Scott Webb (Host): Osteoarthritis is one of the primary reasons why folks get shoulder replacements. And though your shoulder may never feel like it did when you were 18 again after surgery, my guest today, says he can get us pretty close. And I'm joined today by Dr. Michael Codsi. He's a surgeon at Evergreen Health Orthopedic and Sports Care in Kirkland, Washington.

 Hello and welcome to Check-Up Chat with EvergreenHealth. I'm Scott Webb.

 Doctor, thanks so much for joining me.

Michael Codsi, MD: Thanks for having me.

Host: You know, I am old enough. I'm not sure if you are, but I'm old enough to have grown up watching the Six Million Dollar Man. So anytime joint replacements is something I can talk about, I get excited about it. So let's just start there. What are some of the common reasons for needing a shoulder replacement?

Michael Codsi, MD: Shoulder replacements are made for people who have bad shoulder arthritis. And arthritis is a condition where the cartilage in your joint, that really nice smooth tissue, that is six times smoother than ice on ice; when that wears out, you get arthritis. And that can cause pain, it can cause stiffness, and it can make your shoulder, when it gets really bad, almost unusable. So, when you're in that situation, a shoulder replacement can help tremendously.

Host: Yeah. And are we talking just basically osteoarthritis? So someone like me, I'm in my fifties and everything just kind of hurts and aches because I, you know, lived a life and I have some osteoarthritis. Is that generally it? Is it just the wear and tear?

Michael Codsi, MD: So osteoarthritis is when you get arthritis for no good reason. There's other types of arthritis that you get from inflammatory diseases or from trauma. And those conditions also would benefit from a shoulder replacement, but osteoarthritis just happens to be the most common type. And so that is what you'd probably see most often.

Host: Sure. Most common. All right. So then let's talk about, when we think about patient outcomes, right? So let's assume that a patient has a shoulder replacement surgery. How does it really help them to get back where they want to be?

Michael Codsi, MD: I think the first step is to figure out, well, what can't you do now and then go from there. And I think that most people who come to see me for a shoulder replacement, their pain is bad enough where it wakes them up at night. It keeps you from doing your favorite activity, like playing golf or other racquet sports, or doing any kind of workouts at the gym, yoga, things like that where you can't do it because it hurts or because your shoulder is so stiff and you can't do the movement that you want to do. So after a shoulder replacement, most people's pain decreases from let's say an 8 out of 10 down to a 1 out of 10. So that's a big improvement.

 Their function improves tremendously as well. Most people can go back to playing golf, playing racquet sports, get in the pool and do swimming. And there's even people that can play tennis with their normal overhead serve. Now, in terms of do you get back to normal, well, normal is a different term, right.

 So normal when you're 18, probably not, but getting back to the time, maybe five years before you started having any pain in your shoulder, a lot of people can get back to that.

Host: Yeah, I would love to feel like I did maybe 20 years ago. You know, like 35, you know, my late 30s felt pretty good back then. Now at 55, sometimes it's a struggle just to get out of this chair after I finish a podcast.

Michael Codsi, MD: Right, we're good, but not that good.

Host: Yeah, absolutely. I understand. So let's talk about the recovery then. What can patients expect? How long before they get back to quote unquote normal? What's that process like?

Michael Codsi, MD: Yeah, I think when most people think about recovery, they're thinking mostly, well, how long is my arm kind of useless or stuck in a sling. And that time ranges from two to six weeks after a shoulder replacement. But the ultimate recovery where you're really working out with the therapist, you're getting your strength back and you're back to doing like your favorite sport, that can sometimes take six months to even a year. You'll see little improvements like the last 10 percent of your function comes in the last six months of the year following your replacement.

So a lot of the improvements are right away in those first one to two months. Then you get more improvement up to six months. And then all the way up to a year from your surgery.

For

Host: Yeah. So some patients may be necessary to get fully recovered, be able to do everything you'd hope to maybe get back to. When we think about the normal day to day life when we were talking about maybe, you know, going from an eight to a one, something like that. Is there ever a where, you know, despite all your best efforts are there some limitations, I guess, even though they have a new shoulder?

Michael Codsi, MD: Yes, for sure. Pain is, is a subjective thing. And some people, they could put their hand in a bucket of ice and go, that's like a one type pain and some people say it's a 10 and it's the same bucket of ice. And so there is a range of what people feel. And so, some people unfortunately don't get back to what they consider normal.

And they might say, Hey, my shoulder is 70 percent or 80 percent of normal. And, we usually tell people that expecting 100 percent is a really tough thing, even though that's what we strive for. But I'd say to expect 75 percent is probably about right. Now, unfortunately, there are always risks to having complications with any surgery that happens.

 And hopefully, most people don't have those, but I'd say about 10 percent of patients can have a complication of some sort that may limit their ultimate outcome.

Host: And 75 percent sounds pretty good, all things considered, right.

Michael Codsi, MD: Right. And maybe you don't get everything back, but you're better than where you were when you started.

Host: Right. And, uh, and a lot less pain.

Michael Codsi, MD: Correct.

Host: Yeah. You know, I think that a lot of folks suffer, right? Maybe they suffer in silence. Some maybe not so silent, but a lot of us suffer from osteoarthritis and other ailments and things. How do we get them into your office? How do we get them to come see you? They're suffering. Their shoulder hurts. They can't use it. They can't do things that they love anymore. How do we get them in your office? I guess maybe like, let's go over the benefits again.

Michael Codsi, MD: Yeah, most of the time, the primary access point for most people is through their primary care doctor. And your primary care doctor is really excellent at diagnosing arthritis. They do an excellent job at this, and they would be the ones that would be able to refer you to me. Other ways of doing that are, if you already know you have arthritis, then you can make an appointment directly with our office, and then we can talk about the options.

Host: Yeah. And that's the main thing is the options, you know, for some, maybe it's going to be some physical therapy or injections or OTCs, you know, some conservative things, but then there's surgery and it's an option and it may work for some and maybe not others. So I just want to thank you for your time and your expertise. Thanks so much.

Michael Codsi, MD: Thank you for having me on.

Host: The experts at Evergreen Health Orthopedic and Sports Care include psychiatrists, physical therapists, pain specialists, and more than 20 renowned orthopedic surgeons. Visit evergreenhealth.com/ortho-sports-medicine to learn more and to make your appointment.

 I'm Scott Webb. And please remember to subscribe, rate, and review this podcast and all the other EvergreenHealth podcasts. For more health tips and updates, follow us on your social channels.