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All I want for Christmas is a new…Shoulder?

Stem-less Total Shoulder Replacement

One common theme that I have noticed when discussing options for joint pain is that though most every patient is familiar with the possibility of a hip or knee replacement, most are surprised when I offer a shoulder replacement as an option for their pain. Yearly in the US, approximately 700,000 total knee replacements are performed versus only about 55,000 total shoulder replacements, but the rate of shoulder replacements being performed is raising faster than that for hip and knee.

While the majority of shoulder problems in young age are related to instability or labral tears, and as we age, the rotator cuff is the main source of problems, shoulder arthritis can develop, typically past the age of 40. Severe pain is common, as well as a gradual loss of shoulder motion and potentially a loss of strength. It can be secondary to an old injury, or overuse, and for some, there is a strong genetic association. Shoulder arthritis is easily diagnosed of standard X-rays, but typically more imaging is performed.

If your surgeon did determine that a shoulder replacement was a treatment option for your shoulder pain, my goal today is to discuss a few recent advances in shoulder implant options, and technologies that may be available to you.

The first new technology is computer navigation during surgery. Traditionally, the surgeon would review the X-rays, and could estimate implant sizes and location based on measurements made off of those films. Today, there are many different options for pre-operative planning. For my patients, a special imaging study is done, and those images are uploaded to special software programs that allow creation of 3D models. Using that software, exact measurements can be made, bone deformity corrected, and then special guides are created to make sure that during surgery, the implants are placed in the correct position. 3D printed models can be made to use during the surgery as well to assist in bony preparation. Similar things can be also done with intraoperative GPS technologies.

Another new technology is related to implant design. While traditional total shoulder implants attach a metal head onto a long metal stem, the lengths of those stems have gradually shrunk over time. Now, there are a few “stem-less” options available in the US, which cut down on the amount of bone removed, can decrease surgical time, do not require cement, and more accurately recreate the anatomy. The Arthrex Eclipse, my preferred stem-less option, has actually been used in Europe for years, and there has been 9-year follow-up data published to support its benefit.

So if your shoulder has been bothering you, keeping you up at night, and preventing you from doing the things you enjoy, maybe it’s time to make an appointment. If you’re lucky, Santa may bring you a new shoulder.   One recommendation—find a Santa that is a board certified shoulder specialist first!

Andrew Kersten, MD Asheville, NC based, dual board-certified in Orthopedic Surgery and Orthopedic Sports medicine, specializing in sports injuries, arthroscopy and joint replacement for shoulder, elbow, and knee conditions.

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Courtesy: AP

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