In February, E. Scott Paxton, MD, an orthopedic surgeon at East Providence, R.I.-based University Orthopedics, became the first surgeon in the state to perform a partial shoulder replacement using Stryker’s Tornier pyrocarbon humeral head.
The pyrocarbon material offers several advantages for patients, including durability, which allows younger patients to undergo more invasive shoulder replacement procedures.
Dr. Paxton spoke with Becker’s about bringing the new procedure to Rhode Island and how he hopes it will benefit patients.
Question: How will this new procedure benefit your patients?
Dr. E. Scott Paxton: So this is a new procedure, not really a new procedure but a new surface that we’re using to replace the ball part of the ball and socket joint. For many years, we’ve had joint replacement surgeries and shoulder replacement surgeries, but to date they have been done with metal in the shoulder. At the current time, the gold standard for shoulder replacement is replacing the ball and socket with metal and plastic, similar to knee or hip replacements. But in the shoulder, we have a problem with loosening of the socket component over time. Because the shoulder has so much motion, it relies a lot on soft tissue and has a lot of different ways that the ball and socket move together.
More stress can get put on that socket piece and so it can loosen. We have studies showing at 15 years we have considerable amounts of loosening seen on X-rays. This procedure, while the actual technology, incision and instruments are similar to previous shoulder replacements, the material we are using is different. We are just replacing the ball with pyrocarbon and the socket we are leaving alone or preparing it to accept the new ball. There are benefits to patients, including immediate benefits and later benefits. The most immediate benefit is pain relief, which is a benefit of all joint replacements.
So it’s doing that very well, and patients have been very happy, but another benefit that’s hard for patients to fully appreciate is going forward, they won’t have need for a revision surgery because they don’t have the plastic component that needs to be redone. With that being said, types of patients we can do it on include younger and more active patients. We don’t have to be as worried about what activities they do afterward that could loosen that plastic fragment. Patients that are in their 20s, patients that are very active or just a heavy laborer for their jobs, we worry about the plastic piece loosening but now we can feel better about letting them do whatever they want.
Q: Did you face any challenges debuting the procedure in your state?
ESP: Some of the best studies we have are out of Australia showing very good longer term outcomes. In addition, it has been used in other parts of the body including the hand and heart valve replacements, so we know it’s biocompatible. It’s a novel procedure that’s new in the U.S., within the last one or two years, but we have data from other countries, which made everybody feel more comfortable using it.
Q: What other developments in orthopedics are you keeping an eye on right now?
ESP: Something we are always looking at in all areas, in shoulder surgery especially, is biologic medicine. In addition to just using sutures and plates and screws and things like that, now we are able to alter or positively affect how the body is healing through different biologic interventions, different types of injections, different proteins or diet or synthetic patches we are using to help repair or even regrow different tissues. I think that is going to be really popular and there is going to be a boom in that, which is already developing now, but a big boom especially over the next 10 to 20 years — how we can push the body to heal and regenerate things that have degraded.
Q: Is there anything else you would like to expand on?
ESP: We are using pyrocarbon for active patients, becoming more willing to operate. In the past, middle-aged active patients with arthritis were hard to treat because they still wanna be active and still have a long life ahead of them. We don’t want to give them a device that’s going to fail or wear out that they’ll have to have redone. We’ve been leery to operate on young patients in the past. This pyrocarbon has the ability to change that and help patients who are being told they’re too young to have a replacement. This fills in that gap.
