Transcription:

Maggie McKay (Host): At a certain age, we might start noticing some of our friends or family members getting shoulder replacement surgery, but who is more likely to need this procedure. And is it preventable? Joining us to talk about what we need to know about shoulder replacement surgery are Dr. Stephan Pill and Dr. Michael Kissenberth, both Orthopedic Sports Medicine Surgeons with PRISMA Health, and they also run a Sports Medicine Fellowship Program at Steadman Hawkins Clinic of the Carolinas under PRISMA Health. Dr. Kissenberth is Director and Dr. PilI is Associate Director. This is Flourish, a podcast from PRISMA Health. I'm Maggie McKay. Doctors, thank you so much for joining us today.

Stephan Pill MD (Guest): Thank you. Thanks for having us.

Michael Kissenberth, MD (Guest): Yes. Thank you very much.

Host: Dr. Pill, how do you know if you need a shoulder replacement?

Dr. Pill: Well, I think the symptoms of pain and stiffness are probably what we see most often.

Host: And so does it have to go on for a long time before they need to go see a doctor? Or how does that work?

Dr. Pill: Typically we see folks, as they go through life, they have an onset of pain and stiffness and, we can quickly see them in the office and get x-rays and notice that they have some change on the x-ray, which can diagnose shoulder arthritis.

Host: So is this mostly for older patients or do you ever see it in children?

Dr. Pill: Typically, we see this in the middle years to folks as they go onto their older years. But occasionally if folks have a bad trauma, you can see arthritis in earlier.

Dr. Kissenberth: As people age, arthritis is exceptionally common and people are very familiar with the need for knee replacement, hip replacements, and the third, most common joint that is replaced is the shoulder. And every day that we're in the office, seeing patients we will see some with shoulder arthritis at varying degrees of severity and not all need surgery right away. In fact, we try and have a measured conservative approach. And often at least for us, we're having to perform shoulder arthroplasties on a weekly basis. And it's a big part of our practice.

Host: Dr. Kissenberth, what is the difference between a shoulder replacement and a reverse shoulder replacement?

Dr. Kissenberth: Both of those are replacements. When we counsel and talk to our patients based on the type of arthritis they have or concomitant other conditions, whether it be rotator cuff problems, or other bony problems, we will sometimes discuss with the patient that they have be more suited for a reverse replacement or what we often refer to as an anatomic or a total shoulder replacement.

So both of these are replacements of the shoulder and the reverse is a little more constraining as far as an implant that gives us some security as it relates to their shoulder condition and how they'll function afterwards. And we can't perform a regular shoulder replacement in all patients. And until 2005, we didn't have the ability to perform a reverse replacement, which has now become a big part of our procedures. And in fact, I would say probably more reverse replacements are performed now than anatomic shoulder replacements, but we still do both of them regularly.

Host: Dr. Pill. When would a reverse shoulder replacement, be necessary?

Dr. Pill: Yeah. We see reverse shoulder replacements, most commonly done in those afflicted by not only arthritis, but also rotator cuff problems. So the rotator cuff, there's four muscles collectively known as the rotator cuff. These are deep muscles inside the shoulder that help to keep the ball centered in the socket. And when they start to tear and pull away, the traditional shoulder replacement, wouldn't keep the ball in the socket any longer. So, the reverse replacement switches the configuration so that you get a socket that can grip the ball better and hold it together. The other time we see in addition to rotator cuff tears, is we see reverse shoulder replacements done in the setting of a fracture. So if somebody breaks the bones involving the ball and socket in the shoulder, then often a reverse is necessary.

Host: Dr. Kissenberth, how long does it take to recover from shoulder replacement surgery?

Dr. Kissenberth: When we perform a shoulder replacement surgery, whether it's an anatomic shoulder replacement or a reverse shoulder replacement, it's usually done within an hour or two. And people often stay overnight. Occasionally we could send people home the same day. They're usually then at home recovering, wearing a sling on and off for the first four to six weeks.

And most commonly, it's some of the most satisfied patients we have, because literally when we see them back for their postoperative check within a couple of weeks, most of their pain is already resolved. And so it's actually quite satisfying to see pain relief. Now, when you talk about rehab and getting the shoulder function back, the shoulder's one of the more complicated joints.

So what we often say is a slow progressive rehab to get their function back, which may take months, but they'll be, throughout that process, usually feeling quite good and working on getting their function back, which may take several months after surgery.

Host: Wow, Dr. Pill, is there anything that a patient can do to speed up their recovery?

Dr. Pill: I think working closely along with the physical therapists, we work closely along with them in our clinics, to make sure that the range of motion exercises, are done and then ultimately strengthening to build back up the range of motion.

Host: And Dr. Kissenberth, is it possible to get frozen shoulder after a shoulder replacement?

