Exactech Computer-Assisted Shoulder Replacement

Patients suffering from severe shoulder pain know that it can impact every aspect of life, from mobility to sleep to the ability to perform basic daily tasks like getting dressed or pushing a grocery cart. The shoulder is a ball and socket joint, comparable to the hip, and has a greater range of motion than any other joint. It’s made up of three bones: the humerus (upper arm), scapula (shoulder blade), and clavicle (collarbone), which converge at the socket. The head of the humerus is the “ball” that fits into the glenoid cavity, the “socket” part of the scapula, and is stabilized by a ring of cartilage called the glenoid labrum. Damage to this protective cartilage can cause the bones to rub together, leading to joint pain that can be debilitating.

Damage to the shoulder joint can occur as a result of osteoarthritis, rheumatoid arthritis, rotator cuff tear arthropathy, or bone deterioration caused by restricted blood (avascular necrosis), among other conditions. For patients who haven’t found relief with non-surgical treatments like physical therapy or steroid injections, shoulder replacement surgery may be recommended. The outpatient procedure involves making an incision to access the shoulder joint. The surgeon then removes the damaged cartilage or parts of bone, and replaces them with metal and/or plastic implants.

X-rays have traditionally been used to assess a patient’s shoulder before replacement surgery, but x-ray doesn’t provide a comprehensive view of the joint. Now, some orthopedic surgeons–including our own Dr. Noerdlinger–have embraced a state-of-the-art technology called Exactech Guided Personalized Surgery that creates a detailed 3D model of the shoulder joint. The visual map allows the surgeon to plan and virtually simulate the surgery in advance, and utilize computer-assisted guidance during the procedure. The replacement surgery can be tailored according to the individual patient’s unique anatomy, allowing for optimal implant placement. Exactech GPS enhances precision and accuracy, resulting in better functionality, fewer complications, and an expedited recovery process.

Specializing in shoulder surgery (both Arthroscopic & Shoulder Replacements), our own Dr. Noerdlinger has been voted Top Orthopedic Surgeon by New Hampshire Magazine every year from 2017 to 2023. Dr. Noerdlinger performed 140 replacement surgeries in 2023 and is recognized as one of the top shoulder surgeons in New England. Below, he answers some questions about Exactech GPS.

In your own words, how does this procedure benefit your patients?
The Exactech GPS system allows surgeons to place the shoulder replacement in the most accurate position, which improves outcomes.

Who is a good candidate for Exactech Guided Personalized Surgery?
Anyone considering a shoulder replacement.

Where do you perform this procedure?
I perform the surgery at NECOS and at York Hospital.

Anything else you’d like current or future patients to know about this procedure and how it would benefit them?
Patients considering a shoulder replacement should know that it’s an outpatient procedure and the recovery is quicker than many think. Patients often don’t need post-operative physical therapy. For a Reverse Total Shoulder Replacement, patients can expect to wear a sling for one week, and patients undergoing Anatomic Total Shoulder Replacement can expect to wear a sling for about 6 weeks.

If you’re suffering from shoulder pain and reduced joint function, schedule a consultation with Dr. Noerdlinger to find out if you’re a candidate for Exactech GPS-assisted shoulder replacement surgery. Don’t postpone getting help, so you can get back to enjoying the activities you love.

Platelet-Rich Plasma (PRP) Injections Help the Body Heal Itself

What Are Platelet-Rich Plasma (PRP) Injections?

PRP injections are a treatment that separates the platelets in a patient’s own blood and uses them to promote healing. A small sample of blood is collected and placed in a centrifuge, a machine that spins at high speeds to separate the platelet-rich plasma from the other components, like red and white blood cells. Guided by ultrasound imaging to ensure accuracy and precision, the concentrated PRP is then injected directed into the affected area. The entire procedure takes about an hour.

Post-injection care may mean avoiding certain movements or activities for a period of time to optimize the healing process and minimize potential side effects. It’s normal for the injection site to become inflamed and may be quite painful for one to three days following treatment. The swelling and soreness are part of the healing process, and patients should avoid taking anti-inflammatory medication like Aspirin or ibuprofen, which can make the injection less effective.

What conditions do PRP injections treat?

PRP injections are frequently used to treat musculoskeletal injuries and orthopedic conditions like tendonitis, ligament sprains, bursitis, and partial rotator cuff tears, and tennis elbow. The injections can also be used to reduce joint pain, stiffness, and inflammation caused by arthritis.

How long will it take for me to see improvement?

