Patient Specific Planning in Shoulder Surgery

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    Dr. Dillon Arango

    There are many different types of surgeries available to patients with shoulder pain. In this article, I would like to focus on shoulder replacement surgery for patients with shoulder arthritis. Shoulder replacement involves removing the damaged cartilage and bone in the shoulder and replacing it with artificial components.

    Thanks in part to technological advances in medicine as well as the innovation of master surgeons, patients with shoulder arthritis can expect significantly improved pain relief and shoulder motion after shoulder replacement surgery.  As a result of these positive outcomes, the popularity of shoulder arthroplasty has significantly increased over the last decade.  More and more patients are receiving shoulder replacement surgery, and with an aging population, we expect this number will continue to increase.  Though this surgery is performed only by highly trained orthopedic surgery specialists, certain portions of the procedure can still remain challenging.  This is especially true in patients with significant arthritis and deformity in the shoulder.  In these cases, modern computer technology can help surgeons plan for a successful operation, further improving patient outcomes. The best part is that we are now able to virtually plan the surgery on our computers, even before the actual surgery occurs.

    An example of how we use computers to help us during surgery is in the positioning of our implants.  If we think of the shoulder like a ball-and-socket joint, one of the more difficult portions of the procedure is figuring out in exactly what position to place the new socket for the shoulder. It is important to remember that everyone’s shoulder is unique and no two shoulders will have the same exact pattern of arthritis. With new computer technology, we are now able to take a CAT scan of the patient’s shoulder and obtain a 3D computer model of the patient’s bone.  By sending this to a company that provides us with shoulder implants, we can actually 3D print a hand-held model of a specific patient’s shoulder.  More importantly, we can 3D print a patient specific guide which can then be used during the actual surgery to help us with the positioning of the patient’s new socket.  This can be extremely helpful, especially in cases with advanced shoulder arthritis.

    In addition to helping with the planning of our socket placement, preoperative planning can also help us in a number of other ways. These include but are not limited to; knowing what size implants we will use during surgery, the amount of bone spurs that may need to be removed, whether or not we may need to order special implants, and even helping us estimate what range of motion we might expect for the patient after surgery. The application of virtual surgery in the shoulder continues to evolve and in the near future we may even begin to use 3D goggles to see projections of a patient’s anatomy during the actual surgery.


    In conclusion, when performed for the right patient, shoulder replacement surgery can be a positive life changing procedure for patients with chronic shoulder pain.  Thanks to new technology, surgeons can now perform these surgeries more comfortably and more precisely.  The future is bright for shoulder replacement surgery and surgeons and patients alike have good reason to be excited for what the future holds.

    Dr. Dillon Arango is an Orthopedic Surgeon with Palmetto General Hospital.


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