Shoulder Prosthesis: When is it Useful?

Shoulder Prosthesis: When is it Useful?

Indications for Shoulder Prosthesis

Shoulder prosthesis placement may be offered to patients experiencing significant shoulder pain and resulting joint disability. It's advisable for patients objectively unable to perform normal daily activities. It's indicated if there's no improvement after medication and physiotherapy.

Underlying conditions can be inflammatory (arthritis, autoimmune arthritis, or post-injury arthritis) or degenerative (osteoarthritis, age-related wear). Other causes include avascular necrosis of the humeral head (interrupted blood supply due to trauma or atraumatic causes, including steroid and alcohol abuse), improperly treated major fractures, or failed previous replacement surgery.

When to Consult a Doctor for Shoulder Pain?

Shoulder pain persisting beyond a few days, or recurring after anti-inflammatory medication, requires diagnosis and treatment. An MRI may be ordered to visualize joint structures (soft tissues and bones). If the MRI shows tendon or cartilage wear, surgery may be necessary. With mechanical problems, pharmacological and physiotherapy treatments may only provide temporary relief or even worsen the condition.

Causes of Shoulder Problems

The shoulder is prone to injury because the humeral head is larger than its cavity. Muscles, tendons, and ligaments are under considerable strain for stability and movement. Besides trauma, the acromion's thickness is a factor. A thick acromion causes rotator cuff tendon rubbing, leading to inflammation and wear.

Osteoarthritis (cartilage wear, common in those over 60) is another cause. In younger individuals, tendon wear can result from manual labor or high-impact sports (volleyball, basketball, tennis). Pain can also stem from autoimmune diseases (rheumatoid arthritis), neurological diseases (stroke, cervical radiculopathy), metastatic disease, cholecystitis, and myocardial infarction (with accompanying symptoms like malaise and retrosternal pain).

Diagnosis

A general practitioner is the initial contact for persistent shoulder pain. However, an orthopedic specialist provides a thorough assessment, including medical history and examination, recommending diagnostic imaging: typically X-ray, sometimes supplemented by CT scan (for bone) or MRI (for soft tissues).

Treatment of Shoulder Prosthesis

Total Prosthesis or Resurfacing Shoulder Prosthesis

Surgical treatments vary. Total shoulder prosthesis replaces the entire joint. Endoprosthesis replaces only the damaged humeral head. Other options include reverse prosthesis (inversion of joint concavity and convexity) or resurfacing prosthesis (articular surface replacement of the humeral head).

Complications occur in approximately 6% of cases, including:

• Persistent pain;
• Prosthetic loosening and mobilization;
• Scar adhesions;
• Nerve and/or vascular injury;

Post-operative home convalescence is crucial. Splint use is recommended, along with wound care and specific exercises prescribed by the orthopedic surgeon.

Materials in Shoulder Prosthesis

Modern prostheses primarily use titanium and cobalt-chrome-molybdenum alloys, and very high molecular weight polyethylene.

The Patient Journey for Those Requiring a Shoulder Prosthesis

Patients needing a shoulder prosthesis are initially referred to orthopedic specialists. Depending on the case, diagnostic procedures (X-ray, MRI, ultrasound) are performed.

For safety and quality, all surgical candidates undergo cardiological and internal medicine assessments (evaluating overall health). Once cleared, surgery is performed. Post-arthroplasty, the patient receives medical and physiotherapy follow-up for rehabilitation.

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The Case of Shoulder Arthritis

Arthritis is a degenerative disease from cartilage wear (osteoarthritis) or joint inflammation (rheumatoid arthritis). Inflammation can also affect muscles, tendons, and ligaments, causing pain, swelling, and reduced mobility. Treatment depends on the cause. Osteoarthritis is usually treated with anti-inflammatory drugs. Rheumatoid arthritis may require physiotherapy and other medications. If non-surgical treatment fails, shoulder joint replacement (arthroplasty or shoulder prosthesis) may be necessary.

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