Painful shoulder prosthesis (revision)

As always, the pain varies from person to person, both in terms of origin and severity. The cause of the pain is often to be found in the rotator cuff. For an anatomical prosthesis, it had to be intact when it was implanted. However, it is possible that it has worn out in the meantime and one of the tendons has torn. The shoulder hurts and the arm becomes weak.

The shoulder prosthesis wears out less than knee or hip prostheses. However, anchoring the socket in the shoulder is a major challenge. Unlike in the hip, there is no bony ring around the socket that allows an artificial socket to be pressed firmly into place. Instead, the flat cup must be attached and anchored to a small, flat bone. This anchoring can become loose and the artificial cup begins to wobble. The bone underneath is loaded unevenly. It begins to ache and can also break down.

It is easy to imagine that the humeral head is also no longer well guided if the socket no longer holds. Depending on the forces acting on it, it can become decentred in the joint and put unequal strain on it. This leads to asymmetrical wear, which further promotes uneven loading. This can go so far that the humeral head is practically fixed in an incorrect position, a subluxation.

It is very unfavourable if the prosthesis leads to a complete dislocation of the shoulder. Fortunately, this is rarely the case. However, the previously well-functioning rotator cuff may then tear or the artificial socket may become detached.

However, falls or accidents in older patients are particularly problematic. If you fall on a prosthesis, uncontrolled forces act. Because the bone and the metal of the prosthesis do not have the same material properties, there is a predetermined breaking point. A periprosthetic fracture can occur. This means that the prosthesis no longer holds in the bone. It must therefore be replaced, but the bone that would have to hold the new one is broken. A tricky situation that often requires major surgery.

A special situation exists when a fracture of the humerus was previously treated with a hemi-prosthesis. The healthy joint socket was not replaced, only the broken humeral head. However, because the artificial head made of chrome steel now stands opposite the natural socket, the cartilage of the socket will wear away over time and an artificial socket will have to be implanted.

If the joint suddenly not only hurts, but also swells and reddens, then an infection could be the cause. Particularly in the early phase after implantation, but also throughout life, it is possible for bacteria that circulate in the blood after dental treatment, for example, to settle on a prosthesis. Such an infection is extremely difficult to diagnose because it requires a joint puncture. It is even more difficult to treat because the bacteria form a protective film under which they hide. Therefore, often the only solution is to remove the prosthesis.

A reputable doctor will want to see you with a prosthesis once a year and carry out an X-ray check. This allows you to stay ahead of potential problems and react before it is too late. However, if you have sudden, persistent or unusual shoulder pain, you should see your orthopaedic surgeon quickly. He or she will examine you and certainly order an X-ray. This often establishes the diagnosis, but sometimes a computerised tomography scan is also required. An MRI is used less frequently as the metal of the prosthesis interferes with the image. In uncertain cases, a so-called SPECT-CT may be carried out. This examination focuses on the activity of white blood cells, which can indicate a small localised focus of inflammation that cannot be detected otherwise.

If someone has shoulder pain due to a problem with the prosthesis, don't beat about the bush - the prosthesis probably needs to be revised. This is a new operation in which the damaged components are replaced. This may sound like changing a tyre, but it involves much more. The new prosthesis must be anchored in the joint and should be functional again. It therefore not only needs new material, but also the biology that absorbs it. However, because a painful prosthesis has often damaged the bone and soft tissue in advance, it is not always a given that the replacement will be as good as the original prosthesis. Similarly, a second operation is usually more difficult than the first.

If the original prosthesis was an anatomical one, it can probably be replaced with an inverse prosthesis. The function is then often as good as before. Modern implants are already equipped for this case in such a way that they have components that can be easily replaced and others that can simply be left in place. However, if an inverted prosthesis loses its support or function, the revision is much more demanding and the results are sometimes only a reduction in pain but no improvement in function.

If the prosthesis is dislocated due to an accident, it will be repositioned (usually under anaesthetic), the joint immobilised for a few days and then observed to see how it works. If a fracture occurs around the prosthesis, the bone must be repaired. If the prosthesis remains stable, it can be left in place. However, one component is usually replaced with one that holds better because it is larger.

It goes without saying that revision surgery is a larger and more demanding procedure than primary implantation - both for the surgeon and for the patient. It takes more time for the joint to heal and recover. The follow-up treatment must be correspondingly more careful. But here too, efforts will be made to move the joint a little as soon as possible so that it does not become stiff.

Physiotherapy is crucial. During the period in which the arm cannot be actively moved, patients occasionally need help at home or go to a rehabilitation centre. This is followed by a period in which strength and coordination are rebuilt. The arm can now be easily used again in everyday life. Eventually, the situation normalises and even strenuous work becomes possible again.

The costs of revision surgery depend on various factors, including the implant, the duration and complexity of the procedure and the length of hospitalisation.

As a rule, your health insurance will cover the costs in full if you have the appropriate insurance.

Private or semi-private insurance is required for treatment at our specialist centre.

If the treatment is self-financed, we will be happy to provide you with a cost estimate after a thorough examination. This applies in particular to foreign patients.

As explained above, subsequent rehabilitation is rarely necessary. Simple physiotherapy is sufficient. Both are covered by health insurance.