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Modern Shoulder Replacement: Who Needs It and How It Helps · Flourish- A Prisma Health Podcast

• 0:00
  Scott Webb (Host): Shoulder pain is so common.
• 0:01
  And today, we're speaking with orthopedic surgeon, Dr.
• 0:03
  Christopher Mazoue from Prisma Health about modern shoulder replacement--
• 0:07
  who needs it and how it helps.
• 0:16
  This is Flourish, the podcast brought to you by Prisma Health.
• 0:19
  I'm Scott Webb.
• 0:20
  Doctor, it's nice to have you here today.
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  We're going to talk about modern shoulder replacement.
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  Like, what does that mean?
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  Maybe comparing what you're doing today versus some of the old
• 0:27
  school stuff, but essentially like who needs shoulder replacement?
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  How can it help them?
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  And I guess maybe that's the obvious place to start, Doctor.
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  It's just like, how do you know if you need shoulder replacement?
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  Do we just know it ourselves?
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  Do we talk to experts like yourself?
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  Take us through that.
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  Dr. Christopher Mazoue:
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  Obviously, shoulder pain is extremely common.
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  There are lots and lots of reasons for people who have shoulder pain.
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  But two of the more common reasons that people have shoulder pain are
• 0:53
  arthritis in their shoulder and/or rotator cuff tears in their shoulder.
• 0:59
  And, obviously, when you meet your physician and as you go through
• 1:03
  the history and the physical exam, and typically x-rays
• 1:07
  and maybe an MRI or CT scan.
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  Then, your physician can determine what they believe is
• 1:13
  the primary source of your pain.
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  And if they believe that the primary source of your pain is arthritis
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  and, in some situations, a rotator cuff tear, there are lots of
• 1:26
  options for non-operative treatment.
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  But one of the options for surgical treatment these days is a shoulder
• 1:32
  replacement, and there are different variations of a shoulder replacement
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  that we have these days available to us.
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  But again, the reason for choosing a shoulder replacement is basically
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  your diagnosis and typically failure of non-operative treatment.
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  Host: Yeah.
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  And I certainly have somebody, probably like millions and millions of Americans
• 1:51
  who suffers from osteoarthritis, "My shoulder's a little sore."
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  You know, you go to shampoo your hair and you're like, "Yeah, maybe I
• 1:57
  should talk to somebody about this."
• 1:59
  And I think, Doctor, it just feels me that this is anecdotal at best, but it just
• 2:02
  feels like a lot of us, unless it's an acute injury, we tend to put these things
• 2:06
  off for as long as we possibly can, right?
• 2:09
  Pain, stiffness, whatever it is.
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  So, you know, how long before we should act and take action and speak with
• 2:15
  our provider and get those referrals.
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  Dr. Christopher Mazoue:
• 2:18
  What typically happens, and we'll kind of focus on arthritis
• 2:21
  maybe, that's the common reason for people to see a physician.
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  A lot of people have night pain.
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  That's one of the biggest things that we see with our patients.
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  And so if you are having a lot of night pain, if you're really having
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  difficulty sleeping, which we hear a lot of patients complain about their
• 2:38
  inability to sleep when they have arthritis in their shoulder, or certainly
• 2:41
  just daily activities, especially if it's affecting your work and your
• 2:45
  activities that you enjoy, don't hold off.
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  Like I mentioned, there are non-operative treatments out there.
• 2:52
  That can be very, very effective, things like physical therapy, medications,
• 2:57
  injections, activity modification.
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  There are a lot of things that we do on a regular basis for non-operative treatment.
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  And, of course, again, if those things don't work, there are surgical options.
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  Host: Yeah.
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  It's like when you take your car into the shop, they don't just replace
• 3:10
  the engine immediately, like they try some other stuff first, right?
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  Diagnostics and, as you say, physical therapy, injections.
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  So, think though, Doctor, about the actual shoulder replacement
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  and, like, who's a good candidate?
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  Paint a picture for us, if you would.
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  Just like who typically gets a shoulder replacement?
