The area of orthopedic surgery that still needs to be conquered, per Dr. Andrew Green

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As shoulder surgery technology grows, rotator cuff procedures still need developments for long-term outcomes, Andrew Green, MD, said.

Dr. Green, chief of shoulder and elbow surgery at University Orthopedics in East Greenwich, R.I., discussed the future of shoulder and elbow surgery on the "Becker's Healthcare Spine and Orthopedic Podcast" June 1.

This is an edited excerpt. Listen to the full episode here.

Question: What do you think will be the future of shoulder elbow surgery? 

Dr. Green: I think there's still a number of problems that we understand but don't know how to manage. Some of it relates to having more experience, but also I think there's been demographic changes in the types of patients that we see. We have a lot of patients who are older and this presents more issues related to problems such as rotator cuff tearing and rotator cuff problems and advanced arthritic conditions. I think we still haven't conquered the rotator cuff. We know how to repair it, but we don't know how to make it heal better. We don't know how to prevent the gradual deterioration of the muscle and tendon structures of the rotator cuff, which occurs with aging naturally and also after successful rotator cuff surgery. There are areas that will probably evolve under better understanding and application of biologics.

There's a lot of interest in managing shoulder arthroplasty patients who have failed arthroplasties or those that have worn out over time. How do you manage these patients who have more complex problems with revision surgery? Another aspect of this is addressing things like periprosthetic infections. They're developing better ways to make the diagnosis, but we need to have better ways to figure out how to treat these patients successfully and maintain good outcomes. The other technological aspect that is coming into play is virtual reality and preoperative planning. A lot of us now use computer software to do the procedure virtually and plan ahead of time so that we can anticipate what we're gonna encounter and perform the surgery well. 

There are patient-specific guides and instrumentation available to make surgery more accurate, and then there's the implementation of augmented reality so that we can bring some of that planning into the operating room. I think these are things that are being intensely studied right now, and there's a lot of activity producing this and developing it. 

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