A day in theatre
Professor Peter Chiu, a joint replacement surgeon at the University of Hong Kong, spent a day operating at Brisbane Private Hospital in November 2014. Several reverse total shoulder replacements were performed together.
Operating together, rather than one surgeon observing the other, means the exchange runs in both directions. A valuable visit for both of us.
What a reverse total shoulder replacement is
A healthy shoulder has a ball on the arm bone and a shallow socket on the shoulder blade. A reverse replacement turns that arrangement around: a metal ball is fixed to the shoulder blade and a socket is fitted to the top of the arm bone. The purpose of reversing it is mechanical. With the centre of rotation moved, the deltoid muscle over the outside of the shoulder can raise the arm without needing the rotator cuff to hold the joint down, which matters because a worn-out shoulder often has a torn cuff as well as damaged cartilage.
It is used in situations such as arthritis combined with an irreparable rotator cuff tear, a cuff tear that has led to the joint wearing out, some complex fractures of the upper arm bone, and certain revision cases. It is a joint replacement, so it involves an anaesthetic, a hospital stay, a sling, and a staged rehabilitation programme afterwards. Suitability is decided case by case on examination and imaging. Individual results vary.
Why surgeons operate together
Shoulder replacement and hip or knee replacement share a common engineering problem, which is how to set a component accurately in bone that has been reshaped by disease and have it stay there. Surgeons who spend their time on different joints approach that from different angles, and a visiting joint replacement surgeon brings a view of implant fixation and alignment formed elsewhere. Working through a list together, with both surgeons at the table, exposes the small differences in technique that neither would think to mention in conversation. Individual results vary.