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IC 205-2022: Shoulder Arthritis In Young Active Pa ...
Shoulder Arthritis In Young Active Patients - What ...
Shoulder Arthritis In Young Active Patients - What Are The Best Options? (3/5)
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Video Transcription
This is ICL 205. For those of you that were, I'm not sure which room you're in, and we're going to be talking about shoulder arthritis in young, active patients, what are the best options available? We were honored to give this ICL last year, and they invited us to come back and give this again this year. We have some specific learning objectives for all of you in the room. We really want to understand imaging and how that helps us make the decision. We want to understand what's available in the non-arthroplasty world. Today, in 2022, it keeps changing on a regular basis, and it gets more and more challenging because a lot of these things may make sense, but we're doing these cases in an outpatient environment, and if you're in an ambulatory surgery center, you can't afford to do them. So they're being done in a hospital outpatient environment where people have to figure out ways to carve out contracts to be able to get these covered with these new ideas and technology. We want to understand what we need to do if we're doing more soft tissue combined with arthroplasty, and of course, when it comes to that point of doing an arthroplasty, what's the best options available, and then what complications or problems we need to think about. We have a good group of speakers here that all deal with this problem on a daily basis in their clinical practices, and so that really helps us in terms of trying to put together some better understanding of how to manage this. We're going to start out with Brandon Erickson, who's practicing in New York. He's part of the Rothman Institute in New York and works primarily in the suburbs north of Manhattan. Brandon is not able to be with us this morning. He has an important personal event. This evening he had to take the red eye home last night, but he did put together a video of his presentation, and we'll hear that, and we can respond to that as we go along. And Brandon has been dealing with these cases. I was with Brandon for a while, and he basically assumed my practice and so has a lot of these patients, and we can share a lot of ideas on that. In terms of biologic options, we have an outstanding opportunity to hear from Matt Preventer, who's been on the cutting edge of this for a long time. Yesterday, he received an award for his work with the use of allografts, both in terms of not just his clinical practice, but in terms of the innovation. As you all know, he started the whole idea with the distal tibial allograft, and that's expanded to a lot of different areas. And also, I'm very proud of Matt. I was at his formal retirement from the Navy. This was on the Midway ship, and this was just in the month of June. It was really a great ceremony, and it's impressive all the things Matt's done outside of just being an orthopedic surgeon in terms of helping the people of this country. So we're really proud to have Matt here as part of this group, and he, too, has to deal with these younger patients. Imagine all these military guys that have arthritis, and they don't want to have a shoulder replacement. What else can you do? And then Sam Taylor's from Hospital for Special Surgery, and Sam's, as you know, the team physician for the New York Giants. He has to deal with a lot of this arthritis issue, too, and it gets to the point where you say, there's just nothing else I can do. You need an arthroplasty. So what's the best arthroplasty options available for these younger patients? You'll see Sam's a pretty good-sized guy, but next to New York Giants people, it's not quite the same size. Nate Soldier, I know, I met him, my daughter went to Colorado University, and she was a trainer there, and she told me she had to stand on the table just to get up to about the middle of his calf so she could do his hamstring stretches. So I think he's like 6'10", 300-and-something pounds, so he makes everybody look small. And then Sam was a tight end and played football at Harvard University in his younger days, so he's done a lot of research in this area. It would be helpful to give us some good insight. And I'm currently the executive vice president of Musculoskeletal Institute. A lot of my administrative work is on trying to create a value-based care integrated model, but I still have a full practice in shoulder and elbow and sports medicine, and I've been very proud to be president of the Shoulder and Elbow Society, and now 10 years the chief medical editor for orthopedics today. So it gives me some valuable insight in caring for these patients, and we've done our best to try to publicize that when we can. There's a nice paper from Brian Saltzman in the Carolinas talking about this, and it's really remarkable when you think about one out of four adults will have an arthritic joint somewhere, and in that one out of 10, their shoulders will be arthritic. Doesn't necessarily mean it needs treatment, but it is a problem that we see regularly in our practice. And we've recognized now with some of the increasing technology, particularly the reverse and these complex cases we deal with, the number of shoulder arthroplasties has increased dramatically, and