .05). However, for the intraoral measurements, no statistically significant difference of fit between the arches was possible to observe (P < .05). This could possibly be explained by the finding that intraoral measurements of the mandibular prostheses indicated a deformation and rotation of the mandible that was not observed in the maxillary prostheses. A further factor in the lack of statistical significance could be the relatively small sample size.

Dental Abutments↗
PubMed1997

Bileaflet mechanical prostheses in mitral and multiple valve replacement surgery: influence of anticoagulant management on performance.

BACKGROUND: The St. Jude Medical (SJM) mechanical prosthesis has been the predominant mechanical prosthesis worldwide since its introduction in 1977. The CarboMedics (CM) mechanical prosthesis, also a bileaflet pyrolite carbon prosthesis, was introduced in 1986 and was approved by the Food and Drug Administration of the United States in 1993. The experience of the two prostheses was evaluated in a parallel, nonrandomized study commencing with the CM investigational study in 1989. METHODS AND RESULTS: The clinical performance of the two prostheses was evaluated in accordance with the Guidelines for Reporting Morbidity and Mortality After Cardiac Valvular Operations. The CM prosthesis was implanted in 239 mitral valve replacements (MVR) and 106 multiple valve replacements (MR), and the SJM prosthesis was implanted in 379 MVR and 137 MR. The CM and SJM populations were not distinguished within MVR and MR for mean age, previous surgery, concomitant surgery, mean follow-up, and late mortality (P=NS). The linearized occurrence rate for the combined experience for major thromboembolic and hemorrhage events >30 days was 3.4% of patients per year for MVR (inclusive of cerebral thromboembolism reversible, major; systemic; thrombosis; and fatal; and major systemic hemorrhage) and for MR was 3.9% of patients per year (P=NS between prostheses by position). The major crude event rate for < or =30 days was 1.3% for MVR and 1.2% for MR (P=NS between prostheses by position). The inadequacy of anticoagulation (as determined by international normalized ratio 2.5) for all thromboembolic events (major and minor) < or =30 days was 93%, and that for >30 days was 75%. The freedom from major thromboembolism for MVR at 3 years was 92.7+/-1.9% for CM and 94.0+/-1.5% for SJM; for MR, it was 94.2+/-3.0% for CM and 93.5+/-2.5% for SJM (P=NS). The freedom from major thromboembolism exclusive of early events for MVR at 3 years was 94.4+/-1.8% for CM and 94.8+/-1.4% for SJM, and for MR, it was 94.2+/-3.0% for CM and 95.0+/-2.2% for SJM (P=NS). The freedom from major thromboembolism and hemorrhage for prostheses (CM and SJM) by valve positions (MVR and MR) was also indistinguishable (P=NS). CONCLUSIONS: There are no distinguishing performance characteristics with regard to thromboembolic and hemorrhagic events between the CM and the SJM mechanical prostheses in MVR and MR. There was an identified need for improvement in the early and late anticoagulant management. A randomized trial with optimization of anticoagulant management between the CM and SJM mechanical prostheses is recommended.

Anticoagulants↗
PubMed1996

Performance of small diameter synthetic vascular prostheses with confluent autologous endothelial cell linings.

Autologous grafts are superior to their synthetic counter-parts for grafting arteries smaller than 6-mm diameter both in terms of acute thrombogenicity and chronic intimal hyperplasia. Endothelial cell (EC) coating of the blood contacting surface may reduce thrombogenicity of synthetic small diameter vascular prostheses. In this study, the survival of EC monolayers on synthetic 4-mm diameter arterial prostheses over short-term implantations (< or = 6 weeks) was examined. Graft types examined were expanded polytetra-fluoroethylene (ePTFE) and microporous polyurethane (PU). Lumenal coverage with ECs was achieved by culturing ovine ECs on prostheses treated by either physical adsorption or covalent binding of ovine fibronectin (Fn). An ovine carotid interposition model was used to examine the performance of EC coated ePTFE and microporous PU over implantation periods of 1, 3, and 6 weeks. Outcomes assessed at the end of each experiment were graft patency, area covered by ECs, and thrombus free surface area (TFSA). Fn concentration, cell density at the time of coating and prostacyclin production in vitro were similar for both graft types. Occlusion occurred more frequently in unseeded grafts compared with EC coated grafts over 3 and 6 week implantation periods; however, the difference was not significant (p = 0.099). In prostheses precoated with ECs, approximately 40-60% of the surface area remained covered with endothelial-like cells following the first postoperative week. Recovery of EC layers occurred rapidly thereafter with 80-90% coverage at 3 weeks. TFSA remained low in comparison to EC cover in these prostheses until between 3 and 6 weeks postoperatively, suggesting a lag phase in recovery of EC function of seeded cells. In contrast, EC cover of unseeded prostheses only achieved 10-30% at 3 weeks, primarily by pannus EC ingrowth from the adjacent artery. TFSA of unseeded grafts increased in direct proportion to EC cover over time suggesting that there was no lag phase in function of these ingrowing cells.

