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Reverse Total Shoulder Replacement
Total shoulder replacement surgery can relieve pain and other symptoms that result from damage to the shoulder joint. Dr. Wasik Ashraf takes a closer look at reverse total shoulder replacement surgery, when it's the best option, the results, and more.
Featured Speaker:
emergency medical technician who worked as a volunteer and participated in community education programs. Dr. Ashraf has a passion for sports medicine and research. He has provided team coverage for the
Roslyn, Manhasset, and Hewlett, New York high school football teams, and during his Hughston Sports Medicine Fellowship at the Hughston Foundation took care of team coverage for the Columbus Cottonmouth professional hockey team. Dr. Ashraf is currently board eligible in orthopaedic surgery and is a member of the American Orthopaedic Society of Sports Medicine (AOSSM) and the American Osteopathic Academy of Orthopaedics (AOAO) as well as Arthroscopy Association of North America (AANA).
Wasik Ashraf, DO
After graduating summa cum laude with a degree in biology from the New York Institute of Technology in Old Westbury, New York, Dr. Ashraf went on to receive his medical degree from the New York College of Osteopathic Medicine, also in Old Westbury. He then trained in Orthopaedic Surgery at North Shore University Hospital in Plainview, New York, and recently completed a sports medicine fellowship at the Hughston Foundation in Columbus, Georgia. Before becoming a surgeon, Dr. Ashraf was a licensedemergency medical technician who worked as a volunteer and participated in community education programs. Dr. Ashraf has a passion for sports medicine and research. He has provided team coverage for the
Roslyn, Manhasset, and Hewlett, New York high school football teams, and during his Hughston Sports Medicine Fellowship at the Hughston Foundation took care of team coverage for the Columbus Cottonmouth professional hockey team. Dr. Ashraf is currently board eligible in orthopaedic surgery and is a member of the American Orthopaedic Society of Sports Medicine (AOSSM) and the American Osteopathic Academy of Orthopaedics (AOAO) as well as Arthroscopy Association of North America (AANA).
Transcription:
Reverse Total Shoulder Replacement
Cheryl Martin (Host): Total shoulder replacement surgery can relieve pain and other symptoms that result from damage to the shoulder joint. For example, osteoarthritis, rotator cuff injuries, or fractures. And depending on the type of joint damage you have, your doctor may recommend what's called a reverse total shoulder replacement instead of a standard shoulder replacement.
Welcome to Doc Talk, presented by Montefiore St. Luke's Cornwall. I'm Cheryl Martin. On this episode, we take a closer look at the option of a reverse total shoulder replacement, what it is, when it's the best choice, the results and more. Our guest is Dr. Wasik Ashraf, Medical Director of Sports Medicine for Montefiore St. Luke's Cornwall. Welcome, doctor.
Dr Wasik Ashraf: Thank you. Thank you for having me.
Cheryl Martin (Host): First question, what's the major difference between a standard shoulder replacement and a reverse procedure?
Dr Wasik Ashraf: So the main difference between a standard and a reverse is the orientation where we put the implants. In a reverse shoulder replacement, we put the ball of the shoulder on the socket side and we reverse where the socket goes into the humerus side, as opposed to a normal shoulder replacement, where we keep that normal orientation.
Cheryl Martin (Host): How popular is this option?
Dr Wasik Ashraf: It's actually very popular. These days, if someone has 10 shoulder replacements, about six out of seven out of those 10 shoulder replacements are actually reverse shoulder replacements.
Cheryl Martin (Host): And why is that?
Dr Wasik Ashraf: It's multi-pronged reason. You know, first reason is technology. Technology has really advanced on how we deal with shoulder injuries. And so we've learned how the biomechanics of the shoulder work. And so the new adaptive technology using CT scans, MRI and patient-specific implants have really made it easier to do this procedure with a more predictable result. Number two is more surgeons are more used to now doing the reverse shoulder replacement for multiple reasons, not just arthritis.
Cheryl Martin (Host): Talk more about those other reasons.
Dr Wasik Ashraf: The reasons for the shoulder arthritis, one is osteoarthritis, which is basically where the joint deteriorates and that's why we do a replacement. The second most common reason is a thing called rotator cuff arthropathy. Rotator cuff arthropathy is a disease where the rotator cuff is injured or not functioning or can't be fixed. And once that happens, now we could replace it with the reverse and patients return to their activities of daily living. The third reason most common is fracture. Someone falls, they break their shoulder and now instead of piecing them back together, we do a reverse shoulder replacement.
