Transcription:
Carrying the Weight of the World on Your Shoulders

Scott Webb (Host): Shoulder arthritis is common, especially as we get older and those shoulder replacement surgery is an option. My guest today wants us to know that there are other things to try first, but if surgery is the best option advances in materials and technology. Typically lead to happy patients. And I'm joined today by Dr.

Keran Pervez. He's an orthopedic surgeon with the centers for advanced orthopedics orthopedic associates of central Maryland in practice for over 50 years. Hi, I'm Scott Webb and I've got a bone to fix with you doctor. It's so great to have your time. I think that, uh, people of a certain age, uh, things begin to hurt whether that's arthritis or whatever might be causing it.

So it's great to have you on talk through some of this stuff. Find out what the causes are. Treatment options. Surgical techniques and so on. So as we get rolling here, tell us about shoulder arthritis.

What is it exactly. And are there different types? Right. Got.

Dr. Khurram Pervaiz: shoulder arthritis, is like arthritis that would affect any other joint in your body. So arthritis is basically wear and tear of the joint. Loss of cartilage cartilage is that smooth white stuff that lubricates the joint and makes it glide normally. And so as we get older, the cartilage can deteriorate and then the cartilage disappears and underneath the cartilage is bone.

The bone is harder and rougher and then. Bone grinds against bone. , it causes pain and it can cause stiffness loss of motion, weakness, lack of abuse. So now there's different types of arthritis. There is osteoarthritis, which is where and tear arthritis caused. By getting older, there can also be post traumatic arthritis.

Somebody's had an injury before they have a fracture, and that has led to. Loss of cartilage. And sometimes it, this can come on fairly rapidly. They get arthritis after an injury. So that's called post-traumatic arthritis. And then we also have inflammatory conditions like autoimmune diseases, like rheumatoid, rheumatoid is an autoimmune disease where the bodies cells attack itself and it can lead to loss of cartilage also, and can also lead.

Arthritis, rheumatoid arthritis affects much more younger patients cuz it's not wear and tear it's autoimmune based and it historically not more recently, but historically before modern drugs for rheumatoid came about would lead to much more rapidly destructive arthritis of the.

Host You know, that really helps. And I've always wanted to ask an expert like yourself. You know, many of us, non doctors, of course, non experts, we tend to believe that our sort of youthful indiscretions, whether that's. Sports or other types of injuries just overuse, whatever it is we do when we're younger that at some point that, metaphorically speaking, although also literally that the bill comes due for that.

Is there something to that when it comes to arthritis in general, but specifically shoulder arthritis, those things that we do playing football and contact sports and things. When we're kids does that bill come due eventually.

Dr. Khurram Pervaiz: and no. So it depends on. If you've had injuries, right? So if it's just, you played sports and you didn't have any injuries and it was just your way of being active and staying healthy, not necessarily. However, if you've had certain injuries, like if you were a contact athlete, then you had dislocations where your shoulder popped out, you needed to have surgery at a younger age.

To, you know, put things back in place or you had a broken bone that needed to be repaired. Yes. That can then lead to, arthritis earlier in life than you would have. If you hadn't had those injuries.

Host Yeah, I think there's like old school thinking about what you would've done 5, 10, 25 years ago per shoulder arthritis and what You can do today.

So tell us about the latest in treatment options.

Dr. Khurram Pervaiz: The good news with orthopedics is that even though there's advances every day, the underlying sort of principles of orthopedics are still the same as they were a long time ago. So shoulder arthritis is treated. Essentially on a basic level, the same as it was, you know?

I would say 50 years ago, right? So patient comes into the office and says, I have pain. You get x-rays. They have arthritis. Basically it boils down to. Are we gonna treat them with surgery or not? Right. So most of the time it's a degenerative condition. And almost always, we are gonna try simple things to get patients better first.

Right? So simple things for arthritis first. So we never, almost never jump immediately to surgery. We're always gonna try to get somebody better with simple things first. So what are those things? Anti-inflammatory medication. Maybe an injection into the shoulder injection into the shoulder of steroid, which is an anti-inflammatory physical therapy exercises.

Now these are basic things, but there's been a lot of advances in medication, right? There's been advances in therapy techniques. The big advancement in the treatment of shoulder arthritis that's happened over the last. 5,200 years. And particularly over the last 10 to 20 years has been surgical treatment options.

So surgery we consider when somebody has already tried a lot of basic simple nonsurgical things. Let's say they've tried therapy, they've tried medication, they've tried injections, nothing is working. Then we consider surgery. And then. All the modern advances in surgical techniques, implants come into play and you're right.

You know, these, implants are changing, yearly, there's advances in materials techniques. We have implants now that are more bone preserving, meaning that you cut off a smaller piece of bone and try to replicate the patient's anatomy a lot better.

We have modern implants that can help us overcome or help us treat conditions that maybe 30 years ago had no answer. So that's where the advancements have come.

Host Let's dig in here. Let's talk more about the surgical techniques, the advancements, you know, the, the buzz things in medicine, especially for patients and maybe for doctors as well are. Wants, minimally invasive. They want smaller scars. They want faster recovery times. So how can you sort of address those things and in layman's terms anyway, tell us about some of the really cool stuff that you're doing.

