Shoulder replacement

Shoulder replacement

The shoulder is the most mobile joint in the human body. The shoulder joint is formed by the spheric head of the humerus and small articular cavity (or fossa).

A shoulder arthrosis is a degenerative disease of a shoulder joint affecting the articular cartilage and the subchondral bone. AS the disease progresses osteophytes develop along with cysts of the subchondral bone, erosions of the articular cavity and a deformity of the humeral head. Eventually joint degeneration progresses with subsequent deterioration of the shoulder joint function. This is accompanied by pain, which requires permanent use of pain killers and is associated with the reduced quality of life. Usually this disease affects elderly people, however arthrosis of a shoulder joint can develop in the patients of younger age because of shoulder traumas and/or permanent traumatisation at work or during sport activities. Patients usually experience pain at night, they cannot sleep lying on the affected shoulder. As in case of all degenerative shoulder joint diseases,  a radical surgery s the only treatment for shoulder joint arthrosis.

About the surgery:

The articular surfaces of a degenerative and deformed shoulder joint are replaced by the artificial ones (made of polyethylene and metal). There is a wide variety of shoulder joint endoprosthesis, however, the main differences can be seen among the types of anatomical and reverse endoprostheses. Anatomical endoprostheses repeat the natural anatomy of the shoulder joint, when in the reverse shoulder endoprostheses the natural positions are reversed: an articular cavity is replaced by hemispheric glenosphere and the spherical humeral head is replaced by the hollowed-out polyethylene insert.

If only humeral articular head ant its surface is damaged, hemiarthroplasty is possible, which  involves only implantation of the implant to replace the  articular head. If the articular head and the articular cavity are affected, a total arthroplasty should be carried out involving implantation of a metal implant to replace the humeral head and a polyethylene implant to replace the articular surface of the cavity. Shoulder joint arthrosis along with tears of rotator cuff tendons is the main indication for the reverse arthroplasty. A special endoprosthesis was designed to maintain stability of the humerus even without the rotator cuff support and to enable arm elevation function by the deltoid muscle.

To whom this surgery is indicated?

When all non-surgical treatment procedures (medical therapy, kinesitherapy etc.,) cannot help in alleviating pain and restoring mobility as well as in improving the quality of life, a shoulder joint endoprosthetic surgery is indicated. Endoprosthetic shoulder joint surgery alleviates pain, improves shoulder joint function, thus, pain killers are not necessary and patient's quality of life is improved. The majority of patients recover completely and can enjoy good sleep and continue moderate daily activities.

Before the surgery:

The team of physicians in our clinic will carry out all necessary examinations and will assess general patients’ health condition. Aiming to ensure the best possible result, before the surgery you should follow physician's instructions.

During the surgery:

The surgery will be carried out under a general anaesthesia. During the surgery an incision is made in the shoulder joint area. The articular surfaces of a degenerative and deformed shoulder joint are replaced by the artificial ones. The surgical wound is closed using the special sutures. Usually, the surgery lasts for about 2 hours.

After the surgery:

After the surgery the patient for several hours is transferred to an intensive care ward for observation, later the in-hospital treatment is continued. Usually after this surgery the patient continues the in-hospital treatment for about 7 days. On the next day after the surgery an early rehabilitation treatment is initiated: exercises of the elbow, wrist and hand joints. Exercise involving the passive movements of the affected shoulder can be initiated. The exercises of the early rehabilitation treatment should be continued for about 6 weeks. Active small amplitude  movement of the arm forward is allowed. Sleeping on the affected shoulder and resting on the affected arm is not allowed for about 6 weeks. The muscles and the bone adapt to the joint endoprosthesis and partially altered biomechanics during this period. Traction and active motion exercises are initiated after 6 weeks. Shoulder muscle strengthening exercises are initiated after 6 to10 weeks. 2-3 months after the surgery the patient is allowed to take part in moderate physical activities.