Advances in shoulder replacements: A personalized approach
Shoulder replacement has come a long way. Today, advances in imaging, 3D planning, implant design and navigation allow surgeons to approach each patient’s shoulder replacement with a greater understanding of their individual anatomy.
Earl Brewley, MD, is a shoulder and elbow surgeon with Salem Health Orthopedics. When Dr. Brewley talks with patients about shoulder arthroplasty, he emphasizes that there is no single operation that is right for everyone.
Every shoulder is different
The shoulder is designed for an enormous range of motion. Unlike the hip, which has a deep socket that provides stability, the shoulder socket is relatively small and flat.
“The shoulder is like a golf ball sitting on a golf tee,” said Dr. Brewley. “That gives us tremendous motion, but it also means that the anatomy of each patient’s shoulder matters.”
When arthritis damages the cartilage, the smooth surfaces of the joint can wear away, causing pain, stiffness and grinding. But arthritis is only part of the picture.
The condition of the rotator cuff, the amount and shape of available bone, previous injuries or surgeries and the patient’s goals all help determine which type of shoulder replacement may be appropriate.
Choosing the right replacement
An anatomic shoulder replacement is designed to recreate the shoulder’s normal anatomy. A metal component replaces the worn humeral head, and the socket can be resurfaced with a plastic component. This approach is generally considered when a patient has arthritis and a functioning rotator cuff.
A reverse shoulder replacement changes the mechanics of the joint by placing a ball on the socket side and a cup on the arm side. This allows the deltoid muscles to help elevate the arm when the rotator cuff is severely damaged or irreparable.
“Choosing between an anatomic and reverse replacement isn’t simply about choosing an implant,” said Dr. Brewley. “It’s about understanding the individual shoulder and determining which reconstruction will best address that patient’s problem.”
Planning for the individual patient
One of the biggest advances is the ability to create a CT-based, three-dimensional model of a patient’s shoulder before surgery.
“This allows us to look at the patient’s anatomy in three dimensions and develop a surgical plan before entering the operating room,” said Dr. Brewley.
Modern implants can also be smaller and designed to preserve more of the patient’s own bone when appropriate.
For selected healthy patients, shoulder replacement is increasingly being performed as a same-day procedure, potentially allowing patients to recover in the comfort of their own homes.
Technology as a surgical tool
Salem Health Orthopedics will soon be able to utilize augmented reality navigation. With this technology, surgeons can see guidance based on the patient’s surgical plan while performing the procedure.
“Technology can help us carry out a carefully developed plan with greater precision,” said Dr. Brewley. “But it doesn’t replace the decisions that matter most — choosing the right operation for the right shoulder at the right time.”
Ultimately, the goal of these advances isn’t simply to use newer technology. It is to provide a more individualized approach to shoulder replacement.
“The best results come from combining the patient’s anatomy and goals with the surgeon’s experience, careful planning and rehabilitation,” said Dr. Brewley.
Orthopedic care
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