Shoulder Joint Replacements

Joint replacement or joint replacement is a surgery where a bad and painful or fractured joint is replaced by a few
metal and plastic elements that allow to improve or disappear the
pain and allow you to improve function.
This prosthesis is not appreciated outside the body. Just left
an external scar on the skin. With this surgery, the
joint movement and the general function of that limb.

Shoulder replacement is a surgical procedure to treat the shoulder joint if it has been damaged or worn, usually from arthritis or injury. Your surgeon replaces part or all of your shoulder joint with artificial parts.

It is a very large surgery and has the possibility of presenting com- Implications inherent to the anesthetic and surgical act. most of
the patients do not present any complications.
Complications may include residual pain, rigidity,
bleeding, blood clotting problems, instability, re- chazo, limb inequality, fractures, infection, accommodation
components, injury to nerves or blood vessels, problems of
scarring and others. Sometimes sooner or later it is necessary- It is necessary to re-operate or change that prosthesis again (Total Prosthesis
revision). The duration of the prosthesis is variable ( of 15 a 20 years).

Shoulder Joint Replacements in Bogotá

La cirugía de reemplazo de hombro consiste en eliminar las áreas dañadas de su hombro y reemplazarlas con partes artificiales. El procedimiento se realiza para aliviar el dolor y mejorar la movilidad.

Es posible que necesite un reemplazo de hombro si tiene artritis grave o una fractura en la articulación del hombro . Aproximadamente 53,000 personas se someten a una cirugía de reemplazo de hombro cada año.

Siga leyendo para obtener más información sobre cómo se realiza esta cirugía y cómo será su recuperación.

¿Quién es un buen candidato para este procedimiento? | Candidatos

La cirugía de reemplazo de hombro generalmente se recomienda para personas que tienen dolor severo en el hombro y han encontrado poco o ningún alivio con tratamientos más conservadores.

Algunas afecciones que pueden requerir un reemplazo de hombro incluyen:

  • Osteoartritis. Este tipo de artritis es común en personas mayores. Ocurre cuando el cartílago que protege los huesos se desgasta.
  • Artritis reumatoide (AR). Con AR , su sistema inmunológico ataca por error sus articulaciones, causando dolor e inflamación.
  • Necrosis avascular. Esta afección ocurre cuando se produce la pérdida de sangre en un hueso. Puede causar daño y dolor en la articulación del hombro.
  • Un hombro roto. Si se rompe gravemente el hueso del hombro, es posible que necesite un reemplazo de hombro para repararlo.

Su médico puede ayudarlo a decidir si la cirugía de reemplazo de hombro es la mejor opción para usted.

Las personas que obtienen buenos resultados con la cirugía de hombro comúnmente tienen:

  • debilidad o pérdida de movimiento en el hombro
  • dolor severo en el hombro que interfiere con la vida cotidiana
  • dolor mientras descansa o durante el sueño
  • poca o ninguna mejoría después de probar terapias más conservadoras, como medicamentos, inyecciones o fisioterapia

Este tipo de cirugía tiene menos éxito en personas con:

  • diabetes
  • depresión
  • obesidad
  • enfermedad de Parkinson
Shoulder Joint Replacement
Shoulder Joint Replacements in colombia

Shoulder Joint Replacements in Colombia

Your shoulder is an important joint that rotates with a greater range of motion than any other joint in your body.. If it causes you pain to the point that you cannot reach into a cabinet, you can't sleep well or experience other symptoms, your healthcare provider might consider replacement surgery. This procedure can ease your pain and increase mobility..

Total anatomical shoulder replacement

In general, total shoulder joint replacement surgery involves replacing the arthritic joint surfaces with a highly polished metal ball attached to a stem and plastic socket.

Patients with bone-on-bone osteoarthritis and intact rotator cuff tendons are good candidates for conventional total shoulder replacement..

Reverse Total Shoulder Replacement

For patients with a total rotator cuff tear, severe arthritis with rotator cuff tear or having had a failed shoulder joint replacement, a conventional total shoulder replacement can leave pain and limited mobility.

In reverse total shoulder replacement, the lace and metal ball are swapped. That means a metal ball is attached to the shoulder bone and a plastic socket is attached to the upper arm bone.. This allows the patient to use the deltoid muscle instead of the torn rotator cuff to lift the arm..