Cheryl Martin (Host): Talk more in more detail about what this surgery is like, and if it's more complicated or at a higher risk factor than the standard shoulder replacement surgery?
Dr Wasik Ashraf: So most of the shoulder replacement surgeries we do are same-day outpatient setting. And what that really means in the real world is it's only a 45-minute surgery and patients are going home pretty comfortable almost the same day, most of the time. So as far as being more risky, it really isn't more riskier than a standard shoulder replacement. With that said, there are risks to every surgery. And the risks that we see that is increased with the reverse shoulder replacement is if the hardware, the screws, the metal we use, if it loosens, and unfortunately that is a risk that's increased in the reverse shoulder replacement population.
Cheryl Martin (Host): Why is that?
Dr Wasik Ashraf: Well, that's because most of the patients that we do an anatomic or a normal shoulder replacement tend to be somewhere between 40 to 65 years old. While in the reverse shoulder population, that tends to be our more seasoned patients. So somewhere between 65 to even 85 years old. So the bone tends to be a little bit more osteoporotic or a little softer, so the screws we put in aren't going into bone that is as hard.
Cheryl Martin (Host): What results can a person expect if he or she opts for a reverse total shoulder replacement?
Dr Wasik Ashraf: That's a great question. And it really is different for each person. I have patients that are avid golfers, that they just want to go back to playing golf or pickle ball, or just want to be without pain. So the goals are different from each patient. But most of the time, pain relief. People are sleeping better. Their quality of life is better because they're not having so much shoulder pain. Number two is, really, you get back to almost everything the shoulder does, from lifting, pushing, pulling, playing sports without pain. And so quality of life wise, there's very few surgeries that we do as orthopedic surgeons that make patients this happy after a pretty big surgery.
Cheryl Martin (Host): Wow. Now, once a person has had this surgery, is there ever a chance that he or she would need the surgery again?
Dr Wasik Ashraf: Yes, there's always chance of revision. And, you know, I tell all my patients that these implants are not made by God. They can break, they can loosen. And that's one of the things that can happen. If you fall, the metal can break, the bone can break around. So can these need revisions? Absolutely. But the timeline and when patients need revisions or replacement parts for the replacement depends on which piece and what is happening with that individual patient.
Cheryl Martin (Host): And what about after the surgery? How often would a patient have to come in for you to check everything and to do an assessment of how it's working and if it's working properly?
Dr Wasik Ashraf: So usually, right after surgery, we tend to see our patients in the higher frequency the first six months. So I see my patients two weeks after surgery, six weeks after surgery, three months after surgery and six months after surgery. Once we get over the first six months, then I see my patients yearly for the first three years and then I set them loose. They only come back if they need me.
Cheryl Martin (Host): Okay. Now, are there any persons who are having problems with their shoulder, who should not have a reverse total shoulder replacement?
Dr Wasik Ashraf: Yes, that's a great question. Really our younger patients. So if I have a 40, 50-year-old patient that's going to use their shoulder to do heavy lifting, laborers who are going to put a lot of torque into the shoulder, they should not have a reverse shoulder, because they're going to wear that shoulder out much sooner than a patient that's using the shoulder for normal activities, no weights and no lifting heavy or not pushing anything heavy.
Cheryl Martin (Host): Now, you mentioned early on that this particular procedure is really popular now. So is there ever the option that a patient gets to choose one or the other, because both will work?
Dr Wasik Ashraf: Well, the most important part is the decision-making process to see which procedure is the right procedure for this individual. And that's where a good patient-physician relationship comes into play, talking about the risks and benefits for either surgery and what we can anticipate. There's a few factors we look at when we decide which type of shoulder replacement to go with for a patient. Number one, we decide on the level of arthritis. Significant arthritis with a lot of bone loss is sometimes better with the reverse. We look at the rotator cuff. If the rotator cuff tissue isn't great or the quality of that rotator cuff isn't great, then usually reverse is a better option. But it is absolutely a decision that's made with the patient. And usually, we know which one we prefer, the anatomic or the reverse. Very seldom do we have to pick one over the other and usually that decision is much easier.
