MEDICAL HISTORY AT OUR HOSPITAL
HISTORY was made at Echuca Regional Health yesterday with an Australian-first shoulder surgery.
Known as ‘‘navigated short-stem reverse shoulder surgery”, the procedure is the least invasive shoulder replacement in Australia to date.
And a major step forward in national orthopaedics as the reconstruction saw Melbourne orthopaedic surgeon Devinder Garewal and his team replace the ball joint with the country’s first ‘‘short-stem’’ prosthesis.
A new bone-preserving prosthesis allowing patients needing shoulder treatment to have further replacements down the line.
Mr Garewal chose to debut the ground-breaking operation right here in Echuca.
Working with an expert team of ERH staff, he guided the 1.5-hour surgery to a successful outcome.
And while it’s a triumph for local and national medicine, Mr Garewal said it would also be life-changing for his 74-year-old Echuca patient.
“This is a person who has had years of shoulder pain and quite severe dysfunction,” he said.
“He could only move his arm about 30 degrees in a forward plane and sideways and he was in constant pain and had difficulty sleeping.
“Now, his pain will decrease drastically.
‘‘And with rehabilitation he should get to a point where he can lift his hand above his head again.”
The complex procedure involved replacing the ball and socket of the shoulder with a prosthetic ball and socket – but in reverse.
Meaning vital ‘‘rotator cuff’’ tendons which help the shoulder to
move smoothly are no longer needed.
‘‘If your rotator cuff muscles and tendons are still intact, you can have an anatomic shoulder replacement where you replace like for like — so you put the socket where the socket belongs, and the ball where the ball belongs,’’ Mr Garewal said.
‘‘But once those tendons are gone, you have to do a reverse shoulder replacement, inverting the prostheses. And by putting the socket where the ball belongs, and vice versa, you only have to use an outer muscle of the shoulder, the one that’s called the deltoid, to help you move it.’’
It’s a procedure that’s been done thousands of times before. But this time, with a twist. The “stem” of the socket prosthesis (which attaches to the bone of the upper arm) is 50mm shorter.
A few centimetres that may seem insignificant.
This is a person who has had years of shoulder pain and quite severe dysfunction. He could only move his arm about 30 degrees in a forward plane and sideways and he was in constant pain and had difficulty sleeping. Now, his pain will decrease drastically. And with rehabilitation he should get to a point where he can lift his hand above his head again
But which could provide millions fighting shoulder pain with hope for the future.
“The problem with traditional longstem reverse shoulder replacement is there’s very little you can do from there,” Mr Garewal said.
“Whereas short-stem shoulder replacement means less bone stock needs to be removed to insert the prosthesis.”
So if the short-stem shoulder replacement fails in the future, there’s a back-up plan.
“We can then revert to using a longer stem, allowing for an additional replacement,” Mr Garewal said.
“And while shoulder replacements are generally a last resort for people who are in their 70s or older, this will allow us to use it in younger patients as well, because we will have another option if it does fail down the line.”
Mr Garewal was trained in the new procedure while completing a shoulders master’s course in Spain, where short-stem surgery was launched.
And having completed more than 50 similar shoulder replacements with long-stem prostheses, he said he wasn’t daunted by this new aspect of the surgery.
“Above all, I’m just excited that it got to be done for the first time in Australia here, in Echuca,” he said.
‘‘I consult here on a regular basis and knew the theatre team could manage this beautifully even though it is a new approach to this particular surgery.’’
THE SHOULDER BONE’S CONNECTED TO...: Devinder Garewal screwing a plate to bone to mount the new shoulder joint, assisted by ERH surgical resident Luke Brennan.
THE MAGIC: Surgeon Devinder Garewal demonstrates the sterilised Exactech short-stem prosthesis, assembled and ready to be inserted into the patient yesterday, the first time the operation has been done in Australia.