Good evening, I'm Sandy Thomson ,the host of Life Ahead Tonight and I am so glad you're watching because we have a new topic and a new guest and I think will probably be of interest to many of you.

I think probably everybody knows someone or has someone in their family that has had a rotator cuff issue at some point we're going to be talking to a surgeon, a specialist in this area that's going to be introducing you to a new type of total total shoulder replacement.

>> And I'm going to introduce you now to Dr. Matt Noyes.

So nice to have you, Sandy .

Thank for having me on.

>> I appreciate it.

I had no trouble getting through that.

But it's officially what's the surgery officially called again to reverse total shoulder Arthur Plasty right now you're going to tell us why we need that or when we need that help.

>> We're going to get to it first, OK?

>> All right.

First of all, just define to me what is the rotas Tarkoff?

I mean people will point and say Oh I have trouble in my shoulder.

It must be the rotator cuff.

>> Is it always and what is rotator cuff?

So the rotator cuff you'll hear other people say it's rotary you hear to the community to really recover but it's really the rotator cuff and what it is is a cuff of tissue.

>> It's for tendons that wrap around the ball or the humeral head OK?

>> And they attach to muscles and then the muscles attach to the so it goes tendon muscle to the bone.

>> OK, and so what happens then is these tendons hold and stabilize the shoulder against the socket and that's what helps us to raise arm overhead.

>> OK, so like the ball and ball and socket and then you have a bunch of tendons that wrap around the ball to hold it into place.

All right.

And then people won't injure themselves shirts and arthritis issue what happens then we'll need a replacement so there's different types obviously but people will tear the rotator cuff as they age or they could have a trauma or an injury such as a fall.

And then there's also different types of arthritis you can get human arthritis which is osteoarthritis, the wear and tear arthritic pattern that you have you could get inflammatory or rheumatoid arthritis and then the one that's really specific to the reverse shoulder replacement is what we call rotator cuff tear our therapy and that's when people have arthritis along with a big rotator tear that is not repairable and then the ball starts to slide up onto the socket and people are unable to raise their arm anymore.

>> OK, so then because of the tear in the arthritis you can't hook it back up to you cannot wear it was you cannot reattach the tenants to the bone there irrepairable and then the ball starts to slide up on the socket and then they lose the ability to raise their arm overhead.

>> Wow.

And that's a term what we call pseudo paralysis pseudo paralysis that's pretty serious.

>> Is that fairly common?

It's it's certainly a common entity.

How do I say this rotator cuff tear is a very common arthritis is common and this is a subset that has really been studied over the past you know, twenty , thirty years and we're really starting to understand why it happens and we're I think we're more astute to diagnosing it now if that makes sense.

>> Sure it does.

And a lot of the people that I know that have had rotator cuff issues have been not always arthritis.

>> Maybe it was a sports injury.

Sure.

Picking up something too heavy or and so in these situations usually if it's an injury and it's caught early we and fix the tendon back to the bone to avoid such surgery.

>> OK, so the way to avoid a reversal avoid the surgery, you're going to show a correct moment.

>> And I do want to remind you all that this is your show and we want to tell you what you want to know, Dr. Noize.

It's going to be welcoming any questions that you might have about shoulder replacements and rotator cuff.

>> I love that you were calling and Rotary Clubs.

That's well, that's obviously that's what my grandmother used to call him so that's pretty good.

Again, probably a very common issue.

So if you have questions, give us a call here at (969) 27 twenty if you about the two six zero area code just put a one eight eight in front of Banten it'll be toll free for you.

>> OK, you have a demonstration to show us the difference between the reversible so and the regular OK so the regular if you can fix it.

>> So no it's if the attendants aren't correct it got torn.

>> OK, so people can have just regular old fashioned osteoarthritis.

>> The tendons aren't torn then they're usually a good candidate for what we call an anatomic or regular shoulder replacement because it's matching their regular anatomy.

OK, we put we you take off the arthritic ball, you put a metal ball in on the on the arm side and on the socket side we replace it with a a medical grade plastic OK and that becomes your new socket and that gets cemented into place.