Stem Hemiarthroplasty

Depending on the condition of the patient's shoulder, [doctor] can replace only the ball. This procedure is called a hemiarthroplasty..

In general, the head of the humerus is replaced with a metal ball and stem, similar to the component used in a total replacement.

Rejuvenation hemiarthroplasty

With shoulder arthritis, this offers an alternative to standard stem replacement.

Rejuvenation hemiarthroplasty involves replacing the joint surface of the humeral head with a stemless cap-shaped prosthesis.

This is a popular option for patients who are young or very active., as it avoids the risk of component wear and loosening that can occur in the other procedure.

When is a shoulder prosthesis required?

Shoulder replacement surgery is necessary when the shoulder joint is destabilized to the point that the arm can no longer be used without pain.. This lack of mobility without pain in the joint may be due to osteoarthritis or after a traumatic injury to the shoulder.

The implantation of a shoulder endoprosthesis is necessary if the wear or damage of the shoulder joint is so advanced that non-surgical operations and / or joint preservation do not solve the problem.

This is often found in cases of advanced arthritis of the shoulder joint (osteoarthritis) where the wear of the articular cartilage surfaces (primary osteoarthritis) is particularly painful and movement has become extremely restrictive.

What's more, severe fractures or upper arm injuries (humerus (fractura glenoidea), changes in blood flow to the humeral head (humeral head necrosis), rheumatic diseases (chronic polyarthritis), instability (chronic shoulder dislocation) o Joint infection (omartritis), leads to damage and wear of joint surfaces (secondary osteoarthritis).

The goal of the shoulder prosthesis

In shoulder replacement surgery, the shoulder joint is replaced with an artificial joint prosthesis. The main objective of this operation is the reduction of pain in the affected shoulder. How normal function of the shoulder joint requires freedom of movement (mobility), you will regain maximum mobility of the shoulder along with relief from lateral pain.

Hemiartroplastia o “shoulder prosthesis”

The hemiarthroplasty replaces only the articular surface of the humeral head. The humeral head bone is not removed. This prosthesis model is suitable in cases where the stabilizing muscles of the shoulder joint (rotator cuff) are intact or only slightly damaged and the shoulder socket (glenoidea) barely shows signs of wear. With this type of shoulder prosthesis, the shoulder joint is repaired by placing a metal surface on the humeral head at the top of the humerus. Cartilage on the surface of the joint cavity (glenoide) remains intact. Shoulder hemiarthroplasty has the potential to preserve the joint surface still intact or unused.

One of the main problems of shoulder hemiarthroplasty is the continuous wear over time of the glenoid surface. Pain may increase and mobility and weight-bearing ability may decrease if the glenoid component wears out prematurely.

Average improvement in range of motion in all directions after shoulder hemiarthroplasty is more than 40 °. This clinical result is similar to the results of total shoulder arthroplasty. To recommend hemiarthroplasty, the shoulder specialist must carefully evaluate the glenoid surface and be sure it is in good condition to ensure a satisfactory result for the patient.

The reason why hemiarthroplasty is considered a desirable option, if it is possible, is that it preserves the natural bone surface and bone mass of the shoulder. Under these circumstances, if in the future secondary surgery is necessary, the result would be superior to revision surgery for a total shoulder arthroplasty.

Shoulder Joint Replacement Procedure

Total joint arthroplasty

Total shoulder arthroplasty replaces both components of the shoulder joint: the humeral head and glenoid socket. It is the most widely used type of shoulder replacement. If both articular surfaces, the humeral head and glenoid are worn, a total endoprosthesis is necessary. Using this replacement method, the part of the humeral head closest to the joint is removed. Following, the interior is prepared (bone marrow space) from the upper arm bone to the prosthesis stem. A prosthetic stem is implanted into the bone. One of the most serious complications of a total shoulder prosthesis is loosening of the glenoid component.. This results in new pain and reduced mobility.. Therefore, a complete diagnosis and a perfect size and fit of the prosthetic components is an essential aspect of shoulder surgery.

Joint replacement or joint replacement is surgery where a bad joint is replaced, painful or fractured by metal and plastic elements that improve or eliminate pain and reactivate function. This prosthesis is not appreciated outside the body; only an external scar remains on the skin. With this surgery the movement of the joint and the general function of that limb can be improved.

