This treatment, which is performed by partially or completely replacing the shoulder joint with a prosthesis, restores your quality of life. It can be applied in cases such as osteoarthritis, rheumatic diseases, avascular necrosis, and tumors in the shoulder joint. Shoulder prosthesis surgery alleviates your pain and restores your mobility when other treatment methods are ineffective. In this article, we will explain what a shoulder prosthesis is, the situations in which it is applied, and the surgical process.
What is the Shoulder Joint and Shoulder Prosthesis?
Structure of the Shoulder Joint
The shoulder is the joint in your body with the widest range of motion. It consists of the head of the upper arm bone (humerus) and the socket part called the glenoid in the shoulder blade. This structure allows you to move your arm in every direction.
The joint surfaces are covered with cartilage tissue. Cartilage allows the bones to glide over each other without friction and is nourished by a capsule that produces joint fluid. Thanks to this ball-and-socket joint, you can easily perform many movements, from combing your hair to reaching for an object behind you.
The rotator cuff muscles, which provide stability to the shoulder, are of great importance. These four muscles wrap around the shoulder joint, maintaining both movement and balance. Ligaments surrounding the joint capsule also connect the bones, providing stability to the joint.
Definition of Shoulder Prosthesis
Shoulder prosthesis is the partial or complete replacement of a damaged shoulder joint with an artificial joint. This artificial joint, made of metal and polyethylene parts, replaces the damaged bone components.
The prosthesis application comes into play when the cartilage tissue in the joint is severely damaged. The aim is to eliminate your pain and restore function in your daily life activities. While the prosthesis is applied to the upper part of the arm bone, whether a prosthesis is placed in the socket where the bone head sits depends on the technique used.
The prosthesis system allows the damaged shoulder to be stronger and move flexibly. However, this treatment is not a process that should be sought for minor problems. The degree of damage in your condition is a fundamental factor in determining the prosthesis application.
When is Shoulder Prosthesis Surgery Necessary?
Shoulder prosthesis surgery is performed when other treatment methods do not provide benefits. Initially, medication, intra-articular injections, and physical therapy are preferred.
In the diagnosis process, X-rays are usually sufficient. In some cases, computed tomography is required to evaluate bone integrity. Magnetic resonance imaging may be performed to examine the condition of the muscles and fibers in the shoulder joint. If there is suspicion of nerve damage, EMG tests or nerve conduction studies are requested.
If your pain does not go away with conservative treatments and your mobility restriction continues, a prosthesis becomes necessary. You will experience severe pain due to the wear of the joint cartilage. The friction between the bones severely limits your ability to move.
If the joint structure cannot be repaired with radiological imaging and medications, prosthetic options are considered. The decision for surgery should only be made after detailed examinations and expert opinions. In this process, the patient's overall health condition and the effects on quality of life are evaluated.
In Which Situations is Shoulder Prosthesis Applied?
Shoulder prosthesis surgery is applied in certain disease conditions. Each patient's situation is different, and the treatment plan is shaped accordingly.
Osteoarthritis in the Shoulder Joint
Osteoarthritis is one of the most common problems in the shoulder joint. Over time, the cartilage in the joint wears away, and the bones begin to rub against each other. It usually occurs after the age of 50.
As the cartilage tissue thins, you will feel pain in your shoulder. It becomes difficult to lift your arm, and your sleep at night is disrupted. Even your daily activities become challenging. If medication and injections no longer work, a shoulder prosthesis offers a permanent solution.
Rheumatic Diseases
In inflammatory rheumatic diseases such as rheumatoid arthritis, your immune system attacks your joint structures. Chronic inflammation gradually destroys the joint cartilage and the underlying bone.
These diseases cause progressive destruction of the shoulder joint. Your joint functions gradually decrease. When rheumatic disease progresses and the joint is severely damaged, prosthetic treatment may be necessary.
Avascular Necrosis
Avascular necrosis develops due to insufficient blood supply to the head of the shoulder bone. The bone tissue loses its vitality and collapses over time. This disease is the second most common site for bone vascular disorders after the hip.
When the nutrition and structure of the humeral head are disrupted, bone cells die. Your joint structure is damaged, and the need for a prosthesis arises. Avascular necrosis has different stages, and in advanced stages, partial or total shoulder prosthesis is applied.
Shoulder Fractures
Multi-fragmentary fractures occurring in the shoulder head in elderly patients are of special importance. Especially in patients over 70 years of age, bone quality is low. In fractures with a low probability of functional healing, prosthesis is preferred.
When non-surgical treatment or healing with plates and screws is not possible, prosthesis comes into play. In fragmented and crushed fractures, sometimes the bones cannot be stabilized. In this case, a reverse shoulder prosthesis may be applied to treat the fracture and preserve shoulder function.
Shoulder Prosthesis in Tumor Cases
Individuals diagnosed with bone tumors may experience significant bone loss. Both benign and malignant tumors are among the conditions that require shoulder prosthesis.
After the tumor-affected bone and joint tissue are surgically removed, a tumor prosthesis is used to restore the bone's function. These prostheses are designed for use in cases of significant bone loss.