Because the bioactive substances in the platelet-rich plasma need time to stimulate tissue repair and cellular regeneration, it can take a few weeks to start noticing the effects of PRP injections. Patients with musculoskeletal injuries like tendonitis or ligament sprains may experience improved functionality and pain relief quicker than patients with more severe or chronic conditions. Factors like age, overall health, and adherence to post-injection instructions all influence the speed of the healing process. It’s crucial to follow your doctor’s recommendations to maximize treatment benefits.

We recently sat down for a Q&A with our Sports Medicine provider and PRP expert, Dr. Andrew McMahon.

Q: In your own words, how does this procedure benefit your patients?
A: Platelet-rich plasma (PRP) therapy uses injections of a concentration of a patient’s own platelets to accelerate the healing of injured tendons, ligaments, muscles and joints. In this way, PRP injections use each individual patient’s own healing system to improve musculoskeletal problems.

Q: Who is a good candidate for a PRP Injection?
A:

Patients with overall good health
Patients with mild to moderate arthritis, partial tears, or chronic wear and tear injuries
Patients with decreased function due to pain, stiffness, or lack of mobility
Failure with more conservative treatment methods

It’s important to note that while PRP injections are generally considered safe, they may not be suitable for everyone. The treatment can’t be used if the tendon is torn completely and though PRP injections can address symptoms of arthritis, they can’t reverse pre-existing damage. The treatment’s efficacy and appropriateness depend on the specific condition being treated and individual patient factors. It’s important to consult with a specialist to evaluate whether PRP injections are appropriate for your specific needs.

Q: Where do you perform this procedure?
In our Portsmouth, NH office only, some of the surgeons use it intraoperatively.

Q: Do you have a recent patient success story you can share?
A: Recently, I have had a lot of success with PRP treating knee arthritis. Peter S. is a 68-year old gentleman who is very active in tennis/pickleball and is an avid skier. His moderate arthritis has given him a lot of stiffness and some pain which resulted in him cutting back on these activities at times, affecting his happiness and mental health. He had a consult for treatment options and we ultimately opted to inject PRP into both knees. Within 4 weeks, he had regained a significant amount of his function and he was able to play more tennis, and he successfully took a week long ski trip to Colorado.

Q: Anything else you’d like current or future patients to know about this procedure and how it would benefit them?
A: In the appropriate patient, PRP can offer a nice treatment option for patients with musculoskeletal problems who have failed conservative treatment options like PT, bracing, and cortisone injections. PRP can help heal soft tissue injuries (a torn tendon, for example), potentially avoiding surgical repair. PRP also provides patients with arthritis a treatment option that decreases pain and increases mobility and function. It typically lasts 2-3 times longer than cortisone injections and does not contribute to deterioration of the joint like a cortisone injection can.

Think PRP Injections may be right for you? Schedule a consultation with our specialist Dr. McMahon to learn more.

Pain Relief for Rotator Cuff Tears–Introducing the Stryker InSpace Balloon

What is a Rotator Cuff Tear?

The rotator cuff is a group of four tendons that surround and stabilize the shoulder joint, connecting the muscles of the upper arm to the shoulder blade. When a rotator cuff tear occurs–from acute trauma, repetitive stress, or degeneration over time–the tendon becomes separated from its attachment point on the bone. Rotator cuff tears are painful and cause weakness in the joint and limited shoulder mobility. Common symptoms of a tear include difficulty lifting your arm, a popping or crackling sensation in the shoulder, and pain both at rest and with movement.

Unfortunately, rotator cuff tears don’t heal on their own. If an untreated tear results in arthritis in the joint, patients often require shoulder replacement surgery, but for patients who still have shoulder function and haven’t developed arthritis, there is a less invasive treatment option called the Stryker InSpace Balloon.

What is the Stryker InSpace Balloon?

The Stryker InSpace Balloon is a medical device used to treat rotator cuff tears. It’s made of biocompatible material–a substance that can be implanted in the body and tolerated without damaging existing tissue. The balloon creates more space within the subacromial area–the space between the bone at the top of the shoulder and the ball of the shoulder–reducing compression and friction caused by the torn rotator cuff.

What’s involved in the procedure?

The Stryker InSpace Balloon is placed arthroscopically, using a small incision and the guidance of a camera to precisely place the deflated balloon in the subacromial space. The balloon is then inflated with a sterile saline solution, causing it to push the acromion away from the rotator cuff tendons. This reduces impingement on the injured tissues to restore function and alleviate pain.

The procedure is minimally invasive and performed on an outpatient basis. Recovery time varies, depending on the individual patient and the extent of the injury, and rehabilitation may include physical therapy to help restore strength and mobility in the shoulder.

