Medical Advances, Artificial Joint
By Juliett Morales García
In Cuba Clotilde is usually a woman’s name, but it is the name of a man who suffered severe osteoarthritis and, a little over two months ago, received a shoulder prosthesis and is now participating in physical therapy.
He is one of the 15 patients who have so far received this implant in Cuba, all of them operated free of course, at the “Frank País International Scientific Orthopaedic Complex (CCOI in Spanish)” in Havana.
Shoulder prostheses are used for large fractures, such as when the head of the humerus breaks into four fragments. Prosthesis is also used in cases of severe osteoarthritis, a degenerative state due to articular wear, and for rheumatoid arthritis or other types of collagen-induced arthritis, CCOI Director Rodrigo Alvarez Cambras explained to Cubaplus.
An emblematic figure of Cuban medicine and orthopaedics in particular, Professor Alvarez Cambras said these implants are made in France, sold by FH Ortophedic, but placed in local patients without charge in Cuba. This originally came about some years ago when shoulder prostheses were presented at an international orthopaedics meeting in St Maurice, France, and the CCOI began negotiations for their import.
The first results of the application of these implants were published at the 22nd International Congress of the Cuban Society of Orthopaedics held in Havana last September.
Depending on their condition, shoulder prosthesis may replace the humeral head and glenoid cavity (a shallow articular surface on the shoulder scapula, that articulates with the head of the humerus).
In some cases, as in that of Clotilde, whenever patients don’t have a structure called the rotator cuff that is critical for shoulder stability and mobility, rather than place the prosthesis anatomically, that is at the humeral head, it is placed in reverse in the glenoid cavity, explained Dr. Ricardo Tarragona, a member of Professor Alvarez Cambra’s team who has performed multiple replacement surgeries. Maybe not pitch softball, but...
Patients lead a relatively normal life, although they can’t become softball pitchers, quipped the eminent physician, who practiced the game in his youth.
Shoulder joint replacement operations in Cuba have so far been only performed at the Frank País CCOI, where they are tested. With a larger import of these prostheses, operations will be performed in other hospitals in Havana, like Hermanos Ameijeiras Hospital and Fructuoso Rodriguez Orthopaedic Hospital.
Later the technique will be introduced in other regions of Cuba, such as in Santiago de Cuba, which will cover Holguin, Las Tunas and Granma Provinces. This type of operation will also be available in the western province of Matanzas, as well as in Mayabeque and Artemisa.
Materials’ Engineering These replacements are made of titanium and plastic or stainless steel, said the scientist. He added that the titanium ones do not need surgical cement and are placed in young people, because the implants must be replaced after 25 years. The stainless steel replacements, also with plastic, are cemented implants.
Cementless titanium replacements contain hydroxyapatite, a mineral formed by crystalline calcium phosphate representing 99% of body calcium and 80% of total phosphate, and is used in the creation of biomaterials. Alvarez Cambras explained that hydroxyapatite is largely applied in extensive surgery as in orbital or orthopaedic implants.