>> All right and that's so that's an anatomic she'll replace anatomic but then this is what we would call the reverse shoulder replaced.

>> We have a question by the way and let's get to that before we get into demonstration.

I want to make sure we answer as many as we can.

This is Denise and she says I had the surgery but find it hard to explain it.

>> Can you explain what happened during this surgery?

>> Well, I'm assuming that well, let's see.

I'm assuming Denise had regular do you think she's Denise?

>> I had the surgery but you know so I'm assuming she had a reversal.

>> You're usually really informed on what they're getting.

OK, so Denise, I'll explain it to you right with the model.

So what this is is the reverse shoulder replacement OK?

>> And so what we do that's your that's the socket bone and socket.

>> So this is what we would your be your arm bone OK my arm bone OK and what happens is we cut the arthritic ball off away we put a stem down into the bone OK sort of like that would it physically be about your size and yes correct.

>> This is this is one that would be put into somebody's arm.

This is the exact same size now and it goes down into your bone.

It goes into what we call an intermediary canal.

>> OK, OK. And then we have this is the the socket that now the socket is on the arm side.

>> This is what's going to receive the ball OK. Oh the ball with normally the ball would normally be on this side of the you on at OK so now instead of the cup being back up here now on your arm correct .

>> Now this is the socket OK right and then what happens is in this clear stuff is the bone and then we implant the screws in the metal and then we put the ball onto the socket side.

>> Where are the screws going into your bone?

This is all bone.

This clear portion is bones for the patients to kind of see what it looks like inside the bone and then what happens is this is how it now or wow or articulates and rotate correctly then.

Correct.

And so that's this is for someone who has a nonfunctioning shoulder with no rotator cuff and bad arthritis and can't be fixed.

>> Whirlaway can't be fixed when you fix the rotator cuff now you can also use this implant for people that sustain bad breaks to the shoulder that we can't fix with plates and screws then we can utilize something such as the reverse shoulder replacement that has been kind of proven to give better results than sometimes the arm just sit in a sling.

>> Is this fairly common?

It's becoming much, much more common.

I think a lot of people even if they're not shoulder specialists, a lot of just general orthopedic surgeons are learning to trying to put these implants in because I think they see a lot of these common conditions.

>> You are you're calling this an implant, correct?

Okay.

I'm calling I'm calling the implant.

I'm saying the shoulder replacement.

>> The implant.

OK, got it.

I understand where you are.

You're implanting your hearts in there so I guess that's true again (969) 27 twenty is our phone number here and Denise, thank you for watching by the way and I hope that we were able to answer that question for you.

>> OK, now as far as the the regular and the reversible, would you say that the reversible type of surgery that you do is is fairly new or not?

>> I mean how long has that been around?

Well, it's you know, I I was placing I was doing the surgeries when I was in training so you know, it's been around for 15 plus years.

>> But what we're finding out now is that there's just a lot of more indications there are a lot of people that could qualify for a reverse shoulder replacement that we really didn't know about 15 years ago we are really just putting him in for the arthritis with the torn rotator cuff now we're putting him in for other reasons such as when you have a broken broken shoulder that is irrepairable people that have allowed the bones to heal in crooked positions that's something what we would call a massive union.

So the reverse shoulder replacement is is able to accommodate those deformities, is able to accommodate those injuries more in a regular shoulder replacement.

>> Can I accommodate those?

Well, if you said if it's healed the wrong way say somebody has had some sort of an injury and it healed wrong, what do you do do you like well a long time ago you break it if you will to then do not implant no.

>> So what?

No, you just approach it just like you were just doing a regular shoulder replacement.

They just have different pieces that we would use to you know, in the unique situations.

You know, there's a for what you see here there's a thousand different pieces that you can to build up the type of implant that you want for each patient.

>> You can almost make it like customized OK right now it sounds really naive about the medical procedure but the ball in the socket the whole piece here if you will is that come in like different sizes for different people.

>> Absolutely.

So there if you can see right here this stems can come in a short stem.

>> It can come in a longer stem.

So what happens is that the way you put these into a bone into the canal, we mallott them into place and it's what we call press fit.

