Professor Dr Aristotelis Kaisidis, Adjunct Professor and specialist in orthopedics and trauma surgery, is an expert in the field of shoulder surgery and a driving force behind the development of innovative treatment methods. As Head of the renowned Clinic for Shoulder Surgery at the Frankfurt Red Cross Hospitals, he specializes in various areas of shoulder surgery, including shoulder arthroplasty, shoulder arthroscopy, shoulder stabilization, rotator cuff tears, sports injuries, shoulder trauma, tendon transfers, conservative shoulder therapy and shoulder diagnostics.
His extensive expertise and innovative approach enable him and his highly specialized team to successfully treat a wide range of shoulder conditions and injuries. Under the leadership of Professor Dr Kaisidis, the Clinic for Shoulder Surgery is distinguished by a comprehensive clinical structure that ensures effective and patient-centered care. The clinic is equipped with state-of-the-art surgical equipment and instruments, which are continuously updated to keep pace with the latest technologies.
A pioneering feature of the clinic is the modern SVF (Stromal Vascular Fraction) autologous fat stem cell therapy. This innovative treatment method has proven to be extremely effective in the treatment of osteoarthritis, soft tissue defects and other shoulder problems. The use of the body’s own resources facilitates improved regeneration and healing.
The Clinic for Shoulder Surgery performs around 700–800 shoulder operations annually and, with approximately 5,000 outpatient consultations with shoulder patients per year, has set a record across Germany. This impressive caseload underscores the high demand and the trust that patients place in the clinic’s expertise. The extensive experience and specialist knowledge of Professor Dr Kaisidis and his team make them sought-after contacts for well-founded second medical opinions on shoulder pathologies and the various treatment options.
The editorial team of the Leading Medicine Guide took the opportunity to learn about conservative and surgical treatments for the shoulder and spoke with Prof. Dr Kaisidis.
In addition to surgical procedures, there are various non-surgical treatment methods that have proven particularly effective in managing shoulder osteoarthritis. “Classic conservative treatment methods include hyaluronic acid injections, cortisone injections and physiotherapy. Among the more modern treatment options are autologous blood therapies or injections. Many professional athletes frequently resort to these, but they are also used for people who are not particularly active in sport and who suffer from osteoarthritis and other soft tissue pathologies and defects, and are suitable for all age groups. All of this can be complemented with modern high-energy laser therapies and, where appropriate, magnetic field therapies,” says Prof. Dr Kaisidis, adding the following regarding the individual treatments:
“Hyaluron has specific indications. It is used for Kellgren grade 2–3 osteoarthritis, and it is not really a painkiller; rather, it works a bit like oil in an engine – it lubricates and has anti-inflammatory properties, though it is significantly less effective at relieving pain than, for example, cortisone. Cortisone is administered in combination with a local anesthetic, which acts directly on the pain but is not at all long-lasting (nor is hyaluronic acid, for that matter), though it does relieve acute pain. And one hopes that the pain relief lasts as long as possible – for how long, that remains to be seen. No more than 3–5 injections should be given within a year, and only in a few cases more than five times a year. If we then look at autohaemotherapy, this is a step above in terms of long-term effectiveness, as we have a biological means of suppressing inflammation. And osteoarthritis is a form of aseptic inflammation. To make the right choice of treatment, it is important to discuss the patient’s perceived pain level, as well as their lifestyle and occupational activities, and to tailor the treatment individually to the patient. If you then combine hyaluronic acid or cortisone with high-energy laser therapy, this increases the effectiveness of the entire treatment. Or you can combine hyaluronic acid with cortisone. It always depends on how experienced the doctor is with the specific joint and with the treatment options.”
In addition, regular physical activity and weight loss can reduce the strain on the shoulder joint and alleviate the symptoms of shoulder osteoarthritis. The effectiveness of treatment methods can vary from person to person, and in some cases surgical intervention may be necessary, particularly in cases of advanced osteoarthritis with deformities. “During the course of treatment, the patient should carry on doing everything they would normally do. We always want to test the therapy under real-life conditions; otherwise, we have no way of knowing whether the therapy is effective in real-world situations, nor do we have the opportunity to adapt it. Certain sports should not necessarily be practiced too intensively, such as weight training; in such cases, the patient can scale back a notch or two. Physiotherapy, whether exercise therapy or manual therapy, is also a form of supportive exercise that often takes place alongside the treatment,” recommends Prof. Dr Kaisidis.
