Scott Webb (Host): Shoulder pain is so common. And today, we're speaking with orthopedic surgeon, Dr. Christopher Mazoue from Prisma Health about modern shoulder replacement-- who needs it and how it helps.

​This is Flourish, the podcast brought to you by Prisma Health. I'm Scott Webb. Doctor, it's nice to have you here today. We're going to talk about modern shoulder replacement. Like, what does that mean? Maybe comparing what you're doing today versus some of the old school stuff, but essentially like who needs shoulder replacement? How can it help them? And I guess maybe that's the obvious place to start, Doctor. It's just like, how do you know if you need shoulder replacement? Do we just know it ourselves? Do we talk to experts like yourself? Take us through that.

Dr. Christopher Mazoue: Obviously, shoulder pain is extremely common. There are lots and lots of reasons for people who have shoulder pain. But two of the more common reasons that people have shoulder pain are arthritis in their shoulder and/or rotator cuff tears in their shoulder. And, obviously, when you meet your physician and as you go through the history and the physical exam, and typically x-rays and maybe an MRI or CT scan. Then, your physician can determine what they believe is the primary source of your pain. And if they believe that the primary source of your pain is arthritis and, in some situations, a rotator cuff tear, there are lots of options for non-operative treatment. But one of the options for surgical treatment these days is a shoulder replacement, and there are different variations of a shoulder replacement that we have these days available to us. But again, the reason for choosing a shoulder replacement is basically your diagnosis and typically failure of non-operative treatment.

Host: Yeah. And I certainly have somebody, probably like millions and millions of Americans who suffers from osteoarthritis, "My shoulder's a little sore." You know, you go to shampoo your hair and you're like, "Yeah, maybe I should talk to somebody about this." And I think, Doctor, it just feels me that this is anecdotal at best, but it just feels like a lot of us, unless it's an acute injury, we tend to put these things off for as long as we possibly can, right? Pain, stiffness, whatever it is. So, you know, how long before we should act and take action and speak with our provider and get those referrals.

Dr. Christopher Mazoue: What typically happens, and we'll kind of focus on arthritis maybe, that's the common reason for people to see a physician. A lot of people have night pain. That's one of the biggest things that we see with our patients. And so if you are having a lot of night pain, if you're really having difficulty sleeping, which we hear a lot of patients complain about their inability to sleep when they have arthritis in their shoulder, or certainly just daily activities, especially if it's affecting your work and your activities that you enjoy, don't hold off. Like I mentioned, there are non-operative treatments out there. That can be very, very effective, things like physical therapy, medications, injections, activity modification. There are a lot of things that we do on a regular basis for non-operative treatment. And, of course, again, if those things don't work, there are surgical options.

Host: Yeah. It's like when you take your car into the shop, they don't just replace the engine immediately, like they try some other stuff first, right? Diagnostics and, as you say, physical therapy, injections. So, think though, Doctor, about the actual shoulder replacement and, like, who's a good candidate? Paint a picture for us, if you would. Just like who typically gets a shoulder replacement?

Dr. Christopher Mazoue: Yeah. So, like knee arthritis and like hip arthritis, the typical patient for us is a patient in there late 50s, 60s, 70s, someone who has been diagnosed with arthritis, someone has gone through a fairly extensive amount of non-operative treatments. And so, a typical patient would be a 65-year old either man or woman. We see it in both males and females at a high rate who is diagnosed with arthritis via an x-ray and possibly MRI or CAT scan and, again, who's had non-operative treatment and just continues to have pain in their shoulder.

Host: Yeah. And it's probably affecting their quality of life, whether it's picking up the grandkids or playing pickleball or whatever it might be. I want to ask you-- like, I was reading about in preparing for this-- the difference between a shoulder replacement and a reverse shoulder replacement. What's the difference?

Dr. Christopher Mazoue: So, there are two different types of shoulder replacements we do. One is what we refer to as an anatomic total shoulder replacement, or some people will just refer to it these days as the total shoulder replacement, and then a reverse shoulder replacement. And so, if you think about a shoulder, a typical shoulder, it's a ball-and-socket joint. And so, an anatomic total shoulder replacement is when we replace your ball with a metal ball and your socket with a plastic socket. The reverse shoulder replacement reverses that. So, it actually replaces the socket with a metal ball, and it replaces the ball with a metal and plastic socket. And so, it reverses the nature of the components, the ball and socket, and there are different reasons why we choose one versus the other.

