PD Dr. Wolfgang Pötzl

This was not always the case. For many years, the implantation of an artificial shoulder joint was considered complicated and prone to complications. But in the last 20 years, implants and instruments have become technically more advanced, and surgical techniques have become more refined and less traumatic—a blessing for the growing number of patients. "We now achieve similar longevity as in hip and knee endoprosthetics," says Orthopedist Pötzl happily.

However, not everyone who comes to him wanting a new shoulder joint actually receives one. As long as possible, shoulder specialist Pötzl adheres to "joint preservation before joint replacement". With physiotherapy, physical therapy, and pain medication, as well as with the help of minor surgical procedures, the doctors in the department try to delay the use of an artificial shoulder joint. At the same time, it is also important not to miss the right time for the new shoulder joint, says Pötzl. "If arthritis has already spread to tendons and muscles, the result will not be as good as it could have been."

In Bad Rappenau, shoulder specialists only use total endoprostheses (TEP). Partial endoprostheses have not proven successful for him, says Pötzl. More than half of the TEPs are so-called inverse joints. The doctors insert the head instead of the former socket; the end of the humerus forms the new socket. An inverse joint is used when normal shoulder prostheses would not help sufficiently—for example, in older people who have had a complicated humeral fracture, or patients whose shoulder joint-encompassing muscles are not intact.

Patients with normal arthritis of the shoulder, called omarthrosis, receive an anatomical prosthesis. Unlike hip or knee replacements, there is no off-the-shelf option for the shoulder. Each prosthesis is precisely tailored to the patient by the doctors. "We mimic the natural anatomy of the joint," explains Pötzl. The reason for the effort? The shoulder is by far the most mobile joint. Any restriction would be experienced by patients as significant. Therefore, the shaft, connecting part, and joint head are precisely adjusted in terms of inclination angle—their optimal position ensures maximum mobility later.

When choosing the artificial joint, the orthopedist relies on proven solutions. "Before switching products, we carefully examine who developed the prosthesis, how long it has been used, and whether it truly offers an improvement for the patient," says Pötzl. This is the case with a new inverse prosthesis that the doctors in Bad Rappenau have been using since 2016: It enables stronger internal rotation, thereby improving the ability to reach behind.

To better monitor their own results, the doctors at the Vulpius Clinic examine all patients they have equipped with an artificial shoulder joint after ten years. "In 2016, we re-examined our first patient, to whom we had inserted a new shoulder joint," recounts Pötzl. "The man remains very satisfied with it and can use his arm almost without restriction."

The secret of Pötzl and his team? Perhaps it is the combination of clear focus and precision. Even in his free time, Pötzl loves this challenge. He climbs, plays golf, and knows: "You have to keep your nerves, demonstrate mental strength, and develop a strategy before you take the next swing or climb higher." He cannot afford carelessness in sports—just like in his profession.