Joint Replacement (Prosthesis)

Introduction
Artificial hip and knee joints have been implanted for many years in large numbers and with excellent results. Equally successful and increasingly popular is joint replacement at the shoulder, too. Fortunately advanced joint destruction (wear) is much rarer in the shoulder, than it is in the lower limb. Recently, we also have been using special prostheses for cases with rotator cuff tears. Possible reasons for joint wear are: Cartilage abrasion (arthritis), humeral head necrosis, rheumatism, old fractures or massive cuff tears.

Surgical procedure
Two completely different types of joint replacements are available: First, the Anatomical Prosthesis for shoulders with an intact rotator cuff and second, the Reversed Prosthesis for shoulders with a cuff tear. In the first (anatomical) situation, I have been using the joint resurfacing principle since 2004, which is much less invasive than the traditional stem prosthesis. Usually we replace both, the head and the socket. We use an anterior exposure that preserves the deltoid origin, allows a fast rehabilitation and is cosmetically the best solution. We are obliged, however, to take off the subscapularis tendon, to be able to get into the joint. That is why mobilisation in the first 6 weeks has to be slowed down, until the tendon has healed to its original insertion.

Follow-up and prognosis
Following the postoperative protocol the shoulder is normally mobilized immediately with assistance. You will wear a sling for 6 weeks (Ultrasling or Mitella) for comfort and protection. After that you will be allowed to move your shoulder freely and receive a strengthening programme from your physiotherapist. Three months postoperatively, work with light and medium shoulder strain should be possible, as a rule. Most patients will obtain excellent overhead function with time. The new joint will serve an elderly person well for every-day use, if it is a reversed prosthesis. If it is an anatomical surface replacement in a younger patient, professional activities and, yes, even overhead sports, are often not restricted!