The following surgical measures may be considered in the setting of omarthrosis (shoulder osteoarthritis):
- Arthroscopy of the shoulder joint (arthroscopy) – procedure:
- Debridement (removal of infected, damaged, or necrotic (dead) tissue/cartilage).
- Partial surface replacement for cartilage defects at the humeral head (advantages: biomechanics and important structures are preserved in the best possible way)Indications: focal chondral avascular necrosis (dead tissue) of the humeral head/upper end of the humerus (stages 3-4 according to Cruess); omarthrosis without significant glenoid destruction (destruction of the glenoid cavity of the shoulder joint, which is in contact with the humerus) when restricted by the implant size of currently 3.5 cm in diameter
- Cup prosthesis – endoprosthetic replacement of the humeral head (upper end of the humerus).
- Endoprosthetic replacement of the glenohumeral joint (shoulder joint)/shoulder endoprosthesis – gold standard.
- Hemiendoprosthesis (HEP) – humeral head prosthesis: the articular surface of the humeral head is replaced.
- Total endoprosthesis (TEP) – shoulder total endoprosthesis (shoulder TEP): both the articular surface of the humeral head and the glenoid cavity is replaced.
Standard of endoprosthetic treatment of omarthrosis with preserved rotator cuff represents so far the anatomical shoulder prosthesis with stem component. This poses a significant problem in the event of revision, as there is significant bone loss during stem removal.In contrast, the use of stemless shoulder endoprostheses (stemless metaphyseal shoulder endoprosthesis) in arthrosis of the glenohumeral joint preserves the anatomy and leads to a significant reduction in operating times.
- Inverse shoulder prosthesis (delta prosthesis) – for defect arthropathies (osteoarthritis in defective rotator cuff): the head is replaced by an epiphyseal socket and the glenoid (glenohumeral joint socket) by a glenospherical socket.
- Arthrodesis (joint fusion) – only in exceptional cases.
Further notes
- Elective arthroplasty of the shoulder joint (shoulder arthroplasty) has sex- and age-specific differences for the risk of revision surgery.
- Women >85 years of age (one in 37 had to undergo revision surgery after shoulder arthroplasty (shoulder replacement)).
- Men: 55-59 years (one in four had to undergo revision surgery; risk was increased esp. during the first five years).
