Article

High-Tech Approaches Can Improve Shoulder Surgery Outcomes

But expertise and experience still provide a key to success

Shoulder radiograph with added pain indicator

When orthopaedic surgeon Oke Anakwenze, MD, MBA, walks into the operating room to perform surgery on his most challenging shoulder reconstructive cases, he has already mapped out and practiced the procedure on his laptop using advanced imaging, software modeling, and 3-D printing to create an exact model of the patient’s shoulder.

The chief of shoulder surgery at Duke, Anakwenze says that this high-tech approach is extremely valuable for patients with severe deformities. Without it, “you are not sure how much bone they have or what you can do, so you recreate a model of their specific disease and deformity. This way, there are no surprises,” he says.

He begins the process by working with the Radiology Department to obtain a specialized, small-slice CT scan that measures all the angles of the patient’s shoulder. The scan information is then combined with sophisticated software to create a physical model of the shoulder and to show where bone grafts will be needed to correct specific defects. The modeling means that any required custom implants can be on hand to ensure that he is using the right ones. It also enables Anakwenze and his team to place trackers on the patient’s shoulder and use custom guides to maximize accuracy.

Anakwenze recently joined Duke from a joint replacement practice he founded in southern California, where he became comfortable handling any kind of shoulder surgery. “As a tertiary-level provider, I get referrals for complex revision surgery, such as significant bone loss, significant trauma, nerve injuries, periprosthetic fractures, and various other complications after shoulder replacements, such as dislocations or infections,” Anakwenze says. Other less common surgeries that Anakwenze offers include tendon transfers, reverse shoulder replacements, and superior capsular reconstruction using tissue grafts for massive, irreparable rotator cuff tears.

Additionally, Anakwenze is pursuing an active research program, exploring, for example, new pain protocols to minimize narcotic use by using more sophisticated multi-modal pain regimens. He is also studying new forms of local anesthetics, infused by the anesthesiologists, that can increase the duration of pain relief from 12 hours to 48 hours. Other research involves new implants and techniques to manage complex shoulder fractures. He is creating an outpatient shoulder replacement program to allow healthy patients to go home the same day of surgery.

Introducing state-of-the-art surgical techniques and performing cutting-edge research are just the first steps in his goal of building a center for excellence in shoulder surgery at Duke, Anakwenze says.