Shoulder prostheses: types and necessary care

What types of shoulder prostheses exist and what are they indicated for?

When we consider replacing the shoulder joint, we basically have two prosthetic surgery options: the anatomical prosthesis, in which we replace the anatomy of the shoulder with a prosthetic element, and the reverse prosthesis in which we completely change the anatomy of the shoulder with a device that allows us to move the limb without the need for rotator cuffs.

We will consider choosing between an anatomical prosthesis or a reverse prosthesis when there is an anatomical or functional competition of the rotator cuff, i.e. when the rotator cuff is not functional because it is irreversibly injured or because we do not have a correct functioning of this cuff, we cannot use an anatomical prosthesis, because its results would be extremely bad, and we have to use a reverse prosthesis.

Thus, the anatomical prosthesis will be used in those diseases in which the rotator cuff is intact as osteoarthritis of the glenohumeral joint that we call idiopathic, ie those that have occurred spontaneously, those that appear as a result of trauma and those that also appear as a result of chronic instability in those patients who have had multiple shoulder dislocations and that appears a degenerative and disabling arthrosis. We will also use the anatomical prosthesis in rheumatic diseases such as rheumatoid arthritis, lupus erythematosus and in diseases that produce lack of irrigation of the humeral head producing what we call an osteonecrosis of the same.

In the last decade the indications for the reverse prosthesis have been expanding, we use it in those situations of arthropathy secondary to chronic rotator cuff disease, we can also use it in those chronic and irreparable rotator cuff injuries and we also use it in the treatment of severe fractures in people over sixty-five/seventy years of age. Likewise, it is also a very good solution for those situations in which an anatomical prosthesis has to be replaced and we want to ensure a good post-operative result.

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Both the anatomical prosthesis and the reverse prosthesis are implanted under general anesthesia generally reinforced by an interscalene block to control postoperative pain. Patients who have undergone total shoulder replacement surgery must wear a sling for four to six weeks to ensure proper healing of the subscapularis tendon, during which time it is necessary to perform passive exercises to ensure good mobility of the limb while protecting the healing of the tendon.

From the sixth week, active lifting exercises are started, strengthening the stabilizing muscles of the scapula to progressively achieve a mobility as close as possible to the physiological one. From the third month we begin exercises to strengthen the periscapular musculature and achieve good control of the limb. Optimal functional results are achieved after the sixth month.

Shoulder pain, what are the most frequent injuries?

The causes of shoulder pain can be found within the glenohumeral joint, we can find it in the periarticular space and we can also find patients with shoulder pain whose origin is outside the shoulder joint, this is what we call referred pain.

Among the most frequent causes of joint pain would be glenohumeral arthrosis either idiopathic, that is to say, spontaneous or post-traumatic and among the causes of periarticular pain the most frequent causes, without a doubt, would be the lesions associated with the rotator cuff. Among the causes of referred pain the most frequent, by far, is pain of cervical origin, especially injuries occurring between the fifth and sixth cervical vertebrae.

What sports should I not practice with a shoulder prosthesis?

Ninety percent of patients who undergo shoulder joint replacement surgery, either with an anatomical prosthesis or a reverse prosthesis, achieve a very good functional result. They can even practice sports that allow them to lead a reasonable social life. Perhaps the only exception would be racquet sports, but even golf can be played, swimming can be practiced and outdoor sports can be practiced without any limitation.