Shoulder prosthesis: Information & shoulder prosthesis specialists

The artificial shoulder joint has been in use for many years. However, it is not required in as many cases as artificial knee and hip joints. Today, a wide range of shoulder prostheses are available, which can be used depending on the individual diagnosis. A shoulder prosthesis is only fitted if conservative therapies or joint-preserving operations are unsuccessful.

Here you will find the most important information and qualified shoulder prosthesis specialists.

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Article overview

Shoulder prosthesis - Further information

Different reasons for pain in the shoulder area

The shoulder joint is a very versatile joint that allows the arm to move in all directions. It connects the humeral head and the shoulder blade. However, the joint bones only form the basis for the movements.

Not everything that hurts in the shoulder is due to wear and tear on the joint. In the event of discomfort in the shoulder joint, it is primarily

  • the muscles,
  • the supporting ligaments and
  • the joint capsule

play an important role. A detailed diagnosis of the soft tissues must therefore always be carried out in the event of pain and damage in the shoulder area. Torn and worn tendons occur very frequently, especially in older people. The doctor must recognize such injuries and treat them correctly.

Anatomie der Schulter
The shoulder joint relies on strong ligaments and tendons © bilderzwerg / Fotolia

It is assumed that over 50% of patients over 70 years of age have tears in the rotator cuff. The rotator cuff is made up of tendons that move the shoulder. These tears and damage to the rotator cuff can lead to

  • Pain on movement,
  • pain at rest and
  • restriction of movement

and restriction of movement.

Shoulder tightness syndrome can also be responsible for the symptoms. This must be clarified.

Joint-preserving treatment of shoulder pain

In mild cases, conservative treatment with physiotherapy and medication may be sufficient. Arthroscopic surgery on the shoulder can also correct some disorders or diseases and relieve pain. Arthroscopy is possible, for example, for

  • the reconnection of torn tendons,
  • widening the space under the acromion or
  • stabilizing dislocated shoulders.

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Many older people also suffer shoulder fractures as a result of falls. This is often caused by osteporosis, in which the bones become increasingly decalcified and porous.

In addition to conservative treatment, nailing or plating may also be necessary. Increasingly, however, an artificial shoulder joint is also being used in older patients. This should be decided at an early stage to prevent stiffening.

Wear and tear of the shoulder joint is referred to as shoulder osteoarthritis (omarthrosis).

How often is an artificial shoulder joint used?

Compared to joint replacements in the knee and hip area, the artificial shoulder joint is implanted less frequently. The shoulder joint is not load-bearing. The degenerative changes therefore become apparent later and can be better compensated for.

Schulterschmerzen
Pain in the shoulder can severely impair quality of life © yodiyim / Fotolia

Around 30,000 shoulder prostheses were implanted in Germany in 2020. This figure has doubled compared to 2003, when around 15,000 shoulder prostheses were implanted. The increasing number of shoulder prosthesis implantations reflects the growing demand and improved technology in this field. These figures may fluctuate and change over time. For more up-to-date data, the latest available information from medical authorities or professional journals should be consulted.

When is a shoulder prosthesis necessary?

A shoulder prosthesis is the last option to enable the patient to lead a normal life again. This option is considered when conservative and arthroscopic procedures can no longer resolve the symptoms. In most cases, the wear and tear in the shoulder joint is too advanced.

Before the operation, it is important to discuss which form of artificial shoulder joint offers the best prospects of recovery. The doctor always makes this decision together with the patient.

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Shoulder surgery to install a shoulder prosthesis

Specialists in shoulder prostheses are specialists in orthopaedics and trauma surgery who have acquired special qualifications and experience in shoulder endoprosthetics.

A range of shoulder prostheses are available, which can be used depending on the severity of the damage.

Anatomical shoulder prosthesis

The smallest possible procedure is desirable, i.e. artificial replacement of the humeral ball. This is known as a partial prosthesis.

Numerous studies show that such a partial replacement only makes sense if the shape and surface of the glenoid cavity are still intact. Otherwise a total replacement is required. In a total replacement, both bony parts of the joint are replaced.

If the damage is more advanced, the partial replacement must be combined with a polyethylene socket. The socket is then often cemented in place. This must be decided by the experienced surgeon and discussed with the patient.

In the case of major damage to the rotator cuff, it must be checked whether muscle or tendon plasty/repairs are still possible. Otherwise, only an inverse shoulder prosthesis can be implanted.

Inverse shoulder prosthesis

This shoulder prosthesis is used if the rotator cuff is defective. The prerequisite for this is that the deltoid muscle outside the shoulder is still strong enough.

The inverse shoulder prosthesis has seen the highest growth rates in recent years. It also shows good to very good results in the medium and long term.

If this prosthesis fails, the retraction options are limited. It is therefore preferred for patients over the age of 70.

Inverse Schulterprothese
The inverse shoulder prosthesis shows very good results, even in the long term © bilderzwerg / Fotolia

What happens after the implantation of an artificial shoulder joint?

Special pain catheters make it possible to manage post-operative pain.

Most artificial shoulder joints can be mobilized and moved at an early stage. The patient must not put any heavy weight on the shoulder for some time. They should carry weights of no more than two to three kilograms.

Particularly in the case of inverse shoulder prostheses, the patient must not lean on the arm to prevent the prosthesis from loosening.

Aftercare for a shoulder prosthesis includes

  • Physiotherapy treatments,
  • motorized splint treatments,
  • massages and lymphatic drainage,
  • cold applications and
  • pain therapy

It can usually be continued on an outpatient or inpatient basis after an inpatient stay of approx. one week.

In consultation with the surgeon, the patient should attend regular follow-up appointments. These include x-rays and clinical examinations.

Shoulder prosthesis and sport

After the implantation of a shoulder prosthesis, avoid sports involving impact and pressure loads. The following are possible

  • Swimming,
  • cycling and
  • lighter sports activities such as Nordic walking or golf.

Overall, exercise your shoulder as little as possible. This is particularly important if an artificial acetabular implant or an inverse shoulder prosthesis has been implanted.

Healing prospects after implantation of a shoulder prosthesis

Anatomical and inverse prostheses have a clinical 10-year durability of approx. 90%.

References

  • Deutsche Vereinigung für Schulter- und Ellenbogenchirurgie e. V.
  • Garving C et al., Impingementsyndrom der Schulter. Dtsch Arztebl Int 2017; 114(45): 765-76; DOI: 10.3238/arztebl.2017.0765
  • flexikon.doccheck.com/de/Schulterschmerz
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