While shoulder replacement surgery was created to help patients with arthritis decrease their pain, it’s not without its own problems. It can leave patients in pain and with limited mobility after surgery and rehabilitation can take six to nine months.
It was because of these issues that Dr. Michael Greiwe, an orthopedic surgeon with Commonwealth Orthopaedic Centers, which practices at St. Elizabeth Healthcare, decided to look into finding another way.
“I got interested in orthopedic surgery probably during my childhood,” says Greiwe. “I played sports all the way through college and I felt like the way that bones and joints move was really intriguing and interesting to me.”
Because of the long recovery patients face after having the procedure, he began looking into alternative ways a couple years ago.
“I had been thinking about how to improve shoulder surgery in a way, especially regarding total shoulder replacement. Shoulder replacement is still, it’s a great procedure, it helps people with pain quite a lot but there’s a lot of recovery that’s involved because of taking down the rotator cuff,” says Greiwe. “And so for the last several years I’ve been trying to work on a way where we could improve the surgery by not taking down the rotator cuff.”
This new technique, called the Rotator Cuff Sparing Method for Total Shoulder Replacement, decreases both patient pain and rehabilitation time.
“In a standard shoulder replacement, in order to get in to do the work that we need to do on the arthritis inside the shoulder joint, we have to open the front door to the shoulder, which is the rotator cuff. We actually have to take the rotator cuff off and then reattach it at the end of the procedure once we’re done replacing the joint,” he says. “But in my procedure, what we do is we actually open the rotator cuff like curtains in a window. We actually never cut it, we just sort of separate the fibers and we peer inside the joint to do the work we need to do and then we just bring the curtains back together at the end of the procedure, so there’s not the down time and the recovery that’s needed for the rotator cuff repair. And that I think is what slows down patients’ progress a lot from the beginning.”
The procedure was first performed in September 2016 and has been used six times since. The first six operations were inpatient while the seventh was outpatient. Griewe is already seeing a difference in these patients from the roughly 200 patients he sees each year for shoulder replacements.
“The first patient I had told me he had no pain after surgery and he lifted his arm up to about 90 degrees on the first day after surgery. That was quite astounding. My second patient had a [previous] shoulder replacement on the left side that I did four years ago and he told me that he was able to stop pain medicine within the first week. On the first day after surgery when I visited him he told me that his pain was really low,” says Greiwe.
Greiwe says the procedure is still in its beginning stages, but he’s already seen interest from other surgeons.
“Every time I show a doctor this procedure, they get really excited about it,” he says. “I think that in the next three to five years this is something that’s going to be used more frequently.”
While Greiwe is proud to have created the procedure, he says the most important aspect is that it’s helping patients get back to their lives more quickly and with less pain. He calls it a “game changer” for both surgeons and patients.
“We’ve found the pain experience for the patients has been a lot better. I think that that’s a big benefit of not having to take the rotator cuff off,” he says. “Several patients at two months have had near full mobility and many of my patients have gone back to their job ... by about six weeks, so that’s ahead of schedule.”