The editorial team of the Leading Medicine Guide learned more about modern minimally invasive procedures in shoulder surgery and innovative joint replacement in a conversation with Prof. Dr. Markus Scheibel.
Minimally invasive surgical techniques and new technologies in the field of artificial joint replacement have significantly transformed the treatment of shoulder disorders in recent years. Thanks to less invasive procedures, improved implant options, and more precise surgical methods, not only can the physical burden on patients be significantly reduced today, but functional outcomes can also be sustainably improved.
Shoulder surgery becomes necessary when conservative treatments such as physical therapy, pain medication, or injections are no longer sufficient to relieve symptoms or restore joint function. In addition to acute injuries such as fractures or tendon tears, there are many non-traumatic causes that can lead to persistent shoulder problems.
“Our shoulder and elbow surgery department at the Schulthess Klinik in Zurich covers the entire spectrum of orthopedics and trauma surgery for these joints – we consider ourselves joint generalists. While many joint specialists treat only specific sub-areas, such as cruciate ligaments, meniscus injuries, or corrective procedures at the knee, we offer all procedures for the shoulder and elbow: from fracture treatment and tendon repair to arthroscopy, endoprosthetics, and revision prosthetics.
This allows us to comprehensively treat both acute injuries and degenerative conditions. Aside from trauma-related injuries, degenerative disorders are a major reason for shoulder surgery. The most common are rotator cuff tears, often starting with the supraspinatus tendon. Larger tears may involve multiple tendons, making tendon reconstruction the most frequently performed shoulder procedure – our ‘blockbuster operation.’ Shoulder arthritis also occurs, though less commonly than in the hip or knee because the shoulder is subjected to less daily load.
In addition, there are other wear-related conditions such as bursitis, calcifications in the shoulder, or the so-called frozen shoulder. These conditions share typical symptoms: pain, restricted mobility, and often noticeable weakness. They frequently arise from age-related degeneration, chronic overuse, or inflammatory processes.
Common conditions include rotator cuff tears, shoulder osteoarthritis, impingement syndrome with painful narrowing of tendons under the acromion, and calcific tendinitis. Chronic shoulder instability due to congenital ligament laxity or repeated dislocations can also lead to significant limitations.
Symptoms often present as persistent pain, particularly during overhead movements or at night, especially when lying on the affected side. Patients frequently report increasing limitations in mobility, loss of strength, and sometimes a sensation of instability in the joint. Sounds or a grinding sensation within the shoulder may indicate structural changes“, explains Prof. Dr. Scheibel at the beginning of our conversation, and continues with diagnostics:
„We typically begin with a clinical examination and a detailed patient interview. This combination of medical history and physical assessment already allows us to estimate the underlying condition with high accuracy – whether it is bursitis, a tendon tear, or arthritis. Based on this evaluation, further diagnostics follow. In most cases, a standard X-ray is taken first. For tendon-related issues, ultrasound or MRI is often used next, while CT scans may be helpful when bone abnormalities are suspected“.
Minimally invasive techniques have fundamentally transformed shoulder surgery in recent years and offer several significant advantages over traditional open surgery – both medically and from a patient-centered perspective.
The key difference lies in the surgical approach: While open surgery requires larger skin incisions and wide exposure of anatomical structures, minimally invasive procedures – particularly arthroscopy – use very small incisions and a camera that projects a high-resolution image of the surgical field onto a monitor. This allows structures inside the shoulder joint to be evaluated and treated with great precision while minimizing trauma to surrounding tissue.
„Various strategies are available depending on the surgical technique. The basic rule is: not every condition requires surgery – conservative treatments are always preferred when possible. For tendon tears or advanced arthritis causing severe symptoms, surgical options are considered.
One common procedure is minimally invasive tendon reconstruction, meaning arthroscopic tendon repair. Using keyhole techniques produces excellent outcomes, while significantly reducing complications such as infections. Scarring and secondary frozen shoulders also occur less frequently, allowing patients to regain mobility and function more quickly.
