Dr. E. Scott Paxton, a member of the Division of Shoulder and Elbow Surgery at University Orthopedics and an assistant professor of orthopedic surgery at the Warren Alpert Medical School of Brown University, has started performing two new surgical procedures of keen benefit to a growing number of younger, more active patients with sports- and exercise-related injuries.
Paxton completed fellowship training in the treatment of problems of the shoulder and elbow at the Rothman Institute in Philadelphia, where he trained with many of the world’s leaders in shoulder and elbow surgery. Today, Paxton is an attending surgeon at Rhode Island Hospital and The Miriam Hospital in Providence, and a consultant at the Providence V.A. Medical Center.
Providence Business News asked Paxton to talk about some of the new surgeries he has begun performing, including the Tornier Simpliciti shoulder implant and the allograft dermis shoulder reconstruction, and how the procedures benefit younger patients, as well as his approach to various new orthopedic procedures.
PBN: The Tornier Simpliciti prosthesis appears to leave the patient’s existing shoulder mostly intact. Can you explain the problems this procedure addresses and compare it to previous approaches?
PAXTON: This implant is the only stemless shoulder replacement on the market in the United States. It allows for treatment of shoulder arthritis with preservation of more bone, while also resurfacing both sides of the ball and socket joint to decrease pain and improve motion.
Traditional implants require a stem that goes down the center of the bone with the bone then attaching itself to the implant over time or the stem being cemented into place down the shaft of the arm. This new technology does not require a stem down the center of the bone or cementation in the arm bone. Therefore, if a revision surgery needs to be done in the future and the implant needs to be removed, it can be done much easier and with much less damage to the bone of the upper arm. This makes it easier to re-implant a subsequent shoulder implant and likely improves the outcomes of a subsequent procedure. This is especially important in younger patients undergoing a shoulder replacement
PBN: Please explain how allograft dermis is used to reconstruct portions of the shoulder to improve function. Also, what is “allograft dermis”?
PAXTON: This new technique was originally described in Japan, but now has gained popularity in the United States. This procedure is designed for patients with very large tears of the rotator cuff that are not able to be repaired.
Allograft dermis is the deeper part of the skin. In this procedure, it is taken from a deceased human donor and processed to remove all DNA, leaving the portion that provides strength behind.
For those patients with large, irreparable rotator cuff tears that have yet to develop significant arthritis, who have higher-demand levels or who are younger, a procedure where the portion of the shoulder, the superior capsule, is reconstructed, is showing great promise. The superior (top) part of the joint capsule becomes deficient in these large tears and allows the ball to slide upwards on the socket. In this procedure it is reconstructed with allograft dermis. This results in the ball being re-centered on the socket. This can significantly improve function and also decrease pain, all while allowing preservation of their native joint without the need to replace it.
Again, this is especially important in younger patients. Twenty years ago, there were few options for these patients in the United States. Newer technologies, including a specific type of shoulder replacement (the reverse shoulder replacement) for patients with large irreparable rotator cuff tears, who also have shoulder arthritis, have improved our ability to treat these patients successfully.
PBN: You appear to be a frequent early adopter of new orthopedic procedures – what’s driving that for you and how is it affecting your practice?
PAXTON: I certainly am not an early adopter of all new technologies, but there is a tremendous amount of advancement being made in the field of orthopedics and especially shoulder surgery. Therefore, as specific technology and techniques become available, I evaluate them. The vetting process is quite rigorous. It often includes lab demonstrations, cadaver trials, biomechanical testing and participation in training courses. After a thorough evaluation, if I see a benefit to my patients, I will include it in the treatment of my patients so they can ultimately benefit.
PBN: You mention some of the new procedures treat younger, more-active people with shoulder arthritis. Is that a growing demographic?
PAXTON: Shoulder replacement is the fastest-growing joint-replacement procedure in the United States. The rate at which shoulder replacements are being performed is increasing at a rate faster than both hip and knee replacement. With a more-active population and our ability to treat younger patients with newer technology, this demographic is increasing in size.
PBN: Can you share a new treatment on the horizon that you find the most exciting?
PAXTON: University Orthopedics’ affiliation with Warren Alpert Medical School at Brown University allows us to direct many clinical research efforts intended to innovate new orthopedic surgery techniques. With so many advancements being made in orthopedics, it is difficult to pick any one treatment that I am most excited about. The treatments that I do get most excited about, however, are the ones that fill a gap in our ability to treat certain patients. They are treatment modalities for unmet clinical needs. Fortunately, as we continue to advance, the amount of these unmet clinical needs is decreasing.
Rob Borkowski is a PBN staff writer. Email him at Borkowski@PBN.com.