In theatre in Cairns
With my colleague Dr James Beazley after a shoulder replacement procedure at Cairns Base Hospital.
Working at Cairns Base Hospital is a genuine pleasure, and it means patients in far north Queensland can have specialist shoulder surgery without travelling to Brisbane for it.
What shoulder replacement surgery is
Shoulder replacement, or shoulder arthroplasty, means replacing the worn surfaces of the shoulder joint with artificial components. It is considered when arthritis or damage to the joint surface is causing pain and restriction of movement that has not settled with non-operative treatment such as medication, injections and physiotherapy.
There are two main types. An anatomic total shoulder replacement reproduces the normal layout of the joint, with a ball on the upper end of the arm bone and a socket component on the shoulder blade, and it depends on the rotator cuff tendons still functioning. A reverse total shoulder replacement reverses that layout, fixing the ball to the shoulder blade and the socket to the arm, so that the deltoid muscle over the outside of the shoulder can lift the arm in situations where the rotator cuff is torn beyond repair. The choice between them, and whether an operation is appropriate at all, is made on the examination findings, the imaging and the individual patient's circumstances. Individual results vary.
Specialist surgery outside the capital cities
Subspecialty surgery tends to concentrate in the larger cities, because the number of cases needed to support a dedicated unit, and the theatre staff, imaging and rehabilitation services that go with it, are easier to assemble there. For patients in regional and remote parts of Australia that can mean a long journey, time away from home and family, and the cost that comes with both.
Visiting arrangements are one response to that. A surgeon who subspecialises travels to a regional hospital and operates there with the local team, which means patients are treated closer to home and their follow-up and rehabilitation can be arranged locally. It also builds capability in the regional unit, since the local surgeons, registrars, nursing staff and theatre teams are part of the list rather than observers of it. Cairns Base Hospital serves a large catchment across far north Queensland, and shoulder replacement is among the procedures that can be provided there.