Many tendon repairs can now be performed on an outpatient basis, enabling patients to return home the same day. In some cases, inpatient treatment is recommended depending on the individual findings and needs“, notes Prof. Dr. Scheibel.
Intraoperative control and precision also benefit from the technological capabilities of minimally invasive procedures. The arthroscopic camera provides enlarged, high-resolution images of the joint interior, allowing a detailed assessment of even the smallest defects. As a result, accompanying injuries that might be missed during open surgery can be identified and treated at the same time.
This is particularly advantageous for complex shoulder conditions such as combined tendon and cartilage damage, joint instability, or inflammatory processes. Minimally invasive surgery is also beneficial for certain risk groups, such as elderly or medically compromised patients, where tissue-sparing techniques are especially important.
In recent years, both the technologies and materials used in shoulder prostheses have undergone significant advancements, directly improving durability, functionality, and customization of implants. Progress in materials science, implant design, and computer-assisted planning has enabled modern shoulder prostheses to be better tailored to each patient’s anatomy while offering increased longevity.
Prof. Dr. Scheibel explains: „Shoulder prostheses are used when patients experience significant discomfort and conservative treatment options have been exhausted. Ideal candidates are those with severe arthritis, where X-rays show a clearly destroyed joint, and who suffer from pain, restricted mobility, and loss of strength.
The goal of the prosthesis is to relieve pain, improve mobility, enhance quality of life, and reintegrate the patient into daily activities. Recently, prostheses have become increasingly bone-sparing, especially on the humeral side, and many anatomic prostheses today are stemless, requiring less metal for fixation.
The glenoid component has also benefited from new developments that improve prosthesis longevity. Traditional materials include cobalt-chrome alloys for the head and polyethylene for the gliding surface. In clinical practice, far more reverse prostheses are used than anatomic ones – approximately 85–90% versus 10–15%. Registry studies show that reverse prostheses last longer, while anatomic prostheses are more prone to loosening, particularly on the plastic glenoid component.
Another modern innovation is the use of pyrocarbon heads. These softer surfaces can be used in partial prostheses, improve long-term outcomes, and reduce the risk of loosening“.
Difference Between Anatomic and Reverse Prostheses
An anatomic prosthesis replicates the natural structure of the joint: the humeral head is replaced with a metal ball, and the glenoid receives a plastic socket. This approach is most suitable when the rotator cuff and other tendons are still intact, as the joint can function normally. A reverse prosthesis, on the other hand, reverses the joint geometry: the ball is placed on the glenoid, and the socket on the humerus. This allows the deltoid muscle to compensate for rotator cuff damage.
Regarding durability of prostheses today, Prof. Dr. Scheibel comments: „The durability of shoulder prostheses varies depending on the type. Anatomic prostheses often show signs of loosening between five and 15 years. This does not necessarily mean immediate replacement is required, but indicates increased vulnerability to loosening over time.
Fixation techniques remain a limiting factor for anatomic prostheses. Reverse prostheses, in contrast, show survival rates of over 90% after ten-year follow-up. Due to these strong long-term results, reverse prostheses are now used far more frequently, while anatomic prostheses – aside from special pyrocarbon variants (a carbon-based material similar to natural bone in certain properties) – are less common“.
Preoperative planning using modern imaging and computer-assisted navigation is becoming increasingly important in shoulder surgery and can significantly improve surgical success. High-resolution imaging such as CT or MRI provides detailed, three-dimensional visualization of the shoulder joint’s anatomical structures.
Robotics is becoming increasingly relevant in shoulder surgery, particularly in joint replacement.
Prof. Dr. Scheibel comments: „Initial applications already exist in the U.S., where robots precisely prepare joint surfaces. The surgeon can then implant the prosthesis minimally invasively and with greater tendon preservation. However, the technology is still in an early developmental stage and is far less advanced than in knee surgery.