Dr. Khurram Pervaiz: and we are doing all of those things, right. So when shoulder, replacement started almost 70 years ago, you know? So the shoulder implants have been around for a long time. Now shoulder arthritis or shoulder replacement surgery is not as common as hip or knee replacement surgery, but it's still, you know, fairly common.

So, Back in the old days, implants were, not as, refined as they are now. So with modern technology, we are, able to use implants that are more bone preserving. So for example, we make smaller incisions. Now we try to go between the tendons. We try to minimize., surgical trauma to the shoulder.

And then we also use implants that are more bone preserving. So you remove less bone. The implant is smaller. So it's still functions the same as an old style implant would work, but it's able to. Fix itself to the bone because of better fixation technology that we have now. So we don't have to put in an implant that's as big.

So it's a smaller piece of metal functions the same. So because it's a smaller piece of metal and you sacrifice less bone. So it's a good option. These modern implants are a much better option for a more younger patient, right? Because a younger patient who's gonna have shoulder replacement surgery.

Like let's say someone has shoulder replacement surgery, when they're 40 or 50, if they live to be a hundred, they're gonna need to have a revision at some point these are some of the things that shoulder replacement surgeons like myself. Think about if we're doing an implant on somebody in their eighties or late seventies, we're not worried about that so much.

Theoretically, the implant is gonna outlive the patient. But when you're doing it in a much younger patient, then you have to think about, you know, 15, 20 years from now, this implant is gonna wear out. And what are gonna be my options at that point. So for your first surgery, you end up removing less bone.

It's less traumatic, less surgical, scar, more minimally invasive. So you leave more room for future revisions down the road and accomplish the same sort of good. With doing less. So that's sort of the direction that not just shoulder replacement surgery, but all joint replacement surgery and orthopedics is headed now, you know, minimally invasive, smaller scars, smaller incisions.

We are always looking for ways to minimize trauma to the patient's normal tissues and accomplish the same result, which is replacing the degenerative shoulder with sort of an artificial shoulder.

Host Yeah. When you work with patients and you consult with them, perhaps, so patients and their spouses or significant others, maybe even their kids too. How do you help them, to make these decisions? Right? So they've tried therapy, they've tried over the counter, they've done everything as you say, everything, but surgery and now they're confronting surgery.

How do you help them to get there or at least to help them to make those decisions?

Dr. Khurram Pervaiz: one of those things where experience comes in. I 12 years of experience under my belt now. it's not one size fits all. So really have to take time understanding the needs of the patient. But at the end of the day, you know, it's kind of an informed decision.

I try to explain all the options for my patients, but ultimately the decision for major surgery, like joint replacement surgery, like shorter placement surgery is ultimately the patient's decision. So the patient has to decide. The person suffering with the shoulder arthritis and the pain has to decide, am I sufficiently disabled to have to go through this?

easiest way to understand it. If somebody says, you know, my pain's not really that bad I can live with this, then I tell them, you don't need surgery. You're not ready for surgery. You're ready for surgery. the pain is bad enough, or the lack of function is bad enough that you're willing to undergo the risks of surgery, bleeding infection.

What if things don't work out right? If you're disabled enough, then that's the time to go ahead for the surgery.

Host And you mentioned, some of the risks, obviously, and there are risks. Anytime anybody has surgery, even the most sort of mundane surgeries, gallbladder, or something like that. Right. There are always risks. So, you know, you, as someone who replaces people's shoulders, why would you want them to consider that if that's their last resort, after they've tried everything else.

Dr. Khurram Pervaiz: the outcomes are exceptional. The right patient, who's done all the right things. They've tried everything and they're sufficiently disabled have enough pain, lack of function. Those patients do very well with this surgery. Out of all joint replacement surgery, we found is that the shoulder is the easiest to recover from.

And the reason is because it's a non-weight bearing joint. You know, you're not having to walk on your shoulder. We are actually, with modern techniques are able to do this surgery, outpatient. I do this surgery outpatient now. So patients go home the same day. We mobilize them in a SL and for four weeks they do physical therapy starting two weeks after the surgery.

At about a three month timeframe. And sometimes six months, we let them return to pretty much normal use patients are able to return to golf. They're able return to fishing, working out fairly normal lifestyle. There's always a risk for complications, but 99% of patients do exceptionally well. The rate of complications with shoulder replacement surgery is low, and patients for the most part do very well. I would say my patients are very happy, which is why we continue to do this.

Host Yeah, I'm sure that they are. And in Minimally invasive, smaller scars, faster recovery, times 99% successful, very low risks, great outcomes.

It all sounds good to me, doctor. Thanks so much for your time. you stay well.

Dr. Khurram Pervaiz: you so much. God.

Host We now have online scheduling, please visit MD bone docs.com and click the new online scheduling button to instantly make an appointment.

Host: Find out more about us online at mdbonedocs.com. And please remember to share and subscribe to this podcast and that's all for today. I'm Scott Webb and that was a Bone That's Fixed.