METHOD FOR SURGICAL TREATMENT OF SHOULDER JOINT ARTHROSIS WITH INSTALLATION OF INDIVIDUAL TITANIUM AUGMENT Russian patent published in 2024 - IPC A61B17/56 A61F2/40 

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to traumatology, orthopaedics, and can be used for surgical treatment of shoulder joint arthrosis with installation of individual titanium augment. Anatomically correct implantation axis of the virtual model of the glenoid component of the prosthesis – an individual titanium augment – is determined on the virtual computer model of the shoulder joint. Virtual implantation of a model of an individual titanium augment is performed into an articular process of a scapula with imitation of a plasty of the articular process of a scapula involved in the pathological process with verification of its correctness. Individual augment is made from a titanium alloy, which repeats the shape of the inner surface of the metaglene on one side and the shape of the deformed glenoid on the other side. Titanium augment is equipped with a central axial round hole for subsequent reaming of the hole in the articular process of the scapula with diameter of 6.8–7.2 mm for placement of the metaglene leg during its surgical implantation, individual augment is equipped with 2-3 curved fixing hooks arranged along the front edge for fixation of the individual augment on the glenoid during the surgical intervention. Deltopectoral approach to patient's shoulder joint is performed by incision of skin and subcutaneous fat with length of 14–16 cm with isolation of v.cephalica. Soft-tissue tenodesis of a long head of biceps is performed with Vicryl sutures, held on sutures, a subscapular muscle is cut off and mobilized, and a shoulder joint is inspected. Humeral head is dislocated into a surgical wound, cartilage remains are removed, an osteotomy of the humeral head is performed at the level of the anatomical neck, and a glenoid with periarthrolysis of the shoulder joint is separated. Remnants of cartilage on glenoid are removed. Glenoid lip is excised. Individual titanium augment is positioned with help of 2-3 curved hooks on the anterior surface on the glenoid. Canal is formed in the central hole with a drill in the glenoid with diameter of 6.8–7.2 mm and depth of 10 mm or 15 mm. In the glenoid canal on the pre-installed individual titanium augment, a pedicle of a revision metaglene with a pedicle length of 10 mm or 15 mm is implanted. Metagen is fixed with two screws with blocking and with two screws without blocking. Glenosphere with diameter of 38 mm or 42 mm is fixed to metaglene. Canal is formed in the proximal part of the humerus. Required size of the shoulder component of the prosthesis is determined. Bone cement penetration limiter BioSTOP is inserted into the cavity of the medullary canal. Medullary canal of the humerus is filled with bone cement with an antibacterial agent represented by an aqueous solution of vancomycin with concentration of 20–40 mg/ml. Prosthesis leg is cemented; a polyethylene insert is implanted and the prosthesis is reduced. Range of motion and stability of the prosthesis are checked, and the rotators are transosseously reinserted to the patient's humerus. Joint is washed with an antiseptic solution. Haemostasis. Wound closure. Active drainage and fixation of patient’s upper extremity in abduction splint. At the same time fixing screws, including those with blocking, are made of titanium alloy BT6.

EFFECT: method provides restoring the shape and anatomical function of the shoulder joint structures by creating the volume of active and passive shoulder abduction and flexion in the patient's shoulder joint, lateralizing the scapular component in the shoulder joint, increasing the lever effect of the deltoid muscle function.

2 cl, 3 ex