MedStar Georgetown is the area’s first and most experienced with this procedure.
Each year, approximately 53,000 Americans undergo a total or partial shoulder replacement, greatly reducing or eliminating pain and restoring mobility and quality of life.
However, many others are ineligible for traditional replacement due to loss of rotator cuff function or major bone loss from severe arthritis. For them, Brent Wiesel, MD, chief of Shoulder and Elbow Surgery at the MedStar Orthopaedic Institute, offers help and hope through another approach—the reverse total shoulder replacement or its even rarer alternative, a customized reverse replacement.
“Reverse total shoulder replacement has been a game changer,” says Dr. Wiesel, one of the first orthopedic surgeons in the Washington, D.C., area to perform the procedure in 2008, who now uses it routinely. “It’s greatly expanded our ability to help more people with incapacitating shoulder pain or immobility.”
A traditional shoulder replacement is similar to a hip replacement in that both the ball and socket are removed and then replaced by a metal ball and plastic socket. A reverse shoulder replacement changes the position of the ball and socket joint so that patients can use a different set of healthy muscles to move their arm, instead of their damaged rotator cuff muscles.
Karen Wright, RN, a longtime employee at the Surgery Center at MedStar Georgetown University Hospital, had seen, firsthand, the benefits of Dr. Wiesel’s work. Terrible weakness and pain in her shoulder left her unable to lift her arm, and an X-ray and MRI confirmed the extent of the damage but also revealed something unexpected.
“Karen had a serious, and potentially catastrophic, compression of her spinal cord in her neck,” explains Dr. Wiesel. “Shoulder replacement would have to wait until after my colleague, S. Babak Kalantar, MD, chief of Spine Surgery at MedStar Georgetown, successfully decompressed and stabilized three cervical discs.”
Karen had developed spinal stenosis and instability in her cervical spine, which were causing pressure on the spinal cord and nerves going down her arms. To correct those issues and help protect her cervical spinal cord, Dr. Kalantar performed what is referred to as a C4–7 anterior cervical discectomy and fusion.
Luckily, with a multidisciplinary approach, the team was able to recognize these issues, which would have complicated her shoulder surgery had they not been addressed prior to it. After Karen’s cervical spine was stabilized, she was cleared for reverse total shoulder replacement about six months later.
By 2019, Karen was finally ready for the surgery she originally sought. However, the passage of time and her progressing arthritis had taken their toll.
“At this point, Karen didn’t have enough good bone left for a standard reverse shoulder replacement,” says Dr. Wiesel. “She needed a specially made implant that could wrap around her remaining shoulder blade and provide an anchor for the hardware.”
Working with engineers at a leading medical device manufacturer, Dr. Wiesel sent a CT scan of Karen’s shoulder to create parts uniquely designed for her anatomy. A pioneer in orthopedic surgeries, he was the first surgeon in the area to use customized reverse shoulder components and now performs four or five of the complex procedures each year. He installed her new tailor-made joint in September of 2019.
“My shoulder surgery was actually easy to recover from,” Karen says. “And if I didn’t have my surgeries, I probably wouldn’t be working. The surgeries have enabled me to continue to do what I enjoy while also being pain free. I have no limitations whatsoever. Dr. Wiesel, and the rest of the Orthopaedics team, are just amazing.”
MedStar Georgetown is part of the MedStar Orthopaedic Institute, with over 40 orthopaedic surgeons at locations throughout Washington, D.C., Maryland, and Virginia.
If you believe you or a loved one may need reverse total shoulder replacement surgery, visit MedStarGeorgetown.org/ReverseShoulder or call 202-295-0549.