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Shoulder replacement

The purpose of the shoulder prosthesis is to replace, partially or totally, areas of cartilage that have been damaged by trauma, osteoarthritis or degenerative processes. The aim of a prosthesis is to restore joint amplitude and function as far as possible, and to alleviate pain.
Shoulder prosthesis features and function

The aim of a total shoulder prosthesis is to restore shoulder mobility. Two prosthesis designs are available; the choice of one or the other is made in the light of the clinical and radiological picture. Joint prostheses are generally composed of metal implants (titanium alloy, stainless steel, chrome-cobalt) and polyethylene, or pyrocarbon. The two implants slide over each other during movement, just like the original joint surfaces. However, as they are not innervated, sliding is painless.

Anatomical prostheses (partial or total)

It closely replicates the anatomy of the humerus: one implant, called a calotte, replaces the head of the humerus, and is extended by a stem to secure it in the humerus. The other implant, shaped like a small oval cup, is attached to the scapula. This type of prosthesis requires a functional rotator cuff (muscles and tendons around the shoulder).

The reverse prosthesis

The reverse prosthesis is so called because of its design, which is reversed in relation to a so-called anatomical prosthesis. This time, the convex component is implanted on the scapula side and the concave component on the humerus side. The reverse prosthesis was originally designed to treat osteoarthritis concomitant with rotator cuff deficiency. The disappearance of the dynamic compression provided by the rotator cuff led to instability and early loosening of the glenoid component, compromising the results of anatomical prostheses.

Unlike an anatomical prosthesis, the inverted prosthesis uses a semi-constrained design which derives its stability from this particular configuration, transferring the mobility of the humerus to the deltoid muscle and other residual muscles. The reverse prosthesis is generally implanted in cases of rotator cuff damage, bone wear, or fracture of the proximal humerus in people over 70.

Procedure details

The procedure is performed under general anesthesia, possibly combined with an arm nerve block to limit pain on awakening. The procedure takes about an hour. An incision is made in the front or top of the shoulder. The surgeon removes the damaged bone segment, then installs the prosthetic components.

Rehabilitation and recovery

Rehabilitation should be gentle and progressive. It generally begins the day after surgery, under the supervision of a physiotherapist. It is dictated by the intraoperative status and is therefore personalized. The surgeon will tell you what exercises to do.

You should then continue self-mobilization exercises at home, with short but repeated sessions throughout the day. Physiotherapy sessions may be prescribed, particularly if you are at risk of developing a stiff shoulder (frozen shoulder). It takes six weeks to regain a certain degree of independence in activities of daily living, and around eight weeks before you can resume light sporting activities such as gardening.

Benefits and risks

Post-operative benefits expected

The results of an operation vary according to the nature of the disease, its degree of progression and each patient's recovery. With over 30 years' experience of these prostheses, wear and loosening may occur over time, but only in 5% of cases is it necessary to replace all or part of the prosthesis. Generally speaking, the improvement over pre-operative discomfort is such that the majority of patients are satisfied with their results.

Possible post-operative complications

As with any surgical procedure, there are risks and potential complications specific to the fitting of a shoulder prosthesis. Potential risks include :

  • infection (rare)
  • transient sensory disturbances (for reverse prostheses)
  • instability
  • fatigue fracture of part of the scapula

We take every possible precaution to limit these risks, and in the vast majority of cases, the post-operative period runs smoothly.

By integrating the Value-Based Health Care (VBHC) approach to shoulder arthroplasty, we have been able to quantify the real value delivered to our patients, and focus our efforts on what really matters: their quality of life. This method enables us to accurately measure the effectiveness of care in relation to direct costs. Our study reveals that the majority of our procedures surpass quality standards by reaching thresholds of substantial clinical benefit after shoulder prosthesis. »
Alexandre Lädermann
Latest innovations and research

Technological advances and medical research continue to improve shoulder prostheses. Stronger materials and improved designs mean longer-lasting prostheses and better functional results. Innovations also include minimally invasive surgical techniques, reducing recovery time and post-operative complications.

See the latest publications by Dr. Lädermann and Dr. Martinho 

Conclusion

Shoulder prostheses represent an effective solution for patients suffering from severe shoulder pain and dysfunction. With high satisfaction rates and ongoing advances in techniques and materials, it offers a promising alternative to improve patients' quality of life.

FAQ sur la prothèse d'épaule

Questions fréquentes sur la prothèse d'épaule.

Quand est-il nécessaire de considérer une prothèse d'épaule ?

L’implantation d’une prothèse est à envisager en cas d’échec d’un traitement conservateur bien conduit et lorsque la symptomatologie entrave de manière notable la qualité de vie.

Quelle est la différence d'indication opératoire entre une prothèse anatomique et une prothèse inversée ?

La prothèse anatomique imite l'articulation naturelle de l'épaule, tandis que la prothèse inversée est utilisée lorsque la coiffe des rotateurs est endommagée.

Combien de temps dure la récupération après l'installation d'une prothèse d'épaule ?

La période de récupération peut varier mais dure souvent plusieurs mois. Il est généralement conseillé d'éviter les activités qui sollicitent excessivement l'épaule, comme certains sports ou le port de charges lourdes, jusqu'à ce que le médecin donne son accord.

Quelle est la durée de vie d'une prothèse d'épaule ?

Les prothèses d'épaule peuvent durer 20 ans ou plus, cela varie selon l'activité du patient et d'autres facteurs individuels.

Peut-on conduire après une prothèse d'épaule ?

La conduite peut être reprise une fois que le sevrage de l’attelle a été effectué, que la douleur est gérée et qu’une mobilité suffisante de l'épaule est restaurée, souvent après quelques semaines de rééducation.

The number

The shoulder prosthesis scores very high in terms of patient satisfaction, with studies showing over 90% satisfaction with pain reduction and improved quality of life.

Specialties involved

Orthopedic surgery
Elbow & shoulder orthopedics and traumatology