Clinician-to-Clinician Update Clinician-to-Clinician Update

New Procedures, Technology Meet Rising Demand for Shoulder Replacement

March 2017

Improvements in surgical procedures and joint technology are making total shoulder arthroplasty an option for more patients. The number of total shoulder arthroplasties has increased markedly in recent years, perhaps in part to the emergence of new approaches to the procedure.1 An aging population with its associated increased risk of osteoarthritis is expected to continue to drive increases in the procedure; however, demand for total shoulder arthroplasty among patients age 55 or younger has also risen.2 Orthopaedic surgeons versed in the new approaches and technologies and who perform a high volume of shoulder arthroplasties have yielded better outcomes for patients.3, 4

The majority of patients undergoing total shoulder replacement are over the age of 65. In these patients, the need for the procedure usually stems from extensive cartilage loss due to advanced osteoarthritis.1 These patients, however, can have associated rotator cuff pathology, which causes traditional shoulder implants to fail at a high rate. Approved by the Food and Drug Administration in 2004, reverse total shoulder replacement is designed to address shoulder conditions including cuff tear arthropathy, glenohumeral arthritis, failed conventional total shoulder arthroplasty, and proximal humerus tumors and fractures.5 In the conventional approach to total shoulder arthroplasty, the replacement mimics anatomy, and the rotator cuff controls joint and arm movement. In reverse total shoulder joint replacement, surgeons place a ball-shaped metal piece within the glenoid socket and fix a plastic cupshaped attachment at the head of the humerus. With this joint replacement, the deltoid muscle controls upper arm and joint motion, which enables patients without a working rotator cuff to raise their arm.

March-2017-Adult-Spec-Ortho-Feature-Article-Image
— The unique anatomy of the shoulder allows it to have the most motion of any joint in the body but also creates challenges in the care of this complex joint.

This approach to the procedure has produced good outcomes in patients with irreparable rotator cuff pathology, allowing these patients greater range of arm motion than possible under conventional approaches. (See Case Study for further discussion.) At 10 years, survival rates of implanted joints under reverse total shoulder arthroplasty have exceeded 85%. Long-term satisfaction rates on conventional total shoulder arthroplasty, by comparison, range from 86%-95%.5 Improvements in shoulder replacement design and the advent of individually tailored implants made from 3D printers have also allowed surgeons to perform more complex total shoulder arthroplasties.6

Although the risk of complications is low for shoulder arthroplasty, surgeons who perform a high volume of procedures see half the rate of complications compared to their low-volume practice counterparts. Experienced specialists can operate 30 to 50 minutes faster on average, which lowers the rate of complications due to blood loss, and their patients have shorter hospital stays.3, 4 Experience in complex cases also tends to translate to good outcomes in more straightforward, first-time procedures as well.

Improved designs and new surgical approaches have allowed shoulder arthroplasty to become a viable option for more patients.2, 5 Whether a patient seeks a return to work or sport or treatment for a degenerating joint, shoulder arthroplasty can offer lasting pain relief and improvements in mobility.5

References

  1. Kim SH, Wise BL, Zhang Y, et al. Increasing incidence of shoulder arthroplasty in the United States. J Bone Joint Surg Am. 2011;93(24):2249-2254.
  2. Padegimas, E.M., Maltenfort, M., Lazarus, M.D. et al. Future patient demand for shoulder arthroscopy by younger patients: national projections. Clin Orthop Relat Res. 2015;473:1860.
  3. Singh A, Yian EH, Dillon MT, et al. The effect of surgeon and hospital volume on shoulder arthroplasty perioperative quality metrics. J Shoulder Elbow Surg. 2014;23(8):1187-1194.
  4. Jain N, Pietrobon R, Hocker S, et al. The relationship between surgeon and hospital volume and outcomes for shoulder arthroplasty. J Bone Joint Surg Am. 2004;86-A(3):496-505.
  5. Westermann RW, Pugely AJ, Martin CT, et al. Reverse shoulder arthroplasty in the United States: a comparison of national volume, patient demographics, complications, and surgical indications. Iowa Orthop J. 2015;35:1-7.
  6. Sahni V, Narang A. Recent advances in shoulder surgery. J Ortho All Sci. 2014;2(2):29-33

When to refer

At the University of Minnesota Health Orthopaedic Clinic, our shoulder specialists have the expertise to treat the full spectrum of shoulder conditions. Our experienced shoulder surgeons employ minimally invasive arthroscopic procedures and the latest technology in shoulder replacements and repair of torn rotator cuffs, dislocating shoulders, and fractures around the shoulder. Our highly skilled team of experts addresses the most complex shoulder conditions due to injury, arthritis, or growth disorders.

Our surgeons are members of the society of American Shoulder and Elbow Surgeons, which recognizes highly skilled subspecialist surgeons and promotes research into the science and practice of shoulder and elbow care. Drs. Alicia K. Harrison and Jonathan P. Braman maintain a high-volume practice, together performing more than 125 shoulder arthroplasties a year.

To schedule a consultation, referral, or appointment, call 612-672-7000.

Multidisciplinary, Collaborative Care

Our shoulder patients benefit from an innovative and collaborative treatment environment that combines research and education with patient care to better their health. Our goal is to work side-by-side with primary care providers to get their patients back to work and play as pain-free as possible. Our shoulder specialists collaborate with rheumatologists and sports medicine physicians to help the primary care provider determine when surgical intervention may be necessary for their patients with chronic pain or bone conditions such as osteoarthritis. Our anesthesiology partners are essential members of our surgical team and now provide non-opioid strategies to reduce pain after surgery. We partner with cardiologists, endocrinologists, and oncologists to treat patients with complex medical conditions who may benefit from the pain-reducing benefits of shoulder surgery. And our physical therapy partners are true champions for patients during recovery and rehabilitation.

To find current clinical trials available through M Health providers: studyfinder.umn.edu

The 2017 University of Minnesota Health Adult Specialty Directory is now available. To request a free copy, visit mhealth.org/for-medical-professionals/adult-specialty-directory.

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