Dr. Kissenberth: Frozen shoulder itself is a different diagnosis. We don't see a frozen shoulder as we like to call it, with arthritis. Any surgery we do on the shoulder can result in some stiffness afterwards. I would say that it's very uncommon. The classic diagnosis of a frozen shoulder is somebody who hasn't had a replacement. Now occasionally, when we operate on shoulders, there can be a component of stiffness afterward, but we wouldn't refer to it as a frozen shoulder, but just somebody who's having some stiffness after surgery that we're often able to work out with physical therapy.

Host: Well, that's good news, right? Dr. Pill, can you play sports after shoulder replacement surgery or is there anything you shouldn't be doing?

Dr. Pill: That's one of the main reasons we do the surgeries is to get people back into the things they enjoy doing. I would say one thing that we're a little careful with and this could go with any joint replacement is really heavy lifting or really forceful, activities.

Host: And what percentage of shoulder replacement surgeries are successful?

Dr. Pill: I would say that the vast majority have excellent pain relief and a much improved range of motion. The thing that some folks still have some issues with is certain reaching maneuvers, such as reaching way up their back or reaching way up to change a light bulb or something. But the functional range of motion is much improved. People can reach cupboards and do things around the house and get back to some sporting activities.

Dr. Kissenberth: And most of the time, the reason we're operating on patients and performing shoulder replacement is they have pain that's affecting their quality of life. They have marked difficulty sleeping at night and they can't do the activities they enjoy, whether it be golf or tennis and various things around the house. And that's probably one of the more satisfying things afterwards is not only the pain relief, but their ability to return to things they enjoy doing.

Host: So in the majority of cases, do you only have to get this done once or do you ever see patients that need to do it say 20 years later?

Dr. Kissenberth: Yeah. As far as longevity, we talk about that a lot with hip replacement and knee replacement. And it's the same discussion with the shoulder replacement. You know, we've been doing shoulder replacements for decades. And we do prefer that patients are a little bit older, middle aged, 50 or older because there is more likely than not in 15 or 20 years, if we could get that survivability out of that replacement we're pretty happy with that.

So we're careful to indicate them for replacement when they're age appropriate and their x-rays and their whole physical examination fits a great indication to move forward with a replacement. It wouldn't be smart to say you have a little arthritis at the age of 40 and we ought to replace your shoulder. In fact, that would be something we would frown on pretty heavily and say, hey, we need to be sure. And you need to be doing some other things. And there's some other treatment modalities and things we do for what I like to call early arthritis. And that does include injections, different treatments, anti-inflammatory medications, at some point, and sometimes we're even performing arthroscopic procedures, where we'll go try and buy some time so that we could get them a little further along in life before we would indicate them for a replacement.

Host: Okay. Dr. Pill is there anything else you'd like to add that we didn't cover?

Dr. Pill: I think the only other thing that your audience might like to hear is that there's been a lot of technological advances in shoulder replacement, and often we're getting advanced imaging in the form of CAT scans, preoperatively. And we can load the images from the CAT scan into computer software now that we can virtually plan the replacement. So in other words, we're doing the surgery on computer models before the patient even goes to the operating room. So, we already know, what size implants and where to put them. And it gives us sort of virtual practice to figure out just the right implant for the patient before we get to the operating room.

Host: That's fascinating. Is that relatively new that you can do that?

Dr. Pill: Yeah, and it's sort of growing in its technology in that now there's patient-specific guides, even that can be ordered based on our planning. So, if someone has a lot of deformities such that the arthritis has miss-shapened the bones, we can not only plan the surgery beforehand, but we can order patient-specific instruments that can allow us better alignment of the implants when we'd go to surgery.

Host: That's amazing.

Dr. Kissenberth: And I would just add over the last decade we have seen tremendous advances, not only what Dr. Pill's discussing regarding our patient-specific implants and virtual planning, using amazing new technology, but not only that, but the implants we're putting in, the way we're putting them in, even in some situations we're trying to save as much normal anatomy as possible.

And putting in implants that may be smaller, with very good longevity. So a lot of what we know regarding survivability is on an implant that was made 15 years ago. What we're doing today is way different than 15 years ago. So we expect, and we're hopeful that we're going to see you know, the holy grail here would be one replacement.

You don't need another one. Now we could only look at survivability from implants that were done 15 or 20 years ago. And what we do know is that the materials that are being used have improved tremendously, and some of our techniques have also improved. So we're excited to see how this will hold up in the future.

Host: That all sounds so encouraging. Thank you so much, Dr. Pill and Dr. Kissenberth for your time and your expertise. We appreciate it.

Dr. Kissenberth: Thank you very much.

Host: For more information and other podcasts, just like this head on over to prismahealth.org/flourish. This has been Flourish, a podcast brought to you by PRISMA Health. I'm Maggie McKay. Be well.