Shoulder prosthesis is now a widespread surgical procedure with effective results, enabling patients to resume normal daily activities. There are different types of shoulder prosthesis, from anatomic to inverted, whose use varies according to the patient’s specific needs. In this article, we provide an in-depth analysis of the pathologies that may require shoulder arthroplasty, as well as how the operation is performed and the rehabilitation that follows.
Prosthetic shoulder surgery has grown considerably in Italy in recent years, as the RIAP (National Register of Prostheses) also points out. The growing use of this technique has been made possible not only by significant scientific advances, but also by the development of surgical techniques and equipment that have made it possible to perform complex operations even in non-specialized centers.
Shoulder prosthesis: when surgery is necessary
Shoulder prosthesis surgery is indicated in all conditions where the structures that make up the joint are irreparably worn and deformed, causing pain and functional limitation.
There are various pathologies that can lead to a similar condition. The most common is certainly glenohumeral osteoarthritis, which consists of a progressive reduction in the cartilage lining the mucosa, resulting in the disappearance of the joint space between the humerus and the scapula, deformation of the joint surfaces and the formation of bony outgrowths known as osteophytes. Osteoarthritis is often a natural consequence of aging, but is sometimes promoted and conditioned by previous damage to the joint, such as major trauma or repeated microtrauma caused, for example, by repeated shoulder dislocations. A particular variant of osteoarthritis is that resulting from massive, inveterate damage to the rotator cuff, in which the humerus rises upwards, reducing its relationship with the glenoid (eccentric osteoarthritis, or arthropathy due to non-repairable damage to the cuff).
There are also other pathologies that represent an indication for a possible shoulder prosthesis operation:
Certain rheumatic diseases such as rheumatoid arthritis, psoriatic arthritis or others in which the chronic inflammation that occurs leads to progressive destruction of all joint structures, with severe deformation of the joint;
Necrosis of the humeral head, in which part of the head no longer receives a blood supply, degenerates and becomes deformed (the administration of prolonged cortisone therapy, for example, can be the cause and facilitate its occurrence);
The consequences of poorly-healed fractures with joint deformities;
Certain multi-fragment fractures of the proximal humerus, for which there is no longer any possibility of reconstructing a functional joint, and the only solution is to implant a prosthesis.
However, prosthetic shoulder arthroplasty should only be considered when all conservative and rehabilitative treatments have failed, and the pain and disability caused by the various pathologies are markedly and persistently impairing quality of life, making it difficult to carry out everyday activities.
The different types of shoulder prosthesis
There are currently several different types of shoulder prosthesis. Firstly, a total prosthesis can be performed, in which both sides of the joint are replaced (humeral head and scapular glenoid); or an endoprosthesis (or hemiarthroplasty), in which only the humeral side is replaced.
In the case of a total prosthesis, which is the most common solution today, the choice is between an anatomical prosthesis and an inverted prosthesis.
Anatomical prosthesis
In the anatomical prosthesis, the upper part of the humerus (stem and humeral head) and the surface of the scapula (glenoid) are replaced, in an attempt to reproduce and thus mimic the normal anatomy of the shoulder. Movement and strength are guaranteed by the rotator cuff.
In this case, a metal or, more frequently, plastic part is positioned on the surface of the scapula (glenoid) after appropriate preparation, while a spherical part mounted on a metal rod replaces the upper part of the humerus. Experience with this type of anatomical prosthesis dates back to the 1950s, and for many years it was the most widely used type of implant.
The inverted prosthesis
The inverted shoulder prosthesis, developed in France by Dr. Paul Grammont, has recently become the most widely implanted prosthetic model. In this case, the hemispherical component is positioned on the glenoid of the scapula, while the concave component is implanted on the humerus, mounted on a stem of varying length inside the humeral canal.
The reverse shoulder prosthesis was initially used to treat glenohumeral arthritis associated with rotator cuff tears in elderly patients with loss of active arm elevation. But thanks to reported successes and increased implant survival times, indications were subsequently extended to younger patients with irreparable rotator cuff lesions, complex proximal humeral fractures or disabling fracture sequelae, and finally in the case of failure of an anatomical prosthesis.
Shoulder arthroplasty surgery: methods, anesthesia and duration
The procedure for inserting a shoulder prosthesis in Turkey is performed through an incision in the anterior region of the shoulder. The damaged upper part of the proximal humerus is removed and the glenoid cavity prepared to accommodate the prosthetic components.
The procedure is performed under locoregional anesthesia, usually via a puncture at the base of the neck, which may be combined with deep sedation for patient comfort (combined anesthesia). The operation lasts an average of 60 to 90 minutes, and requires a hospital stay of around 3/4 days.
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The post-operative course and shoulder rehabilitation: orthosis and physiotherapy
After the operation, a bandage is applied and a shoulder orthosis is worn. Pain after surgery is generally moderate, and can be easily controlled and managed with analgesics.
Mobilization of the operated shoulder begins the day after surgery, with the help of a physiotherapist and according to a precise protocol. The corset is temporarily removed to allow progressive movement of the shoulder, until it is completely removed within a month of surgery.
After orthopedic hospitalization, physiotherapy is generally carried out with a physiotherapist on an outpatient basis, but in special cases it may also be possible to be admitted to a rehabilitation department.
Driving can be resumed a little over a month after the operation, while the resumption of work activities depends on the type of work, which is otherwise possible after the first month. Resuming sporting activities (golf, swimming), however, takes a few months longer.