SHOULDER PROSTHESIS: Have an artificial shoulder joint implanted in Prof. Ockert's Munich clinic

If all other treatment measures no longer help with painful joint wear and tear on the shoulder, an artificial shoulder joint can be a reliable and effective solution.

In the case of advanced osteoarthritis, gain a new quality of life through joint surgery with shoulder prostheses.

The aim of the shoulder prosthesis is to relieve pain and restore shoulder mobility - and thus restore a large part of the quality of life.

When and for what illness is an artificial shoulder joint used?

Joint replacement is considered when there is severe pain, limited mobility and joint wear that can no longer be adequately alleviated by other treatments (e.g. physiotherapy, medication or injections) and the level of suffering is high.

Common reasons for using a shoulder prosthesis are:

• Advanced shoulder arthrosis (joint wear) of the shoulder
• Complex fractures of the humeral head
• Rheumatic diseases that damage the joint and cartilage
• Severe rotator cuff damage
• Bony misalignments or broken bones that have healed incorrectly after operations

Goals of a shoulder prosthesis

The aim of the artificial shoulder joint is to:

• to eliminate pain
• to improve mobility
• To restore everyday skills such as dressing, lifting or combing hair

It is particularly important to precisely plan and select the right prosthesis. Modern technology such as computer-assisted implantation, patient-specific CT data and even robotics help to insert the shoulder prosthesis accurately and safely.

What different types are there and when is a shoulder prosthesis necessary?

The shoulder joint is a ball-and-socket joint. Choosing the right shoulder prosthesis depends on how badly the articular surfaces are damaged and whether the rotator cuff is still intact.

1. Partial prosthesis (hemi prosthesis)

If only the humerus is affected - for example due to a fracture or limited arthrosis - and the socket (glenoid) is still well preserved, it is often sufficient to replace a hemiprosthesis, i.e. only the head of the humerus.

To do this, the damaged joint surface of the humerus is removed and provided with a so-called shaft-free surface prosthesis. The natural bone is largely preserved - this is particularly gentle.

If desired or necessary, the pan can also be replaced.

2. Total shoulder endoprosthesis

If both the shoulder head and the socket on the scapula of the shoulder are severely damaged due to arthrosis or injury, a complete endoprosthesis is necessary.

This will:

• the humeral head replaced by a short metal shaft
• the socket was replaced by a plastic implant (made of polyethylene).
• The socket is anchored either without cement (e.g. through bone growth) or with bone cement. 

There are different types of pans including:

• Pans with tenon anchoring
• Pans with keel anchoring
• Titanium pans with a plastic insert that can be converted into another system if necessary

Modern technology: navigation and computer-assisted implantation from the shoulder prosthesis specialist

Modern shoulder prostheses are now often performed using:

• Patient-specific CT data
• Computer-aided planning
• navigation systems
• and in some centers also with robotic support used. 

The aim is to place the implant with millimeter precision – for better mobility, less wear and longer durability of the prosthesis.

A precisely positioned artificial joint significantly improves the result and ensures greater patient satisfaction.

Reverse shoulder prosthesis – the solution for tendon damage and severe fractures

In some cases, not only is the joint worn out, but the important rotator cuff - the muscle group that stabilizes and moves the shoulder joint - is so damaged that it can no longer fulfill its function. 

Then an anatomical prosthesis is usually not a good choice, as shoulder mobility and shoulder pain are not reliably restored after an artificial joint replacement.

A special form of artificial shoulder joint is used to reduce pain and improve mobility: the reverse shoulder prosthesis.

What does “inverted” denture mean?

Significance and success of the reverse shoulder prosthesis

In a normal (anatomical) shoulder prosthesis, the ball sits on the upper arm and the socket on the side of the shoulder - as in natural anatomy.

With the inverted prosthesis it is exactly the opposite:

The ball is attached to the shoulder socket

The sliding socket is located on the humerus

Advantage of the reversed technique:

By reversing the joint mechanics, the center of rotation is shifted during the procedure so that the deltoid muscle can partially take over the function of the rotator cuff. 

This makes it possible to actively lift the arm again, even if the tendons are torn.

The reverse shoulder prosthesis is usually used for:

• Patients over 65 years old
• with severe rotator cuff damage
• and good deltoid muscle function.

Materials of anatomical and reverse endoprosthesis

Artificial shoulder joints are made of body-friendly materials that ensure long durability and good tolerability:

Metal components usually made of titanium or cobalt-chrome alloys

Sliding surfaces made of polyethylene (PE) – a special, durable plastic

Cemented or cementless anchoring, depending on bone quality

In most cases, the implants with a short shaft are designed so that they can be changed or adjusted later if necessary (e.g. conversion to an inverse system).

Follow-up treatment and rehabilitation after an endoprosthesis was implanted on the shoulder in the clinic.

The implantation of a synthetic shoulder joint is an important step on the way to less pain and better mobility - but the right follow-up treatment is just as crucial for long-term success.

Immediately after the operation

After the operation, the arm is initially immobilized in a shoulder bandage. This is usually worn for a few days to a few weeks, depending on the type of prosthesis and the course of the operation. Painkillers and targeted positioning help to alleviate the initial discomfort.

Early mobilization

Early functional physiotherapy usually begins the day after the operation under the guidance of experienced therapists. The aim is to regain shoulder mobility step by step in the first six weeks - without jeopardizing healing.

Rehabilitation

Depending on the individual findings and restriction of movement before the procedure, inpatient or outpatient rehabilitation can take place. Here you will:

• Flexibility, strength and muscles are systematically built up
• Protective postures avoided
• Everyday functions are specifically trained
• The rehabilitation usually lasts 3 weeks and is individually adapted to the patient.

Healing process

Full recovery can take several months. Patience and regular practice are crucial for a good result. After rehabilitation, many patients report a noticeable improvement in shoulder function and a pain-free everyday life.

How long does a shoulder prosthesis last after surgery?

Modern implants are long-lasting. The average shelf life is:

• 10 to 20 years, often longer
• Depending on load, implant type and individual factors

If wear, loosening or infection occurs again after many years, the prosthesis can usually be revised (replaced).

Conclusion: An artificial shoulder joint can bring back quality of life

A new shoulder joint is a proven and effective way to relieve pain and regain mobility when other therapies are no longer sufficient.

Thanks to modern technology, individual implant selection and gentle surgical procedures, many patients today benefit from significantly improved well-being - in everyday life, during leisure activities and even in sport.

The decision to have a shoulder prosthesis should always be made in close consultation with the treating doctor - taking into account individual complaints, wishes and living circumstances.