Adsorption↗
PubMed2001

Treatment outcome of bone-anchored craniofacial prostheses after tumor surgery.

BACKGROUND: Percutaneous endosseous implants have acquired an important place in the prosthetic rehabilitation of patients with craniofacial defects. The objective of this study was to evaluate the clinical outcome of the use of endosseous implants in the orbital and auricular region as well as to assess the satisfaction of patients with implant-retained craniofacial prostheses after tumor surgery. METHODS: The clinical outcome and patient satisfaction of implant-retained prostheses in the auricular and orbital region were evaluated in a group of 26 patients with facial defects after tumor surgery by using standardized questionnaires and a clinical assessment. Twelve patients (n = 31 implants) received the implants during ablative tumor surgery, from which 7 patients (n = 20 implants) were treated with radiation therapy after surgery (mean, 65 grays [Gy]). Fourteen patients (n = 44 implants) received the implants after the tumor surgery, from which 5 patients (n = 21 implants) were irradiated after ablative surgery (mean, 54.4 Gy), but before implant placement. RESULTS: No implants were lost in patients who had not undergone irradiation (100%), whereas 5 implants were lost in the irradiated group (87.8%). The overall implant survival rate was 93.3%. The peri-implant tissues had a healthy appearance, and no cases of osteoradionecrosis occurred. When compared with patients treated with conventional adhesive retained facial prostheses, satisfaction was higher in patients treated with implant-retained facial prostheses. CONCLUSIONS: From this study, it is concluded that implant-retained facial prostheses are better tolerated than adhesive retained prostheses and offer an improvement in the quality of life. Radiotherapy is not a contraindication for the use of osseointegrated implants in the maxillofacial region, but the loss of implants is higher than in nonirradiated sites.

Adult↗
PubMed1989

Nondestructive investigations on ninety-seven surgically excised mammary prostheses.

The information contained in the medical files of 68 patients having undergone surgical excision of a total of 97 internal mammary prostheses allowed us to define a typical patient profile at time of first implantation. Age: 33 years 11 months, height: 1.59 m, weight: 51.5 kg, two children. Twenty-one percent of these patients had the operation done subsequent to a mastectomy, while 79% requested it for cosmetic reasons. The duration of implantation was less than 55 months for 76% of the prostheses received after excision. The most frequent evolutive complications were the formation of a fibrous capsule followed by silicone bleeding, as well as mineralization. Macroscopic examination of the 97 explanted prostheses provided information on their integrity (38.1% of prostheses ruptured), gel differentiation (24.7%), sticky surfaces (26.8%), surface deposits (33%), memory folds (54.6%), and Dacron fixation patches (20.6%). According to the medical files, a fibrous capsule was found in association with 69.8% of the breast implants. We received only 46 capsules. The average thickness was 1.4 mm. Mineralizations were present on 15 capsules (32.6%). Two zinc phosphates were identified, for the first time, in human body: parascholzite and hopeïte. Statistical examination showed that Heyer-Schulte prostheses stayed in place for a longer time. Integrity and gel differentiation depended on the duration of the implantation. Presence of mineralization was model-related (Dow Corning prostheses were associated with deposits) and depended on the presence of fixation patches.

Adult↗
PubMed1992

Evaluation of digital prostheses.

Fifty-one digital prostheses were made for 33 patients between 1986 and 1988. A questionnaire was developed to assess the patients' satisfaction with these prostheses and was administered 6 months and 3 years after the prostheses were made. The majority of patients requested prostheses for esthetic reasons. While they reported satisfaction with the appearance of the prostheses, at 3 years 36% of the patients no longer continue to use the prostheses.

Adult↗
PubMed1995

Attachments used for implant-supported facial prostheses: a survey of United States, Canadian, and Swedish centers.

