An in-depth interview with Dr. James Shaffer, Part 4 of 4

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Dr. James Shaffer, board certified orthopedic surgeon

Dr. James Shaffer, shoulder surgeon


Dr. James Shaffer was recently interviewed on WEEU’s “Health Talk” program.  Here is the final excerpt from the interview, full of helpful information relating to shoulder treatment and surgery.

Question: What are the latest surgical advancements in shoulder surgery?

Dr. Shaffer: In the past, the perception has been that shoulder replacements have been less reliable. Part of that was the number of shoulder replacements being performed, and less data on their outcomes. Today, shoulder replacement is really just as good as knee and hip replacement in terms of the types of outcomes.
Basically, there are two broad types of shoulder replacements. They both involve removing some bone from the shoulder. These are open procedures, they’re not arthroscopic, and they involve putting in implants sort of like a hip or knee replacement. There are a couple factors that I think that influence the difference between hip and knee, and shoulder replacement. I think that being that the shoulder does have that intrinsic instability because of the naturally shallow socket. It’s made it more sensitive to the small changes in the way the implants are placed, and in order to have a good outcome you’re relying on not just the way the implants are made or positioned or the way the surgery is performed but on having a functioning rotator cuff, because in a conventional shoulder you’re still relying on your rotator cuff, your other muscles and ligaments in the shoulder in order to have a good shoulder.

If you put in a standard shoulder replacement with someone with any sort of significant amount of rotator cuff problem, they’ll either have pain or they may just have a complete failure where that extra movement in the shoulder joint wears out the implants or knocks them loose. Luckily, we now have solutions for people who have rotator cuff tears that can’t be repaired or what’s called rotator cuff arthropathy, which is an arthritic problem of the shoulder that occurs due to a large rotator cuff tear and that’s called a reverse shoulder replacement or reverse shoulder arthroplasty. Just like the name, it involves reversing the ball and socket of the joint in the shoulder, so there’s a metal stem placed inside the arm bone that actually has a socket attached to it where the ball of the shoulder used to be and on top of the shoulder socket, there’s a metal ball placed and it’s held in place with a post and some screws. That is a more constrained design, meaning there’s more stability built into those components; the socket is a little deeper, the ball is a little different shape and that in combination with having good muscles on the outside of the shoulder, and the deltoid in particular, which is the large muscle that wraps around the whole shoulder, as long as that muscle is intact and you have the deeper socket, you can have a well functioning shoulder with very little or no pain, even if you don’t have any rotator cuff muscles. And that has really been a huge advancement. There’s been a misconception in Berks County that to get these kinds of procedure performed you had to travel outside of the area, and I think now that isn’t the case. I’ve been doing these types of shoulder procedures for many years.


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