Arthrosis and prostheses
Arthrosis is the most common chronic joint disease. It is characterized by continuous loss of the hyaline joint cartilage, which over the course of the disease leads to deforming changes of the surfaces of the joint cartilage. Patients usually complain about pains while at rest and while weightbearing, thus leading to regular use of pain medications. A narrowing of the joint opening occurs, as do bony protuberances. This leads to increasing limitation on movement, and even to complete stiffening. Conservative treatments, such as physical therapy or injections, in the end are no longer of any help. In this stage even arthroscopic joint operations no longer have a chance of relieving pain and restoring function.
In the last 10 years, endoprosthetic reconstruction of shoulder joints changed by arthrosis has become increasingly common. While the artificial replacement of hip and knee joints is established and well recognized, endoprosthesis of the shoulder joint has not yet achieved the same acceptance and standing, despite very good results and satisfied patients. In selected centers, endoprosthetic replacement of the shoulder joint today offers the possibility of effective and reliable treatment for destroyed joint surfaces. The goal of the joint replacement is first reduction in pain or freedom from pain, and second, clear improvement of the functioning of the shoulder joint.
The optimal time of the operation is quite important for a very good functional result. Too long a delay of treatment – to the point of stiffening – should be avoided. A good pre-operative shoulder movement means excellent post-operative function without a large-scale operation. In addition to the painful destruction of the shoulder joint by degenerative wear and tear, other indications, including rheumatoid arthritis, necrosis of the humeral head, and fracture of the humeral head, have been successively treated by joint replacement. Various prosthetic components are available for the specific needs of the individual disease. An intact rotator cuff is a prerequisite for all anatomic prostheses. If this is not the case, an inverse prosthesis should be inserted.
The operation must be performed under general anesthesia. The joint is inserted via a 10 cm long incision on the front of the shoulder. In addition, the tendon of the subscapularis muscle (a strong interior rotator) must be partially detached, something that has an effect on follow-up treatment. The operation lasts 90-120 minutes.
Physical therapy is begun as early as the first day after the operation. For the first 6 weeks, active internal rotation must be avoided as well as rotation to the outside over the neutral position. At night a tubular bandage is worn for immobilization; during the day a loose sling is sufficient. The initial stay in the hospital is a short-term inpatient stay. This is possibly followed by inpatient rehabilitation for 3-4 weeks. Physical therapy is then continued on an outpatient basis by specialist therapists. The operating physician conducts regular monitoring of the course of rehabilitation. Close cooperation between the operating physician and the follow-up physical therapists guarantees a high degree of security, and optimizes the post-operative result for obtaining function and freedom from pain.