Easier shoulder surgery

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Posted: Thursday, July 25, 2013 3:00 pm

PHOENIX, Ariz. (Ivanhoe Newswire) -- Osteoarthritis can lead to severe shoulder pain, wearing down the joint so much that simple movements can become unbearable. Now, a new shoulder replacement is giving patients their reach back.

Larry Green lived with shoulder pain for years, until everyday tasks became debilitating.

“One of the things that, for example, my wife and I do is cuddle at night and I just couldn’t get my arm up and around,” Larry Green, StepTech patient, told Ivanhoe.

That’s when he opted for a new shoulder replacement surgery. You can see in Larry’s case there was virtually no cartilage left, just bone on bone. Dr. Jason Scalise says that makes Larry an ideal candidate for StepTech.

“I think that this will be one of those milestones that will help us address significant shoulder arthritis with bone loss,” Jason Scalise, MD, Orthopedic Surgeon and Shoulder Specialist at The CORE Institute, told Ivanhoe.

With this new technique surgeons make a 90 degree cut, preserving as much bone as possible.

“What we do is we make a very precise cut in the bone and then instead of implanting a slanted socket, we can implant a more orientated anatomic socket, which we believe will have better results in the long term,” Dr. Scalise explained.

“I have no pain. I have no pain at all,” Larry said.

StepTech patients can be safely out of the sling within the first 24 hours and engage in light activities. The doctor believes about 25 centers nationwide are offering this new approach.


Jason Scalise, MD, Orthopedic Surgeon and Shoulder Specialist at The CORE Institute, talks about a new technology that’s helping treat shoulder pain.

We’re talking about the StepTech. Can you tell us what type of candidate this would be for?

Dr. Scalise: For the most part, people that utilize the StepTech are people with shoulder osteoarthritis, which is the wear and tear of the shoulder joint or the socket. Usually the back side of the socket wears out more than the front side of the socket and because of that worn out socket we have to accommodate with a different type of implant. So, the best candidates for a Step-Tec are people who have shoulder arthritis in which the back side of their socket has worn out in such a way to leave them with little bone left remaining. It’s a common pattern that we see and up until recently we had very few tools in which to adequately address that.

Can you get arthritis in your shoulder just like you do in your knees or the hips?

Dr. Scalise:  Yes. It is not as common mostly because we don’t bear so much weight on our shoulders, but the same patterns of arthritis that we see in the shoulder is what we also see in the knee and the hip.

What makes this a breakthrough?

Dr. Scalise: The nice thing about this is that it allows us to accommodate very high, complicated levels of pathology in the shoulder without removing as much bone as we used to. So, it allows us to correct shoulder arthritis especially for people that have a lot of bony wear or a lot of missing bone in their shoulder and we’re talking mostly about the socket side. We had very few tools to be able to adequately address this before, but now this technology allows us to do so while preserving as much bone as possible. I think that this is substantial. I mean there are milestones in shoulder replacements that we’ve seen over the years, including shoulder replacement itself, reverse shoulder arthroplasty, and newer techniques with respect to better implant design and better materials. I think that this will be one of those milestones that will help us address significant shoulder arthritis with bone loss in ways that we really didn’t have much of an opportunity in the past.

So, you really can save the bone?

Dr. Scalise: We can save the bone and we can also re-correct the joint mechanics in a much better capacity than we previously thought.

What were some of the existing models that you had to use before the StepTech came out?

Dr. Scalise: Prior to this, we would have either tried to grind down the remaining bone that the shoulder had to try to rebalance the shoulder at the expense of losing some anatomy and losing some bone or we could have bone grafted the defect. The history of bone grafts in the shoulder has shown that a lot of those bone grafts resorb or fail; so there are some problems with that. This technique allows us to potentially overcome that.

Can you talk about the patient?

Dr. Scalise: Yes, the patient that we’re talking about had the surgery done. Mr. Green was an active elderly gentleman. He plays golf and tennis. He is very active, but was really debilitated by a high level of pain and dysfunction secondary to this shoulder arthritis. At the time that we initially evaluated him we noticed on his x-rays and on his subsequent CT scans that he had a characteristic yet very profound amount of bone loss on the back side of his shoulder, because of that we elected to use this technique to try to restore that.

So this is safe for someone who is even in their eighties?

Dr. Scalise: Correct, especially for the active adults who we are seeing more and more these days. Shoulder replacements in general allow people to remain active and have a higher quality of life.

How does it work as far as recovery time?

Dr. Scalise: The recovery time is actually pretty reasonable. We used to have people stay in slings for weeks and weeks and quite frankly we now have people come out of the sling right away and start their exercises. They’re in the hospital often just overnight; most patients go home that first morning. They do some dedicated exercises, which we teach them. However, they can start using their arm right away for simple activities of living, like brushing their teeth, typing on a keyboard, or holding a magazine. We tell people that the time between surgery and back to heavy duty activities, like golf or tennis, may be as soon as three months depending on how they’re doing.

How long until they can be out of the sling?

Dr. Scalise: We have them safely out of the sling within the first twenty-four hours. The day after surgery, they’re out of the sling using their arm again for simple things. Even that night of surgery, if they have surgery in the morning, they’re using their shoulder and their arm that night to feed themselves for dinner. So, that is something that is very helpful.

How long does it last?

Dr. Scalise:  The joint replacements last anywhere from fifteen to twenty years or beyond. Some of the data that we have indicating how long these shoulder replacements last are based on data ten or fifteen years ago. With newer technologies and newer techniques, we’re seeing that they might have a longer duration.

Have you found that you’ve had to do a lot of revisions from people who have done it the old way without the steps?

Dr. Scalise:  We haven’t seen a lot of revisions yet. The StepTech technology has only been available over the last year or so. So, the numbers of patients that have had this done are relatively low compared to everything else, but we have not had a lot of revisions in this case so far.

Could you discuss some of the previous models of shoulder replacement?

Dr. Scalise: In previous models of shoulder replacement we did not really have a great opportunity to restore the native anatomy of the shoulder while replacing the shoulder at the same time. So, we needed to remove a lot of bone and we needed to adjust the normal anatomy to accommodate the shoulder implants that we had. The advantage that this potentially offers is that we can restore normal anatomy to a greater degree without removing nearly as much bone as we might have had to in the past.

Is that really important for someone who is older?

Dr. Scalise: Yes, we believe that’s true.

Would it just wear down or give away because there was less bone?

Dr. Scalise: Yes. The problem was not so much that the older implants would wear out, although we do think that the longevity of implants is directly tied to their ability to be implanted precisely and restoring the anatomy as closely as we possibly can. This technique allows us to be able to do that. We would find those implants that were not precisely placed that their longevity was lessened and they would wear out.

How many patients would you say this could be used for or how many people would have this problem in a given year that would seek surgery?

Dr. Scalise: I would say as a percentile of patients that we see with shoulder arthritis probably affects a greater number than we thought in the past. We’re seeing this with different eyes these days, probably somewhere around twenty to twenty-five percent of the patients may actually be a candidate for this.

They come in with shoulder arthritis?

Dr. Scalise: Correct.

Sometimes it seems like the simplest devises are the ones that have the most impact. What do you think?

Dr. Scalise: Yes. The key to this device is not so much in its geometric shape or design is the ability to have the surgical tools to implant it in a very precise way so that we can make very fine geometric cuts and interlock puzzle pieces as opposed eyeballing it.

Would that give the patient a better range of motion?

Dr. Scalise: We think once the joint has been restored to normal mechanics as we can get, then that affords the ability to have a much more normal and better range of motion in the end.

This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.

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