A visit to London, Ontario
Several days spent with Dr George Athwal and his family in London, Ontario, including a day in theatre watching his approach to reverse total shoulder arthroplasty.
He is a very capable surgeon, and watching a full day of his lists is a more useful education than any number of papers on the same operation. I was reportedly close to being restrained by hospital staff for trying to get too involved.
What reverse total shoulder arthroplasty is
A reverse total shoulder replacement inverts the normal arrangement of the joint. In the natural shoulder the ball is on the upper arm bone and the socket is on the shoulder blade. In a reverse replacement a ball is fixed to the shoulder blade and a cup to the upper arm bone. The point of the change is that it allows the deltoid muscle to lift the arm, which matters when the rotator cuff tendons that normally do that job are torn beyond repair or absent. It is used in several situations, including arthritis together with an irreparable cuff tear, some fractures of the upper end of the arm bone, and revision of a previous replacement. Individual results vary.
Why surgeons spend a day in another surgeon's theatre
A published series tells you what was done and what was recorded afterwards. It does not show how the patient was positioned, where the incision was placed, how the socket component was prepared, how the soft tissue was balanced, or what the surgeon did when the bone was not as the scan had suggested. Those judgements are the operation, and they are visible only in the room.
Watching a full list rather than a single case also shows how the same surgeon varies the approach from one patient to the next, which is where the reasoning behind the method becomes clear.
Related information
Several of our fellows have gone on to fellowships with Prof Athwal, covered in our posts on Dr Wu Kang and Dr Ryosuke Iio. See also our reverse total shoulder replacement and rotator cuff tear pages.