A survey was conducted of one Swedish, three Canadian, and 24 United States centers that provide implant-supported facial prosthetic treatment. All centers responded to the survey. A total of 357 patients began treatment. Of those, 338 completed treatment: 165 in Sweden, 131 in the United States, and 42 in Canada. The incidence of facial sites treated with implant-supported prostheses indicated that the auricular (72%) region was the most common site, followed by the orbital (20%), nasal (6%), and combination (2%). Clips were the predominant mechanism used to retain auricular prostheses. Orbital prostheses were fabricated with a wider variety and combination of attachments. Nasal and combination prostheses were too few to elicit any specific trends of attachment use. A variety of manufacturers' attachments were used for clip, magnet, and miscellaneous attachments to retain implant-supported facial prostheses. Results of this survey indicate a need for further investigation regarding the most efficacious attachment method to serve patients treated with implant-supported facial prostheses.

Canada↗
PubMed2003

Long-term results of allograft composite total hip prostheses for tumors.

The functional results of standard reconstruction prostheses are impaired by instability because of poor muscular reinsertion, especially of the gluteal muscles. In 21 patients, composite hip prostheses including proximal femoral allografts were used after primary malignant tumor resection. Ten reconstructions used combined bone-tendon allografts that allowed reinsertion of the gluteal muscles to the allograft tendons. None of the 21 patients had dislocation or infection. Ten patients died within 2 years of surgery without complications requiring reoperations. The mean followup in the 11 other patients was 10 years. Eight patients had reoperation: four for loosening (two at 3 years, two at 11 and 12 years), and four had autologous graftings for nonunion of the trochanter or of the distal graft-bone interface. Evaluation of function in the 11 patients with follow-ups ranging from 4 to 15 years showed an average Musculoskeletal Tumor Society score of 77%. Satisfactory strength of the abductor muscles was achieved by reinsertion of the trochanter or by suture of the patients gluteal muscles with the combined tendon-bone allograft. At long-term, radiologically, the bony allograft showed no change in five patients, very mild resorption in five, and severe resorption in one. Stem fixation was excellent in 10 patients and fair in one. Comparison between the functional results of reconstruction prostheses versus composite prostheses showed a significant improvement with the composite prosthesis. In the authors' institution, at 10 years, the mechanical survival of composite prostheses was 81%, as compared with only 65% for reconstruction prostheses.

Adolescent↗
PubMed2004

Treatment of midfacial defects using prostheses supported by ITI dental implants.

The purpose of this study was to evaluate retrospectively the use of ITI dental implants used for anchoring facial prostheses in the restorative treatment of midface defects. The authors analyzed the clinical data of 26 patients with orbital defects (n = 11), orbitonasal defects (n = 4), orbitonasomaxillary defects (n = 3), and nasal defects (n = 8). Data included age, sex, primary disease, implant position, implant length, implant failure, prosthetic attachment, radiation therapy, and peri-implant skin reactions. Follow-up was at 1, 3, 6, and 12 months and then on a yearly basis. The authors noted the status of healing and complications, if any. In total, 62 implants were placed as follows: 27 (43.5 percent) for orbital prostheses, 12 (19.4 percent) for orbitonasal prostheses, 14 (22.6 percent) for orbitonasomaxillary prostheses, and nine (14.5 percent) for nasal prostheses. Thirty-eight implants (61.3 percent) were placed in previously irradiated areas in 18 patients (69.2 percent). Mild skin reactions together with mild accumulation of sebaceous crusting around implants were recorded in 14.2 percent of the skin observations. No patient experienced severe inflammation requiring administration of systemic antibiotics or surgical revision. Implant success was 100 percent in both irradiated and nonirradiated patients. In conclusion, ITI dental implants result in a high rate of success in retaining midface prostheses and offer good stability and aesthetic satisfaction.

Adult↗
PubMed1993

A comparison of the capsules around smooth and textured silicone prostheses used for breast reconstruction. A light and electron microscopic study.

