Anatomically-designed shoulder hemiarthroplasty made after 3-D models and implanted in a child with rheumatoid arthritis. A case report

The first known report of shoulder arthroplasty is that by Pean, a French surgeon who replaced a joint destroyed by tuberculosis with a prosthesis made of platinum and plastics. In 1951, and mostly in 1974, Neer became the strongest advocate of this practice by designing his own systems. In the 1990s, knowledge on the kinematics and recognizing the significance of adjacent soft tissues involved in shoulder function, led to technique improvements having a significant impact on the outcome.
Shoulder arthroplasty is unusual at an early age. Diseases such as juvenile rheumatoid arthritis (JRA), however, warrant this treatment modality as shoulder pain and a limited range of motion significantly compromise function. The main problem is that this disease leads to bone loss that usually occurstogether with soft tissue incompetence and muscular atrophy.
The purpose of this paper is to present the case of a patient who underwent shoulder hemiarthroplasty due to JRA sequelae, and to review the literature about it.

Case Report
Male, 14-year-old patient, with a 6-year history of juvenile rheumatoid arthritis (JRA), who received several therapies beginning with anti-inflammatory agents and followed by multiple infiltrations. Multiple musculoskeletal conditions occurred due to the disease, including bilateral hip and wrist lesions, which had previously undergone arthrodesis. Both shoulders showed severe functional limitation with 15° of abduction, 10° of flexion, 10° of extension, and 15° of external rotation. According to the UCLA classification score, the patient had a score of 7, indicating poor function. The pain visual analog scale (VAS) indicated 9/10 (severe pain). Xrays revealed a severe panarticular destruction pattern and evidenced closure of the physis (Figure 1), which was confirmed by MRI.
The decision was made to place a hemiprosthesis in the left shoulder. The prosthesis was designed after the natural anatomy of the patient under the supervision of the bioengineering department of the orthopedics group in our hospital. A three-dimensional model was used for the surgery planning and optimum prosthesis manufacturing.

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http://www.medigraphic.com/pdfs/ortope/or-2005/ors051k.pdf

Hemiartroplastía del hombro a la medida, obtenida mediante modelos tridimensionales, en niño con artritis reumatoide.

El primer reporte de artroplastía de hombro que se conoce es el de Pean, cirujano francés que sustituyó una articulación destruida por tuberculosis, por una prótesis confeccionada a base de platino y plástico. Neer en 1951 y principalmente en 1974, se convierte en el mayor impulsor de esta práctica, al diseñar sus sistemas. Durante la década de los 90, el conocimiento de la cinemática y el reconocimiento de la importancia de las partes blandas adyacentes que colaboran en la función del hombro, llevó a mejoras en la técnica que redundan en el resultado.
La atroplastía del hombro suele ser rara a temprana edad, sin embargo, patologías como la artritis reumatoide juvenil (ARJ), en que el dolor del hombro y la limitación de movimiento comprometen importantemente la función, posibilitan la práctica de esta forma de tratamiento. El principal problema radica en que esta patología se acompaña  de gran deficiencia ósea, así como de incompetencia de tejidos blandos y atrofia muscular.
El objetivo de nuestro trabajo es presentar el caso de un paciente a quien se le practicó hemiartroplastía de hombro por secuelas de ARJ, y revisar la literatura al respecto.

Para conocer el resto de este artículo entra a este link:  http://www.imbiomed.com.mx/1/1/articulos.php?method=showDetail&id_articulo=29048&id_seccion=1266&id_ejemplar=2978&id_revista=84