Latest Innovations
Treatments for musculoskeletal conditions are always evolving and advancing. This section highlights some of the exciting recent advances that have been incorporated into my practice and will improve outcomes for my patients. It will be updated occasionally to show the latest and greatest developments.
Computer-Guided Templating and Patient Specific Instrumentation (PSI)
A CAT scan (CT scan) is usually obtained prior to your Shoulder Replacement Surgery in order to better define the degree and nature of the bone loss/deformity from the arthritis. Your CT scan is then uploaded into a computer-based templating system. This allows the surgeon the ability prior to surgery to determine the exact size and position of the implants. This Computer-guided Templating can also show me whether a Total Shoulder Replacement or a Reverse Shoulder Replacement would be the best option depending on the extent of the arthritis and bone loss.
Once the type, size and exact position of the implant are determined, then Patient Specific Instrumentation (PSI) can be created for your surgery. PSI gives the surgeon a 3-dimensional (3D) sterile model of the socket of your shoulder (glenoid) that can be used as a reference during the surgery. In addition, there is a sterile drill guide with a depth stop which is custom designed for your shoulder. This allows the surgeon to restore the optimal joint line for the implant and correct the deformity in 3 dimensions exactly. Although a surgeon may think he/she has years of experience and can judge where to place this pin in each and every case, the truth of the matter is that the computer does this more accurately each and every time. The Computer-guided Templating allows the surgeon to visualize what the ideal Shoulder Replacement should look like for you ahead of time, before the surgery is even started. All that being said, the PSI is not always utilized at surgeon discretion when the case is an acute 4-part fracture or head-splitting fracture (minimal chronic boney deformity) or with more simple straight-forward cases.
Reverse Total Shoulder Replacements
FDA approved for use in the United States since 2004. This type of shoulder replacement is the best option when the patient has severe arthritis and a chronic massive non-repairable rotator cuff (Rotator Cuff Tear Arthropathy) or with severe boney deficiencies of the glenoid (shoulder socket), and other conditions. The optimal designs have been updated in recent years and now mini-stem versions as well as stemless versions have been developed. These versions potentially involve less bone work, less blood loss and less surgical time during the initial surgery and would make a revision surgery (a re-do in the years to come because of loosening, infection or periprosthetic fracture) so much easier for both the patient and the surgeon.
Mini-stem Total Shoulder Replacements
The original length of the humeral (upper arm) prosthetic stem for shoulder replacements from the 1950’s up until recent years was approximately 130 mm (13 cm). Now if your bone is strong and healthy enough, then a Mini Stem can be utilized. These stems are approximately 55mm in length. This means less bone work, less blood loss and less surgical time during the initial surgery and would make a revision surgery (a re-do in the years to come because of loosening, infection or periprosthetic fracture) so much easier for both the patient and the surgeon.
Stemless (Canal-sparing) Total Shoulder Replacements
If you are on the younger side and your bone is healthy enough, then a Stemless TSA (total shoulder replacement) is the least invasive of the surgical options. This means 1)shorter time in surgery 2)more accurate restoration of anatomy 3)less blood loss 4)less pain after surgery because less bone is removed and 5)potentially lower risk of intraoperative and postoperative fractures. If a revision (re-do) were necessary in the future, the minimal change in boney anatomy because of the Stemless Design would make the Revision Surgery almost as straightforward and simple as a first-time surgery.
