Shoulder osteoarthritis surgery

introduction

The diagnosis of shoulder osteoarthritis (Omarthrosis) does not necessarily mean that an operation on the shoulder joint must be performed. However, shoulder arthrosis is a progressive disease that cannot be cured.

When is surgery necessary?

In the early stages of cartilage wear, conservative therapy is recommended in most cases, in which mobilization of the joint, removal of the stiffening, loosening of the narrowed (contracts) Shoulder capsule, pain relief and anti-inflammatory measures are paramount. This should slow down the progression of shoulder arthrosis and strengthen the shoulder muscles.

Only when these conservative measures do not improve the symptoms do you need to think about surgical therapy. Depending on the severity of the shoulder arthrosis, a cartilage smoothing performed during a jointoscopy can already provide relief. If this treatment approach is no longer sufficient, the implantation of an artificial joint replacement (Shoulder prosthesis) to be required.

For more information, read on: Cartilage smoothing

Shoulder arthrosis surgery

There are various surgical options available for the treatment of shoulder osteoarthritis, which depend on the severity of the pain and the functional demands of the person affected.

In the early stages of shoulder arthrosis, joint-preserving surgery as part of a shoulder jointoscopy (Arthroscopy) be performed. This measure is particularly suitable if the joint gap is only slightly narrowed by the arthrosis and sufficient mobility of the shoulder joint is maintained. As a rule, the cause of the pain can be eliminated with the small arthroscopic procedure; for example, using the minimally invasive keyhole technique (arthroscopic) a scarred and hardened bursa is removed or calcified or torn tendons are sutured. In addition, the joint cartilage can be smoothed, the roof of the shoulders expanded and inflamed tissue removed. This operation can be carried out on a short-term basis, which corresponds to a hospital stay of around two to three days.

If the shoulder arthrosis is already advanced, the joint space is very narrow or pronounced movement restrictions can be determined, a shoulder joint replacement should be surgically used. Depending on the extent and cause of the shoulder arthrosis, different prosthesis models can be considered (see below).

If the prosthesis loosens, a replacement operation usually has to be performed. Here the loosened part is exchanged; Sometimes it may be necessary to use a different type of prosthesis, for example if there are soft tissue defects or poor bone quality.

Appointment with a shoulder specialist

I would be happy to advise you!

Who am I?
My name is Carmen Heinz. I am a specialist in orthopedics and trauma surgery in the specialist team of .

The shoulder joint is one of the most complicated joints in the human body.

The treatment of the shoulder (rotator cuff, impingement syndrome, calcified shoulder (tendinosis calcarea, biceps tendon, etc.) therefore requires a lot of experience.
I treat a wide variety of shoulder diseases in a conservative way.
The aim of any therapy is treatment with full recovery without surgery.
Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

You can find me in:

• Lumedis - your orthopedic surgeon
  Kaiserstrasse 14
  60311 Frankfurt am Main

Directly to the online appointment arrangement
Unfortunately, it is currently only possible to make an appointment with private health insurers. I hope for your understanding!
You can find more information about myself at Carmen Heinz.

What surgical methods are there?

Nowadays there are several options for treating shoulder arthrosis surgically. In particular, when conservative therapy no longer provides any relief from the symptoms and the osteoarthritis has progressed too much, the patient's level of suffering increases, so that a definitive solution in the form of an operation is used.

In the past, this was mainly done by stiffening the shoulder joint. This makes the joint completely immobile and unusable, the severe pain subsides and osteoarthritis cannot develop again. Nowadays, this surgical procedure is taking a back seat as prostheses of the shoulder joint are becoming more common. To do this, both the joint surface of the humerus and the joint surface on the shoulder blade, the so-called "glenoid", are replaced. Often both joint surfaces are damaged by the longstanding shoulder arthrosis. If the socket on the shoulder blade is still intact, a half prosthesis can be used. In this case, only the part of the humerus near the joint is replaced by the prosthesis. Nowadays a wide variety of prostheses can be selected for different cases. In this way, the prostheses can be cemented into the bone if they are poorly held. So-called "inverse prostheses" can also be used in the case of inadequate shoulder muscles and improve the overall result. In such prostheses, the upper arm forms the socket and the shoulder blade forms the joint head.