Cheryl Martin (Host): Doctor, anything else you'd like to mention about reverse total shoulder replacement?
Dr Wasik Ashraf: Yes. technology-wise here at St. Luke's, we do outpatient reverse shoulder replacement with an anesthesia that does a block for the shoulder replacement. So a lot of our patients are in no pain after surgery. They're going home comfortable in the sling. the implants we have are state-of-the-art, minimal small micro implants, which is again great because you're not having those big pieces of metal. And as you consider a reverse shoulder replacement and to see if it's an option, the downtime's only really about three weeks in a sling. So the recovery process is significantly easier than it used to be.
Cheryl Martin (Host): That's wonderful. That was Dr. Wasik Ashraf, Medical Director of Sports Medicine for Montefiore St. Luke's Cornwall. For more information about our orthopedic services, visit montefioreslc.org. . And please remember to subscribe, rate and review this podcast and all the other Doc Talk podcasts presented by Montefiore St. Luke's Cornwall. Thanks so much for listening.
Reverse Total Shoulder Replacement
Cheryl Martin (Host): Total shoulder replacement surgery can relieve pain and other symptoms that result from damage to the shoulder joint. For example, osteoarthritis, rotator cuff injuries, or fractures. And depending on the type of joint damage you have, your doctor may recommend what's called a reverse total shoulder replacement instead of a standard shoulder replacement.
Welcome to Doc Talk, presented by Montefiore St. Luke's Cornwall. I'm Cheryl Martin. On this episode, we take a closer look at the option of a reverse total shoulder replacement, what it is, when it's the best choice, the results and more. Our guest is Dr. Wasik Ashraf, Medical Director of Sports Medicine for Montefiore St. Luke's Cornwall. Welcome, doctor.
Dr Wasik Ashraf: Thank you. Thank you for having me.
Cheryl Martin (Host): First question, what's the major difference between a standard shoulder replacement and a reverse procedure?
Dr Wasik Ashraf: So the main difference between a standard and a reverse is the orientation where we put the implants. In a reverse shoulder replacement, we put the ball of the shoulder on the socket side and we reverse where the socket goes into the humerus side, as opposed to a normal shoulder replacement, where we keep that normal orientation.
Cheryl Martin (Host): How popular is this option?
Dr Wasik Ashraf: It's actually very popular. These days, if someone has 10 shoulder replacements, about six out of seven out of those 10 shoulder replacements are actually reverse shoulder replacements.
Cheryl Martin (Host): And why is that?
Dr Wasik Ashraf: It's multi-pronged reason. You know, first reason is technology. Technology has really advanced on how we deal with shoulder injuries. And so we've learned how the biomechanics of the shoulder work. And so the new adaptive technology using CT scans, MRI and patient-specific implants have really made it easier to do this procedure with a more predictable result. Number two is more surgeons are more used to now doing the reverse shoulder replacement for multiple reasons, not just arthritis.
Cheryl Martin (Host): Talk more about those other reasons.
Dr Wasik Ashraf: The reasons for the shoulder arthritis, one is osteoarthritis, which is basically where the joint deteriorates and that's why we do a replacement. The second most common reason is a thing called rotator cuff arthropathy. Rotator cuff arthropathy is a disease where the rotator cuff is injured or not functioning or can't be fixed. And once that happens, now we could replace it with the reverse and patients return to their activities of daily living. The third reason most common is fracture. Someone falls, they break their shoulder and now instead of piecing them back together, we do a reverse shoulder replacement.
Cheryl Martin (Host): Talk more in more detail about what this surgery is like, and if it's more complicated or at a higher risk factor than the standard shoulder replacement surgery?
Dr Wasik Ashraf: So most of the shoulder replacement surgeries we do are same-day outpatient setting. And what that really means in the real world is it's only a 45-minute surgery and patients are going home pretty comfortable almost the same day, most of the time. So as far as being more risky, it really isn't more riskier than a standard shoulder replacement. With that said, there are risks to every surgery. And the risks that we see that is increased with the reverse shoulder replacement is if the hardware, the screws, the metal we use, if it loosens, and unfortunately that is a risk that's increased in the reverse shoulder replacement population.
Cheryl Martin (Host): Why is that?
