As seen in the July/August 2019 issue of Advancing Care
Despite enduring pain for almost three years, Harry Knebel Jr., 66, was unsure he wanted to have shoulder replacement surgery. His procedure was scheduled for late November 2018, but in the weeks leading up to it, the Warwick resident was having second thoughts.
Constant pain, difficulty sleeping, trouble getting dressed and other limitations on his daily activities were commonplace. But the notion of a six-week recovery gave him pause.
“I was really depressed until my 18-year-old grandson, Robbie, told me he didn’t like the depression I was in,” Knebel recalled. “That’s when I decided I was going to do it. My mind made a complete 180 — and after that point, I was eager to have it done.”
Unlike knees and hips — weight-bearing joints that wear out frequently — shoulders typically only have to be replaced in people whose lifestyle places extra stress on them. This can include weightlifters, athletes and manual laborers like Knebel, who spent more than 25 years working as a construction contractor.
Emboldened by his grandson and spurred by multiple recommendations, Knebel decided to see Daniel Tomlinson, MD, Director of the Sports Medicine and Shoulder Program at St. Anthony Community Hospital, a member of the Westchester Medical Center Health Network (WMCHealth).
At that appointment, Knebel learned that shoulder replacements are the best option to ease osteoarthritis pain in the shoulder. Knebel held off for a few more months but returned to see Dr. Tomlinson when he could tolerate the pain no longer.
Dr. Tomlinson performs 80 to 100 of these procedures annually. His extensive experience, coupled with recent technical advancements, have led to continuously improving results for his patients.
“Basically, the goal of any joint replacement is to restore the optimal function of the joint by recreating the patient’s anatomy as close to normal as possible,” Dr. Tomlinson said. “Years ago, shoulder replacements only came in a few different sizes to choose from, so there were a lot of surgeries done that didn’t precisely match the patient’s native anatomy.” Today’s expanded size options, according to Dr. Tomlinson, result in implants virtually indistinguishable from the natural joint they replace.
Unlike knee- and hip-replacement joints, which have shorter lifespans due to frequent use, shoulder replacements were more likely to come loose from the shoulder socket.
In recent years, the mechanism for attaching the stem and socket to the bone has improved. However, the biggest advancement has been the improved ability to precisely align the implant.
Placement of a socket even just a few millimeters off can drastically impact shoulder function. Until a few years ago, doctors were forced to partially estimate the placement, because doctors were unable during surgery to see the entire shoulder blade, just the socket. This is because the scapula, or shoulder bone, is covered in soft tissue and muscle. Arthritis also can change the shape of the socket. During surgery, the goal is to recreate the patient’s pre-arthritis anatomy.
“Before using a CT in our planning, we would look at pre-op studies, like a CT or MRI, and make our best guess as to what the correct position is during the surgery,” Dr. Tomlinson said. “Usually we could get pretty close, but for someone who does not do many replacements, this can be challenging.”
The new CT scans enable doctors to create a three-dimensional model of the shoulder, virtually place the implant into the model on a computer and adjust it until it is placed with exactness, based on the patient’s anatomy. This offers the surgeon a patient-specific plan for the procedure. The computer model is then used to create a physical 3D printed model of the patient’s shoulder with guides that attach during surgery, to ensure the implant is placed precisely in the right position.
Dr. Tomlinson has been using the 3D mapping for roughly three years, including on Knebel, who said he was completely pain-free after a week. By his six-week checkup, he had regained half of his range of motion. Three months after surgery, he had regained full mobility.
“By placing the shoulder in a more exact position, there’s better overall function,” Dr. Tomlinson said, and added that the biggest frontier now is “to make these shoulders last longer.”
Shoulder replacements can take up to a year to fully heal, although 90 percent of the recovery takes place in the first six months, according to Dr. Tomlinson. And though Knebel continues to heal, he would recommend Dr. Tomlinson to anyone.
“I am in no pain or discomfort,” Knebel said. “I can do things with my arm and shoulder that I couldn’t do before. I am very happy I had this surgery done.”
Visit us at St. Anthony Community Hospital, a member of Westchester Medical Center Health Network, to learn more. Advancing Care. Here.