So you put in a bigger size until it's to the point where it kind of wedge wedges into the right and so then you have to be delicate enough not to break it.

So there's you know, that's why we we were talking earlier.

It's important to understand you're the the company's implant that you're using so you understand the nuances what what they have just a surgical question if you will.

So you as a surgeon are preparing to do the reversible shoulder replacement.

>> Do you have different sizes that laid out in the operating room that you can choose from or do you do measurements before to gas?

>> How do you know so both so you know, certainly in the past three to four years we're now using computer software to able to almost plan the surgery ahead of time.

>> Now when I was in training we didn't have that.

Yeah.

You know, I guess it's kind of showing that I'm moving along in my career but nowadays we can actually get onto the computer and plan to see what type of implant we want to use ,what type of size is going to best fit the patient and then also in the operating room we then have what we call trials that are sterile and then we trial each size until we are comfortable with what and then we put the final implant in that's sterile.

>> How do you do the trial?

>> We do it in the actual bone.

Yes.

Oh OK. Yeah.

And do you find the one the one that you like sticks the one the one that you know that fits best for the patient and then we put in the sterile product.

>> OK all right got that I think I think too bad we don't have a visual in the operating room but someday we will have that.

>> We could certainly work on that for sure.

What what do you do afterwards ?

>> What kind of recovery period is there and how does one recover so the majority of patients would stay probably overnight in the hospital one night one night certainly sound long ago.

>> There's there's there's definitely been a push really since post covid to have these procedures also done at a surgery center where people go home the same day.

Oh right.

I think a lot of Medicare is now finding that the shoulder replacements can be done safely and in an ambulatory surgery setting where there's really not a need to spend the night in the hospital.

But if people have some medical issues, we feel more comfortable keeping them overnight.

Yeah, they're usually in a sling from somewhere four to six weeks depending on all that was done during the surgery.

>> And you know, therapy can be kind of done two ways.

I think that's another thing covid taught us.

>> I think the majority of time people would just go to the physical therapist and I certainly support that.

>> I used to be a physical therapist for I went to medical school.

So that's a profession, you know, and you related to me.

>> But there's also you know, with the new technology that there's, you know, apps that you can now do on the on your phone or your tablet and walk you through your things through your therapy.

And so, you know, I tell people that a typical recovery period is about three to four months until they're back to doing what they want to do.

>> You know, everybody that I've ever talked to that had rotator cuff replacement or knee replacement or hip replacement, they always say I wish I'd done this five years ago.

>> You know, all those years that they spent in pain.

We have another question by the way and this is from Bass and he said Are there any complications or after the fact that's that's something I was going to ask as well certainly.

>> So any surgical procedure could have a complication and that's something that I think I mean I mean I know a lot of surgeons spend time on because that's what we want to prevent for the patient and you know, some things are just you know, you can't everything's not going to be 100 percent right.

>> So anytime you have any time there's any surgical procedure, there's risk for an infection.

Now these are you know, on a low magnitude you know, anywhere from one percent to under right in terms we give antibiotics, we do all these preps.

>> We make sure that we put on appropriate clean dressings, you know.

>> And so the other risks is that any time we put the implant in you crack a bone, right?

>> Oh, and so that's what happens.

Well, I mean that's maybe for another segment so and so you know what we do you know, we just we're cognizant of what type of you know, the bone quality when we're putting before you even start.

>> Correct.

So we try to mitigate those issues.

>> What's unique to the reverse shoulder replacement is that it can dislocate it functions very much like a hip replacement.

>> You mean it can dislocate afterwards?

Yes, it can it could actually pop out of socket and where you know the implant then you know, is not rubbing together or rotating together.

>> Got it.

All right.

And so that's unique because that doesn't usually ever happen in a regular shoulder replacement.

>> You know, they it makes it more possible to happen just the way the anatomy is now developed.

>> Like I said, this is almost functioning like a hip right.

The shoulder, the new implant, the reverse implant almost functions like a total hip whereas a total hip can dislocate.

>> I see.

