State-of-the-Art Joint Replacement and Precision Surgery for the Shoulder and Elbow: An Expert Interview with Dr. Christian Schoch, M.D.

Dr. Christian Schoch, M.D., is a recognized specialist in shoulder and elbow surgery as well as joint replacement. As a senior physician at St. Vinzenz Clinic in Pfronten, Allgäu, he has many years of experience treating complex conditions and injuries of these highly specialized joints. His particular expertise lies in modern shoulder joint arthroplasty, where he implants both anatomical and inverse prostheses—including innovative stemless models that allow for a less invasive approach. He is also an experienced surgeon for elbow stiffness, instabilities, and rotator cuff tears.

Dr. Schoch completed his medical studies at the renowned Albert Ludwig University of Freiburg and furthered his expertise at the Sportklinik Stuttgart, among other institutions, as well as during an international fellowship with Dr. Graham King in Canada. There, he further specialized in complex elbow surgery, an area of expertise that plays a central role in his daily work today. He has been practicing at St. Vinzenz Clinic since 2012, where he has established modern surgical techniques—ranging from minimally invasive arthroscopic procedures to challenging revision surgeries for failed prostheses or complex deformities.

Athletes, particularly those in ice hockey, also rely on his expertise. As team physician for EV Pfronten, he is thoroughly familiar with the specific challenges posed by sports-related shoulder and elbow injuries. In addition to his clinical work, Dr. Schoch is deeply involved in scientific research. He has authored numerous professional publications and regularly presents at national and international conferences. As chair of the AGA’s Elbow Commission and an active member of leading professional societies, he plays a key role in advancing orthopedic and trauma care. His goal is to provide his patients with the best possible treatment through innovative techniques and the highest precision.

The editorial team of the Leading Medicine Guide spoke with Dr. Schoch about modern joint replacement and the precision of shoulder and elbow surgery today.

Diseases and injuries of the shoulder and elbow can severely limit mobility and quality of life. Modern joint replacement and precise surgical techniques are now opening up new avenues for the long-term restoration of function, strength, and freedom from pain. Through custom-fitted implants, minimally invasive procedures, and the latest surgical techniques, patients can receive targeted and gentle treatment. The goal: optimal restoration of joint function combined with faster recovery and long-term durability of the results.

Shoulder and elbow problems that require joint replacement surgery are usually caused by advanced degenerative joint diseases such as osteoarthritis or by inflammatory processes associated with rheumatoid arthritis. 

Complex fractures, particularly in older patients, can also damage the joint so severely that an artificial replacement becomes necessary. In addition, severe and long-term untreated damage to the rotator cuff tendons in the shoulder, as well as post-traumatic changes following injuries, frequently lead to irreparable joint destruction. In rare cases, tumors may also necessitate joint replacement. “We broadly distinguish between primary omarthrosis and secondary omarthrosis. In primary omarthrosis, no clear medical cause can be identified; however, risk factors include advanced age, physically demanding work, and being female. Secondary omarthrosis refers to all degenerative conditions that arise as a result of another injury: post-traumatic (malalignments caused by fractures), following shoulder dislocation, long-term rotator cuff tendon damage, circulatory disorders, rheumatism, or other inflammatory or infectious diseases. The same ultimately applies to the elbow as well. Given its unclear etiology, there is naturally little that can be done to prevent primary knee osteoarthritis. In general, the shoulder in particular is a joint that relies heavily on muscle control; this means that the best protection against rapid wear and tear is good function combined with moderate exercise. Strength training can accelerate the progression of osteoarthritis (the dose/load makes the poison). However, movement and moderate stress in and of themselves promote cartilage nutrition. In the case of secondary osteoarthritis, countermeasures can only be taken in the early stages—that is, by resolving the underlying problems before the condition progresses to end-stage shoulder osteoarthritis. This at least slows the progression of osteoarthritis. “In other words, after a shoulder dislocation, a stable joint must be restored; in cases of tendon damage, the tendon must be reattached to the bone,” explains Dr. Schoch.

Early treatment of inflammation and minor injuries can help prevent secondary damage such as osteoarthritis. A healthy lifestyle—including a balanced diet, avoiding nicotine, and maintaining a healthy weight—also contributes significantly to maintaining joint health. In older age, fall prevention also plays a central role in avoiding serious fractures of the shoulder and elbow.

Shoulder arthroplasty has advanced significantly in recent years. Particularly noteworthy are improvements in implant design, surgical techniques, and the customization of treatment based on the patient’s specific situation. 

“In modern shoulder arthroplasty, implants are becoming increasingly versatile and better tailored to patients’ individual needs. In some cases, the prostheses are even custom-made from titanium using 3D printing. Today, implant components are predominantly anchored using a cementless technique. In my practice, I generally use stemless implants for primary shoulder replacements; this means that a long stem in the humerus is not used if the bone quality is good. This preserves valuable bone tissue. “The theoretical advantages of this technique include shorter surgery times, a lower risk of infection, less blood loss, better bone preservation, and simplified options for future revision surgeries should the prosthesis become loose,” says Dr. Schoch.

Whether a patient is better suited for an inverse shoulder prosthesis or an anatomical shoulder prosthesis depends primarily on the function of the rotator cuff and the condition of the joint. 

