Rare total shoulder replacement performed using rotator cuff sparing approach

Jupiter Medical CenterMar 29 2012

On Tuesday, March 6, 2012, Ryan Simovitch, M.D., Board Certified and fellowship trained orthopedic surgeon, performed one of the first successful total shoulder replacements with a rotator cuff sparing technique in South Florida. Jupiter Medical Center remains on the leading edge of orthopedics, offering orthopedic surgeons, state-of-the-art facilities, and comprehensive rehabilitation services to help patients return to an active and healthy lifestyle. Last month, The Anderson Family Orthopedic and Spine Center earned The Joint Commission's Gold Seal of Approval for its total knee, total shoulder and total hip replacement program.

Surgeons at the Hospital for Joint Disease have collaborated with Exactech, a surgeon founded company, to develop the equipment necessary to facilitate this rotator cuff sparing approach.

Jupiter Medical Center is proud to offer this procedure to patients. "While it is a more difficult procedure, the Rotator Cuff Sparing Technique allows us to use modified instruments and techniques to leave the rotator cuff intact and utilize a small window between the rotator cuff tendons. This eliminates the need for a sling beyond a few days and can significantly shorten the necessary time for rehab and nullify the risk of subscapularis non-healing or dysfunction. This is truly a cutting edge technique poised to change the way we do total shoulder replacements and rehab them," says Dr. Simovitch.

In conventional shoulder replacements, the subscapularis tendon (one of the four rotator cuff tendons) is temporarily released from the humerus to gain access to the glenohumeral joint. Once the procedure is complete, the subscapularis is reattached through a variety of techniques, and graduated rehabilitation begins. The goal of the early post-operative phase is to protect the subscapularis to allow for healing. If adequate healing is not achieved, consequences may include subscapularis insufficiency (reduced functionality), limited range of motion, pain, scar-tissue buildup and "stiff shoulder".

The shoulder joint is the third most frequently replaced joint after the hip and knee, with approximately 80,000 procedures performed in the United States in 2011. Osteoarthritis (degenerative arthritis) results from 'wear and tear' to the joint cartilage and develops after years of constant pressure on the joints. Total shoulder replacement is an effective treatment for patients when non-surgical options fail to provide relief.

The rotator cuff sparing technique is not for everyone because of the limitations of current instrumentation. The technique is easier in thin patients and patients without large musculature. It is also better in patients without severe bony changes and with an appropriate bone structure. "As Exactech design surgeons and I gain experience, we hope to facilitate the technique and apply it to a larger percentage of total shoulder arthroplasty candidates," says Dr. Simovitch.