How do I know if the Stryker InSpace Balloon can help me?

If you’re experiencing shoulder pain, or have been diagnosed with a rotator cuff tear, it’s important to consult with a shoulder specialist as soon as possible. The specialist will evaluate your injury and medical history, and may recommend the Stryker InSpace Balloon procedure as a treatment option.

Below is our Q&A with Dr. Noerdlinger, an orthopedic surgeon specializing in the shoulder. Dr. Noerdlinger is a partner at Atlantic Orthopaedics with extensive experience performing the Stryker InSpace Balloon procedure.

Q: In your own words, how does this procedure benefit your patients?
A: This is a pain relieving procedure.

Q: Who is a good candidate for the Stryker InSpace Balloon procedure?
A: The procedure is indicated for patients with irreparable rotator cuff tears, with good shoulder function and minimal to no arthritis.

Q: Where do you perform this procedure?
A: I perform the procedure at NECOS (New England Center for Orthopaedic Surgery) in Portsmouth, and York Hospital in Maine.

Q: Do you have a recent patient success story you can share?
A: I performed the Stryker InSpace Balloon procedure on a 67 year old man with years of pain and an unfixable rotator cuff tear. He described his shoulder as getting worse despite physical therapy and injections. He had pain with an active range of motion, and stated his shoulder was 30% normal. Four months after his February surgery, he described his pain as a 2 out of 10 on a daily basis and rated his shoulder as 60% normal.

I also treated a 73 year old female patient who came to me with pain from an irreparable rotator cuff tear. She described her shoulder as 40% normal before the procedure and 70% normal 3 months after her March 1st surgery.

Another patient, a 60 year old man with bilateral irreparable rotator cuff tears, had the balloon placed in his right shoulder on March 1st, and his shoulder improved from 20% normal to 65% normal in 6 weeks. He then underwent left shoulder balloon placement May 10th.

Q: Anything else you’d like current or future patients to know about this procedure and how it would benefit them?
A: The rotator cuff is the one structure that, when torn, causes the most pain and dysfunction in the shoulder. Rotator cuff tears do not heal, get bigger over time, become unfixable, and cause arthritis. Rotator cuff repair surgery is very successful and can restore normal, pain-free function.

If the rotator cuff is irreparable, the painful shoulder is often treated with a reverse shoulder replacement. For patients with unfixable, painful rotator cuff tears with little to no arthritis and good function, an InSpace balloon is a good option.

If you’re suffering from shoulder pain from a rotator cuff tear that hasn’t responded to treatments like injections or physical therapy, schedule an appointment to find out if the Stryker InSpace Balloon procedure is right for you.

What is Collagen Augmented Rotator Cuff Repair?

Rotator cuff injuries are one of the most common causes of shoulder pain, affecting more than 2 million Americans each year. If you have a partially torn rotator cuff that hasn’t responded to non-surgical treatment like physical therapy and cortisone injections, you may be a candidate for a procedure called Collagen Augmented Rotator Cuff Repair, performed by our shoulder specialist Dr. Noerdlinger.

What is the rotator cuff?
Shoulders are not singular joints, but rather a complex arrangement of bones, cartilage, ligaments, muscles, and tendons. The rotator cuff is made up of four muscles, connected by tendons, that originate from the shoulder blade (scapula) and attach to the upper arm bone (humerus) to form a cover, or “cuff.” The rotator cuff provides stability to the shoulder joint and helps the arm lift and rotate.

What causes a rotator cuff tear?
A rotator cuff tear happens when the tendons pull away from the bone. With a partial tear, the tendon remains attached to the bone and with a full tear it separates from the bone completely. Tears most commonly happen as a result of normal wear and tear due to aging, with people over 40 at greatest risk. A tear can also be caused by an acute injury like a fall, from repetitive shoulder movement from jobs like carpentry or painting, or from sports like tennis or rowing. Untreated, a rotator cuff tear can worsen over time and may lead to chronic shoulder pain and limited range of motion.

How do I know if I have a rotator cuff tear?
The most common symptom of a rotator cuff tear is pain. A tear can also cause weakness in the arm and shoulder, difficulty raising your arm or lifting something, and a clicking or popping sensation in the shoulder. You may also experience swelling or tenderness in the shoulder joint. If you think you have a rotator cuff tear, a doctor will need to perform a physical exam and may confirm your diagnosis with an x-ray, MRI, or ultrasound.

