Hip and Shoulder
Replacement Chat

0:00 · Introduction to joint surgery

Welcome to our channel today, we'd like to discuss something a little bit of an interesting thing for you. And that's really to compare and contrast between hip replacements and shoulder replacements. I'm Dr Chien-Wen Liew, a hip and knee replacement surgeon from Adelaide, South Australia, and I'm here with my colleague. Raymond. Hi, I'm Dr Raymond, you. An orthopaedic surgeon from Orthopaedics 360 in S.A. I specialise in shoulder and upper limb surgery.

So I thought this would be a good idea for us to be able to compare between the two sub-specialties. Arthritis affects every can, affect every joint in the body. Certainly does, I think. We find that there's quite a few more hip replacements than shoulder replacements in Australia at the moment. I think roughly 40 000 hip replacements a year get done in Australia every year, and sixty thousand knee replacements every year.

It's interesting because there's actually quite a few more hip replacements, I'd say, than shoulder replacements that get done every year. In Australia. We know that there are thousands and thousands of hip replacements and their replacements that get done. And today, I guess both of those joints are ball and socket joints, so they have some similarities, but a lot of differences.

1:25 · Stability and joint mechanics

Absolutely, I guess. The key thing is that the hips and knees are the big weight bearing joints in the body. Lots of wear and tear can take place and cause arthritis or osteoarthritis. As we. As is technically termed in the shoulder, it's also a ball and socket joint. However, unlike, for example, the hip, where the ball is very much enveloped by the socket. The shoulder joint is more like a golf ball sitting on a golf tee.

There's lots of mobilities, in fact, almost mobile joint in the body. Despite this, arthritis can still occur in this joint. There are many other indications, or many other reasons that a shoulder replacement might be required as well. Let me go back to something you said before about the stability of the joint. We know that the hip itself is actually quite a congruent joint. The ball and the socket match pretty much perfectly around the outside of the socket is also called the labrum, which is almost like a calamari looking thing that goes as a ring around the socket itself.

There is a labrum in the shoulder as well. But from remembering what we got taught when I was doing shoulders many, many years ago. It's more like that game where you swing the ball onto the cup and try and keep the ball onto the cup. Whereas the hip is super stable. In comparison, would that be right? Yeah, look, I never thought about it, like the cup and ball game, but it's certainly there are.

2:52 · Surgical approaches

We rely on less so, the congruence of the bone in the shoulder to keep the ball on the golf tee, so to speak. But we do rely on the labrum, which is where all the ligaments attach onto and help keep that shoulder joint nice and stable. And often we know that with shoulders, a labral reconstruction, or a label repair, is a much more common thing. But for the hip, it's really just something that's coming into place now, and a Labral surgery for the hip is certainly not as prevalent as shoulder label surgery.

For stability. I would say, Yeah, absolutely, I'd agreeing. A shoulder dislocating is much more common than the hip dislocating, which I guess brings us to, you know, the stability of the actual joint. With a joint replacement in there for a hip, it's quite straightforward. There are not a lot of options. You have a stem like this that sits within the actual femur, and then you've got a socket.

There's a very congruent connection between the ball and socket. And, as you know, Ray, I perform all of my surgeries with a direct anterior approach. We don't cut or detach any of the muscles, tendons or ligaments as we approach the hip. And certainly, I would say that has added a lot of stability to my patients postoperatively, we have no movement restrictions after the surgery. Sure, a little bit different to the shoulder, yeah, tell me a little bit about the differences in design there. Well, it gets a bit technical. But in broad terms, there's two main designs for a shoulder replacement.

4:22 · Shoulder replacement designs

As we know it, there is the anatomic design, which is a design where essentially we're placing light for. Like, we replaced the worn out ball of the humerus or the arm bone with a metallic component or implant, and we replace the worn out socket with a plastic liner. And so that's the new shoulder joint. We don't have worn out bone rubbing against worn out bone, causing pain and stiffness, but we do need to.

When we do a shoulder placement such as this, we do need to protect it and protect the tendons and the muscles which surround the shoulder. So that does mean that we use a sling to help rest the shoulder and protect it for the first four to six weeks. But look, we're not locked up in a sling 24 hours a day. During that period of time, we actually still do get that person moving, get that shoulder moving, but in a safe, in a safe manner.

Well, compared to the socket that we put in, this looks like a very small socket. Absolutely, you know, this is like two centimeters or so in length. And you look at my socket, it's much more impressive. Hey, it's a much more impressive socket, I'm quite happy with my socket.

5:36 · Navigation and surgical tools

Yeah, okay, it's. It's very delicate. We have to, and that goes on to our next point, which I wanted to bring out. How do you work out where that goes? Yeah, because it's tiny, unlike the pelvis where you've got this big. You know? From what I've compared with the shoulder blade, this big surface area in which to place your socket, and it's obviously it's a very important.

