Shoulder prosthesis: when to resort to surgery and what it consists of

“Functional limitation of the shoulder is quite a disabling condition for a patient,” explains Dr. Camos. “Many people, in fact, have difficulty in the simplest daily activities, such as putting their wallet in their pocket, taking care of their personal hygiene, or exercising.”  

There are several pathologies that may result in the need for shoulder prosthesis surgery. 

The most common one is eccentric glenohumeral arthrosis, caused by irreparable massive rotator cuff injury: wear and tear of the articular cartilages and alteration of normal shoulder biomechanics inevitably results in shoulder pain, leading to progressive functional limitation.

Other pathologies that may lead to shoulder prosthesis:

• concentric glenohumeral arthrosis;
• rheumatoid arthritis;
• fractures or sequelae of fractures involving the proximal epiphysis of the humerus (humeral head);
• aseptic necrosis of the humeral head. 

Symptoms of glenohumeral arthrosis

The most common symptoms of glenohumeral arthrosis are:

• pain;
• joint stiffness and functional limitation;
• swelling (joint effusion);
• hypotrophy of the shoulder muscles.

Patients who are candidates for shoulder arthroplasty present with a clinical picture characterized by intense pain and significant functional joint limitation in all planes. Generally, surgery is indicated for patients over 65 years of age.

How to diagnose glenohumeral arthrosis

“The process of diagnosing glenohumeral arthrosis occurs through several steps,” the specialist continues.

First, a thorough collection of the symptomatology presented by the patient (history) is necessary, followed by several clinical tests that should be performed during the visit with the orthopedic specialist. Finally, instrumental tests will have to be performed to confirm the diagnostic hypothesis.”

The most useful tests for better diagnostic framing include: 

• X-ray of the shoulder in two projections;
• computed axial tomography (CT) scan;
• nuclear magnetic resonance imaging (MRI).

“Regarding the prosthesis surgery, a pectoral deltoid surgical access is used, which will leave a scar of about 10-12 cm. After reaching the joint, the head of the humerus will be removed, and then the glenoid cavity and humeral canal will be prepared to accommodate the prosthetic components, - the specialist continues. -The surgery ends with insertion of the prosthetic components, joint function testing, and suturing by layers. Specifically, regarding the type of surgical and prosthetic intervention, we proceed with:

• anatomic arthroplasty for concentric glenohumeral arthrosis;
• reverse arthroplasty for eccentric glenohumeral arthrosis. 

The average duration of the surgical procedure is about 75 minutes.

In all cases, selective anesthesia useful for postoperative analgesia will be performed, and general anesthesia will be given.

There are alternative conservative therapies, however the medical-physical ones act on the effects of the pathology (pain, muscle contracture) and not on the cause (anatomical alteration), leading to partial and absolutely transitory results".

From the first postoperative day, the patient begins cautious mobilization of the shoulder. After 3-4 days the patient is discharged, and the stitches will be removed after about 15 days. A brace is not prescribed but an immediate rehabilitation program is started.

“After about 30 days," Dr. Camos concludes, "a radiographic checkup with orthopedic examination will be performed: these assessments will be repeated after 6 and 12 months and then once every year. After about 6 months, the stabilized clinical outcome is characterized by absence of pain and marked improvement in shoulder mobility.”