A total of 18 women who had undergone modified radical mastectomy and tissue expansion for breast reconstruction were studied. When the expanders were replaced, nine patients had received smooth, gel-filled permanent prostheses and nine had received textured, gel-filled permanent prostheses. For medical reasons, e.g. capsular contraction, incorrectly placed or sized implant, an additional operation was performed, and then biopsy specimens from the capsules around the prostheses were taken and subsequently examined with the aid of the light and transmission electron microscope (TEM). A histologist was able to classify blindly 11 capsules out of 13 which were investigated by light microscopy in the correct groups and several differences between the capsules were found. Capsules around the smooth implants had a clear line of separation between the inner surface and the prosthesis, and formed a single collageneous layer. They were sparse in fibroblasts, which were long and thin. Capsules around textured implants consisted of two layers, the outer layer being compact with long, slender fibroblasts, and the inner one looking rugged with wavy bundles of collagen often splitting from each other, and with shorter and more rounded fibroblasts. The overall thickness seemed greater compared to the capsules around the smooth prostheses, which, on the other hand, showed a greater variation in thickness. To analyze collagen fibril diameters, sample sections were photographed at magnification 22,000 x in the TEM. The fibril diameters were measured with an interactive image analysis system (IBAS). The mean diameter of the collagen fibrils was 47.2 nm in the capsules around the smooth prostheses and 51.7 nm in the capsules around the textured prostheses.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2003

Comparison of tissue integration between polyester and polypropylene prostheses in the preperitoneal space.

Tissue integration and implant characteristics of various biomaterials commonly used for inguinal hernia repair have not been studied extensively. The aim of this study is to compare behavior and tissue response between two new polyester prostheses and a commonly used polypropylene (PP) mesh. The polyester prostheses utilized were polyester flat (PF) and polyester soft three-dimensional (PS); the PP mesh utilized was Marlex. Eight randomly assigned 4 x 4-cm2 pieces of two different meshes were fixed in the preperitoneal space with a centrally placed single suture. Gross evaluation included shrinkage and stiffness. Histological evaluation included amount of fibrous and fat encapsulation, connective tissue, foreign-body reaction, neovascularization, hemorrhage, necrosis, and exudate. Evaluations were graded on a zero to four scale. The area and the area ratio were measured using a calibrated micrometer. PP mesh resulted in more fibrous encapsulation and stiffness than PF and PS prostheses. PP also resulted in less connective tissue formation and foreign-body reaction than PF and PS prostheses. There was no difference in fat encapsulation, necrosis, hemorrhage, or exudate between prostheses. Both polyester prostheses (PF and PS) have better tissue integration than the PP mesh, as evidenced by the higher amount of connective tissue and lower extent of fibrous encapsulation.

Animals↗
PubMed1981

[Silicone ureteral prostheses: results of an experimental study of tolerance and surface conditions over six years, and clinical use for four years (author's transl)].

Two main points of interest are discussed more particularly in this report. Results of the experimental use of spiral prostheses in dogs are presented, studies having been conducted for a period extending over nearly six years, this being longer than any known previous study on this type of prosthesis. Those carried out by the Rhone Poulenc Centre lasted for three years. In this series, four prosthesis were studied for 30 months and two for 70 months. At the same time, the results of the use of straight prostheses in humans over a period of 4 years are also analyzed. Furthermore, the experimental study included a relatively complete ultrastructural study of these prostheses after they had been in contact with the dog's urine for six years, the surface being examined by electron microscopy, and the resulting lipidic deposits analyzed biochemically. The data obtained is used in an attempt to respond to two questions concerning ureteral replacement by silicone prostheses: the effect on the silicone of contact with urine after 6 years, and the possible extension or restriction of use of theses prostheses in humans as a result of the information obtained. The conclusions reached are that the quality of these prostheses has been confirmed and that their valid conception permits continuing clinical application. The indications are limited, however, by reflux and the alterations, even though minimal, appearing on their surface. Lipidic deposits are visible both macroscopically and by electron microscopy, and these could be the starting point for calcaneous incrustation after longer periods of use. Indications should be presently restricted, therefore, to patients with neoplastic lesions.

Aged↗
PubMed1993

Diagnosis and therapy of subclinically infected prostheses.

We believe 5 to 7 percent of prosthetic devices are "subclinically" infected by Staphylococcus epidermidis. These infections are manifested by chronic pain, migration and late extrusion of the devices. To examine this problem, we cultured penile and mammary prostheses. For the experimental arm, we cultured painful penile and mammary prostheses that were being removed because of symptoms (pain). For patients in a control group, we cultured penile prostheses being replaced because of mechanical failure (no pain) and mammary tissue expanders that were temporarily installed. Actual parts of the device were cultured in Trypticase Soy Broth. There were 14 and 12 painful penile and mammary prostheses, 13 and ten, respectively, were cultured positive, for an infection rate of 88 percent. The primary organism identified was S. epidermidis. The nonpainful penile prostheses (zero of five and three of 22 mammary prostheses) grew S. epidermidis. The differences were highly significant (p < 0.001), suggesting that the painful prosthesis is infected. In an attempt to resolve the problem of the painful prosthesis, ten prosthesis were removed and exchanged for new devices. Patients received preoperative and postoperative antibiotics. All ten had positive cultures and nine of ten were successfully exchanged (no pain).

