Minimally Invasive Shoulder Arthroplasty
What is the innovative stemless reverse shoulder arthroplasty
Shoulder arthroplasty is the replacement of the surfaces of the bones of the joint that come into contact and are usually worn. These surfaces are replaced with artificial implants, known as prostheses. The materials used are either metal or ceramic and are fully compatible with the human body. The type of arthroplasty is determined by the extent of damage to the joint and the condition of the overlying muscles. Shoulder arthroplasty is usually performed to relieve pain and restore range of motion after conservative treatment has failed. If the muscles surrounding the joint are functioning, anatomical total arthroplasty is recommended, in which the joint surfaces are replaced in the same anatomical configuration as before surgery. If the muscles surrounding the shoulder are damaged, reverse total arthroplasty is recommended, in which the ball and socket components are positioned in the opposite configuration to normal. This variation allows the shoulder joint to function normally even without the overlying muscles.
The most common shoulder conditions treated with arthroplasty are:
- Osteoarthritis – destruction of the articular surfaces
- Post-traumatic Arthritis, meaning arthritis resulting from a shoulder injury
- Rheumatoid Arthritis and other inflammatory arthritides
- Fractures in which the articular surface has been destroyed
- Massive irreparable rotator cuff tears
The most common symptoms are:
- Pain on the front or outer surface of the shoulder. The pain may radiate as far as the elbow, as well as to the neck and back.
- Night pain that wakes the patient, especially if they sleep on the affected shoulder
- Severe and persistent pain even when the shoulder is not moving
- Weakness of the upper limb
- The patient cannot easily raise the arm fully (stiffness)
Mr Leonidou specialized in shoulder arthroplasty at one of the largest clinics in the world, the Reading Shoulder Unit. It was at this clinic that the Copeland resurfacing arthroplasty and the stemless reverse arthroplasty were developed. The doctor has extensive experience in shoulder arthroplasty with patients from all over the world. In Greece, Mr Leonidou is introducing for the first time minimally invasive reverse shoulder arthroplasty without a stem and without cement, using the Verso system. The incision is located on the outer surface of the shoulder and is less than 10 centimetres long.
Advantages of Minimally Invasive Reverse Shoulder Arthroplasty
- Smaller incisions – excellent cosmetic result
- Less trauma to the underlying tissues
- Bone preservation – only the worn surfaces are removed
- Bloodless procedure – no transfusion required
- Less postoperative pain
- Faster recovery
- Fewer intraoperative and postoperative complications
- Shorter hospital stay
During the preoperative assessment, the patient will be informed about the proposed surgical treatment with arthroplasty. The anesthesiologist will examine the patient, take a detailed medical history and organize the necessary investigations. The preoperative assessment includes routine blood tests, a chest X-ray and a cardiological evaluation. The patient is admitted to the hospital on the day of surgery. The specialized anesthesiologist, Ms Koutra, administers regional anesthesia, which ensures the absence of postoperative pain and enables immediate mobilization of the patient. When indicated, Mr Leonidou’s team applies, for the first time in Greece, shoulder arthroplasty without general anesthesia and without sedation. The patient receives regional anesthesia only and remains awake during surgery.
After surgery, the patient will return to the ward. Immediate mobilization is encouraged. The patient will not have a urinary catheter or drains. The surgery is bloodless and minimally invasive and therefore no postoperative transfusion is required. The patient will wear a sling for a few days and is discharged from the hospital in less than 24 hours after surgery (fast track protocol). Before discharge from the hospital, the patient will discuss the surgical findings in detail with Mr Leonidou and will receive the relevant leaflet with postoperative instructions. The patient will be followed up by a physiotherapist from the team, following an individualized rehabilitation protocol. Most shoulder movements are allowed from the first postoperative day.
Shoulder arthroplasty is a demanding surgical procedure and requires a specialized surgeon with a high volume of cases. In experienced hands, it provides excellent results both in eliminating pain and in restoring the patient’s function. It is a safe technique with exceptionally low complication rates.
Relief from acute pain is immediate and shoulder movement is restored to a great extent.
The return to daily activities is gradual. Within a few days after arthroplasty, the patient is able to take care of themselves and perform the basic movements required in everyday life.
Correct positioning of the arthroplasty components is an important factor that determines its longevity. In the hands of the specialized shoulder surgeon Mr Leonidou, shoulder arthroplasty lasts 15–20 years in most patients.
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