Rotator Cuff Tears
Long-term rotator cuff muscle tears lead to osteoarthritis in the shoulder. Severe tearing of shoulder fibers results in functional disorders.
In large tears that cannot be repaired, rotator cuff arthropathy occurs. This condition is characterized by the upward migration of the humeral head and degeneration in the joint. In irreparable rotator cuff tears in older patients, reverse shoulder prosthesis surgery is preferred.
What Types of Shoulder Prostheses are There?
When shoulder prosthesis surgery is performed, your doctor will choose the most suitable type of prosthesis for you. All shoulder prostheses basically consist of a head and a socket, but their designs and operating principles differ. The structure of your shoulder, the location of the damage, and the condition of the rotator cuff muscles determine the choice of prosthesis.
Partial Shoulder Prosthesis
Partial shoulder prosthesis is a method in which only half of the shoulder joint is replaced. In this application, only the head of the upper arm bone is replaced with an artificial prosthesis. No intervention is made to the glenoid part, which is the joint socket.
A metal stem is placed in the canal part of the humerus bone, and a metal head is attached on top. This metal head works by sitting in the natural joint socket. As long as the glenoid surface remains intact, the joint function can be preserved by only replacing the head of the arm bone.
Partial humeral fractures are the most common situations where partial prosthesis is used. This method is preferred especially in irreparable fractures occurring in the shoulder head of elderly patients. It can also be applied in cases of bone loss due to bone tumors.
The integrity of the rotator cuff muscles is essential for the success of this method. If your shoulder fibers have lost their function, a partial prosthesis may not be sufficient. The average duration of the surgery is 60-90 minutes, and you will need to stay in the hospital for 1-3 days.
Total Shoulder Prosthesis
Total shoulder prosthesis involves replacing both surfaces of the joint. Both the head of the arm bone and the shoulder socket are renewed with artificial parts. This method is applied in cases of extensive damage to the shoulder joint.
A plastic polyethylene socket is fixed to the joint socket with a special adhesive. A stem made of titanium is placed inside the arm bone. A metal head made of chrome-cobalt alloy is placed on top of the stem.
It is an ideal option for patients with shoulder osteoarthritis and intact rotator cuff muscles. The smooth surface between the metal ball and the plastic socket facilitates joint movements. This prosthesis mimics the normal anatomy of the shoulder.
On the other hand, certain conditions are required for total shoulder prosthesis to be performed. The fibers surrounding the shoulder joint must function properly. It is also important that the bone structure is strong enough to support the prosthesis. The difference from partial prosthesis is that it is applied bilaterally.
Reverse Shoulder Prosthesis
Reverse shoulder prosthesis is a special system that reverses the anatomical structure of the shoulder joint. The metal ball is placed in the shoulder blade, while the plastic socket is placed in the arm bone. Thanks to this intelligent design, shoulder movement is now provided by the deltoid muscle.
It was first developed in 1985 by French surgeon Paul Grammont. Grammont created a new biomechanical system that compensates for rotator cuff insufficiency with the strength of the deltoid muscle. Today, more than 30 different designs of reverse shoulder prosthesis are used.
It is the most effective option for patients with rotator cuff tear arthropathy. In large rotator cuff tears that cannot be repaired, the deltoid muscle takes over the task of lifting your arm. It also yields promising results in multi-fragmentary shoulder fractures seen in the elderly.
However, this prosthesis is not suitable for every patient. Generally, successful results are obtained in individuals over 70 years of age with intact deltoid muscles. There must be enough bone in the shoulder blade to support the prosthesis. It can also be a salvaging option in cases where previous shoulder surgeries have failed.
Complications of reverse shoulder prosthesis include dislocation, which is significant. The dislocation rate varies between 1.5-31%. Some studies have reported that up to 20% of patients may require revision.
Shoulder Prosthesis Surgery Process and Recovery
Knowing how the process will progress after deciding on surgery will ease your mind. Collaborating with your doctor at every stage will accelerate your recovery.
Preoperative Preparation
Before the surgery, you will undergo a detailed examination. Based on physical examination and radiological imaging tests, it will be decided which type of prosthesis is suitable for you. Your activity level and expectations from the surgery will be discussed with your doctor.
Blood tests and X-rays will be performed. You will be informed about how the surgery will be carried out, the risks, and the outcomes. The details of the rehabilitation process after surgery will be explained to you.
How is the Surgery Performed?
Shoulder prosthesis surgery is usually performed under general anesthesia. The average duration of the surgery is between 1.5-2 hours. The risk rate is low when performed by experienced surgeons and in suitable hospital conditions.
After the surgical incision is made, the damaged and non-functional joint tissues are removed. Prostheses made of metal and polyethylene are placed appropriately in their place. The muscles, tendons, and joint capsule around the shoulder are preserved as much as possible.
After the surgery, your hospital stay is generally 2-4 days. In some cases, this duration may vary between 1-3 days.
Initial Postoperative Period
The first 24-48 hours after surgery are the most critical period in terms of pain management. Thanks to modern anesthesia techniques and local blocks, this process is now much more comfortable.
