Moving Closer to the Holy Grail in Shoulder Replacement

The shoulder’s unique ball-and-socket joint offers the greatest range of motion in the entire human body. Preserving as much function and longevity as possible is the holy grail of shoulder replacement surgery—and a recent advance is making it possible.

Shawn Solhpour, MD, a Harvard-trained orthopedic surgeon and a leader in elevating outcomes for shoulder injuries and conditions, discusses patient specific CT-guided surgery and how it is creating a whole new level of accuracy and precision.

What is patient-specific CT-guided surgery?

A sophisticated planning software uses CT scans to create a detailed 3D model of the patient’s shoulder joint, allowing me to plan every detail of optimal positioning and anchoring—down to the length of the screws— before I walk into the operating room.

During surgery, views of the area are often limited by muscle and tissue. Yet with this technology I can study the joint from any angle, better understand the degree of erosion or wear, determine ideal access points and develop a much more accurate surgical plan.

The simulation software allows me to change the angle, version and depth of an implant, while making important functional assessments. For instance, I can move the prosthesis one degree over and see its impact on rotation, or test whether reducing the size of the prosthesis would allow me to preserve more bone and increase stability.

Having these answers before beginning surgery is a game changer in creating the best possible outcome for the patient.

Why is this such an important advance?

In shoulder replacement, millimeters matter, as outcomes completely depend on correct anatomical placement. Being off by just two millimeters can reduce rotation by 20%, increase the likelihood of complications such as impingement, and shorten the implant’s longevity.

Yet studies show that positioning errors are common. Almost 90% of shoulder replacements are done by surgeons who perform fewer than 10 a year. Even among surgeons who perform seven to eight times that number—a group offering the highest outcomes—the malposition rate is estimated at nearly one-third.

CT modeling allows us to change that by making it far easier to plan and execute the ideal anatomic placement. This technology radically moves us closer to absolute accuracy.

Who is a typical shoulder replacement patient?

Twenty years ago, the vast majority of shoulder replacement surgeries were performed on those in their 70s and 80s. A patient in their 40s would have been almost unheard of, yet today I routinely see and successfully treat patients that young.

Because of improvements in outcomes as well as an unwillingness to tolerate a loss of function, younger active patients, including weekend warriors and recreational athletes, are choosing shoulder replacement to regain pain-free motion and a good night’s sleep.

Is it an outpatient procedure?

Yes, over 95% of my shoulder replacement patients arrive in the morning and are back home that afternoon. Outcomes and patient satisfaction are both higher when patients recover at home and sleep in their own bed.

Recognized as one of Southern California’s top orthopedic surgeons, Dr. Solhpour is fellowship-trained in biological joint reconstruction, total joint replacement, and sports medicine. He specializes in treating knee and shoulder pain, bringing innovation and excellence to procedures from cartilage restoration to tendon and ligament reconstruction.

To make an appointment, please call 714-626-8630.