Types of shoulder prostheses

In the case of a very pronounced, severe shoulder osteoarthritis, an artificial joint replacement can be a good therapeutic option. The goal that should be achieved with the artificial joint is long-term pain relief and an improvement in the (usually considerably) restricted shoulder mobility.Statistically, the functionality of an artificial shoulder joint is around 15 years, but there may be individual deviations.

Better shoulder function is to be expected with a total shoulder prosthesis, but short- or long-term risks may arise from the fact that the joint socket was also artificially implanted.

The shelf life of a so-called inverse shoulder prosthesis is a little under 10 years. The joint head (actually the humerus head) becomes the joint socket and the shoulder joint socket becomes the joint head (inverse means that the tasks are swapped). The existing bones on which the artificial, inverse joint is mounted are subject to greater abrasion, which is why the artificial joint can loosen faster and may have to be replaced earlier.

The inverse shoulder prosthesis ensures better active mobility and is stable against possible dislocations, but there is a higher risk of loosening of the head component and an infection. For this reason, inverse shoulder prostheses are only used for those over 70 years of age and for very extensive tendon damage, chronic instability, massive bone destruction and for replacement operations.

Aftercare

The aim of the operation is to achieve freedom from pain in the shoulder and to improve mobility so that the shoulder can be fully used in everyday life. Shortly after the operation, the shoulder is immobilized with a stabilizing shoulder splint so that the healing process can begin. However, the first small and careful movements with the shoulder are practiced as quickly as possible in order to regain the mobility of the shoulder soon. Initially, the movement exercises take place passively (by a therapist or passive motorized rails), and only after two to four weeks (depending on the operation) can the person concerned actively participate in the physiotherapy exercises.

If an artificial shoulder prosthesis has been installed, it is necessary to completely immobilize the shoulder for about four weeks. Then slowly and increasing movement exercises are carried out, after a further two weeks it should be possible to spread the arms by 60 degrees and tilt the shoulders forward. The entire follow-up treatment phase usually takes around 12 to 16 weeks.

Which patients benefit from shoulder surgery?

Shoulder surgery is often postponed for a long time with conservative treatment methods. This is because, similar to other joint prostheses, the durability of the prostheses is 10 years at best. Young people in particular are therefore advised to hold up osteoarthritis conservatively and to wait a long time for an operation on the prosthesis.

However, many of those affected suffer very much from the pain and restricted mobility associated with advanced shoulder osteoarthritis. You will benefit from a shoulder prosthesis in most cases. The most important prerequisites for this are reasonably strong muscles, good blood circulation and stable bone conditions. Fresh fractures or osteoporosis make it very difficult for the prosthesis to anchor itself in the bone. The prosthesis is also not advisable if the arm muscles are weak or paralyzed. In this case, stiffening is more important.

Alternatives to surgery

Shoulder osteoarthritis can also occur without surgery (conservative) be treated. This therapy option depends on the course of the disease, symptoms and the disease mechanism. Various physiotherapy exercises, drug therapy or other treatment methods can be considered. Especially with shoulder osteoarthritis, conservative treatment can often be sufficient to positively influence the course of the disease and alleviate symptoms. For this reason, shoulder osteoarthritis surgery is only indicated in selected cases.

Non-surgical therapy for shoulder osteoarthritis is particularly suitable if the disease begins slowly and gradually. The earlier the individual treatment is started, the easier it is to manage shoulder osteoarthritis in the long term. A cure for shoulder arthrosis cannot be achieved with conservative therapy. However, the treatment methods can achieve pain relief, maintenance and improvement of joint mobility and muscle strengthening. This can preserve the function of the shoulder and slow down the progression of shoulder arthrosis.

Therapy options are, for example, a shoulder splint (Orthosis), Cold therapy (Cryotherapy), physical therapy, Heilstrom applications or shock wave treatments. Medicines can also be injected into the shoulder joint, as well as anti-inflammatory and pain reliever medication. The person affected should learn to regulate movements and loads on the shoulder joint and to adapt his behavior to the disease. For example, contact and throwing sports or activities with high leverage such as golf or tennis should be avoided.