Shoulder Replacement Surgery
What should you know about the structure of the shoulder joint? When is shoulder replacement surgery indicated? What can be expected before, during, and after the prosthesis surgery? How long does it take to regain pain-free freedom of movement?
With the help of BMM’s shoulder specialist, we have gathered the most important information.
The Healthy Shoulder Joint
The shoulder joint is one of the most mobile and complex joints in the human body, allowing for a wide range of arm movements.
The shoulder joint consists of 3 main bones:
- Humerus
The head of the humerus fits into the glenoid cavity of the scapula, which is a flat, dish-shaped depression. This joint forms the main pivot point of the shoulder. - Clavicle
The clavicle connects the skeletal structure of the chest to the upper limb. This important connecting role is performed by the acromion of the scapula, which is the extension of the shoulder blade. Medical literature refers to this area as the acromioclavicular joint. - Scapula
The movement of the scapula complements the movement of the arm.
The role of the rotator cuff is also important for the structure of the shoulder. This sheath, consisting of 4 interconnected muscles, stabilizes the arm and is responsible for the correct movement of the limb. The joint capsule, with its associated cartilage, tendons, and ligaments, is also an integral part of the shoulder joint.
The large range of motion of the shoulder joint is ensured by its anatomical design. This mobility often comes at the expense of stability, making the shoulder joint more prone to injuries.
About Shoulder Prostheses
The technical achievements of the 21st century have brought significant results in the field of medicine. The most modern surgical techniques available and high-quality implants enable the restoration of pain-free function to the affected shoulder.
Today, shoulder replacement surgeries are considered safe and successful routine procedures.
Shoulder replacement surgery can provide a pain-free and permanent solution for degenerative and inflammatory joint diseases, as well as injuries.
During the surgery, the orthopedic surgeon removes the damaged or worn joint parts and replaces them with a prosthesis made of plastic or metal. The implanted prosthesis mimics the movement and functionality of a natural joint, allowing the patient to regain the normal range of motion and strength of their shoulder after rehabilitation.
After a successful intervention, patients often feel a significant improvement in their quality of life, as daily activities that were previously painful become easy to perform again. It is important to note, however, that as with all surgical procedures, shoulder replacement also carries potential risks, so a thorough medical consultation is necessary before the intervention. Following the surgery, regular physiotherapy and appropriate aftercare are essential for achieving lasting and successful results.
Types of Shoulder Prostheses
There are different types of shoulder prostheses. Their application depends on whether it is a total, partial, or resurfacing prosthesis.
Two main groups of prostheses can be distinguished. The selection of the specific prosthesis type depends on the existing problem and the patient’s physical condition (e.g., bone quality).
In every case, the doctor chooses the prosthesis that best suits the individual’s problem, to ensure the patient’s fastest and most complete recovery.
Anatomical Prosthesis
Its goal is to reduce pain and improve shoulder movement in patients with severe joint degeneration (arthrosis) or fracture of the shoulder joint.
It consists of two main components: a metal ball replacing the humeral head and a plastic (usually polyethylene) component replacing the glenoid socket of the scapula. Its design mimics the natural anatomy and movement of the shoulder joint.
Reverse or Inverse Prosthesis
A special shoulder prosthesis primarily used in cases where a traditional implant (anatomical shoulder prosthesis) would not be effective. It is often used for severe rotator cuff ruptures or previous unsuccessful shoulder surgeries.
This type of prosthesis provides an inverted pattern of the natural anatomy of the shoulder joint. The humerus has the depression that mimics the socket, while the scapula has the metal ball that replaces the humeral head.
During prosthesis surgery, the orthopedic surgeon precisely inserts and secures the prosthesis components to ensure they fit the patient’s anatomy perfectly and provide shoulder stability. After surgery, the patient is advised to begin physiotherapy, which helps to quickly restore the shoulder’s strength and mobility.
Regular medical check-ups of the prosthesis are important for long-term successful results.
Special Diagnostic Method
At BMM, we place great importance on establishing the most accurate diagnosis possible. Therefore, before the intervention, an Arthro-MRI (arthrographic magnetic resonance imaging) scan is performed.
During the procedure, contrast material is injected directly into the shoulder joint. The contrast material helps to make the internal structures of the joint more visible, including the cartilage, joint capsule, joint ligaments, and meniscus.
This type of procedure is much more detailed than a traditional MRI scan.
When is shoulder replacement surgery necessary?
Shoulder replacement surgery is considered in cases of long-standing, continuous shoulder pain. In such instances, the intense stabbing, aching sensation also makes nighttime rest difficult.
Another characteristic symptom is a restricted range of motion in the shoulder, which limits the patient’s ability to perform everyday activities. To alleviate symptoms, the doctor usually first recommends conservative treatments. If conservative therapy is ineffective, surgical intervention should be considered.