SVF autologous fat stem cell therapy (Stromal Vascular Fraction).
“Autologous fat stem cell therapy, known as SVF (Stromal Vascular Fraction), is not actually that new. SVF has been available in Germany for around ten years, and it has been around for much longer in the USA and the UK. This is a pioneering method at the Maingau Clinic, particularly for people with osteoarthritis. This condition often affects the body’s large joints, such as the knee, hip and shoulder, where it leads to cartilage damage. The body’s own stem cells and progenitor cells are extracted from adipose tissue. These stem cells have similar properties to stem cells from bone marrow. They can differentiate into cartilage, bone and muscle cells and thus regenerate the joint. “A significant advance in the treatment of osteoarthritis,” explains Prof. Dr Kaisidis.
SVF therapy is a regenerative procedure that utilizes stem cells from the body’s own adipose tissue to repair this cartilage damage. The isolated stromal vascular fractions (SVF) from adipose tissue contain various regenerative cells, including mesenchymal stem cells, which are known for their reparative properties. By injecting these cells into the affected joint, SVF therapy can effectively treat osteoarthritis, inhibit inflammation and promote regeneration.
“SVF therapy is a purely biological, sustainable treatment without any additives. It is performed under local anesthetic, whereby a small amount of adipose tissue is extracted from abdominal fat directly beneath the skin, approximately 30–40 ml. After processing by centrifugation, approximately 1.5–2 million of the patient’s living stem cells are obtained and injected directly into the affected joint. These stem cells possess enormous regenerative power, and cartilage, mucous membranes and joint capsules regenerate, giving this therapy a success rate of approximately 70%. The indication must be absolutely correct here – mainly patients with grade 3 and 4 osteoarthritis are treated. After the treatment, which lasts approximately one hour, the patient goes home and carries on with their life as normal. The first signs of improvement become apparent within the first 1–3 months. “In 2020, there was a comprehensive meta-analysis examining 7,800 patients from 180 renowned studies with regard to the success rate, which yielded a 70% success rate,” reports Prof. Dr Kaisidis.
The effects can last for years and be prolonged through regular booster treatments with platelet-rich plasma. Prof. Dr Kaisidis highlights the effectiveness of this therapy for various shoulder problems and emphasises the possibility of using the body’s own resources to promote regeneration and healing.
The development of modern imaging techniques such as magnetic resonance imaging (arthro-MRI) and ultrasound has significantly improved the diagnosis and management of shoulder osteoarthritis.
These technologies enable doctors to obtain detailed images of the shoulder joint, allowing them to precisely identify, classify and assess osteoarthritis and associated changes within the joint. With the help of MRI scans, doctors can not only determine the severity of osteoarthritis but also identify other potential issues such as ligament injuries or inflammation within the joint. This enables a more accurate diagnosis and helps doctors to develop a personalized treatment plan. Furthermore, MRI imaging can also be used during the course of treatment to monitor the effectiveness of the therapy and make adjustments where necessary. Modern ultrasound diagnostics offers an alternative imaging method that can be particularly useful for detecting soft tissue injuries and inflammation in the shoulder joint. Compared to MRI, modern ultrasound diagnostics is often more cost-effective and can be performed in real time, making it a practical tool for investigating shoulder problems.
“MRIs are now high-resolution – the standard in Germany is 1.5–3 Tesla; in specific cases, an arthro-MRI can also be used (contrast agent injected into the joint). This allows shoulder pathologies to be detected and classified. 7-Tesla MRIs are rather rare in Germany. Personally, I first encountered this high-resolution form of MRI with 7 Tesla 17 years ago in Dubai, when I was invited to a private clinic there. At that time, only 1.5 Tesla MRIs were available in Germany,” explains Prof. Dr Kaisidis.
Physiotherapy interventions play a crucial role in the multimodal treatment of shoulder osteoarthritis.
Through targeted exercises and techniques, physiotherapists can help to improve the mobility and function of the shoulder joint, alleviate pain and enhance patients’ quality of life. An important component of physiotherapy for shoulder osteoarthritis involves exercises to strengthen the complex shoulder musculature. These include, for example, isometric exercises, which gently strengthen and build up the muscles and joints, as well as dynamic exercises that more actively improve the mobility and strength of the shoulder joint. In addition, specific exercises can help improve posture and coordination. Another important technique in the physiotherapy treatment of shoulder osteoarthritis is manual therapy. This involves the use of targeted manual techniques to improve the mobility of the shoulder joint, release tension and promote blood circulation in the tissues. These include, for example, mobilization techniques, soft tissue techniques and fascial techniques.
