A reconstruction of the shoulder joint in cases of chronic-degenerative arthrosis or inflammatory or post-traumatic arthrosis requires great clinical experience from the operating surgeon. The best results in these cases have been achieved by the implantation of artificial shoulder joints, with the prosthetic implant reproducing the anatomy as accurately as possibly. The main reason why patients seek advice from their doctor is unbearable pain in the shoulder under movement, under stress, and - most importantly - at rest. It is the degree of suffering more than the age of the patient that largely determines the decision to implant an artificial shoulder joint. Of course, it is an important prerequisite that all available conservative measures have been exhausted.
The operation is generally carried out under general anaesthesia and normally takes about 1.5 to 2 hours. The worn surfaces of the joints are removed and shaped to a specific plan to ensure that the artificial joint can be matched exactly to the bone. During the operation, the surgeon decides whether the humeral head and the socket of the joint also need replacing.
After closing the access, the shoulder is immobilized in a Gilchrist bandage immediately after the operation. Physiotherapeutic exercise treatment is started straightaway on the first post-operative day, initially practising passive movement patterns, later also progressing to active-assisted and active exercises. In cases of good pre-operative mobility of the shoulder (alas rarely the case), mobility is relearned after about 45 days; the focus can then be on actively increasing muscle strength. However, if the shoulder joint had stiffened prior to the operation, the patient needs to perform stretching and extension exercises several times a day for the first year after the operation in order to improve mobility of the joint and to retain the achieved level of mobility.
Standard model of an
artificial shoulder joint