Joint replacement surgical options


This technique consists of repairing tears in the soft tissues around the knee., the hip, shoulder and other joints. Damaged cartilage is repaired and broken pieces of cartilage are removed.

Replacement arthroplasty

An arthritic joint surface is replaced by an orthopedic prosthesis.

Joint rejuvenation

For knee joints, it is a unicompartmental or partial knee replacement. Implants are inserted into only one of the three compartments of the knee: the medial compartment (interior), lateral (exterior) o femororrotuliano (frontal). In the rejuvenation of the hip joint, a metal cup replaces the hip socket while the damaged hip ball is reshaped and finished off with a metal prosthesis.


A bone is cut and removed, or a piece is added near a damaged joint. In the knee, an osteotomy shifts weight from an arthritic area to a healthy area. In the hip it is used to correct hip misalignment or dysplasia.


Inflammatory arthritis affects the lining of the joints, synovium, and damages the cartilage and surrounding joints. In this procedure the affected synovium is removed.

Arthrodesis or fusion

Hardware such as pins are used, plates or rods to fuse two or more bones in the affected joint to create a continuous joint. As the bones grow together, stabilize the joint and hold it in place.

Total joint replacement (TJR) or total joint arthroplasty

The damaged joint is replaced with an implant constructed of plastic components, metal, ceramic or carbon coated. The implant works like the original joint.

Minimally invasive TJR

Like in TJR, this technique also replaces damaged joints, but with smaller incisions. It's about less cutting and reattachment of muscle.

Joint review

The life of an implant is 15 a 20 years. Those who acquire them at a young age may eventually need a second replacement, known as revision.

The relatively long-term efficacy of a joint replacement procedure provides a better quality of life. Painless movement, increased strength of the joints, easier management of daily activities and independence are possible.

Joint replacement means removing part or all of a damaged joint and installing hardware to allow the limb to move without pain or limitations.. The replacement hardware is called a prosthesis. These are made of plastic, metal, ceramic or a combination of these materials. Most joint replacements are done to treat arthritis damage to the knees or hips.. Orthopedic surgeons perform the procedure under general anesthesia.

The decision to replace a joint depends on several factors:

  • How severe are the symptoms? Moderate to severe pain, stiffness and limited function of the joint may indicate the need for a new joint.
  • How severe is the joint damage? An x-ray or other imaging test can show if the bone and cartilage in the joint have deteriorated.. The joint can also go out of alignment. Moderate to severe joint damage is an indication for joint replacement.
  • Does the joint problem limit daily activities and compromise a person's quality of life? This also indicates that joint replacement may be beneficial..

Like any major operation, joint replacement surgery carries the risk of possible complications. For example, there are small risks that you may have a reaction to the anesthesia, develop a blood clot or get an infection.

Shoulder Joint Replacements

Shoulder Joint Replacements Bogota Medellín Colombia Cali Pereira Manizales

Shoulder replacement is a surgical option to treat arthritis pain or damage from a traumatic or degenerative injury.. In joint replacement surgery, the doctor removes the damaged tips of the bone and cartilage from the joint and replaces them with artificial parts. The round end of the arm bone is replaced with an artificial stem and rounded metal head, while the cavity part of the shoulder blade is replaced by a soft plastic acetabulum that is held in place with a special cement. If only one of these two bones needs to be replaced, the surgery is called partial shoulder arthroplasty, o una hemiarthroplasty. The parts of the artificial joint are designed to fit smoothly, eliminating pain caused when bones rub against each other.

Arthroplasty (joint replacement) consists of a surgery to replace the ends of the bones of a deteriorated joint. This surgery creates new joint surfaces.

In shoulder arthroplasty, Doctors replace the ends of the damaged bone in the upper arm (humerus) Y, as usual, shoulder bone (omóplato) or cover them with artificial surfaces lined with plastic or with metal and plastic. Components of the shoulder joint can be held in place with cement. Or they may be made of materials that allow, over time, new bone grows into the joint component to hold it in place without cement.

The upper end of the humerus is ball-shaped. Muscles and ligaments hold this ball against a cup-shaped part of the shoulder bone.. Surgeons often replace the upper part of the humerus with a long piece of metal that is inserted into the humerus and has a rounded head.. If the surface of the shoulder bone that is cup-shaped and supports the humerus is also impaired, doctors smooth it out and then cover it with a piece of plastic or metal and plastic.