Adult↗
PubMed2001

Air-flow resistances of silicone rubber voice prostheses after formation of bacterial and fungal biofilms.

Laryngectomized patients use silicone rubber voice prostheses to rehabilitate their voice. However, biofilm formation limits the lifetime of voice prostheses by causing leakage or an increased air-flow resistance and the prosthesis has to be replaced. To determine which bacterial or yeast strains, isolated from explanted voice prostheses, contribute most to increases in air-flow resistance of silicone rubber voice prostheses, biofilms consisting of either a bacterial or a yeast strain were grown on voice prostheses in the artificial throat model. The effects of these biofilms on air-flow resistances were determined by calculating the difference in air-flow resistance of the individual voice prosthesis as covered with a 7-day-old biofilm with the situation prior to biofilm formation. Conspicuously, voice prosthetic biofilms formed by the bacterial strains Staphylococcus aureus GB 2/1 and Rothia dentocariosa GBJ 41/25B and their excreted organic matter showed larger increases in air-flow resistance (more then 30 cm H(2)O.s/L) than biofilms formed by Candida species. This is contrary to the literature, where there seems to be agreement that Candida species are mainly responsible for clinical failure of silicone rubber voice prostheses.

Bacteria↗
PubMed1989

Cobalt, chromium, and nickel concentrations in body fluids of patients with porous-coated knee or hip prostheses.

Co, Cr, and Ni concentrations were determined by electrothermal atomic absorption spectrophotometry in serum and urine specimens collected from a group of 28 patients at intervals of from 1 day to 2.5 years after total knee or hip arthroplasty with porous-coated prostheses fabricated of Co-Cr alloy (ASTM F-75-82). Two control groups were also tested: (a) 42 healthy adults and (b) 16 orthopaedic patients after total knee or hip arthroplasty with porous-coated prostheses fabricated predominantly of Ti-Al-V alloy (ASTM F-136-84). All prostheses contained polyethylene components to avoid metal-to-metal contact. Mean Co concentrations in serum and urine were slightly increased in patients with Co-Cr knee implants at 6-120 weeks after surgery, compared with (a) preoperative values, (b) corresponding values in patients with Co-Cr hip implants, and (c) corresponding values in control patients with Ti-Al-V knee and hip prostheses. Substantially increased Co levels were observed in serum and urine of two patients at 7 weeks and 22 months postarthroplasty, associated with loosening of the prostheses; one of the patients also had elevated Cr levels in serum and urine. Although ASTM F-75-82 and F-136-84 alloys contain very little Ni (less than 1.0 and less than 0.2% Ni, respectively, by wt), mean Ni concentrations in serum and urine were greatly increased at 1-2 days after implantation of Ti-Al-V and Co-Cr prostheses, diminishing by 2 weeks. The postoperative hypernickelemia and nickeluresis may reflect contamination of the operative field with Ni-containing particles from the drills, cutting jigs, and drilling jigs, or it may represent a previously unrecognized pathophysiological response to surgery.

Adult↗
PubMed2006

[Shoulder prostheses].

The design of shoulder prostheses has been developed through four generations which mirror adaptation to our increasing knowledge of the biomechanics of the shoulder joint. Modern shoulder prostheses are adapted to the size, inclination, posterior offset, and retrotorsion of the shoulder. The main reasons for implantation of a shoulder prosthesis are primary osteoarthritis, posttraumatic and rheumatoid arthritis, avascular necrosis, instability arthritis and cuff defect arthropathy. Typical implants are cup prostheses for surface replacement, anatomical stem prostheses, and reverse prostheses. Total prostheses are functionally better as soon as the arthritis involves the glenoid, whereas hemiprostheses should be preferred as long as the glenoid is intact. The stem is mostly cemented, whereas in younger patients with good bone quality a cementless stem may be used. Cemented glenoids may be considered as standard.

Arthritis, Rheumatoid↗