It used to be that shoulder replacement was the kind of surgery best avoided, and if it must be performed, it was a treatment pathway to be embarked upon with realistic, even low, expectations for the outcome.
Frequently compromised by premature failure arising from poor surgical planning and prolonged duration of surgery increasing medical and anaesthetic risks, I have seen more than my fair share of surgery that hasn’t gone well. I’ve often seen patients who experience present day pain and discomfort from a shoulder condition they’d hoped would be resolved through surgery, sometimes delivered just three or four years prior.
As a shoulder specialist with a deep understanding of the benefits of shoulder replacement surgery done well, I’m happy to say this is changing, with continued advancements in technology and operating techniques.
The factor making the biggest difference to lifting the low rates of shoulder replacement surgery failure is the ability to plan well in advance of surgery using 3D computer planning. Advanced planning makes it possible to do a patient’s shoulder replacement surgery virtually before doing the actual surgery. Like a surgery test drive, it allows the surgeon to identify any complicating factors that could emerge during the procedure through 3D print guides that represent the patient’s actual shoulder.
The ability to prepare for surgery in this way means joint placement is performed to a much greater degree of accuracy, a patient spends less time under anaesthetic, there are fewer complications, and a greater likelihood of shoulder replacement surgery success.
What does 3D planning look like?
The 3D guides used to plan surgery look like the kind of imagery you see in computer game. Think of it as a kind of gaming for surgeons! In the image below you can see an example of a 3D guide used to facilitate surgery. As you can see from the image below, the parts of a shoulder replacement fit together like parts of a car’s engine. If you were to work on a car and were careless about how you assembled the pieces, you’d expect there to be trouble with the engine. Our bodies are like that too so when it comes to shoulder replacement, it is vital the replacement is position optimally. Achieving this requires meticulous precision and ensure the replacement lasts longer than just a few short years.
I perform all kinds of shoulder replacement surgery, and without wanting it to sound like it’s a one-size-fits-all, I find this approach is very beneficial for every patient, regardless of whether their case is complex or straightforward. The intent and aim is to optimise every patient’s outcome by increasing the lifespan of the shoulder replacement.
Recently, I treated a patient who had a shoulder replacement performed only three years previously. When they came to see me, it was evident the shoulder replacement was loose and causing the patient increased pain, resulting in a corresponding lack of movement in the shoulder joint. Unfortunately, due to the inaccurate placement in the original surgery, this patient now requires a second operation to correct the same issue. Without it, they will continue to live with pain and reduced mobility. Hardly an appealing option.
When I’m assessing the type of surgery that will meet a patient needs, I will always consider it within the context of many variables, choosing from the full range of shoulder surgery replacement options. Having had the benefit and privilege of working with the designers of the 3D surgery planning technology from Harvard University and the Mayo Clinic, I know the power of what it can do for patients, especially those who have suffered the distress and inconvenience of surgery that hasn’t fulfilled its intent.
If you have osteoarthritis in your shoulder joint and wonder about your options, it is worth a conversation to explore these with a specialist who has focused knowledge and experience in this area. Together, you can discuss your options and decide which will work best for your specific circumstances.
Dr Sommit Dan is a leading Adelaide shoulder specialist. He provides minimally invasive and more complex treatment for all shoulder injuries and conditions. An Australian trained orthopaedic surgeon and highly skilled in arthroscopic (key-hole) shoulder reconstructions, rotator cuff repair and shoulder replacement surgery, Dr Dan treats patients as people. His goal is to his patients navigate the frequently challenging roadmap to recovery, empowering them along the way.
But is shoulder replacement surgery the best and only option if you have osteoarthritis in this joint? Check out my blog that answers this question. You can read it here.