Surgeons are now testing a newer procedure called reverse total shoulder replacement for people who have painful arthritis in the shoulder and also have deteriorated muscles around the shoulder.. In this procedure, after the surgeon removes the damaged bone and smoothes the ends, Attach the rounded joint piece to the shoulder bone and use the cup-shaped piece to replace the upper part of the humerus. Initial results are encouraging. This surgery is not suitable for everyone. And not all surgeons have done it. Success doesn't just depend on careful evaluation to make sure it's the right surgery for you, but also from having a surgeon who is experienced in doing a reverse total shoulder replacement.

Frequently Asked Questions about: Shoulder Joint Replacements

Common Questions and Answers about Shoulder Joint Replacements

The shoulder is a complex ball and socket joint that allows full arm movement.

Offers a wide range of motion, but it also makes you vulnerable to injury.

In the shoulder, three main bones meet and create an angle of 90 degrees. These bones are the

  • clavicle (clavicle)
  • shoulder blade (scapula)
  • humerus, the largest bone in the arm.

Three joints are formed from the junctions of these three bones and the sternum. These joints are the

  • glenohumeral joint,
  • acromioclavicular joint (AC) Y
  • sternoclavicular joint.

Each shoulder joint is surrounded by filler cartilage, ligaments to connect bones, muscles and tendons to attach muscles to bones.

A shoulder joint replacement eliminates painful contact between the worn humeral head and the socket of the shoulder blade and replaces them with a new bearing surface that eliminates arthritic pain.. The surgery is performed under sterile conditions in the operating room under general anesthesia +/- nerve block. An incision is made over the affected shoulder to expose the shoulder joint.

The upper arm bone (humerus) separates from the glenoid cavity of the shoulder blade (scapula). The arthritic humeral head is cut and the humeral stem is prepared.

Following, the surgeon exposes the glenoid cavity.

  • The arthritic part of the socket is removed and prepared to take the glenoid component.
  • Following, the glenoid component is pressed into the socket.

Later, the humeral component is inserted into the arm bone. This can be press fit depending on the bone to grow or cement based on a number of factors, such as bone quality and surgeon's preference.

  • Following, the Humeral Head Component is placed over the Humeral Stem. This component is made of metal.
  • Artificial components are fixed in place.
  • Following, muscles and tendons are repaired and the skin is closed.

Arthritis is an umbrella term that covers numerous conditions in which the joint surfaces (cartilage) they wear out. The joint surface is covered by a smooth joint surface that allows pain-free movement in the joint.

There are numerous conditions that can cause arthritis and, sometimes, The exact cause is unknown. When articular cartilage wears out, the ends of the bone rub against each other and cause pain.

  • Osteoarthritis
  • Rotator cuff tear arthropathy
  • Postraumatic arthritis
  • Rheumatoid arthritis
  • Necrosis avascular (osteonecrosis)
  • Severe fractures
  • Failed anterior shoulder replacement surgery

A shoulder replacement is a procedure that attempts to eliminate the source of pain and dysfunction by replacing damaged parts of the shoulder joint with artificial components called prosthetics.. The most common reasons for shoulder replacement surgery are osteoarthritis, rotator cuff tear arthropathy, avascular necrosis or rheumatoid arthritis. The procedure is intended to relieve your pain, improve your strength, increase your range of motion and allow you to use your shoulder and arm.

Doctors recommend arthroplasty when shoulder pain and loss of function become severe and if medications and other treatments stop relieving pain. Your doctor will use X-rays to examine your shoulder bones and cartilage to see if they are damaged and to make sure the pain is not coming from elsewhere..

Shoulder replacement may not be recommended for people who:

  • Are in poor general health and cannot tolerate anesthesia and surgery well.
  • Have an active infection or are at risk for infections.
  • Have osteoporosis (significant thinning of the bones).
  • Have severe muscle weakness or deterioration around the shoulder.

Some doctors will recommend other types of surgery, if possible, for younger people and especially those who do hard work. A younger or more active person is more likely to wear an artificial shoulder joint than an older or less active person.

Doctors do not usually recommend shoulder replacement for people who have very high expectations of what they will be able to do with the artificial joint. (for example, people who hope to be able to play tennis at a competitive level, being able to paint ceilings or do other activities that strain the joint). The artificial shoulder allows a person to do common daily activities with less pain. Does not restore the same level of function that the person had before the damage to the shoulder joint occurred.

