Dr. Brian Rebolledo, orthopedic surgeon at Scripps Clinic in La Jolla, California, talks about a new procedure to perform shoulder replacement surgery.
Interview conducted by Ivanhoe Broadcast News in September 2022.
Why are shoulders a complex joint for replacement?
REBOLLEDO: The shoulder is extremely complex because of the mobility and function that it allows us to have. There is much more mobility with the shoulder given less constraint. However, because of that it is also susceptible to injury.
What can some of the issues be with shoulder replacement surgeries post-surgery?
REBOLLEDO: For post-surgery shoulder replacement, some of the issues can be related to the implant. The implant can loosen over time. Also, we can have problems where the muscles around the shoulder, can also fail. This is what we want to look for in the postoperative setting.
Now, there’s this mixed reality headset. What does that do for you and what does that do for the patient?
REBOLLEDO: The mixed reality headset allows us to use the patient’s anatomy in a 3D-constructed program that allows us to plan for their case. This makes the surgery much more precise and allows us to put in the implants in a much more accurate and precise way for the patient.
Does this actually let you have a direct line of sight in real time to this 3D pre-op plan and overlay it over the anatomy on the OR?
REBOLLEDO: That’s absolutely correct. It gives us a detailed map of the patient’s anatomy. We bring that map into the operating room with us. We’re able to use the headset with the 3D hologram and bring that right next to the patient while we’re putting the implants in. This allows us to make it much more precise in terms of where we put those implants. It specifically matches the patient’s anatomy.
How does it work?
REBOLLEDO: The technology works with a headset that we use in the operating room, and this is by voice command and hand control commands that we use to bring that 3D hologram image into the operating room. In the operating room, utilizing the headset, I’m able to use it with my hand to drag that 3D hologram over the patient’s anatomy. That gives us the overlay that we use during the operation to make that implant precise to what that patient’s anatomy is.
What are the key advantages of this?
REBOLLEDO: The key advantages of the 3D planning software, as well as the hologram or mixed reality headset that we use, is that we’re able to use a 3D detailed map of the patient’s anatomy in the operating room itself. Bringing that into the operating room, we’re able to overlay that and to give us a better idea of where the implant should be in a precise way.
What was it like previous to this technology?
REBOLLEDO: Previous to this technology, we were limited in terms of the imaging we used for the patient’s surgery.. We now are able to use this 3D planning software with the hologram or the mixed reality headset to bring that imaging into the operating room. And that gives us the ability to place that hardware or implant into the precise location.
How do you think it will benefit patients?
REBOLLEDO: This technology will benefit patients because we’re making the surgery precise to their anatomy. We are able to use this planning software to put the implant in exactly where we planned it out. This will lead, hopefully, to less loosening and less failure over time of these replacements.
What’s the difference between the 3D computer modeling and this new technology?
REBOLLEDO: Well, this is the new generation of how we use this technology. This is an extension of what we used here prior. The 3D technology we’re then able to put into the headset, which then allows us to better replicate that in the operating room. This was not available beforehand. This is a way for us to interact with that plan at the time of surgery.
Can you compare some differences?
REBOLLEDO: The real advantage of this technology is that we’re able to use this precisely to put the implants in for the patient matching the patient’s anatomy. What that allows us to do is minimize the risk of improper placement, minimize the risk, hopefully, of loosening over time, and to minimize risk to the soft tissue around the shoulder. Over time, we’re hopeful that this will show that the implant lasts longer and that patient outcomes are better.
Can you talk about how exacting of a process this is?
REBOLLEDO: The way we put in the shoulder replacement is in a small, confined area of bone within the shoulder. Making sure that we are precise where we put the implant is critically important. If we are off just by a few millimeters, this can lend to the implant not being well seated and eventually loosening at a rapid rate. Therefore, this technology allows us to put it in precise by millimeter precision to allow that to be secure.
Is there anything else that that you think is important for our viewers to know about?
REBOLLEDO: The important thing to know is that shoulder surgery continues to innovate and continues to evolve. What we were doing even five years ago is not what we are doing today. We are making this procedure safer, better, and patients are doing well afterwards. And from this, we feel that we’re able to push the envelope in terms of patients doing exceptionally well after replacement if they’re indicated for it.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
Stephen Carpowich
Carpowich.stephen@scrippshealth.org
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