If you read this blog, you know that I often write about what I experience on a day-to-day basis. After all, it’s hard to do this six days a week if you’re not passionate about what you write about. This morning I’d like to share my experiences yesterday with an orthopedic shoulder surgeon who was very frustrated with our approach toward shoulder surgery. I suspect that he had a patient show up with one of my blogs in hand that discussed how the research behind shoulder surgery is not that favorable. So let’s jump into that discussion with an eye turned toward the bright future of interventional orthopedics rather than to the dim past of invasive orthopedic surgery.
A Frustrated Surgeon
Yesterday, my staff alerted me to a local orthopedic shoulder surgeon who had left some unkind comments on our chat system. I immediately recognized the name from a time in my practice when my approach was to try a steroid shot and physical therapy and when that plan didn’t work, I would send these patients to this surgeon. Fast forward a decade and a half and it’s rare that I send patients for shoulder surgery. Why? Interventional orthopedics was developed mostly by our clinic but is now spreading across the country outward from Colorado and other locations.
What is interventional orthopedics in comparison to what I used to do? Watch my video below to both see how much more complex interventional orthopedics is than simple shoulder injections as well as why your shoulder surgeon likely has no idea what it is or how to accomplish shoulder healing without surgery:
Do You Need Shoulder Surgery?
First, let’s put aside the idea that if physical therapy and steroid shots fail, you need shoulder surgery. Let’s instead start with the idea that nobody needs shoulder surgery for pain unless we can prove that it works. So let’s see what’s been published:
- We have research that shows that for many types of rotator tears, this surgery is largely ineffective
- Full-thickness rotator cuff tears do just as well with physical therapy. In other words, this big invasive surgery improved the pain no better than PT.
- Whether your tear heals on MRI after surgery doesn’t determine if your pain goes away; in fact, a chemical in your shoulder joint does a better job of that…
- As many as 6 in 10 large rotator cuff tears have been shown not to heal after surgery
- In a recent high-level study, shoulder labrum surgery was performed in patients with a type-2 SLAP tear and found to be no better than a sham or faked procedure
- One of the more common shoulder surgeries called decompression (where ligaments are cut and bone removed to reduce the pressure of impingement) was also shown to be ineffective.
So what can we say about all of this research that questions the effectiveness of very common shoulder surgeries? That the research support for these invasive procedures for many indications just isn’t robust enough to support the risks of the procedure.
Surgeons Will React to This News…
Let’s face it, if you’ve spent your whole career learning and perfecting shoulder surgery techniques, the last thing you want to hear is that common shoulder surgeries have large studies showing they don’t work. However, make no mistake, that’s what’s happening year after year as more and more high-level research questions whether orthopedic surgeries are effective. Hence, surgeons are bound to react to this news, which is what we saw this week. We’ve even seen surgeons bombing our Facebook page or LinkedIn posts when we share high-level research that questions whether these invasive procedures work.
Is There a Better Way?
We’re just completing our own randomized controlled trial of using advanced interventional orthopedics to heal or reduce pain in rotator cuff tears without surgery. This stem cell study has produced promising results so far in helping patients avoid the knife. Hopefully, this will be done this year and we can publish these results. Given what we’re seeing, I would estimate that by 2030–2040, 50–70% of elective orthopedic shoulder surgery will be relegated to the dustbin of medical history. In addition, what can be done without surgery by precisely placing healing agents (like stem cells, platelets, recombinant proteins, and the like) exactly into the damaged tissue using imaging guidance will expand. Also, we’ll see new tools that allow image-guided injections to compete head-to-head with more and more orthopedic surgeries. To see what we do right now to help patients avoid shoulder surgery, watch my video below that features Dr. Schultz at our Colorado HQ:
The upshot? It’s not surprising that we’re seeing shoulder surgeons react to new technology that will likely replace much of what they do. However, as a patient, please be aware that you’re in the middle of a major paradigm shift. So don’t get caught up in being forced into old tech when new tech is here or just around the corner.