Where that saw gets placed the this socket on the shoulder blade, we don't have a lot of room to work the shoulder blade. If, if, hopefully our viewers can see on this model, it actually tapers down. It's almost like a cone, and we call it the vault of the of the clean oil or the scapula. And so we don't have a lot of room to work with.

My preference when I'm implanting a shoulder replacement is to utilise something called Navigation I. All of my patients will have a 3D scan performed before surgery and allows me to map exactly where that replacement is going to be placed, where the there are screws normally that we use, where those screws will be directed. And all of that is replicated during surgery, with special probes to let me map out exactly where that's all going.

So you're doing a three-dimensional scan before surgery, which is, as you know, something that I do, but you also have a computerized navigation during surgery itself. That's correct, so it's all real time. It allows me to place everything to within a millimeter of accuracy, and it's something that allows me to really optimise the precision of surgery. And I've, I've seen that does actually eventuate to better patient outcomes as well.

That's a little bit different to what we perform with the hip. We do the same sort of three-dimensional scanning before the surgery, we're planning the operation and performing on our computer before the operation occurs, but during surgery. What we actually have are these. These jigs, and they are actually custom made, they're made in Switzerland and shipped back to us. Along with these bony models, we then have the little jigs that fit onto the actual joint itself that enable me to then prepare the bone very accurately.

Now, obviously, with that method, we're both pre-navigating, but with a very different intraoperative philosophy. I would say I agree. And certainly, you know, we've got a lot more room to work in than that tiny little thing that you showed me then. But obviously both extremely accurate and something that I think, you know. Current advances in hip and shoulder surgery have been phenomenal in improving the patient outcome and improving the accuracy of implantation, which probably does translate to longevity.

8:07 · Rehabilitation and recovery

I agree, I agree, we touched on it just before. In terms of rehab, now, I, I tend to, you know, be a little bit, a little bit more protective of my patients, so to speak. But so we do rest the shoulder and sling. How is it with hip replacement rehab? Oh look, it has changed a lot. And for any of my patients watching this today, they'll know that really, there aren't any restrictions after the surgery.

We let them get up and walk, it is often the same day that they're up and walking, and we keep them mobile and active. Which helps us to reduce those risks of things like DVTs, which are deep venous thrombosis and pulmonary embolisms. So blood clots in the legs. That risk reduction occurs when you are mobile early, but really, it's just the idea of getting our patients up and walking as quickly as possible.

And now that has a bit of a flip side to it. Some of the data that came out in the early days of performing the answer approach, we're talking 10 to 15 years ago, showed that. The accelerated movement of a patient after the surgery, because they felt so good, actually put them back a little bit. With chronic inflammation that occurred when patients went too hard or too fast after the operation itself.

All right, so actually, some of my colleagues in Switzerland and around the world have actually resorted to placing patients on crutches or walking sticks for a designated six-week period. Now I don't feel like we need to do that. Our patients are actually very compliant and they certainly use their body as a guide. And they, you know, we find that actually is quite a successful thing. But it's very interesting, you know?

With the change and the push. From becoming a very rarely performed procedure, which was the direct anterior approach, to now being a very fast growing procedure that's taken up in most places around the world. We're seeing that big transition to patients staying in hospital for a long time, requiring a walking frame for a long time, not being able to drive for a long time. Many patients are up and walking soon after surgery.

so very different. Yeah, and it is a load-bearing joint, you have to walk everywhere, definitely more important than a shoulder. I think that's questionable. It's not a competition. But look, how are you going to drive your car? You can walk everywhere? But how are you going to drive your car? You can drive, you can drive with one hand, fair enough. Yeah, that's great look, looks. Been a pleasure talking to you today about shoulders and hips, you know, it's something that is extremely dear to my heart.

I only perform two operations every single day, so this is half of my life. And you know for, I know for you. We share a few very similar philosophies. I agree.

10:42 · Conclusion and closing

They're good to get together on this one. Absolutely look. Shoulder replacements There's an expanding number of indications for needing to have a shot replacement. It's not just arthritis. Sometimes it's for patients whose bone is actually not too bad, but they've had a massive tear of the muscles around the shoulder. It's it's an operation which I think gives patients a great deal of function and restoration of their quality of life.

Something I'm very passionate about, and passionate about trying to optimise the operation and outcomes as well. Look, it's been a pleasure and a pleasure hearing about the hip replacement side of things. The shoulder of the lower limb, as I like to call it was it. I'm saying, like, would you count the elbow as the knee of the upper limb? Yeah, look, you know, a little bit different, a little bit different, a little bit different, a little bit different.

Maybe that's for another video, I think, so we'll catch up about that later on. That. It's been a pleasure. Please like and subscribe to our channel for more videos and we'll see you at the next one. thanks for joining us. see you later. thank you.

Transcript edited lightly for readability.