Dr Wasik Ashraf: Well, that's because most of the patients that we do an anatomic or a normal shoulder replacement tend to be somewhere between 40 to 65 years old. While in the reverse shoulder population, that tends to be our more seasoned patients. So somewhere between 65 to even 85 years old. So the bone tends to be a little bit more osteoporotic or a little softer, so the screws we put in aren't going into bone that is as hard.
Cheryl Martin (Host): What results can a person expect if he or she opts for a reverse total shoulder replacement?
Dr Wasik Ashraf: That's a great question. And it really is different for each person. I have patients that are avid golfers, that they just want to go back to playing golf or pickle ball, or just want to be without pain. So the goals are different from each patient. But most of the time, pain relief. People are sleeping better. Their quality of life is better because they're not having so much shoulder pain. Number two is, really, you get back to almost everything the shoulder does, from lifting, pushing, pulling, playing sports without pain. And so quality of life wise, there's very few surgeries that we do as orthopedic surgeons that make patients this happy after a pretty big surgery.
Cheryl Martin (Host): Wow. Now, once a person has had this surgery, is there ever a chance that he or she would need the surgery again?
Dr Wasik Ashraf: Yes, there's always chance of revision. And, you know, I tell all my patients that these implants are not made by God. They can break, they can loosen. And that's one of the things that can happen. If you fall, the metal can break, the bone can break around. So can these need revisions? Absolutely. But the timeline and when patients need revisions or replacement parts for the replacement depends on which piece and what is happening with that individual patient.
Cheryl Martin (Host): And what about after the surgery? How often would a patient have to come in for you to check everything and to do an assessment of how it's working and if it's working properly?
Dr Wasik Ashraf: So usually, right after surgery, we tend to see our patients in the higher frequency the first six months. So I see my patients two weeks after surgery, six weeks after surgery, three months after surgery and six months after surgery. Once we get over the first six months, then I see my patients yearly for the first three years and then I set them loose. They only come back if they need me.
Cheryl Martin (Host): Okay. Now, are there any persons who are having problems with their shoulder, who should not have a reverse total shoulder replacement?
Dr Wasik Ashraf: Yes, that's a great question. Really our younger patients. So if I have a 40, 50-year-old patient that's going to use their shoulder to do heavy lifting, laborers who are going to put a lot of torque into the shoulder, they should not have a reverse shoulder, because they're going to wear that shoulder out much sooner than a patient that's using the shoulder for normal activities, no weights and no lifting heavy or not pushing anything heavy.
Cheryl Martin (Host): Now, you mentioned early on that this particular procedure is really popular now. So is there ever the option that a patient gets to choose one or the other, because both will work?
Dr Wasik Ashraf: Well, the most important part is the decision-making process to see which procedure is the right procedure for this individual. And that's where a good patient-physician relationship comes into play, talking about the risks and benefits for either surgery and what we can anticipate. There's a few factors we look at when we decide which type of shoulder replacement to go with for a patient. Number one, we decide on the level of arthritis. Significant arthritis with a lot of bone loss is sometimes better with the reverse. We look at the rotator cuff. If the rotator cuff tissue isn't great or the quality of that rotator cuff isn't great, then usually reverse is a better option. But it is absolutely a decision that's made with the patient. And usually, we know which one we prefer, the anatomic or the reverse. Very seldom do we have to pick one over the other and usually that decision is much easier.
Cheryl Martin (Host): Doctor, anything else you'd like to mention about reverse total shoulder replacement?
Dr Wasik Ashraf: Yes. technology-wise here at St. Luke's, we do outpatient reverse shoulder replacement with an anesthesia that does a block for the shoulder replacement. So a lot of our patients are in no pain after surgery. They're going home comfortable in the sling. the implants we have are state-of-the-art, minimal small micro implants, which is again great because you're not having those big pieces of metal. And as you consider a reverse shoulder replacement and to see if it's an option, the downtime's only really about three weeks in a sling. So the recovery process is significantly easier than it used to be.
Cheryl Martin (Host): That's wonderful. That was Dr. Wasik Ashraf, Medical Director of Sports Medicine for Montefiore St. Luke's Cornwall. For more information about our orthopedic services, visit montefioreslc.org. . And please remember to subscribe, rate and review this podcast and all the other Doc Talk podcasts presented by Montefiore St. Luke's Cornwall. Thanks so much for listening.