So it has a lot of degrees of motion just like a hip is a ball and socket the shoulders the bone socket.

OK, so that's kind of unique to it and then any time you get a reverse shoulder replacement we have to there's a lot of nerves in the shoulder that we have to make sure that we're watching out for and so sometimes those can get injured.

But again all those are very, very rare.

>> Rare exactly.

But you have to you have to know that you have to explain to patients laying it OK now maybe it's a silly question but say you did this reverse is that going to appear any different to you physically on the outside when you're done and healed?

No, it usually does not.

I will say sometimes what because what happens in this scenario is you're you're you're lengthening the arm a little because you don't have a rotator so you're trying to stretching the deltoid a little so that you can raise your arm up higher.

So sometimes this really happens in you know, thin thin females is you kind of see their muscle like a little stretched but it doesn't it's not it's not cosmetically displeasing by any means.

OK, you could just you know, it's more common.

>> It's I would pick it up more so than you know, the person who doesn't do you know what you're looking for there you go.

>> Oh boy.

OK, all right again give us a call here.

We've had some good questions already from Denise and Babs but we'd love to hear what you want to know as well.

>> There's something else that I'm curious about.

>> Are there any complications down the line?

I mean not let's say months or years after the surgery we've talked about the possibility of in my new possibilities of any infection or anything but much later.

>> Yes.

So what's unique to any really joint replacement?

You can still have infections whether they're early or late and that's something that we the you know, the research is still ongoing onto why those happen.

>> But what's unique to any another for joint replacement specifically is this plastic liner right here.

>> OK, and it's always plastic.

I mean in reality it's it's it's plastic.

>> It's like it's a very, very expensive piece of plastic and it is and it's it's manufactured.

It's oxidized.

It's all these fancy terms to make it so that it's you be able to to the biologically tolerated in the body.

>> OK and so what happens is just like anything else this plastic will wear away OK, OK. And as that plastic plastic wears away we do know that what will happen is these implants then because those particles can get loose.

>> OK right so then we know that over time the bone erode away and the implants get loose and then we have to go back in and then replace them because people have kind of had different parts and they've kind of different sizes of the wearing away and they've kind of outlived the joint replacement.

>> OK, and that's not anything to I don't want to say serious but certainly well they're certainly fixable.

>> I mean there's more complications.

There's more complications at any time you have to go back in a second time.

>> Sure.

Higher risk of infection, always more risk for fracture.

You know what happens is just the anatomy is not the same anymore.

>> You know, the first time you do the surgeries is always going to be the easiest.

The anatomies normal and there's no scar tissue.

>> There's not as much bleeding.

And so that's what makes going back in a second time.

But you know these the implants, the reverse shoulder, all these implants total hips, knees they're just they're manufactured so well now aren't we lucky in this day and age the technology is just amazing.

>> Oh, I would hear my my professors when I was in residency talk about how hard it was to fix broken bones back then because you know, even just the different types of plates and screws that we have now that they didn't have.

>> You know and and I think what it kind of shows you is how durable the body is and how people can really kind of , you know, figure out or compromise their you know, and learn to function even when we didn't have the latest technology because people still, you know, made it through and functioned and everything is what we're fortunate now.

>> Well, it's pretty amazing even that you say that you can usually get out of the hospital on the next day.

I mean I think back when they all started it was probably at least a week stay because it was a very complicated when I was in training it was three days that people would stay really you know, and now it's down to one or certainly people under home tonight.

>> Sure.

Absolutely.

Absolutely.

I think I think covid proved that for a lot of people.

Here's a curious question too.

Just let's say it's a normal person that has not had any previous injuries or whatever just the first time that this has happened.

>> How long does it take you to do the surgery?

Dr. this surgery from by the time you incisal the skin to the implants in you forty five minutes and then by the time you close the skin up, you know, fifteen minutes put your dressing on so I tell people roughly an hour a made from start to finish amazing.

>> I mean that is amazing to me especially when I look at all of these official parts.

We have a question from Chris by the way and Chris as does the patient have to take any antirejection medicine after the procedure?

>> What do you do to that?

So no no antirejection medication.

