Omuz Artriti Ve Artroplastisi
Özet
Omuz osteoartriti (OA), sinovyal eklemlerde kıkırdak kaybıyla seyreden dejeneratif bir hastalıktır ve ileri yaş ile kadınlarda daha sık görülür. Etyolojik açıdan primer ve sekonder olarak ikiye ayrılan bu rahatsızlıkta en belirgin semptom, kronik süreçte gelişen ve hareketle artan omuz ile skapular bölge ağrısıdır. Tanı aşamasında standart radyolojik grafiler çoğunlukla yeterli olurken, anatomik değerlendirme için bilgisayarlı tomografi (BT) ve manyetik rezonans (MR) görüntülemeden faydalanılır. Tedavi planlamasında hastanın yaşı, aktivite düzeyi ve patolojinin şiddeti dikkate alınır; hafif ve orta derece vakalarda öncelikle ilaç, enjeksiyon ve fizik tedavi gibi konservatif yöntemler tercih edilir. Konservatif tedaviden yanıt alınamayan ileri evre hastalarda en etkili cerrahi çözüm artroplastidir. Genç ve aktif hastalarda artroskopik debridman veya protez öncesi rahatlatıcı cerrahiler uygulanabilirken, kesin tedavi yaklaşımında eklem yüzeyinin durumuna ve rotator manşet sağlamlığına göre hemiartroplasti (HA), humeral yüzey artroplastisi, total omuz artroplastisi (TOA) ve ters total omuz artroplastisi (tTOA) seçenekleri devreye girer. tTOA, rotator manşet yırtığı ilişkili artropatilerde omuz rotasyon merkezini değiştirerek deltoid kas gücüyle fonksiyon sağlar. Cerrahi sayıların artmasıyla implant gevşemesi, instabilite ve enfeksiyon gibi komplikasyon oranlarında da artış gözlenmektedir.
Shoulder osteoarthritis (OA) is a degenerative disease characterized by cartilage loss in synovial joints, occurring more frequently in advanced age and women. Etiologically divided into primary and secondary types, its most prominent symptom is shoulder and scapular pain that develops chronically and increases with movement. Standard radiographs are usually sufficient for diagnosis, while computed tomography (CT) and magnetic resonance imaging (MRI) are utilized for anatomical evaluation. Treatment planning considers the patient's age, activity level, and pathology severity, with conservative methods such as medications, injections, and physical therapy preferred for mild to moderate cases. Arthroplasty is the most effective surgical treatment for advanced patients unresponsive to conservative therapy. While arthroscopic debridement can delay joint replacement in young, active patients, definitive surgical interventions include hemiarthroplasty (HA), humeral surface arthroplasty, total shoulder arthroplasty (TSA), and reverse total shoulder arthroplasty (rTSA) depending on joint surface status and rotator cuff integrity. rTSA provides function via deltoid muscle power by shifting the rotation center in cuff tear arthropathy. Parallel to the increasing number of surgeries, complication rates such as implant loosening, instability, and infection are also rising.
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