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  Dr. Christopher Mazoue:
• 3:27
  Yeah.
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  So, like knee arthritis and like hip arthritis, the typical patient
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  for us is a patient in there late 50s, 60s, 70s, someone who has been
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  diagnosed with arthritis, someone has gone through a fairly extensive
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  amount of non-operative treatments.
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  And so, a typical patient would be a 65-year old either man or woman.
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  We see it in both males and females at a high rate who is diagnosed with
• 3:56
  arthritis via an x-ray and possibly MRI or CAT scan and, again, who's
• 4:01
  had non-operative treatment and just continues to have pain in their shoulder.
• 4:05
  Host: Yeah.
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  And it's probably affecting their quality of life, whether it's
• 4:08
  picking up the grandkids or playing pickleball or whatever it might be.
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  I want to ask you-- like, I was reading about in preparing for this-- the
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  difference between a shoulder replacement and a reverse shoulder replacement.
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  What's the difference?
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  Dr. Christopher Mazoue:
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  So, there are two different types of shoulder replacements we do.
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  One is what we refer to as an anatomic total shoulder replacement, or some
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  people will just refer to it these days as the total shoulder replacement, and
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  then a reverse shoulder replacement.
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  And so, if you think about a shoulder, a typical shoulder,
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  it's a ball-and-socket joint.
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  And so, an anatomic total shoulder replacement is when we replace
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  your ball with a metal ball and your socket with a plastic socket.
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  The reverse shoulder replacement reverses that.
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  So, it actually replaces the socket with a metal ball, and it replaces the
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  ball with a metal and plastic socket.
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  And so, it reverses the nature of the components, the ball and socket,
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  and there are different reasons why we choose one versus the other.
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  Host: So then, Doctor, when would somebody need a reverse shoulder replacement?
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  You've given us a sense there of the difference between the two.
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  So, when would that be necessary or be recommended?
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  Dr. Christopher Mazoue:
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  Yeah.
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  So, I would say that a reverse shoulder replacement has absolutely
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  revolutionized shoulder surgery.
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  And so, the patients who need or benefit from a reverse shoulder
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  replacement are those that don't have a functioning rotator cuff.
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  And so, traditionally, it was developed for patients who have arthritis, but
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  don't have a functioning rotator cuff.
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  We have expanded the indications for that surgery wherein some
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  patients, even if they don't have a tremendous amount of arthritis,
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  they may actually be a candidate for reverse shoulder replacement.
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  Also, patients that have some deformities of their glenoid or
• 6:02
  their socket, that's a reason to do a reverse shoulder replacement.
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  And so, if a patient just has arthritis in their shoulder and they have a good
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  functioning rotator cuff and they have a good socket, meaning not a lot of
• 6:17
  bone deficiency in their socket, we will certainly oftentimes recommend that
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  anatomic total shoulder replacement.
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  But if the rotator cuff isn't working or if there's bone deformities or
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  in revision cases, we will typically recommend a reverse shoulder replacement.
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  Host: So then, Doctor, just kind of broadly speaking, shoulder
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  replacements, if you will, is there a standard recovery time?
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  Is it one to three months?
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  Is it a case by case basis, you know, individualized to the patient?
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  Like, give us a sense, regardless of which one we choose or is recommended,
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  how long it's going to take us to get back to doing the stuff we love.
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  Dr. Christopher Mazoue:
• 6:57
  Yeah.
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  So, shoulder replacements are pretty amazing.
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  Most of my patients and most patients across the world will tell you that
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  their pain is actually markedly improved within the first week.
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  And that's pretty amazing.
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  I have had patients that will tell you that they leave the hospital, and the next
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  day they felt better than they felt in decades with regards to their shoulder.
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  And so, from a pain relief standpoint, that pain relief
• 7:21
  typically comes very quickly.
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  Function is obviously different.
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  So, we have to allow the tissues to heal.
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  We have to allow the implants to grow into themselves with regards to bone
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  growth for fixation of the implants.
