The Shoulder Surgery Clinic, headed by Prof. Dr Aristotelis Kaisidis, Chief Physician at the Frankfurt Red Cross Hospitals, is a pioneer in the field of shoulder surgery. With extensive expertise and specialization in various areas of shoulder surgery, including shoulder arthroplasty, shoulder arthroscopy, shoulder stabilization, rotator cuff tears, sports injuries, shoulder trauma, tendon transfers and conservative shoulder therapy, the clinic offers a wide range of treatment options for shoulder conditions and injuries.
Under the leadership of Prof. Dr Kaisidis, the clinic is distinguished by a comprehensive clinical structure comprising a highly specialized team of doctors, nurses, therapists and specialist staff. This dedicated team specializes in shoulder treatments and provides patient-centered care of the highest quality. A key feature of the clinic is its use of innovative treatment approaches, including the surgical method developed by Prof. Dr Kaisidis using the Kaisidis plate. This method is characterized by minimal invasiveness and high efficacy and is successfully used for fractures. The clinic is equipped with state-of-the-art surgical equipment and instruments, which are continuously updated to keep pace with the latest technologies. In addition to surgical procedures, the team is also proficient in modern conservative treatment approaches and offers individually tailored therapy programs to promote flexibility, mobility and muscle strength.
With around 700 shoulder operations of varying degrees of difficulty performed each year and approximately 5,000 outpatient consultations with shoulder patients annually, the clinic sets the highest standards for optimal shoulder care. This impressive caseload underscores the trust patients place in the clinic’s expertise, as well as the high demand for the highly qualified services provided by Prof. Dr Kaisidis and his team. The clinic’s extensive experience and expertise make its specialists sought-after contacts for well-founded second medical opinions on shoulder pathologies and the various treatment options. Patients can be confident that their well-being is the clinic’s top priority and that its dedicated team is committed to relieving pain and restoring quality of life.
The editorial team at Leading Medicine spoke with Prof. Dr Kaisidis and learnt more about shoulder conditions and their successful treatments.
Shoulder conditions such as tendon tears, osteoarthritis, instability and fractures can cause significant limitations in shoulder function and severe pain. Targeted and early treatment is crucial to avoid long-term complications and improve the quality of life of those affected. Modern medicine offers a wide range of minimally invasive therapies and surgical techniques that enable precise and effective treatment of these shoulder conditions. The right choice of appropriate therapy or surgery depends on various factors, including the type and severity of the condition, the patient’s age and health, as well as individual preferences and circumstances. A holistic approach that takes the patient’s needs into account and incorporates state-of-the-art treatment methods with the highest level of expertise, such as at the Frankfurt Red Cross Clinic, which specializes in shoulder surgery, is crucial for the successful treatment of shoulder conditions.
There is a wide range of minimally invasive treatment options for shoulder conditions such as tendon tears, osteoarthritis, instability and fractures, which can be selected depending on the nature and severity of the condition, as well as the patient’s individual needs.
“There is a wide range of treatment options for tendon tears, osteoarthritis, instability and fractures. Tendon tears and instability can be treated using arthroscopy (keyhole surgery), while osteoarthritis and fractures are less commonly treated using this technique. Recovery time is at least 50% shorter with minimally invasive techniques compared to open methods. The effectiveness is also higher because the camera-assisted minimally invasive technique allows a wider view of the joint and access to corners and areas that are much more difficult to reach with open techniques. Consequently, the effectiveness is significantly increased. In cases of mild osteoarthritis, there is also the minimally invasive option known as microfracturing, in which the affected area is drilled into. “This stimulates the bone marrow, triggers repair mechanisms, and new cartilage tissue forms,” explains Prof. Dr Kaisidis, before going on to describe the unique feature of the Kaisidis plate he developed: “In the case of fractures, plates can be used. In the case of a humeral head fracture, for example, the use of ‘my’ Kaisidis plate with mini-incisions (3–4 cm) can be beneficial. There are, of course, other plates available, but these require larger incisions (15–20 cm) as the plates are significantly larger. This is not ideal for the patient, as the recovery time is automatically prolonged with larger incisions.”
The Kaisidis plate, a small titanium plate, was specifically designed for certain fractures of the humeral head and enables minimally invasive treatment. This innovative solution was developed by Chief Physician Prof. Dr Kaisidis. The biomechanical properties and design of the plate were published in ‘The Open Orthopedics Journal’ in 2018. It is noteworthy that the plate was named after its developer during his lifetime, which is rather unusual.
Deciding on the most appropriate minimally invasive therapy or surgery for a patient with a specific shoulder condition requires a careful assessment of several factors.
Firstly, it is important to determine the exact nature of the shoulder condition and the severity of the symptoms. “This comes down to the experience of the individual surgeon, the number of shoulder operations they have performed to date, how many surgical techniques they have mastered, and how proficient they are in them, in order to be able to make a truly accurate assessment. Here at the Frankfurt Red Cross Clinic, we always aim to use the least invasive technique possible for the patient. In the operating theater, it can happen that the treatment needs to be adapted and we have to extend the procedure slightly. But even the open surgeries are ‘mini-open’. Only in some cases involving very complex tendon tears occurring across multiple levels do we often need to combine ‘mini-open’ and arthroscopic techniques. It depends on the complexity of the condition whether the procedure sometimes needs to be extended,” says Prof. Dr Kaisidis.
