Joshua Dines, MD, Hospital for Special Surgery, New York City, talks about the biggest innovations in shoulder surgery and where the field is headed in the future.
Dr. Joshua Dines: Over the last five to 10 years, there has been a trend toward doing things more arthroscopically, making things less morbid to the patient and providing quicker recoveries without sacrificing outcomes. While we've gotten better with minimally invasive techniques, we've also done better research-wise by looking at and critically evaluating our outcomes. For some pathologies, orthopedic surgeons were tending to do more repairs arthroscopically in lieu of more traditional open surgeries but we are finding that in some cases the open surgeries were providing better outcomes.
Additionally, no discussion about where the field is going is complete without talking about biologics. As surgeons we have gotten better technically at repairing things. We are using stronger implants and repair constructs which help, however continuing to improve or even speed up recoveries will hinge on improving the biology of the repair millieu. We have made some progress over the last few years and that's where research will be focused.
Another topic of interest centers on patients-specific implants to give people the best possible outcomes and speedier recoveries. The quicker patients recover, the less time they are out of work. If I can get my patients back to work more quickly, there is the emotional benefit and the financial benefit.
As we do more procedures with patient-specific instrumentation and implants, we may make surgeries technically easier which will increase reproducibility and lead toward better outcomes. If we can do surgeries more easily, there might be less blood loss and time under anesthesia, which can lead to outpatient shoulder replacements.
I think eventually the overwhelming majority of shoulder procedures in my practice will be performed on an outpatient. I do probably 400 shoulder surgeries per year and 325 could be outpatient. The other 75 are shoulder replacements that require patient stays now, but there is no reason why patients without more medical issues can't be shifted to outpatient surgery.