In Memphis
A visit to Dr Quinn Throckmorton in Memphis, Tennessee, with a day spent in the operating theatre learning his shoulder replacement techniques.
Dr Throckmorton later joined the faculty of the Advanced Shoulder Symposium in Sydney.
Why surgeons travel to watch each other operate
A published paper tells you what was done and what happened afterwards. It does not tell you how the operation felt to perform. The order of the steps, how the patient was positioned, where the incision was placed, how much of a structure was released before the next move, which instrument was reached for and when: these are the things that determine whether a technique works in someone else's hands, and almost none of them survive the translation into text.
So surgeons travel. A day in another surgeon's theatre covers a whole list rather than a single case, which means seeing how the same approach is adapted when the anatomy is not textbook. Visits of this kind also tend to run in both directions over time, and the working relationships they create are what later produce shared teaching faculty, joint research and the sort of candid phone call about a difficult case that is only possible between people who have operated alongside one another.
Shoulder replacement, in plain terms
The shoulder is a ball and socket joint, with the ball at the top of the upper arm bone sitting against a shallow socket on the shoulder blade. When the cartilage covering those two surfaces wears away, bone rubs against bone, which is painful and stiffens the joint. A shoulder replacement removes the worn surfaces and substitutes components for them.
There are two broad designs. An anatomic replacement reproduces the normal arrangement, with a ball on the arm bone and a socket on the shoulder blade, and relies on the rotator cuff tendons still working to move and control the joint. A reverse replacement swaps the geometry, placing the ball on the shoulder blade and the socket on the arm bone, so that the large deltoid muscle can lift the arm when the rotator cuff cannot. Choosing between them, and positioning the components accurately once chosen, is most of what a visit about replacement technique is concerned with. Individual results vary.
Related information
- Our post on the Advanced Shoulder Symposium faculty.
- The anatomic total shoulder replacement page.
- The reverse total shoulder replacement page.
- The shoulder arthritis page explains the condition these operations address.