I think sometimes you on a very small subset people are allergic to Nicole and maybe he's you know, Nicole allergy and so maybe he's referring to that the only time you really have to take antirejection medication is in a like an organ transplant or something like that.

>> The biggest thing for joint replacements is blood thinner.

Do they need a blood thinner after surgery so they don't get what we call DeVita or deep vein thrombosis?

>> Yeah, it's certainly more common in the lower extremity hip and knee replacement.

So in my practice I do not have to you do not have to have any anticoagulation or blood thinner after surgery.

Would you before ever not know you don't want to before because it makes it harder certainly no.

OK so we having people stop doing it if you're going to see Dr. Noice or at least give us a heads up.

>> Yeah I imagine most of those things that are addressed in pre surgery or appointments and blood tests and I'm off the do unfortunately I have a great staff that do a lot of patient education for me and a lot of just well-run organization.

So that really helps to make my job easier because I think patients just need to really be educated not just once.

>> They need to hear it multiple times.

It's easy for the the medical professionals since we're used to it right.

>> The patients they're just not used to hearing it.

You know it's not it's not common terminology so important for us to just repeat it over and over again and the more people they hear it from the better.

>> I love that and the fact that you've explained all this and demonstrated this so well tonight but if someone was to actually have that surgery, I'm guessing that either you would give them additional information or repeat the information just so they're really understanding it.

>> I try to bring the model and explain to them what good the models kind of in the office and just kind of showing the people this is what's going to happen.

>> A lot of a lot of pamphlets, a lot of handouts, you know, joint classes where people are kind of prepared.

>> It's not as much even though a lot of it is just what's going to happen after surgery.

You know what I mean?

I think so.

People are so the patients are so worried about the day of right because they're nervous and it's certainly explainable you get the anesthesia a lot of people around you but it's really what happens after the fact.

You know the sling is complicated for people when do I start therapy?

So I think a lot of it is just you know, in my practice I try to do a lot of handholding and just education and making sure people know that, you know, we're there for them and talking them through the after surgery.

Sure.

One quick question here from Michael.

He said Is Ossy kinetic a good alternative?

>> Do you have any thoughts on this treatment?

So I've I've actually heard the commercial Ossy Kinetic on the radio.

>> Oh, I am not one hundred percent sure what they offer Ossy kinetic but I do know that there are alternatives out there for people trying to avoid surgery such as what we call PRP injections which is platelet rich plasma injections where they draw blood off of you spin it and they take the the platelets and inject it and that's been shown to help with arthritis and there's people also out there doing stem cells.

>> I don't have any experience with stem cells but I have done PRP in my office for the right candidate if if I'm talking to somebody about a reverse shoulder replacement, it's it would be it'd be too far down the line for them to consider something like a PRP injection or you know it once it once or a candidate for reverse there's pretty not many options left right you are right we reserve that for the end when all else fails.

This is this is the this is the end of the line.

OK, We only have about a minute or so.

I'm curious though if you have any advice for our viewers.

>> We have wonderful viewers by the way, if you have any advice for them to know when they might need a shoulder.

>> So what I tell patients in my office is if you have pain at night, OK, that is a big indicator in your shoulder that there's something like a rotator cuff here wrong once you lose the ability to raise your arm overhead and hold it up right.

>> Just like this even with nothing in that's a sign of a rotator cuff tear.

>> Right.

And any time that you lose stiffness rotating right.

>> Because then the shoulder is getting really stiff those really are kind of the hallmark.

So I'm always telling people to make sure you do range motion, make sure you keep your muscles strong around your shoulder and just be cognizant if you really have a night pain you can't sleep through, especially when people roll to lay on that shoulder.

>> That's that's time to come see me.

>> I'm so glad you came tonight.

Well, thank you for having me.

I really appreciate it.

Thank you.

Well, again, Dr. Matt Noyes and we appreciate your education and information.

I learned a lot.

I hope you did too.

We welcome you to come back again next Wednesday night and see what's going on right here in the PBS studios on LIFE Ahead.

>> Meanwhile tonight stay safe and stay healthy.

Good night