In Denver
A visit to David Schneider in Denver, Colorado, with a day spent in the operating theatre learning his surgical techniques for shoulder replacement.
This was one of a series of visits to shoulder surgeons in the United States during 2017.
Why surgeons visit each other
A surgical technique is difficult to learn from a paper. A published description sets out the steps and the results, but it leaves out most of what matters in theatre: how the patient is positioned, the order in which things are done, what the surgeon does when a step does not go as expected, and the many small habits that make an operation run smoothly. The only reliable way to pick those up is to stand in the theatre and watch.
Visits of this kind, often called surgical visitations, are a long standing practice in orthopaedics. A surgeon travels to a colleague who performs a particular operation in high volume, spends a day or more observing, and discusses the cases afterwards. It is an unglamorous and effective form of continuing education, and over a career it runs in both directions.
What shoulder replacement involves
Shoulder replacement is an operation for a shoulder joint whose surfaces have worn out, most often because of arthritis. The worn surfaces are removed and replaced with implant components.
In an anatomic replacement the normal arrangement of the joint is reproduced, with a ball on the arm bone and a socket on the shoulder blade. In a reverse replacement the arrangement is inverted, with a socket on the arm bone and a ball on the shoulder blade, which allows the deltoid muscle to raise the arm when the rotator cuff tendons are no longer able to do so. Which of the two is appropriate depends on the condition of the rotator cuff, the pattern of wear in the socket and the patient's circumstances. Individual results vary, and the decision is made after assessment and imaging rather than in advance.
Related information
See our other 2017 visit posts, including Memphis and Detroit, and our anatomic total shoulder replacement, reverse total shoulder replacement and shoulder arthritis pages.