Dr. Schoch explains: “An anatomical shoulder prosthesis is generally only appropriate if the rotator cuff is intact and functional. These muscles and tendons are responsible for stabilizing the joint and controlling its movements. However, if the rotator cuff is damaged or no longer functional—for example, due to chronic inflammation, injury, or wear and tear—an anatomical prosthesis is often no longer the optimal solution. In such cases, the inverse shoulder prosthesis is usually preferred, as it reverses the joint’s function and thus utilizes other muscles—particularly the deltoid muscle—to control movement. Another important criterion is the position of the joint. For an anatomical shoulder prosthesis, the joint should be relatively “centered,” meaning that the humeral head fits well within the glenoid cavity and there is no significant instability. In cases of joint instability or deformities, the inverse prosthesis is often the better choice, as it provides a more stable form of joint mechanics. The shape of the glenoid cavity also plays a role. An anatomical prosthesis requires a relatively well-preserved, normal glenoid shape, without severe deformities or obliquity. If the glenoid is severely worn or tilted, an inverse shoulder prosthesis is generally more suitable, as it provides a functional solution even with irregular or damaged glenoid shapes.” In addition, factors such as the patient’s age, bone quality, the degree of joint destruction, and individual activity requirements play a role in the decision. The goal is always to find the solution that is functionally best and most durable for the individual patient.”

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Minimally invasive surgery on the shoulder and elbow has made great strides in recent years. Thanks to modern arthroscopic techniques, high-resolution cameras, and specialized instruments, complex injuries can now be treated with minimal invasiveness. Even in prosthetic implantations, smaller incisions result in less tissue damage. For patients, this means less pain, a lower risk of infection, faster healing, and, in most cases, shorter hospital stays or outpatient procedures.

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Preoperative planning now plays a central role in the success of shoulder and elbow prostheses. Modern imaging techniques such as high-resolution X-rays, computed tomography (CT), and, increasingly, magnetic resonance imaging (MRI) allow for a precise analysis of the individual’s anatomy and the severity of joint damage. 

Especially in cases of severely deformed or destroyed joints, 3D imaging provides crucial information about the shape, position, and condition of the humeral head and glenoid cavity. “The quality of a surgery is significantly influenced as early as the planning phase—essentially at the drawing board. For joints with only minor wear, simple X-rays are usually sufficient to plan the implant adequately. However, the more severely the joint—especially the acetabular side—is damaged, the more important detailed 3D planning using CT images becomes for optimal preparation of the procedure. “Although intraoperative navigation is not yet standard practice, it can help with severely damaged joints by ensuring the implant is positioned as precisely as possible according to the preoperative plan, thereby achieving the best possible outcome,” explains Dr. Schoch.

In cases of severe rotator cuff tears where tendon reconstruction is no longer possible—for example, because the tendons are severely retracted or scarred, or the muscles have already degenerated significantly—there are several therapeutic approaches to restore or at least improve shoulder function. 

If direct tendon reconstruction fails or is no longer advisable, an initial attempt can be made to support function through so-called “biological” measures, such as a muscle or tendon transfer procedure. In this procedure, adjacent muscles or tendons are rerouted to partially replace the lost function. However, such procedures are technically demanding and not suitable for all patients.

“Depending on the shape and location of the tear, the patient’s age, and the quality of the remaining tissue, different treatment strategies may be considered. In younger patients with a centered joint and a large central tear, conservative therapy may be appropriate, possibly supplemented by a partial closure of the tendon sheath to prevent further enlargement of the tear. In addition, the long biceps tendon can be used to biologically reinforce the reconstruction. In certain cases, muscle transfer is also possible, in which larger muscles are rerouted to the torn area to restore shoulder function. Other approaches, such as the use of placeholders (e.g., inflatable balloons or implants under the acromion), have so far shown only limited success. I view such so-called “salvage” procedures more as an option for very young patients rather than as a long-term solution. In contrast, for patients over 60 to 65 years of age, the reverse shoulder prosthesis has proven to be the most reliable method. Today, it is the “workhorse” of shoulder surgery for this age group. “Especially in younger patients, a stemless variant is preferred in order to preserve as much of the patient’s own bone as possible,” emphasizes Dr. Schoch.

Interdisciplinary collaboration between surgery, physical therapy, and sports medicine is crucial for the success of rehabilitation following shoulder or elbow replacement surgery. 

“Close collaboration with physical therapists is crucial to the success of the treatment. Even if optimal mechanical stability and joint structure are achieved in the operating room, that alone is not enough: Without targeted restoration of function through active exercises—both independently and under the guidance of a therapist—the success of treatment remains limited. Key factors here include short periods of immobilization, the targeted use of continuous passive motion (CPM) devices, and consistent physical therapy, supplemented as needed by inpatient rehabilitation. Healing of the shoulder generally takes a long time; recovery periods of three to four months are completely normal. To ensure the success of therapy, it is advisable to define clear goals and coordinate them with the therapists. Nevertheless, the treating therapist should, first and foremost, respond flexibly to the current findings and adjust the rehabilitation program accordingly. “Especially for patients who are active in sports, it makes sense to conduct a ‘back-to-sport’ test at the end of rehabilitation to ensure that the joint can once again withstand stress and that a return to sports or intense physical activity is safe,” explains Dr. Schoch, and with that, we conclude our conversation.

Thank you very much, Dr. Schoch, for this insight into your work!