Most Common Conditions Justifying Prosthesis
- Shoulder Joint Degeneration
Cartilage degeneration can naturally occur in joints over the years, during which the cartilage in the shoulder joint thins or completely wears out. Due to the reduced amount of cartilage, the joint bones rub directly against each other, causing pain and inflammation. Shoulder joint degeneration (arthrosis) often develops in older age, or as a result of injuries, rheumatic inflammation, or excessive strain. - Bone Fracture
Severe bone fractures around the shoulder, especially if the humeral head is affected, often necessitate prosthesis implantation. In such cases, the injury is so severe that the bone does not heal properly or the fractured bone fragments cannot unite correctly. In this situation, prosthesis implantation may be the best solution to restore normal shoulder function. - Avascular Necrosis of the Humeral Head
In a condition called avascular necrosis, the humeral head loses its blood supply, leading to the death of bone cells. This can be caused by traumatic injury, long-term use of certain medications, or other health problems. Bone necrosis causes pain and stiffness. If the disease is in an advanced stage, prosthesis implantation may be the optimal treatment option.
Before Shoulder Replacement Surgery – Preparing for the Operation
Preparation for shoulder replacement surgery begins with an orthopedic examination when the need for implant placement arises.
- After a thorough physical examination, imaging diagnostic procedures (CT, MRI scan, ultrasound, X-ray) are performed, and the obtained medical reports are evaluated.
- This is followed by a comprehensive focus search.
- An anesthesiology examination is also conducted, based on existing medical reports (laboratory test, ECG, chest X-ray).
- If necessary, preparatory physiotherapy is recommended before the surgery, which facilitates a successful intervention and rehabilitation.
The Course of Shoulder Replacement Surgery
- During shoulder replacement surgery, the surgeon makes a longitudinal incision from the front, through the anterior muscle. They move the muscles aside to access the shoulder joint.
- With the help of imaging diagnostic scans and a prosthesis planning program, a custom-sized prosthesis is implanted. For this, the surgeon shapes the humeral head and the glenoid socket according to the chosen prosthesis type.
- The prosthesis is placed into the appropriate part of the joint using a cemented or cementless technique.
- It may happen that during prosthesis surgery, reconstruction or replacement of the upper capsule of the shoulder (graft procedure) is necessary. This usually occurs when the rotator cuff cannot be sutured for some reason.
- Subsequently, the surgeon infiltrates the joint area with pain-relieving and hemostatic injections and closes the wound.
The surgery is performed under general anesthesia and local analgesia. It takes approximately 2-2.5 hours. At BMM, shoulder replacement surgeries are performed with dual assistance, just like knee or hip prosthesis surgeries. The central element of operating with dual assistance is that the surgeon’s assistance is provided by a fellow shoulder surgeon. As a result, the surgical procedure becomes safer, and its duration is shortened. This greatly contributes to a faster and more optimal recovery after the intervention.
What to expect after shoulder replacement surgery?
After prosthesis surgery, the patient typically spends 2 days in the hospital. On the day after the surgery, rehabilitation begins with the help of a physiotherapist. This involves guided, active movements.
Physiotherapy continues after discharge from the hospital. Proper movement is essential for optimal healing, but it is important to follow instructions.
Suture removal takes place 7-10 days after the surgery.
Wearing an arm brace is recommended for the first 6 weeks after surgery. After 6 weeks, a specialist check-up follows, where the brace is also removed.
If the position of the shoulder prosthesis has not changed compared to its implantation, and no other complications have arisen, the everyday use of the shoulder joint and arm can gradually begin. Four months after the surgery, patients can cautiously start exercising, such as swimming. The patient is considered fully recovered after 6 months.
The success of shoulder replacement implantation largely depends on the patient, in addition to the surgeon’s expertise. It is important to strictly follow the doctor’s instructions to achieve full recovery.
Possible Complications of Shoulder Replacement Surgery
The chance of complications can be minimized with thorough examination and planning. However, it should not be overlooked that shoulder replacement surgery, like all surgical interventions, can rarely have unexpected consequences:
- Shoulder Dislocation
- Risk of infection
- Shoulder joint stiffness
- Thrombosis
- Bleeding
Most common complaints treated by our shoulder specialists:
Patient Testimonials
Our Shoulder Replacement Specialist
Dr. Bálint Major
Shoulder Specialist Chief Orthopedic Traumatologist
Dr. Balázs Gloviczki PhD
Chief Orthopedic-Traumatologist, Shoulder Specialist
Dr. György Kocsis PhD
Orthopedic-Traumatologist, Chief Hand Surgeon, University Assistant Professor, Wrist, Elbow, and Shoulder Surgeon, Upper Extremity Specialist
Dr. János Bartha
Chief Orthopedic-Traumatologist, Robotic Surgeon
Dr. Ferenc Tompai
Chief Orthopedic and Trauma Surgeon
WHY IS BMM THE SAFEST SOLUTION?
Coordinated Surgical Team
Our orthopedic surgeons performing hip replacement surgery have been working together for decades and know each other’s every move.
Thousands of Surgeries Experience
Our orthopedic surgeons have performed thousands of successful hip prosthesis implantations; there is no case they have not encountered.
Modern Technology
Our surgeons apply hip joint endoprosthesis implantation without muscle cutting, which greatly reduces postoperative pain and accelerates rehabilitation.
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