Similar to the hip joint, his shoulder is a big ball joint. Can rotate through a greater range of motion than any other joint in your body. The shoulder joint is made up of bones, tendons, muscles and ligaments that hold the shoulder in place and allow it to move. The bones of the shoulder joint include the clavicle (clavicle), scapula (large, flat triangular bone called the shoulder blade) and the humerus (upper arm bone).

Your clavicle connects to your shoulder blade at the acromioclavicular joint or AC joint. The clavicle attaches your shoulder to your rib cage and keeps it away from your body. The rounded head of the humerus, or upper arm bone, rests against the socket of the shoulder blade. The surfaces of the bones where they touch are covered by a soft substance called cartilage that protects the bones and allows them to slide and move easily.. The muscles and tendons that surround the shoulder provide stability and support. A thin, smooth tissue called the synovium covers all the remaining surfaces within the shoulder joint.. On a healthy shoulder, This membrane produces a small amount of fluid that lubricates your cartilage and eliminates almost any friction on your shoulder..

The rotator cuff muscles are a group of four muscles that surround the shoulder joint and their tendons attach to the end of the arm bone.. The role of the rotator cuff is to hold the ball joint together and help with its movement.. This is why when the rotator cuff tendons tear, patients experience pain, instability and loss of function. Trauma from a fall in an elderly patient or a contact sport injury can lead to a rotator cuff tear.. Depending on the size and location of the tear and the age of the patient, the duration of symptoms, general health, range of motion and desired activity level, rotator cuff tears can be treated with physical therapy or occasional cortisone injections and when these approaches fail, you may need surgery.

Shoulder replacement surgery is an option offered to patients suffering from joint dysfunction. This is usually the result of osteoarthritis , rotator cuff tear arthropathy, necrosis avascular o rheumatoid arthritis , O (rarely) for those who have suffered a severe fracture from trauma or a fall. Usually, all other modes of treatment are considered first, like physical therapy and medications.

You may be a candidate for shoulder replacement surgery if you have the following symptoms:

  • Your shoulder pain is so severe that you have difficulty with everyday activities such as washing, get dressed and reach into a closet.
  • You have loss of movement in your shoulder.
  • You have weakness in your shoulder.
  • You have such severe pain that it prevents you from getting a good night's sleep.
  • Have tried anti-inflammatory medications, cortisone injections and physical therapy without relief.
  • Have prior arthroscopic surgery, a rotator cuff repair or fracture that failed to relieve your symptoms.

Shoulder replacement surgery is an option offered to patients suffering from joint dysfunction. This is usually the result of osteoarthritis , rotator cuff tear arthropathy, necrosis avascular o rheumatoid arthritis , O (rarely) for those who have suffered a severe fracture from trauma or a fall. Usually, all other modes of treatment are considered first, like physical therapy and medications.

You may be a candidate for shoulder replacement surgery if you have the following symptoms:

  • Your shoulder pain is so severe that you have difficulty with everyday activities such as washing, get dressed and reach into a closet.
  • You have loss of movement in your shoulder.
  • You have weakness in your shoulder.
  • You have such severe pain that it prevents you from getting a good night's sleep.
  • Have tried anti-inflammatory medications, cortisone injections and physical therapy without relief.
  • Have prior arthroscopic surgery, a rotator cuff repair or fracture that failed to relieve your symptoms.

Your surgeon will discuss with you what type of shoulder replacement you may need.. There are four options:

  • Hemiartroplastia : only the ball and stem are replaced in this procedure. The stem is connected to the ball and articulated with its natural fit.
  • Rejuvenation hemiarthroplasty : It involves replacing the articular surface of the humeral head with a cap-shaped prosthesis, stemless.
  • Total anatomical shoulder replacement : the arthritic joint is replaced with a highly polished metal ball attached to a stem on the humeral side and a plastic cup in the glenoid socket.
  • Stemless Total Shoulder Arthroplasty: this is a bone-conserving version of total shoulder arthroplasty where the metal ball is attached to the upper arm without a stem.
  • Reverse Total Shoulder Replacement : in reverse total shoulder replacement, the joint is literally reversed, meaning the metal ball is placed where the glenoid was and a plastic cup is attached to the stem and moved to the upper arm bone (humerus).

