Shoulder replacement is becoming a fact of life as aging baby boomers deal with painful arthritis. Unfortunately, up to 20 percent of the 50,000 shoulders replaced nationwide fail—either immediately after surgery or up to 15 years later; these patients must have a new procedure that limits what they can do afterward. Two surgeons at Atlantic Orthopedic Specialists, Dr. Chad Manke and Dr. Brad Carofino, are trained in techniques that reduce the failure risk and help patients continue to lift weights, play tennis and kayak.
Three to five percent of traditional shoulder replacements fail immediately after surgery and must be redone because the largest muscle in the rotator cuff, the subscapularis, fails to heal after being cut during the procedure, Manke says. A failed rotator cuff also is to blame for additional shoulder replacements that must be revised within 15 years.
These patients will have to get a reverse shoulder replacement, which solves the problem but limits how high the affected arm can be lifted, Manke says. That means no tennis, badminton, squash, basketball, softball or any sport involving overhead activity.
Manke is one of only a few orthopedic surgeons nationwide trained in a procedure to spare that muscle during surgery. Because the muscle is not cut, patients recover about six weeks faster with fewer limits on activity during recovery, he says.
More important, though, is long-term recovery. The muscle-sparing approach means more people are candidates for the standard shoulder replacement. Before adopting the muscle-sparing approach, Manke sometimes did a reverse shoulder replacement as a pre-emptive measure for people with already-compromised rotator cuffs.
Now he can choose the standard approach for more patients.
“The outcome of the standard approach is better than the revers, so I try to do the standard shoulder replacement when I can,” he says.
In 10–15 percent of shoulder replacements, the prosthetic shoulder fails after 10 years because the new plastic glenoid socket wears out or becomes loose, Carofino says.
“That’s the single biggest problem in shoulder replacements,” he says.
Carofino is one of only a few surgeons trained in a procedure that preserves more of the shoulder’s natural structure. He still replaces the ball of the upper arm. But instead of replacing the shoulder socket, Carofino uses a procedure called ream and run that smoothes out the glenoid and stimulates the bone to re-grow new cartilage.
“You’re reshaping the patient’s own socket,” he says. “This is designed for people who want to remain active.”
Recovery does take a little longer, but for these patients it’s worth it because they can continue to do the sports and other activities they love.
Because of that risk of failure, patients with shoulder replacements have been told they shouldn’t lift more than 25 pounds, Carofino says. That means no lifting weights, no riding motorcycles, not even lifting a kayak or canoe in and out of the water, he says.
“Some patients choose not to have a shoulder replacement for that reason,” Carofino says. “They just gut it out.”
Now, they don’t have to.
Atlantic Orthopaedic Specialists has offices in Chesapeake, Norfolk and Virginia Beach. Carofino and Manke are also starting a shoulder replacement center as part of their practice.