Shoulder endoprosthetics means the complete or partial replacement of the shoulder joint with artificial materials. If the joint is completely replaced, i.e. the acetabulum of the shoulder blade and the head of the humerus, it is also referred to as a shoulder TEP (total shoulder endoprosthesis), if only one joint partner is replaced, it is a hemiprosthesis.
The shoulder consists of several joints, the bones of the shoulder girdle and the head of the humerus, as well as the ligaments and muscles surrounding the bones. The largest joint, the shoulder joint, is made up of the humeral head (humeral bone head) and a part of the shoulder blade (the acetabulum). As a ball joint, it is the most mobile joint in the human body. Ligaments and above all muscles serve to stabilize and move the joint.
These muscles are arranged like cuffs around the shoulder joint and are therefore called rotator cuff. Although the mobility is somewhat restricted by other parts and extensions of the shoulder blade, it can still dislocate relatively easily due to the high mobility of the joint (shoulder dislocation). These bony appendages can also break due to external forces and tear the muscles and tendons of the rotator cuff.
The shoulder endoprostheses, which are very well tolerated by the body, consist of a titanium or chromium-chromium alloy and are anchored securely in the bone with or without bone cement (a special plastic), depending on the condition of the bone and the age of the patient.
Shoulder injuries in the past, as a result of rheumatic diseases (rheumatoid arthritis) or other degenerative (wear-related) processes can lead to arthrosis, i.e. joint wear, in the shoulder joint, in which initially the cartilage and, in an advanced stage, the bone itself is broken down. This omarthrosis mainly affects the head of the humerus, but can also occur in the acetabulum and is the most common reason for the implantation of an artificial shoulder joint.
Another relatively common reason for a shoulder endoprosthesis surgery are complex fractures of the upper section of the humerus.
Other diseases or conditions treated by shoulder endoprosthetics experts include, for example:
The patient interview (anamnesis), for example, about the type and duration of the symptoms as well as a physical and clinical examination form the basis of the diagnostics. In many cases, this can be used to identify possible causes of the patient's complaints.
However, imaging examinations are indispensable. X-rays play an important role in this process. They can be used to detect fractures and bony changes. Computed tomography (CT) can be used to assess the bone structure, among other things. Soft tissue such as the rotator cuff, bursa and other muscles can be visualized using magnetic resonance imaging (MRI). For a better representation of the joint space, a contrast agent is occasionally injected directly into the shoulder joint and then an MRI is performed (so-called MR arthrography). Ultrasound examination (sonography) and other procedures are also used for certain issues.
The range of services offered by a specialist in shoulder endoprosthetics includes the following methods:
Experts in shoulder endoprosthetics are usually specialists in orthopedics, trauma surgery, sports medicine or orthopedic surgery who have particular experience in the field of implanting shoulder endoprostheses. When deciding for or against a surgery, they weigh up the opportunities and risks against each other and consider possible alternatives for an endoprosthesis. Through certification, they guarantee high quality in surgical care.
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