In cases of severe tendon injuries or irreparable tendon tears, a tendon transfer may be necessary to restore the function of the shoulder joint. This involves taking an intact tendon from another part of the body and transferring it to the damaged area in the shoulder. The classification of tendons prior to surgery is often based on the so-called Pate system, which describes different grades of tendon injury. This classification helps doctors choose the right treatment strategy, with imaging such as ultrasound or MRI often being used to accurately assess the injury.
“With tendon tears, the tendon usually tears away from its insertion point. When we then want to reconstruct or reattach it, we suture the tendon back to its original site on the humeral head – the tendon is thus reattached to the bone. This can be done using simple sutures or fine anchors. Medical-grade plastic or titanium can also be used. In any case, the tendon is reattached to the bone. Not every tendon is repairable. This is why we have the Pate classification, which is already known before the operation thanks to the MRI scan. So, with a Pate-2 classification, we know that fixation is possible, whereas this is not possible with a Pate-3. We also always explain to our patients that there is a time limit for repairing tears in the main tendons of the shoulder. There is only a specific window of opportunity. If this window is ‘missed’, then the tendon can no longer be reconstructed. However, we are not in favor of so-called artificial bio-patches, which are used elsewhere, because the results are very poor; we therefore resort to tendon transfers from other parts of the body in such serious cases. These are certainly ‘exotic operations’ that do not take place every day, although many patients are referred to us for this purpose, as we, as a shoulder clinic, possess the necessary expertise for such a procedure.
The risks and potential complications of the various minimally invasive treatment options for shoulder conditions can vary depending on the type of procedure.
Despite the minimally invasive nature of the procedures, there is a risk of post-operative infection with all surgical procedures. This can lead to pain, swelling and further complications. Bleeding or the formation of hematomas may occur during or after the operation, particularly in the first few days following the procedure. With minimally invasive surgery, there is a risk that surrounding tissue, such as nerves, blood vessels or muscles, may be damaged. This can lead to numbness, weakness or other neurological problems. In surgical procedures requiring the use of implants such as anchors or screws, there is a risk that these may become loose or fail, which can lead to a recurrence of symptoms and further surgery. With longer surgical procedures, there is a risk of thrombosis or embolism, where blood clots form and can travel to vital organs.
“A particular challenge for us is large tendon tears that have been reconstructed but have torn again and failed to hold. These often have to be repaired using tendon transfers or so-called water cushions, particularly if the patient is perhaps too old for a tendon transfer, has already undergone too many operations, or is biologically older than average. These water cushions then fill the space where the tendon was originally located. Loosened artificial shoulder prostheses also require a high level of expertise. But the greatest challenge of all is probably infected shoulder prostheses. Here, one must proceed in a very objective and professional manner. This is because, as a rule, the surrounding tissue or even the bone is also affected, which makes the procedure quite problematic. “Extremely high levels of experience are required here to assess what is feasible and what is not, and also to ensure that patients are not asked to endure more than is necessary,” states Prof. Dr Kaisidis.
Rehabilitation following minimally invasive shoulder surgery is crucial for a successful recovery and the restoration of shoulder function.
From the outset, the focus is on promoting movement to reduce swelling and improve blood circulation. Rehabilitation often begins shortly after the operation with gentle movement exercises. A key focus is on muscle building and stability training to strengthen the surrounding muscles and improve joint stability.
“We have our own social services team, and for patients with shoulder prostheses, we refer them to rehabilitation very quickly, which is usually one week after the operation. Our social services team, who have the relevant experience, takes care of all this. For patients with tendon tears, instabilities and fractures, rehabilitation – whether outpatient or inpatient – usually begins six weeks after the operation. We also provide all patients with follow-up treatment plans for home use, which we consider very important. It is fair to say that a patient who has had a shoulder replacement is already at a very high level of function after around five weeks (including hospital stay and rehabilitation). It then takes a little more time to return to full activity, including work. Of course, it always depends on the type of work or sport the patient wishes to pursue. Those wishing to return to office work can do so fully after 6–7 weeks, while tradespeople may need 3–3.5 months. In cases of instability and tendon tears, a little more time must be allowed. However, we offer the advantage here that our patients start rehabilitation quickly, whereas in less specialized clinics this only happens after six weeks, so everything is delayed,” explains Prof. Dr Kaisidis.
A successful recovery requires patience, perseverance and a willingness to follow the treatment team’s recommendations. Individual rehabilitation programs are developed depending on the type of procedure and the patient’s individual needs to ensure optimal recovery. Ultimately, the patient’s active participation in rehabilitation is crucial to the success of the recovery process.
There are continuous advances and developments in minimally invasive shoulder surgery, offering promising opportunities for even better treatment.
New imaging technologies such as high-resolution MRI and CT scans, as well as intraoperative imaging techniques, enable more accurate diagnoses and more precise procedures. These advances improve the safety and accuracy of operations. Another promising area is robot-assisted surgery. Robot-assisted systems are increasingly being used in shoulder surgery to enhance the precision and reproducibility of procedures. They enable surgeons to perform complex movements with greater accuracy and make smaller incisions, which can lead to faster recovery times. “The extent to which complementary AI (Artificial Intelligence) will be used remains to be seen. It is not yet possible to say exactly whether AI will play the biggest role during surgery or only in planning, although I see its use more in planning, as well as in the development of devices and design. One must always bear in mind the costs and time involved when considering the added value. But AI may well be able to develop even more effective implants in the future, the factors of which we do not yet know,” suggests Prof. Dr Kaisidis, and with that we conclude our conversation.
Thank you very much, Professor Dr Kaisidis, for the fascinating insight into shoulder surgery!
