by Elizabeth Hofheinz, M.P.H., M.Ed., January 3, 2020
It’s a good day to have a shoulder problem. Options of yesteryear were limited. Indeed, 3,000 years ago the Egyptians left hieroglyphs for us depicting a (presumably limited and painful) leverage method of shoulder reduction.1
Kevin Farmer, M.D. is an orthopedic surgeon at the University of Florida (UF) and is team physician for the UF Athletic Association. “We are seeing a rise in shoulder preservation techniques among patients under 40, something that I predict will continue to gain popularity in 2020. These surgeries span subspecialties as they involve managing or replacing joints in active younger people.”
“Preservation of the native joint in those with early arthritis or cartilage injury is one option. In the past we had no great options to offer younger patients, but with the rise of newer arthroscopic options, we do. We can use cartilage grafts either off the shelf or by harvesting them from patients both in the shoulder and the knee. These options have changed our ability to address certain conditions and even delay replacement. They are minimally invasive, have better outcomes, and gets younger, active patients back to sports more quickly.”
“Shoulder replacement is another option for these patients. In the past, those under 40 were just told to alter their activities for the rest of their lives. Now, we can place an anatomic capsule over the shoulder and inlay socket, and it will protect these areas from forces that lead to early loosening and failure. This has absolutely changed my practice, especially for very active patients with shoulder arthritis. Two of my patients with arthritis shoulder were told by their first surgeons that their only option was to wait until they are in their 50s and until then they would just have to deal with it.”
“Shoulder resurfacing has been demonstrated as a better option in active people. It is a newer technique and some surgeons have not bought into the idea. It is a paradigm shift as we were all ‘brought up on’ joint replacement. In this procedure you are anatomically reconstructing the joint and putting in a prosthesis designed to maintain high forces. It is essentially just an evolution of joint replacement.”
“For a lot of orthopedic surgeons, the idea of an inlay glenoid within the socket is a totally different approach to how we were trained so a lot of surgeons are taking the ‘wait and see’ approach to outcomes in order to ensure they don’t have to be concerned about loosening.”
“I recommend approaching these patients like you would a high school athlete, namely, treat them on an outpatient basis so as to have a less invasive process, decreased blood loss, and ease of operation. And I approach rehab like I am working with a high school pitcher. I have these young arthritic patients see a physical therapist who specializes in sports medicine and pursues an aggressive rehab program.”
“My colleagues and I have undertaken a study where we are prospectively collecting patient data (range of motion, strength, patient reported outcomes). This follows on the heels of work by Cleveland Clinic researchers, who published their outcomes at a minimum of 3-year followup. They demonstrated good outcomes and no revisions. And for work using the Australian registry data on all type of shoulder replacements they found a roughly six-fold decrease in revision rates.”
Dr. Farmer added, “To date, cemented glenoid components have been considered the gold standard. There has been a push towards developing non-cemented glenoid components. I suspect you will continue to see technological advances with the goal of improving non-cemented glenoid options.”
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