“Physiotherapy can help at almost every stage of osteoarthritis, sometimes more, sometimes less. This is because physiotherapy has the ability to strengthen, build up and treat the muscles of the shoulder girdle, thereby relieving mechanical stress on the joint. You can think of this in terms of a car: the better the shock absorbers, the less you feel the bumps and the smoother the ride. That’s how you should picture the muscle sheath around the shoulder. The patient is also given a rehabilitation program to follow at home, so that they can carry out the relevant exercises themselves following prior instruction. The patient is also advised on the best ways to relieve pressure or how to lift objects. This then serves as a means of pain prevention,” says Prof. Dr Kaisidis regarding the possibilities offered by physiotherapy.
In addition to exercises and manual therapy, other physiotherapy measures such as electrotherapy, thermotherapy and hydrotherapy can also be used to relieve pain and improve function. Furthermore, patient counseling plays an important role in motivating patients to adopt an active lifestyle and supporting them with self-management strategies. Physiotherapy treatment for shoulder osteoarthritis is aimed at alleviating symptoms, improving the mobility and function of the shoulder joint, and enhancing patients’ quality of life.
Minimally invasive arthroscopy has emerged as an important surgical option for the treatment of shoulder osteoarthritis and offers a number of advantages and disadvantages compared to traditional open surgery.
Arthroscopy allows surgeons to visualize the affected joint through small skin incisions using an arthroscope, a flexible instrument with a camera and light at the end. This allows for a detailed examination of the joint and the performance of various surgical procedures to alleviate the symptoms of shoulder osteoarthritis.
“Fortunately, the most common shoulder operations are not those for osteoarthritis. Here, it is primarily tendon and ligament tears, general injuries or fractures, dislocations, instabilities, bursitis and impingement syndromes, all of which can be treated with minimally invasive surgery. The most challenging procedures are tendon transfers, which are specialized operations as they involve tendons in the shoulder that can no longer be repaired. When it comes to surgery for osteoarthritis, a joint replacement is used, which we also perform here in Frankfurt am Main using a highly minimally invasive technique with very fine and small incisions. The artificial joints themselves are also becoming smaller and smaller, and the operation takes very little time, around 40–60 minutes. A revision operation takes correspondingly longer. The hospital stay is limited to around 5–7 days, followed by rehabilitation, which can be carried out on an inpatient or outpatient basis. The surgical techniques are the same across all age groups. “With osteoarthritis, one simply has to determine the type – for example, whether tendons have already torn – and then adapt the prosthesis type accordingly,” explains Prof. Dr Kaisidis, adding: “We implant around 200 joints a year, although it must be noted that this figure is enormous for shoulder joint replacements, as most clinics perform only around 30 of these operations a year. Our patients come to us from all over Germany. On the one hand because of the high level of expertise we have here in-house, and certainly also because we are, of course, easily accessible in Frankfurt. What we offer in-house for shoulder surgery is very rare throughout Germany, as we cover the entire spectrum, including non-surgical treatments, and we do so as a clinic rather than a limited medical facility. And, of course, we are one of the few centers with the expertise to use stem cell therapy.”
Innovative technologies and therapeutic approaches in regenerative medicine are showing promising results in the treatment of shoulder osteoarthritis.
The studies clearly indicate that they have the potential to expand the treatment options for this condition and improve the quality of life for affected patients.
Prof. Dr Kaisidis offers a forecast for the future, bringing our conversation to a close: “AI (Artificial Intelligence) will certainly play a major role in the development of implants and new materials. Unlike biomechanics, AI can simulate better with a specificity of 99.99%. This will provide an enormous boost in our field, and I hope that AI is used wisely in medicine. Unfortunately, progress is lagging a little behind because the Western world is over-bureaucratised. What used to take 1–3 years in development now requires significantly more time due to bureaucracy. It’s all moving far too slowly. Other countries are way ahead of us in this respect.”
Thank you very much, Professor Dr Kaisidis, for these fascinating insights into shoulder treatment!