Patients can usually walk around painlessly with an arm sling the next day. From the second or third day onward, you can wash your face and perform elbow movements. You can start using a computer.
On the first day after surgery, you are encouraged to eat your own food with your elbows on the table. The arm sling should be used for 4-6 weeks. During this period, you should not lift weights over 2 kilograms.
Swelling and pain in the early period are normal. Cold application is effective in reducing pain and swelling in the first weeks. You should regularly use the painkillers and muscle relaxants recommended by your doctor.
Physical Therapy and Rehabilitation
Physical therapy is critical to the success of the surgery. 60-70% of surgical success depends on the surgery, while 30-40% depends on physical therapy.
The recovery process varies from person to person and usually lasts 6-10 weeks. The physical therapy process begins with shoulder movements the day after surgery. For about 3 weeks, you will perform the exercises taught to you.
The first 0-4 weeks is the protection period. Shoulder movements are performed completely passively. Passive joint range of motion exercises are applied with the help of a physiotherapist. Elbow, wrist, and hand exercises are started early to support circulation.
In the intermediate period of 4-12 weeks, active movements gradually come into play. Exercises with light resistance bands are started. At the end of six weeks, the arm sling is removed, and depending on the condition of muscle strength, the shoulder can be actively used.
The advanced period covers 3-6 months and beyond. Strengthening exercises intensify. You return to daily living activities.
Return to Work Process
The return to work period depends on shoulder movements and muscle strength. If you have a desk job, returning to work is possible after 2-3 weeks. Those who work in light jobs can return to work within 6 weeks.
Returning to jobs that require heavier physical activity may take an average of 4-6 months. In professions requiring physical strength, this period may extend up to 3 months. The condition of your shoulder muscles and tendons before surgery plays an important role in your recovery process.
Frequently Asked Questions About Shoulder Prosthesis
In the long term, low-impact sports such as swimming, walking, and yoga are safe. On the contrary, activities that put strain on the shoulder, such as weight lifting, tennis, or contact sports, should be limited. A balanced diet and weight management support your long-term shoulder health.
Conclusion
Shoulder prosthesis surgery offers a permanent solution when other treatment methods do not yield results. Your pain decreases, and you can comfortably return to your daily activities. Overall, the success of the surgery depends on both the surgical procedure and physical therapy.
Before the surgery, discuss in detail with your doctor and share your expectations. Adhere to your physical therapy program. In fact, the most important step in your recovery process is regular exercises. Modern prostheses provide durability of 15-20 years.
Do not neglect your specialist check-ups for your shoulder health. With the right treatment plan, you can regain your quality of life.
What activities should I avoid?
Avoiding certain activities after surgery speeds up your recovery. For the first 2-4 weeks, do not lift anything heavier than a glass of water. Avoid overloading your shoulder.
Stay away from heavy lifting, pushing, or pulling movements. You should also avoid sports and activities that will strain the shoulder. Do not participate in contact sports and avoid repetitive heavy lifting.
Driving is generally allowed 6-8 weeks after surgery. You can return to the driver's seat when your shoulder range of motion reaches a safe level and when you no longer need painkillers.
Some patients may feel a different type of pain compared to their pre-surgery pain. This pain decreases over time, and moving as recommended by your doctor provides relief. Each patient's experience is different; some recover quickly while others take longer.
Will there be pain after surgery?
Pain after surgery is normal. You will feel pain for the first few days, but this is not a cause for concern. Thanks to modern pain relief protocols, your pain is managed.
Painkillers recommended by your doctor can be administered orally or intravenously. The severity and duration of pain vary from person to person. Generally, pain significantly decreases within 1-2 weeks.
You should follow your doctor's instructions regarding the use of medications. The dosage and frequency of painkillers should be adhered to as specified. If you experience persistent pain after surgery, consult your healthcare provider.
Regular check-ups maximize the lifespan of the prosthesis. Do not neglect your doctor visits to reduce the risk of complications. If necessary, a second surgery, i.e., revision, can be performed.
What is the lifespan of a shoulder prosthesis?
The average lifespan of modern shoulder prostheses is between 15-20 years. Some sources state that this period can be 20 years or longer. Typically, a lifespan of 10-20 years or more is expected.
The lifespan of the prosthesis depends on many factors. Your age, activity level, and bone quality directly affect this duration. Your physical activities, the materials used, and your lifestyle also determine the durability of the prosthesis.
Including the preoperative preparation and postoperative awakening processes, the total time may reach 3-4 hours. You will need to stay in the hospital for 2-3 days.
How long does shoulder prosthesis surgery take?
The duration of the surgery typically ranges from 1.5 to 2.5 hours. However, this time may vary depending on the complexity of your case. The type of prosthesis applied also affects the duration.
A standard shoulder prosthesis surgery performed by an experienced surgeon and team takes about 2 hours. In some cases, the surgery may take 2.5 to 3.5 hours. If there is bone damage in the shoulder joint or if the joint capsule needs to be expanded, this time increases.
