Shoulder Arthroplasty

Shoulder arthroplasty is the operation that replaces the worn shoulder joint with a prosthesis consisting of metal materials, ceramic and polyethylene. Shoulder arthroplasty is the best method to reduce pain and restore movement in cases of advanced shoulder arthritis.

The shoulder is formed by three bones. The arm bone (arm), the shoulder blade and the collarbone. The main shoulder joint is formed by the head of the humerus bone and by the scapula of the shoulder blade. These are the two surfaces that wear out in shoulder arthritis, and their replacement is called shoulder arthroplasty.

The shoulder joint is complemented by muscles and tendons that ensure both, stability and movement of the shoulder.

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 appropriate choice in the following situations:

• Shoulder osteoarthritis
• Arthritis after rupture of the shoulder tendons (cuff tear arthropathy)
• Post-traumatic shoulder arthritis
• Rheumatoid arthritis
• Aseptic head necrosis of the arm
• Crushing fractures of the head of the arm

Shoulder arthroplasty is extremely effective in reducing pain. As an operation, it does not cause much pain and the patient can move his/her arm normally after the operation with the use of simple painkillers for 2-3 days.

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

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

From the 3-4th postoperative day, the patient is allowed to perform simple daily activities, such as dressing, personal hygiene and care. Gradually and in parallel with the physiotherapy program, the patient returns after 4-6 weeks to a full level of movement and functionality.

The types of shoulder arthroplasty are the following:

Semi-arthroplasty, in which only the head in the humerus is replaced and a swab is placed inside the bone. This arthroplasty is mainly used in cases of fractures of the head of the humerus.

Anatomical total arthroplasty, in which both the head of the humerus and the articular surface of the scapula are changed according to the anatomical principle.

Reverse total shoulder arthroplasty, in which the prosthesis is placed in reverse from the normal anatomy, so that it works without the help of the shoulder tendons.

Surface shoulder arthroplasty, (Fig. 4) which is the most modern form of shoulder arthroplasty, where only a small part of the head is removed and replaced with a metal prosthesis without a swab. This type of shoulder arthroplasty is usually performed in younger patients who present a localized lesion to the head of the humerus.

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

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

Hospitalization after a shoulder arthroplasty is 1-2 days. Subsequently, the patient can go home, where every two days a change in the incision is required. Sutures are removed 2 weeks after surgery. The movement of the hand to the limits of pain is encouraged. Only lifting weights and supporting the hand with force is prohibited.

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