What is Collagen Augmented Rotator Cuff Repair?
Collagen augmented rotator cuff repair is a surgical technique that uses a collagen implant to reinforce the rotator cuff repair. The implant is made of a biologically derived material similar to the collagen found in human tissue. It’s designed to provide additional strength and support to the healing tendon, reducing the risk of re-tear. The postage-size collagen patches are absorbed by the body within about 6 months, and patients generally experience shorter recovery times than with conventional rotator cuff surgery.

We recently sat down with shoulder specialist Dr. Noerdlinger and asked him a few questions about this procedure.

Q: How does this procedure benefit your patients?
A: Collagen implants can lead to quicker recoveries. Adding collagen facilitates the biologic healing of torn tendons in certain situations. They are used in two situations:

To repair a partially torn rotator cuff tendon. In this scenario, the collagen is laid on top of the partially torn tendon. The implant blends in with the thinned rotator cuff tendon, thickens it and allows it to heal. Patients, with partial tears, do not need to wear a sling after surgery.
To augment a repaired shredded tendon that may not heal on its own, particularly in the setting of a revision rotator cuff tear when the tendon did not heal after the first surgery.

Q: Who is a good candidate for the Collagen Augmented Rotator Cuff Repair Procedure?
A: Not everyone is a candidate for this procedure. Patients with irreparable rotator tears would not qualify for this procedure. Also, patients with good tissue may not need to augment their repairs.

Q: Where do you perform the Collagen Augmented Rotator Cuff Repair procedure?
A: The procedure requires anesthesia and is performed arthroscopically at NECOS and York Hospital.

Q: Can you tell us about a success story?
A: I recently saw a 56 year old female with worsening constant shoulder pain since April 2022. I performed a Partial Rotator Cuff Repair with collagen implant in January of 2023. She was seen in early March of 2023 and reported to be doing well with minimal complaints of pain.

NOTE: Shoulder surgery has a long recovery and often people take 4-6 months before they feel great. Having an expert shoulder surgeon like Dr. Noerdlinger may help speed up recovery.

First In Maine!

Dr. Mayo Noerdlinger, Board-Certified Orthopaedic Surgeon and provider at Atlantic Orthopaedics & Sports Medicine, recently became the first surgeon in Maine to perform a computer navigated stemless total shoulder replacement using ExactechGPS-guided technology, an innovative new procedure for shoulder replacement. Already one of the top shoulder surgeons in the Northeast.

Dr. Noerdlinger and his patients continue to benefit from this new technology, a major advancement in shoulder replacement. Dr. Noerdlinger also performed the first GPS-guided total shoulder surgery at York Hospital, the first hospital in the Northeast to purchase ExactechGPS.

ExactechGPS shoulder replacement, also called ExactechGPS Shoulder Application, improves the precision and predictability of shoulder surgery from preoperative planning to real-time execution. This new technology helps the surgeon better understand his or her patient’s anatomy before entering the operating room, and during surgery ExactechGPS provides a real-time view of the implant placement process and guides the surgeon toward any necessary adjustments.

“The shoulder replacement technology keeps getting better, allowing the surgeon to reproduce the patient’s anatomy in a more minimally invasive and bone sparing manner,” said Noerdlinger. “By replicating the patient’s anatomy, we anticipate the functional outcomes will improve and the recovery times will shorten. As life expectancies increase, the longevity of joint replacements becomes more and more of an important issue. Shoulder replacements are thought to last 15-20 years before patients might develop pain needing revision surgery. With the stemless design, there is less metal going into the bone, which will make future surgeries easier to perform. This new design is a particularly attractive option for younger patients undergoing shoulder replacement surgery.”

Mayo Noerdlinger, MD, FAAOS, CIME, specializes in orthopedic, reconstructive and arthroscopic surgery; shoulder surgery and replacement; reverse shoulder replacement; treatment of torn tendons and ligaments; sports medicine and others. He is also the physician behind Seacoast Shoulder, which offers patients the latest in state-of-the-art treatment for shoulder ailments of all kinds. Visit www.atlanticorthopaedics.org for more information, or call 603.431.1121.

Atlantic Orthopaedics & Sports Medicine is a group of Board-Certified physicians who utilize the latest concepts in orthopaedics and sports medicine, coupled with preventive and surgical techniques. For more information, visit www.atlanticorthopaedics.org, or call the Portsmouth clinic at 603.431.1121.

York Hospital‘s surgery center mixes advanced technology with personalized care in a comfortable, and caring environment. The center is equipped with five surgical suites staffed by a dedicated and highly trained team of specialists that care for patients preoperatively, during surgery and in recovery. Our center is well-equipped with the latest advances in technology and instrumentation for the more than 6,500 surgical procedures annually. For more information, visit yorkhospital.com or call 207-351-2385.