Host: So then, Doctor, when would somebody need a reverse shoulder replacement? You've given us a sense there of the difference between the two. So, when would that be necessary or be recommended?

Dr. Christopher Mazoue: Yeah. So, I would say that a reverse shoulder replacement has absolutely revolutionized shoulder surgery. And so, the patients who need or benefit from a reverse shoulder replacement are those that don't have a functioning rotator cuff. And so, traditionally, it was developed for patients who have arthritis, but don't have a functioning rotator cuff. We have expanded the indications for that surgery wherein some patients, even if they don't have a tremendous amount of arthritis, they may actually be a candidate for reverse shoulder replacement. Also, patients that have some deformities of their glenoid or their socket, that's a reason to do a reverse shoulder replacement.

And so, if a patient just has arthritis in their shoulder and they have a good functioning rotator cuff and they have a good socket, meaning not a lot of bone deficiency in their socket, we will certainly oftentimes recommend that anatomic total shoulder replacement. But if the rotator cuff isn't working or if there's bone deformities or in revision cases, we will typically recommend a reverse shoulder replacement.

Host: So then, Doctor, just kind of broadly speaking, shoulder replacements, if you will, is there a standard recovery time? Is it one to three months? Is it a case by case basis, you know, individualized to the patient? Like, give us a sense, regardless of which one we choose or is recommended, how long it's going to take us to get back to doing the stuff we love.

Dr. Christopher Mazoue: Yeah. So, shoulder replacements are pretty amazing. Most of my patients and most patients across the world will tell you that their pain is actually markedly improved within the first week. And that's pretty amazing. I have had patients that will tell you that they leave the hospital, and the next day they felt better than they felt in decades with regards to their shoulder.

And so, from a pain relief standpoint, that pain relief typically comes very quickly. Function is obviously different. So, we have to allow the tissues to heal. We have to allow the implants to grow into themselves with regards to bone growth for fixation of the implants. And so, we usually will have patients in a sling for anywhere to three to six weeks. And then, obviously, go through a rehab process, either a home rehab process or with a physical therapist. By six weeks, they're typically able to do a lot of things around the house-- eat, drink, cook, laundry, dishes, you know, basic functions around the house. By three months, they're able to do most everything they need to do. Oftentimes we'll tell patients it takes six months to a year for a full recovery process. But honestly, by three months, they're doing pretty well.

Host: Yeah, it's pretty amazing. We've sort of framed this, we got started here, the modern shoulder replacement. And so, definitely different just in the few years that I've been hosting these, how far things have come. And I want to get a sense from you, Doctor, is there anything we can do to speed up recovery? Obviously, it would be probably to go for that physical therapy to do our part right at home or wherever. But give us a sense, like anything we can do to move that timeline up a little bit?

Dr. Christopher Mazoue: Yeah. So, the first thing you need to do is obviously get with your physician and find out what your reason for your shoulder pain is, and to determine if there are options for non-operative versus operative treatment. If it is decided that you're appropriate for surgery, then good nutrition, eating a good healthy diet. Sometimes we will recommend physical therapy prior to surgery, just to build up the range of motion, strength prior to surgery, and making sure you have all your clearances from your doctors from a health standpoint.

It's also pretty amazing, a lot of these surgeries nowadays can be done outpatient. You can go home the same day. And so, just making sure you're in as good as health as we can be to ensure that we get a good outcome and avoid any negative events.

Host: Yeah. And, Doctor, I've done podcasts on frozen shoulder. We're not framing this today specifically about frozen shoulder, but it just makes me wonder when we think through the lens of shoulder replacements, is frozen shoulder something that can happen to folks after surgery?

Dr. Christopher Mazoue: So, frozen shoulder is a condition where patients lose range of motion. And there is no doubt that when we do shoulder replacements, some patients will certainly not get their full range of motion back. That typically has more to do with what the patient's range of motion is going into the surgery than the surgery itself.

And so, that goes into, again, what you were talking about before, is that what we want our patients to be as active prior to surgery and using their arms and moving their shoulders. So, we definitely have patients that don't get their full motion back. And some patients will refer to that as a frozen shoulder, but it's not a true frozen shoulder. What it is is just probably a lack of range of motion going into the surgery more than anything.