Artificial intelligence (AI) plays a role at all stages – before, during, and after surgery. Currently, the focus is on preoperative planning: AI can analyze patient data and joint changes to suggest implant selection, positioning, and component configuration. Intraoperative and postoperative AI applications are also being developed, such as tools for rehabilitation or outcome prediction. However, scientific validation of these AI concepts is still pending“.
Postoperative rehabilitation plays a central role in minimally invasive shoulder surgery and is a crucial factor for long-term treatment success. Due to the tissue-sparing nature of these procedures and reduced postoperative pain, rehabilitation can often begin earlier and more actively compared to traditional open surgery.
Prof. Dr. Scheibel explains what happens after shoulder surgery: „Following shoulder surgery, particularly after prosthesis implantation, patients typically undergo a structured rehabilitation program.
The goal is to gradually restore mobility, strength, and coordination of the shoulder. With modern prosthetic systems, nearly normal shoulder function can be achieved today – many patients report mobility that feels 95 to 98 percent like a healthy shoulder. However, slight functional limitations may remain in some cases. Consistent aftercare, collaboration with physical therapists, and patience during recovery are key to success.
Studies and follow-up evaluations show that most patients resume sports after receiving a reverse shoulder prosthesis. Approximately 85 to 90 percent can return to activities such as golf, tennis, or skiing without restrictions. Even under higher loads, increased loosening rates have generally not been observed, underscoring the stability and longevity of modern implants“.
The optimal balance between rest and loading is essential to avoid jeopardizing healing while restoring shoulder function as effectively as possible. Close cooperation between the medical team, physical therapists, and patients is indispensable to ensure a successful rehabilitation process and achieve sustainable treatment outcomes.
Today, Prof. Dr. Markus Scheibel works primarily at the renowned Schulthess Klinik in Zurich – the largest center for shoulder and elbow surgery in Switzerland. Around 1,800 shoulder and elbow procedures are performed there each year – an impressive number even by international standards, highlighting the clinic’s high level of specialization.
„I previously worked for many years at Charité – Universitätsmedizin Berlin, where I helped develop the shoulder and elbow surgery division. I still maintain strong ties to Charité: I continue to operate there once a month and also treat patients. At the Schulthess Klinik in Zurich, where I now serve as Chief Physician, we place great importance on quality assurance. All our patients are systematically recorded in a registry and followed up over extended periods.
This enables us to objectively evaluate treatment outcomes and make targeted improvements – a quality standard that is not yet widespread in Switzerland. I would also like to highlight our organ-specialized concept: At the Schulthess Klinik, all colleagues specialize in a specific joint or anatomical region – such as shoulder and elbow, knee, hip, or hand.
This focus enables us to diagnose and treat injuries and conditions with exceptional precision, regardless of whether they are trauma-related or degenerative“, emphasizes Prof. Dr. Scheibel, concluding our conversation.
Thank you very much, Professor Dr. Scheibel, for your valuable insights into shoulder surgery!
- Recognized expert in shoulder and elbow surgery, a leading specialist in German-speaking countries.
- Treats acute injuries, degenerative conditions, and trauma-related disorders of the shoulder, shoulder girdle, and elbow at Charité Berlin.
- Specialized in modern conservative therapies as well as complex surgical procedures.
- Extensive experience in arthroscopic and minimally invasive procedures as well as joint replacement, including revision surgeries.
- Many years of clinical experience; nationally and internationally sought-after expert at conferences and in scientific committees.
- Secretary General of the D-A-CH Association for Shoulder and Elbow Surgery (DVSE), actively contributing to the field's advancement and professional exchange.
- Focus on continuous improvement of patient care.
- Organizes and lectures at numerous specialist events, promoting the dissemination of innovative treatment methods.
- Expertise in minimally invasive shoulder procedures and innovative joint replacement.
