Interview with Dr. Kaplan, surgeon at the Indiana Hand to Shoulder Center
Dr. Kaplan’s Website http://www.indianahandcenter.com/thomas_kaplan.html
Question: What is humoral resurfacing?
Answer: Basically it’s a procedure for arthritis of the shoulder joint. Similar to patients who have hip or knee replacement surgery, you can also have shoulder replacement surgery. What resurfacing indicates is that instead of cutting off the top of the bone and putting in an implant with an artificial ball, you just kind of shave away the outer surface of the bone and put in a metal cap. You replace part of the ball, which at one point had been normal but is now arthritic.
Note: This procedure is similar to Hip Resurfacing which is illustrated here http://www.surfacehippy.info/resurfacingvsthrillustration.php
Q: Why was an alternative to shoulder replacement surgery necessary?
A: The interesting thing is that with patients who are younger who have arthritis, it can be very difficult because most replacement surgeries won’t last forever. This surgery preserves more of the patient’s normal anatomy, and the hope is that it will provide longevity for patients, with the knowledge that no replacement will last forever. If this does wear out, you can go back and do a more standard replacement procedure.
Q: Is it for patients of all ages?
A: It has been used in younger and older patients. In some of the studies where they have looked at resurfacing versus total replacement, you definitely get a lot better, but it’s not quite as good as someone with a total shoulder replacement.
They have a cut-off in the literature of around 50, 55. With patients younger than 55 who have arthritis, we’ll do this. They want to be active.
Q: How long does the total replacement last?
A: Survivalship has been about 84 percent at 20 years, whereas for resurfacing, it’s down in the 75 percent area.
Q: Is recovery time the same for humoral resurfacing as for shoulder replacement?
A: Recovery is a little faster. Often times, we’re just resurfacing the ball, not doing much to the cup portion. It doesn’t require as big an operational exposure. It can be a faster recovery because there’s less surgery.
Q: Can you do another total replacement later?
A: Yes, but it gets harder. Once you have prepared the bone surfaces and put implants on that side, if they fail — usually that’s associated with additional loss of bone — it can be more difficult to do. You have to bring in bone graft and do other things.
Q: Do you make recommendations on a case-by-case basis?
A: Absolutely. I think it really depends on how old they are, their activity level and what their X-ray findings show as far as their bone quality and the pattern of their arthritis.
This is just another good option that probably a lot of patients don’t realize is out there. It’s something that can be more suited to a younger patient who it has been shown can get back into more sports and potentially more safely, although that’s long-term data that we need to figure out still.