Michael Greiwe, M.D., orthopedic surgeon, OrthoCincy
—As told to Kevin Schultz
The procedure we traditionally do for a shoulder replacement is from the front of the shoulder. In order to get in from the front we have to take down the rotator cuff, then do the replacement and close the rotator cuff back up. We have to heal basically two operations: the replacement and the rotator cuff repair.
I’ve always felt like maybe there was a better way to do things. I thought I might be able to do something through the back of the shoulder that helps to spare the rotator cuff.
I started working on several different approaches about four years ago to try to see which one would work the best. I settled on this posterior approach where we split the muscles of the rotator cuff—kind of like opening curtains—rather than taking them off completely. We basically just peel away and open the curtains to see what’s going on, do the work we need to do, and then close the curtains.
We’ve completed the procedure about 40 times now. What we’ve found are some very encouraging results in terms of people being able to be out of their sling immediately and being able to move the arm early on. We have had some patients with weakness early, which I attribute to the way I was doing the procedure. So we’ve made some small adjustments and are improving. Unfortunately I don’t have any firm data yet because we are still in the process of collecting that, but we are seeing that people are improving and making good progress.
The recovery protocol for someone who has a regular total shoulder replacement from the front is a sling for six weeks. Then we start to work on range of motion and they start to strengthen at 10 weeks. We allow them to progress from there. With the new procedure, we let patients out of the sling immediately and they can start moving their arm right away.
Patients are coming from all over for the surgery. I had one man come all the way from California recently. He was in the San Francisco Bay area and had heard about it. He did great and stayed here for a week in a hotel and went back home.
The long-term goal is to really change the way we do shoulder surgery for the better.