Shoulder Arthroplasty

General

Generally, shoulder arthroplasty is the procedure for the replacement of the damaged joint with a prosthesis made of metal, ceramic and polyethylene. Shoulder arthroplasty is the best method to reduce pain and restore movement in cases of severe shoulder arthritis.

Shoulder anatomy

The shoulder is made up of three bones.
Upper arm bone (humerus), shoulder blade and collarbone. The main joint of the shoulder is formed by the head of the humerus and the glenoid cavity of the shoulder blade (Fig 1). These are the two surfaces that are worn out in shoulder arthritis and their replacement is called shoulder arthroplasty.
The shoulder joint also includes muscles and tendons which ensure both stability and movement of the shoulder.

Εικ 1. Ανατομία άρθρωσης ώμου

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When is shoulder arthroplasty necessary?

Shoulder arthroplasty is necessary either in the case of shoulder arthritis, or in cases of fractures where osteosynthesis is not possible. Specifically, shoulder arthroplasty is the ideal choice in the following situations:

  • Shoulder Osteoarthritis
  • Arthritis after shoulder tendon tear (cuff tear arthropathy)
  • Post-traumatic shoulder arthritis
  • Rheumatoid arthritis
  • Aseptic necrosis of the head of the humerus
  • Comminuted humerus head fractures

 

How painful is shoulder arthroplasty?

Shoulder arthroplasty is extremely effective regarding pain reduction. As an operation it does not cause much pain and the patient can move his hand normally after the operation with the use of simple painkillers for 2-3 days.

 

At what age is shoulder arthroplasty performed?

The typical age at which shoulder arthroplasty is performed is between 60-80 years. Of course there are cases, depending on the problem, in which it can be performed in either younger or older patients.

How long does physiotherapy last after shoulder arthroplasty?

In most cases the physiotherapy program after a shoulder arthroplasty lasts 4-6 weeks.

 

When can I return to normal activities after shoulder arthroplasty?

2-3 days after the operation the patient is allowed to perform simple daily activities, such as getting dressed, personal hygiene and other self-care activities.
Gradually and alongside the physiotherapy program, the patient returns after 4-6 weeks to a pre-injury level of mobility.

 

Which are the types of shoulder arthroplasty?

The types of shoulder arthroplasty are the following:

Hemiarthroplasty: Only the head of the humerus bone is replaced and a stem is placed inside the bone. This arthroplasty is used mainly in cases of humeral head fractures (Fig 2).

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Εικ. 2. Ημιαρθροπλαστική ώμου

Anatomic total shoulder arthroplasty: Both the humeral head, as well as the glenoid cavity joint surface are replaced, according to the anatomical principle.
Reverse total shoulder arthroplasty: The prosthesis is placed reversely, with respect to normal anatomy, so as to function without the assist of the shoulder tendons (Fig 2).

Εικ. 3. Ανατομική και ανάστροφη αρθροπλαστική ώμου

Shoulder Resurfacing Arthroplasty (Fig. 4): Is the most contemporary form of shoulder arthoplasty. Only a small part of the humeral head is removed and is replaced by a metallic prosthetic without stem. This type of arthroplasty is usually perfomed in younger patients with localized trauma on the humeral head.

Εικ. 4. Αρθροπλαστική ώμου επιφανείας

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What is the difference between anatomical and reverse total shoulder arthroplasty?

Anatomical shoulder arthroplasty is designed to work only if the rotator cuff tendons are intact. In contrast, reverse total shoulder arthroplasty is chosen when the tendons (supraspinatus and infraspinatus) are ruptured and non-functional. In this case, the hand moves with the help of the deltoid muscle.

 

What are the success rates in shoulder arthroplasty?

When shoulder arthroplasty is performed by specialized shoulder surgeons, the success rates are quite high, over 90%. Based on international literature, the orthopedic shoulder surgeon should perform more than 30 shoulder arthroplasties within a year to be considered well-trained.

 

How long should I remain in the hospital after a shoulder arthroplasty?

The hospitalization after a shoulder arthroplasty lasts 1-2 days. The patient can then go home and a wound control is required every two days. The sutures are removed 2 weeks after the surgery. It is recommended to move the hand to the limits of pain. Lifting weights and leaning on your hand are the only things forbidden to do.

 

How many years does a shoulder arthroplasty last?

The lifespan of a shoulder arthroplasty now reaches 15-20 years with the new type of implants used. This means that the implants will need to be replaced in very rare cases.

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