MED­I­CAL HIS­TORY AT OUR HOS­PI­TAL

The Riverine Herald - - FRONT PAGE -

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.

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