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  And so, we usually will have patients in a sling for anywhere to three to six weeks.
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  And then, obviously, go through a rehab process, either a home rehab
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  process or with a physical therapist.
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  By six weeks, they're typically able to do a lot of things around the house--
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  eat, drink, cook, laundry, dishes, you know, basic functions around the house.
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  By three months, they're able to do most everything they need to do.
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  Oftentimes we'll tell patients it takes six months to a year
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  for a full recovery process.
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  But honestly, by three months, they're doing pretty well.
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  Host: Yeah, it's pretty amazing.
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  We've sort of framed this, we got started here, the modern shoulder replacement.
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  And so, definitely different just in the few years that I've been hosting
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  these, how far things have come.
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  And I want to get a sense from you, Doctor, is there anything
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  we can do to speed up recovery?
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  Obviously, it would be probably to go for that physical therapy to do
• 8:24
  our part right at home or wherever.
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  But give us a sense, like anything we can do to move that timeline up a little bit?
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  Dr. Christopher Mazoue:
• 8:30
  Yeah.
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  So, the first thing you need to do is obviously get with your physician and
• 8:34
  find out what your reason for your shoulder pain is, and to determine if
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  there are options for non-operative versus operative treatment.
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  If it is decided that you're appropriate for surgery, then good
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  nutrition, eating a good healthy diet.
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  Sometimes we will recommend physical therapy prior to surgery, just to
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  build up the range of motion, strength prior to surgery, and making sure you
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  have all your clearances from your doctors from a health standpoint.
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  It's also pretty amazing, a lot of these surgeries nowadays can be done outpatient.
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  You can go home the same day.
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  And so, just making sure you're in as good as health as we can be to
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  ensure that we get a good outcome and avoid any negative events.
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  Host: Yeah.
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  And, Doctor, I've done podcasts on frozen shoulder.
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  We're not framing this today specifically about frozen shoulder, but it just
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  makes me wonder when we think through the lens of shoulder replacements,
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  is frozen shoulder something that can happen to folks after surgery?
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  Dr. Christopher Mazoue:
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  So, frozen shoulder is a condition where patients lose range of motion.
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  And there is no doubt that when we do shoulder replacements, some
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  patients will certainly not get their full range of motion back.
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  That typically has more to do with what the patient's range of motion is going
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  into the surgery than the surgery itself.
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  And so, that goes into, again, what you were talking about before, is
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  that what we want our patients to be as active prior to surgery and using
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  their arms and moving their shoulders.
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  So, we definitely have patients that don't get their full motion back.
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  And some patients will refer to that as a frozen shoulder, but
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  it's not a true frozen shoulder.
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  What it is is just probably a lack of range of motion going into
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  the surgery more than anything.
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  Host: Yeah, I see what you mean.
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  If you're dealing with somebody who was really active, You know, almost
• 10:18
  right up until the surgery, versus somebody who hasn't really used their
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  shoulder in years, you can see how one might be, you know, a little
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  more successful than the other.
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  And it does make me naturally wonder, Doctor, when we think about playing
• 10:29
  sports after shoulder replacement surgery, like, is everyone going to get back
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  to doing everything that they love or is it going to be some in moderation?
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  You know, like give us a sense what can we look forward to, hopefully, again,
• 10:41
  whether it's pickleball, golf, whatever it is when we think about sports.
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  Dr. Christopher Mazoue:
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  Yeah.
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  The shoulder replacement has developed to a point where we want
• 10:50
  and expect our patients to get back to high levels of activity.
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  We can get patients back.
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  I did a shoulder replacement on a South Carolina state
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  trooper who does triathlons.
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  And so, we want patients to be active.
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  We need patients to be active.
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  We want them to get back to the things they love, such as
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  tennis and pickleball and golf.
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  And so, those things are available.
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  The only caveats are, you know, obviously, it is a shoulder replacement.
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  And so, some of the things we recommend are for those people that lift weights,
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  maybe not lifting heavy, heavy weights.
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  And just be aware of activities that can create like major injuries like skiing
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  and snowboarding and things like that.
