Shoulder arthroplasty | Specialists and information

Certification as an EndoProstheticsCenter (EPC)

Doctors who have been awarded the seal are medical facilities that have been certified as an EndoProstheticsCenter (EPC) or as an EndoProstheticsCenter of Maximum Care (EPCmax) via endocert and have therefore demonstrated compliance with the requirements set out in an audit. Recertification is required every three years.

The criteria, requirements and differences between EPZ and EPZmax can be found here.

What is shoulder arthroplasty?

The shoulder joint is formed by the humeral head and the glenoid cavity. It is the most mobile joint in the human body. As there is little bone-to-bone contact, the ligaments and especially the muscles play an important role in stabilizing the joint. The tendons of the stabilizing muscles are arranged like a cuff around the shoulder joint and are therefore also referred to in their entirety as the rotator cuff.

Due to the high mobility of the joint and the lower level of soft tissue stabilization, particularly in the anterior-posterior direction, shoulder dislocations (dislocations) can occur relatively easily. The bony parts of the shoulder joint can also break due to external forces and the muscles and tendons of the rotator cuff can tear.

Similar to the hip and knee joints, joint wear and tear(omarthrosis) can also occur in the shoulder joint. Depending on the severity of the joint wear, a complete or partial replacement of the shoulder joint with artificial materials, i.e. a shoulder prosthesis, may be necessary. A joint replacement of both the shoulder blade socket and the humeral head is referred to as a shoulder TEP (total shoulder arthroplasty), while a partial replacement of the humeral head is referred to as a shoulder hemiprosthesis.

The shoulder endoprostheses, which are very well tolerated by the body, are usually made of a titanium or chromium-chromium alloy and are anchored in the bone with or without bone cement (a special plastic), depending on the condition of the bone and the age of the patient.

What conditions do shoulder arthroplasty specialists treat?

Shoulder injuries, usually in conjunction with bone fractures in the past, rheumatic diseases (rheumatoid arthritis) or other degenerative (wear-related) processes can lead to osteoarthritis, i.e. joint wear in the shoulder joint, in which the cartilage and, at an advanced stage, the bone itself is degraded.

Other conditions that are treated by shoulder arthroplasty experts include

• Extensive defects of the rotator cuff(defect arthropathy)
• Necrosis of the humeral head(humeral head necrosis), i.e. the bone tissue dies off as a result of an accident or illness
• Tumors of the upper section of the humerus(humeral tumors)
• Pseudarthrosis (false or pseudo joint) at the junction of the humeral head and humeral shaft (non-healing fracture)
• Re-fracture of an already healed fracture
• Dislocation of the shoulder joint (dislocated shoulder joint)
• Omarthrosis as a result of an infection

Which diagnostic procedures are used by shoulder arthroplasty specialists?

Patient questioning(anamnesis), for example about the type and duration of complaints, as well as a physical and clinical examination form the basis of the diagnosis. In many cases, possible causes for the patient's complaints can be narrowed down.

However, imaging examinations are indispensable. X-ray examinations(X-ray diagnostics) play an important role here. It can be used to detect fractures and bony changes. With computer tomography (CT), specialists can assess the bone structure, among other things.

Soft tissue, such as the rotator cuff, bursa and other muscles, can be imaged using magnetic resonance imaging (MRI). To better visualize the joint space, a contrast agent is sometimes injected directly into the shoulder joint and an MRI is then performed (known as MR arthrography).

Ultrasound examination(sonography) is a widely used examination method for assessing soft tissue structures.

Which treatment methods are included in the range of services offered by a shoulder arthroplasty specialist?

The range of services provided by a shoulder arthroplasty specialist includes the following methods:

• Implantation of anatomical shoulder prostheses - i.e. replacement of the humeral head and glenoid cavity with anatomical prosthetic components
• Implantation of inverse shoulder prostheses - i.e. the joint partners are swapped so that the spherical component is implanted on the glenoid side and the concave component on the humeral head side. The aim is to change the pivot point of the joint so that the deltoid muscle is preloaded
• Inverse shoulder prostheses are used in cases of rotator cuff damage, post-traumatic injuries or loosened anatomical shoulder prostheses
• Stemless shoulder prostheses are increasingly being implanted on the upper arm side
• Revision (correction) and replacement of shoulder prostheses
• Treatment of complex fractures of the humeral head
• Treatment of late effects of humeral head fractures

What distinguishes shoulder arthroplasty specialists?

Shoulder arthroplasty experts are usually specialists in orthopaedics, trauma surgery, sports medicine or orthopaedic surgery who have particular experience in implanting shoulder arthroplasties.

When deciding for or against an operation, they weigh up the opportunities and risks and consider possible alternatives for an endoprosthesis. They guarantee high quality surgical care through certification .