A total shoulder replacement: some insights from Dr Hannes Jonker

A CONVENTIONAL TOTAL SHOULDER REPLACEMENT

Shoulder replacements are the final solution for people with osteoarthritis or another form of arthritis that results in osteoarthritis of the shoulder.  Patients with severe shoulder pain and injury will only receive a normal total shoulder replacement if the rotator cuff muscles are still intact, and if conservative treatment or rehabilitation does not relieve the pain, or if the pain negatively affects their quality of life.  The younger the patient is, the more conservative the treatment is likely to be when it comes to shoulder related procedures and OA.

 

A REVERSE TOTAL SHOULDER REPLACEMENT: WHEN IS IT PERFORMED?

A reverse total shoulder replacement is suitable for patients with irreparable rotator cuff disease and who failed to respond to conservative rehabilitation. Or, patients whose bone loss is so severe in normal osteoarthritis that conventional shoulder arthroplasty is at a high risk of failing.  Inflammatory type of arthritis, like rheumatoid arthritis, causes both the bone and the rotator cuff to become inflamed and here a reverse total shoulder replacement is a good option.

 

WHAT ARE THE NEW TRENDS FOR SHOULDER REPLACEMENTS?

A few of the newer replacement technologies are stemless humeral implants and minimal uncemented implants in the glenoid. Dr. Jonker has already been using Apex prosthesis in the humeral head and the VaultLock Glenoid System, both from Arthrex, for six years. The implants he uses are smaller and the procedure is less invasive. Consequently, in the unlikely event of a patient experiencing difficulties, there are more options for remediation. Due to the less-invasive nature of the procedure, patients also return to painless activities sooner.

Dr. Jonker is the only orthopaedic surgeon in South Africa implementing these technologies, like a VaultLock with bone transplant.

 

WHY WEARING A SLING AFTER A TOTAL SHOULDER REPLACEMENT?

In the case of a conventional shoulder replacement, wearing a sling gives the shoulder time to heal.

Sling wear for a period of four weeks is specifically for resting for the soft tissue to heal. Keeping it still, helps with pain relief. 

For a good result shoulder replacements will last 10 to 15 years, and a four- to six-week rest in a sling is a small price to pay. 

 

WHY YOUR INTEREST IN THE SHOULDER?

“One fascinating aspect of the shoulder is that it is the most mobile joint in the body, and reconstruction of the shoulder requires meticulous attention to detail to ensure the patient is satisfied with the outcome. You must align the patient’s expectations with the outcome of the planned surgery.” Dr Hannes Jonker

Dr. Jonker performs an average of 50 shoulder replacements each year.


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