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  It doesn't mean you can't get back to doing those things
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  after shoulder replacement.
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  We certainly expect that you can get back to skiing and
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  snowboarding and other things.
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  You just got to be a little careful.
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  Host: Yeah.
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  Careful moderation, whatever the right word is.
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  And yeah, wondering, Doctor, if you can put a percentage number, if I ask you
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  what percentage of shoulder replacement surgeries are successful, do you
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  have that number at your fingertips?
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  Is it 90%, 95%?
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  Give us a sense of, you know, how successful these procedures are.
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  Dr. Christopher Mazoue:
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  Yeah, I tell patients that the success rate of this surgery is typically 90%
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  to 95% with regard to pain relief.
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  Function's a little bit difficult to assess because everyone, again,
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  comes into the surgery with a different level of function.
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  But I would say from a pain relief standpoint, I think 90-95% of patients
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  overall get pain relief and are better off than what they were prior to surgery.
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  Host: And, you know, some of the things I talk to doctors about, surgeons about,
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  Doctor, there is this sense that if you have it earlier in life, you're
• 12:24
  probably going to have to come back in for a little-- I'll use air quotes--
• 12:27
  "a little bit of a tuneup," right?
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  Just trying to get a sense from you, you know, is this a one-time thing?
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  If I have a shoulder replacement or the reverse shoulder replacement,
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  am I going to need to come back in 10 years, 20 years?
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  Like, what's your expectations?
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  Dr. Christopher Mazoue:
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  The goal is for it to last a lifetime.
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  I mean, that's the goal for our shoulder replacements.
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  And, again, shoulder replacements, because it's not a joint that you walk on like a
• 12:49
  hip or knee, has different stresses on it.
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  And so, we expect our shoulder replacements to last longer.
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  Obviously, a lot of that depends on how old you are when you get it.
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  But the intention is for it to last your lifetime.
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  Host: Yeah.
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  I'm in my late 50s, Doctor, so I feel like if I can put this off to
• 13:07
  like my mid-60s, I should be good.
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  It should be good.
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  Get me in the finish line, right?
• 13:12
  Dr. Christopher Mazoue:
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  Yeah, there is certainly a concern if you start to get into patients
• 13:16
  in their 30s, 40s, early 50s, that it may not last as long as we want.
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  And anytime we have to revise a shoulder replacement, there's
• 13:24
  some complexity there that makes it a lot little more challenging.
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  But again, for most of them, we hope that they would last to the patient's lifetime.
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  Host: Well, it's been great having you on.
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  Just give you a chance here at the end.
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  Final thoughts, takeaways, maybe it's encouraging folks to, you know, to
• 13:38
  speak up and talk to their providers and deal with some of these nagging
• 13:42
  things that have been slowing them down over the years, whatever it is.
• 13:45
  Dr. Christopher Mazoue:
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  if you're having shoulder pain, don't let it linger.
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  Go see your primary care doctor.
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  Go see your orthopedic surgeon, and just get a sense of what's going on.
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  It doesn't mean that you have to have any major treatment or it certainly
• 13:57
  doesn't mean that a surgery is impending.
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  But the sooner that you can get a diagnosis, the better.
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  And then, obviously, you can work with your physician and other healthcare
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  providers as far as getting your shoulder that you can live a happy life with.
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  Host: Right.
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  As you gave us a sense, a little bit of a roadmap, like there's
• 14:13
  things we can do beforehand.
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  You talk this through with patients and you find out, like, what are their goals,
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  expectations, level of pain, you know, and work their way maybe up to surgery.
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  So, appreciate your time, your expertise today.
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  Thanks so much.
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  Dr. Christopher Mazoue:
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  Thank you very much.
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  Have a great day.
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  Host: For more information and other podcasts just like this one, head on
• 14:30
  over to prismahealth.org/flourish.
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  This has been Flourish, a podcast brought to you by Prisma Health.
• 14:35
  I'm Scott Webb.
• 14:36
  Stay well.