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INHANCE™ Shoulder System: A new option for reverse shoulder replacement surgery

For Arthritis Awareness Month, learn how Johnson & Johnson MedTech is innovating to help improve outcomes with this complex procedure.

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235 percent.

That’s the estimated increase there will be in shoulder replacement surgeries between 2017 and 2025.

Shoulder arthroplasty, as this type of surgery is known, “used to be primarily for people in their 70s, but now we’re seeing younger patients who developed early shoulder osteoarthritis from years of playing repetitive sports like tennis and swimming,” says Anand Murthi, M.D., Chief of Shoulder and Elbow Surgery at MedStar Union Memorial Hospital in Baltimore.

But while shoulder replacement surgery is increasingly common, that doesn’t mean it’s uncomplicated. “Your shoulder is a complex joint,” explains Dr. Murthi. It’s a ball-and-socket joint: The ball, or head of your upper arm bone, fits into a shallow socket in your shoulder blade known as the glenoid. Three bones, nearly a dozen different muscles and numerous ligaments and tendons meet in the shoulder. This allows us to move our arms any which way, but it also makes the shoulder more at risk for injury.

Traditional shoulder replacement and reverse shoulder replacement

Traditional shoulder replacement, left; reverse shoulder replacement, right

In traditional shoulder replacement surgery, either just the ball, or both the ball and the glenoid, are replaced. But 70% of all shoulder replacement procedures are something known as reverse shoulder replacements, meaning the ball and socket parts switch sides.

“This is better for people who have very severe arthritis, or have certain injuries like to their rotator cuff, because a standard shoulder replacement might leave them with still limited movement,” explains Dr. Murthi.

Your rotator cuff is a group of muscles and tendons that hold your shoulder joint in place and allow you to move your arm and shoulder. But if those muscles and tendons are severely damaged, the joint may not be stable or work properly even after a traditional shoulder replacement. With a reverse shoulder replacement, however, the large deltoid muscle that covers the shoulder is typically able to move the arm instead. “Rather than use their rotator cuff to lift their arm, patients can use the deltoids,” says Dr. Murthi. “This way, they can usually resume all of their old activities.”

The system is very streamlined with only two instrument trays, offering surgeons a lot of flexibility in the operating room to perform multiple functions depending on the procedure.
Matthew Holda

Last year, following clearance for its use in anatomic shoulder arthroplasty, DePuy Synthes, a Johnson & Johnson MedTech company, received clearance from the Food and Drug Administration to use its INHANCE™ Shoulder System in reverse shoulder replacement procedures. “The system is very streamlined with only two instrument trays, offering surgeons a lot of flexibility in the operating room [OR] to perform multiple functions depending on the procedure,” says Matthew Holda, Senior Marketing Director, Growth and Innovation, Shoulder Reconstruction, DePuy Synthes.

Often, he notes, a surgeon will go into a procedure intending to do a traditional shoulder replacement surgery, only to find that a patient’s rotator cuff is in bad shape. Since the Inhance Shoulder System is approved for both traditional and reverse shoulder replacements, the surgeon can make that switch in the OR, on the spot, without having to change out the system or instruments. “The hope is it will reduce the need for shoulder replacement revisions down the road,” notes Dr. Murthi. Dr. Murthi, a design surgeon who helped develop the Inhance Shoulder System and who receives royalties, is a consultant for an affiliate of DePuy Synthes.

3 Things to Know About Inhance

The system’s versatility is just one of its unique characteristics. Here’s a closer look at what makes Inhance so special.

1. Flexibility and efficiency
Most patients used to spend a few days in the hospital following shoulder replacement surgery, but not anymore. “More than 90 percent of all orthopedic procedures now are done as outpatient surgery, so patients go home the same day,” explains Dr. Murthi.

And Inhance helps make the surgery more efficient: In anatomic procedures, a stemless option is available for qualifying patients. In this case, a rod isn’t inserted into the patient’s arm bone, like it is for most other shoulder replacement surgeries. This may result in up to 25 minutes less time in the OR and an up to 16% reduction in blood loss. “It means less pain, less bone loss and a faster surgery,” says Dr. Murthi.

While other shoulder replacement systems have stemless options, Inhance is the only one that allows a surgeon to use it for both a traditional and a reverse shoulder replacement. That versatility allows a surgeon a lot of flexibility in the OR. “Let’s say that the surgeon plans on doing a regular shoulder replacement but they get in there and see that the rotator cuff is in bad shape,” explains Dr. Murthi. “They can continue right there, on the spot, with a reverse shoulder replacement, without having to change out the system or instruments.”

The Inhance system also has fewer trays and fewer instruments, which not only results in cost savings per case but also reduces the amount of storage and cleaning. “It’s easier to keep things sterile, and there’s less risk of infection,” explains Dr. Murthi. This also means that the OR staff spends less time searching for equipment and lifting and transporting it all.

Inhance reverse should replacement

The Inhance Shoulder System

2. A unique design

“The number-one complication with reverse shoulder replacements is dislocation,” says Dr. Murthi. The Inhance implant itself has a 135-degree neck shaft angle, and “the hope is that it’s a more stable construct, so it will be less likely to get dislocated over time,” he adds. It’s also designed in a way to reduce the number of surgical steps.

What’s more, the glenoid implant itself is made of a substance called cross-linked vitamin E polyethylene, which has been shown to reduce wear and tear on the implant. As a result, shoulder replacements have the potential to last longer..

3. Potential for faster recovery
Since the implants are smaller than traditional ones, incisions are too, which potentially leads to a quicker recovery time with less disruption to surrounding muscles and tissues. “When we’ve followed patients in our registry with regular X-rays and range-of-motion and pain scores, we see the same thing consistently—an earlier return to function, and earlier pain relief,” says Dr. Murthi, who has done hundreds of these procedures over the last six to eight months.

There is one caveat: To get the best results, you need to have a home therapy program or go to formal physical therapy for around three months—and stick with it. “The key to a successful shoulder replacement is flexibility over strength,” explains Dr. Murthi. “That’s why most people require physical therapy to maintain range of motion as much as possible.” When that happens, patients are usually back to regular activities within three months. “My golfers are back on their feet and able to chip and putt at six weeks,” he says.

*Important Safety Information: It is important to remember that the performance of joint replacements depends on age, weight, activity level and other factors. There are potential risks and recovery takes time. People with conditions limiting rehabilitation should not have these surgeries. Only an orthopaedic surgeon can determine if joint replacement is necessary based on an individual patient’s condition.

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