Host: Yeah, I see what you mean. If you're dealing with somebody who was really active, You know, almost right up until the surgery, versus somebody who hasn't really used their shoulder in years, you can see how one might be, you know, a little more successful than the other. And it does make me naturally wonder, Doctor, when we think about playing sports after shoulder replacement surgery, like, is everyone going to get back to doing everything that they love or is it going to be some in moderation? You know, like give us a sense what can we look forward to, hopefully, again, whether it's pickleball, golf, whatever it is when we think about sports.

Dr. Christopher Mazoue: Yeah. The shoulder replacement has developed to a point where we want and expect our patients to get back to high levels of activity. We can get patients back. I did a shoulder replacement on a South Carolina state trooper who does triathlons. And so, we want patients to be active. We need patients to be active. We want them to get back to the things they love, such as tennis and pickleball and golf. And so, those things are available.

The only caveats are, you know, obviously, it is a shoulder replacement. And so, some of the things we recommend are for those people that lift weights, maybe not lifting heavy, heavy weights. And just be aware of activities that can create like major injuries like skiing and snowboarding and things like that. It doesn't mean you can't get back to doing those things after shoulder replacement. We certainly expect that you can get back to skiing and snowboarding and other things. You just got to be a little careful.

Host: Yeah. Careful moderation, whatever the right word is. And yeah, wondering, Doctor, if you can put a percentage number, if I ask you what percentage of shoulder replacement surgeries are successful, do you have that number at your fingertips? Is it 90%, 95%? Give us a sense of, you know, how successful these procedures are.

Dr. Christopher Mazoue: Yeah, I tell patients that the success rate of this surgery is typically 90% to 95% with regard to pain relief. Function's a little bit difficult to assess because everyone, again, comes into the surgery with a different level of function. But I would say from a pain relief standpoint, I think 90-95% of patients overall get pain relief and are better off than what they were prior to surgery.

Host: And, you know, some of the things I talk to doctors about, surgeons about, Doctor, there is this sense that if you have it earlier in life, you're probably going to have to come back in for a little-- I'll use air quotes-- "a little bit of a tuneup," right? Just trying to get a sense from you, you know, is this a one-time thing? If I have a shoulder replacement or the reverse shoulder replacement, am I going to need to come back in 10 years, 20 years? Like, what's your expectations?

Dr. Christopher Mazoue: The goal is for it to last a lifetime. I mean, that's the goal for our shoulder replacements. And, again, shoulder replacements, because it's not a joint that you walk on like a hip or knee, has different stresses on it. And so, we expect our shoulder replacements to last longer. Obviously, a lot of that depends on how old you are when you get it. But the intention is for it to last your lifetime.

Host: Yeah. I'm in my late 50s, Doctor, so I feel like if I can put this off to like my mid-60s, I should be good. It should be good. Get me in the finish line, right?

Dr. Christopher Mazoue: Yeah, there is certainly a concern if you start to get into patients in their 30s, 40s, early 50s, that it may not last as long as we want. And anytime we have to revise a shoulder replacement, there's some complexity there that makes it a lot little more challenging. But again, for most of them, we hope that they would last to the patient's lifetime.

Host: Well, it's been great having you on. Just give you a chance here at the end. Final thoughts, takeaways, maybe it's encouraging folks to, you know, to speak up and talk to their providers and deal with some of these nagging things that have been slowing them down over the years, whatever it is.

Dr. Christopher Mazoue: if you're having shoulder pain, don't let it linger. Go see your primary care doctor. Go see your orthopedic surgeon, and just get a sense of what's going on. It doesn't mean that you have to have any major treatment or it certainly doesn't mean that a surgery is impending. But the sooner that you can get a diagnosis, the better. And then, obviously, you can work with your physician and other healthcare providers as far as getting your shoulder that you can live a happy life with.

Host: Right. As you gave us a sense, a little bit of a roadmap, like there's things we can do beforehand. You talk this through with patients and you find out, like, what are their goals, expectations, level of pain, you know, and work their way maybe up to surgery. So, appreciate your time, your expertise today. Thanks so much.

Dr. Christopher Mazoue: Thank you very much. Have a great day.

Host: For more information and other podcasts just like this one, head on over to prismahealth.org/flourish. This has been Flourish, a podcast brought to you by Prisma Health. I'm Scott Webb. Stay well.