Depending on the case of each patient, the traumatologist can select one type of shoulder prosthesis or another. In this blog post we talk about the four types of prostheses that exist:

  • Total anatomical shoulder prosthesis
  • Anatomic partial shoulder prosthesis or shoulder hemiarthroplasty
  • Resurfacing or metaphyseal anchoring prosthesis
  • Inverted shoulder prosthesis

They are used in the treatment of osteoarthritis in patients with an intact rotator cuff. (stable shoulder). They are called anatomical because they mimic the natural shape of the shoulder and are made up of:

  • Humeral stem: Elongated portion that attaches to the humerus.
  • Glena: Concave polyethylene surface that attaches to the scapula and constitutes the friction surface of the scapular part of the prosthesis.
  • Humeral head: With a spherical cap shape, attaches to the stem and forms the friction surface of the humeral part of the prosthesis.

It is the same as the anatomical total, but glena is not used. The glenoid is responsible for many of the failures of shoulder prostheses and not using it can avoid problems. Usually used if the cartilage of the glenoid is not worn, what happens when the patient has a fracture and does not have an osteoarthritis problem.

They are stemless and simply replace the humeral head. They are used in cases of arthritic degeneration in highly selected patients with very good bone quality (because the lack of stem makes anchoring difficult). They have the advantage of consuming little bone and facilitate future replacement.

They are used in patients with irreparable damage to the rotator cuff (both in fractures and in cases of osteoarthritis). The cuff stabilizes the shoulder and patients who have damaged it lose function and, although an anatomical prosthesis can eliminate the pain they suffer, is unable to restore mobility.

The special configuration of inverted prostheses stabilizes the implant and makes the muscles behave more efficiently. But, as a negative aspect, It should be noted that the implantation of an inverted prosthesis consumes much more bone than the placement of an anatomical one. This can complicate future revisions and causes many orthopedists not to consider them an appropriate option for relatively young patients..

An inverted prosthesis is made up of:

  • Humeral stem: Elongated portion that attaches to the humerus. Unlike the anatomical, its upper part has a bowl-shaped section.
  • Placa glenoidea: It is the component that fixes the prosthesis to the bone of the scapula.
  • Glenosphere: It is the prosthetic component on the side of the glenoid. Attaches to the glenoid plate and is hemispherical in shape.
  • Insert: It is the humeral component of the joint. Attaches to the stem and is made of polyethylene.

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I broke my left rotator cuff while falling. I tried to put up with it for almost a year with medications, physical therapy and basically it didn't help . I was scheduled for surgery elsewhere. I did not like the atmosphere, so I looked for another opinion. I am happy to have done it !! all nursing staff, ambulatory surgical units, postoperative care and now the final results: I have no pain I have a full range of motion, I have strength and continue to develop it while following a very detailed therapy regimen. I can only recommend Dr.. Danilo Velandia and elite staff, professional, personal, warm and friendly.

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I have seen Dr.. Danilo Velandia a couple of times in Bogotá and I'll be back, it's been great so far. No pressure to rush to surgery, great advantage. Gives good information and options from the first day to the surgery process. All staff are friendly and helpful highly qualified, He has been the most proactive and helpful medical person I have dealt with and I am really very happy. Your diligence has made sure you get the help you need, and it even helped me avoid forgetting things. Thank you very much indeed! I am very happy with my visits with him. Highly recommended Dr. Danilo Velandia and his team of professionals!

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My experience as a patient of Dr.. Daniel has been extremely positive. Performed surgery on my right shoulder, completely relieving my symptoms. He patiently listened to my concerns, answered my many questions and provided insightful information, but not too technical. The doctor. Danilo made himself available both before and after my surgery to address my pre-surgery nerves and my post-surgery expectations.. He was always professional, patient and attentive. I feel very lucky that when I could no longer suffer with the symptoms, my husband, who recommended me to Dr.. Danilo Velandia.

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After playing competitive soccer for several years, I broke my anterior cruciate ligament and meniscus. I was very nervous about the long process of surgery and recovery really is a life changing process, I thought I would lose everything since sport is my life and my passion, but Dr.. Danilo Velandia was very helpful, informative and reassuring, he really knew how to handle the situation. My surgery went smoothly and my recovery went according to plan. The doctor. Danilo was present every step of the way and showed his medical competence, as well as his natural compassion, Thank you very much and very grateful, I have been able to continue with my day to day.

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