we're just hitting about 200,000 per year in the United States. And it's really kind of forced us to pay close attention to all the details to try to get better and better. It's not just about alleviating pain, it's about improving function and giving people back their lives now into their 90s and beyond that. We have to keep in mind for this younger group, it's not the same as osteoarthritis. So when you hear talks about osteoarthritis and shoulder replacements, and a lot of times they look really rosy and wonderful, and that's true. Osteoarthritis is a really nice disease to have to treat. But under the age of 50, a lot of other problems present, especially problems related to the surgeries that we do to try to help our younger players, younger athletes, younger people stay active, such as capsulorathy arthropathy, where we tighten down an unstable shoulder, but it leads to consequences that make it challenging in terms of the shoulder arthroplasty world. And this is the kind of thing you can see, you know, at 40 or 50 years old they have, their joint is destroyed, you don't know what the subscapularis status is, and it's not just straightforward osteoarthritis. So our younger patients challenge us every day in terms of figuring that out. And fortunately, there's been a number of recent advantages in shoulder arthroplasty that have really helped us, both on the anatomic and reverse side. We don't normally think about reverse shoulder arthroplasty in this younger patient group, but there are some patients where that's the only choice available. Last year my youngest patient was 30 years old, that I did a reverse shoulder arthroplasty in, and it was not a tumor, it was someone who had post-traumatic arthritis, and had other surgeries, there was nothing else that could be done, had no cuff, his shoulder joint was destroyed, and I won't do a fusion. And doing a reverse on him changed his life, the best he's felt in 10 years. So we sometimes even have to go to that level for treating these young patients. A couple of other points, just to keep in mind, we won't cover, but you're welcome to ask questions if you're interested, is that there's no doubt the government, the payers, and the hospitals, everybody's forcing these cases into the outpatient environment. They're readily going to the hospital outpatient environment, and when Medicare changes the rules with regards to shoulder arthroplasty, so that it can be done in ASC, they'll move to that environment too, if we can align the revenue cycle management. Right now, if you do a shoulder replacement in an ambulatory surgery center, you will lose money, if it's a Medicare patient. You cannot make money off it, there's just not enough reimbursement. So even if Medicare changes, we're not going to be doing them in the ASC, so there's going to have to be some realignment of revenue cycle, but that's another big thing that's changing the way we think about caring for these patients. And so when we get to all of this in 2022, when we're doing shoulder replacements, you know, we want to do preoperative planning, we'd like to do capsule releases to get good range of motion. We think about less and less metal, so stemless, and maybe nothing on the glenoid side in some of these patients, Sam will tell us about that. If we do, we do polyglenoids with plus, minus, some metal kind of sleeves or implants to help. We do subscapularis repair to make sure that that works out well, and we do it as an outpatient. This is a lady who's had bilateral total shoulder replacements, she's a yoga instructor. The arm that she showed that went up to about 175 degrees is her side that was operated on two years ago, and she just had her left side done a couple of months ago and is doing very well. This is her x-rays, and so these people demand from us a better outcome than just giving me pain relief, and she's back as a yoga instructor and helping people out. So it's just really great that we have these options available. So here we go, and we're going to start with Dr. Erickson's video on arthroscopic management. Are there any questions as we get going with this? Any questions to start out with? Okay, great.
Video Summary
The video is a presentation on shoulder arthritis in young, active patients and the available treatment options. The speaker discusses the importance of imaging in decision-making and explains the challenges of performing these surgeries in outpatient environments. The presentation features experts in the field, including Dr. Brandon Erickson, who couldn't attend in person but provided a pre-recorded video. Another speaker, Dr. Matt Preventer, is recognized for his work with allografts. Dr. Sam Taylor, the team physician for the New York Giants, discusses the best arthroplasty options for younger patients. The speaker emphasizes the need for individualized treatment plans and how advancements in shoulder arthroplasty have improved outcomes. The video also mentions the changing landscape of healthcare and the impact on reimbursement for these procedures. A case study is presented to showcase the success of shoulder replacement in improving patient's quality of life. The presentation concludes with Dr. Erickson's video on arthroscopic management.
Asset Caption
Anthony Romeo, MD
Keywords
shoulder arthritis
treatment options
imaging
outpatient surgeries
arthroplasty options
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