Dr Cutbush attended the Biennial Scientific Conference of the Shoulder and Elbow Society of Australia (SESA) in Melbourne in November 2014.Dr Cutbush is a full member of the society and was the SESA travelling fellow to Europe in 2011 when he visited European shoulder surgeons in France, Switzerland, Denmark and Italy. At the meeting held in November seven of Dr Cutbush's research papers were presented at the meeting.Dr Cutbush presented five papers:
Dr Cutbush presented his experience treating patients with frozen shoulder with arthrosopic release. 15 consecutive patients were treated for frozen shoulder with surgery between 2013 and 2014. Two thirds of patients were female and the average age was 55 years old. All patients underwent a surgical release of all involved tissue. There were no complications of the procedure. Six month followup was available for 5 patients. Pain scores improved from 62.2 to 20.5; the Constant score, which is a measure of shoulder function and strength, improved from 18.3 to 56.1; and the Oxford Shoulder score, which is a score of shoulder function, improved from 16.6 to 34.8. Range of motion improved in all measurements: forward flexion improved from 85.7 to 144 degrees; external rotation improved from 20.7 to 63 degrees; and Abduction improved from 52.3 to 130.8 degrees. All scores demonstrated large improvement in all aspects measured. Perhaps most rewarding, patient satisfaction rates improved from a dismal score of 5 prior to surgery to a much improved score of 60 (best score 100) after surgery.
The Inspace prosthesis is an absorbable balloon that is inserted arthroscopically into the subacromial space and inflated with saline. The balloon is made out of a bioabsorbable plastic that is commonly used to make absorbable sutures (vicryl) used in surgery. It degrades and is completely removed by the body of approximately 6 months. The prosthesis is used in patients that have a large irrepairable rotator cuff tear and are in significant pain and discomfort. Dr Cutbush has used the prosthesis in 7 patients with greater than 12 months followup. All patients had very significant improvement in their shoulder pain and funtion following surgery. By 12 months the improvement had lessened in three patients. Two of whom Dr Cutbush went on to perform reverse total shoulder replacements with excellent results. Only one patient remains only somewhat improved compared to his preoperative status. Four of the seven patients continue to have what they consider an excellent postoperative result in their shoulder. These results were superior to those expected for this prosthesis.
Dr Cutbush has developed an arthroscopic technique to repair the labrum when he performs an arthroscopic latarjet procedure. The Arthroscopic Latarjet Technique was pioneered by Dr Laurent Lafosse in Annecy, France. Dr Cutbush performs the Arthroscopic Latarjet as described by Dr Lafosse with a modification to the technique that allows repair of the capsule and labrum. Repair of the labrum and capsule of the shoudler joint increases the stability of the repair and helps to better recreate the original anatomy of the shoulder before it dislocated. He presented his surgical technique and the results to date. 22 patients who had had an arthroscopic latarjet procedure with labral repair with Dr Cutbush were discussed. All parameters measured demonstrated an improvement compared to the preoperative score. Patient satisfaction in regards to their shoulder improved from a score of 12 preoperatively to a very satisfying 82 postoperatively.
Subscapularis tendon tears are generally regarded as being technically challenging to perform as an arthroscopic procedure. Dr Cutbush discussed his technique of arthroscopic repair of subscapularis tendon tears. Subscapularis tendon tears are relatively rare compared to other rotator cuff tears in the shoulder. Dr Cutbush has performed arthroscopic subscapularis repairs since 2007. In the last four years he has performed over 20 subscapularis repairs with more than 6 months followup in a consecutive series. He presented the results of his research. All the repairs were examined with MRI scan at a minimum of 6 months postop. Of the 20 repairs all were found to be intact on MRI imaging. The clinical results were excellent.
Dr Cutbush has developed an all arthroscopic technique to repair both sets of ligaments that are ruptured when the AC Joint dislocates. Previous arthroscopic techniques have only addressed the coracoclavicular ligaments. Due to difficulties with recurrence attention has turned to developing techniques that reconstruct the ligaments that stabilise the AC Joint. The most important of which is the posterosuperior ligament. Dr Cutbush presented the technical details of his procedure.
Dr Kieran Hirpara, Dr Cutbush's Overseas Fellow, presented a series of patients for whom Dr Cutbush had performed an arthroscopic bone block procedure to their shoulder. The bone block was combined with a repair of the posterior capsule and labrum. Posterior bone block surgery is performed for patients with serious posterior shoulder instabilty disorders. Dr Hirpara presented the arthroscopic technique and the intial results. The initial results show great promise, with patients deriving significant benefit from the procedure.
Dr Libby Anderson, Orthopaedic Trainee, presented Dr Cutbush's experience using reflection of the anterior deltoid to enhance exposure of the shoulder for patients undergoing difficult joint revision surgery and fixation of fractures of the proximal humerus. The technique allows a considerable increase in the exposure gained allowing improvements in the surgical procedure to be more effectively performed.