Sunday, January 23, 2022

The future of shoulder surgery

Shoulder and elbow surgery is 75% knowledge, 75% skill and 75% art. It cannot be learned from books or labs alone; rather, like a new language, acquiring mastery requires immersion in a comprehensive experience focused on the evaluation and management of patients and a philosophy of practice. To provide this opportunity to selected young orthopaedic surgeons, we are interviewing candidates for the University of Washington Shoulder and Elbow Fellowship. Ours is a one year advanced clinical and academic experience that enables two highly qualified orthopaedists to hone their skills as shoulder and elbow surgeons, as investigators and as educators.

Our fellowship started in 1988, making it one of the longest standing advanced clinical experiences in our field - this will be our 35th anniversary! Our 56 graduates now practice shoulder and elbow surgery across the country - from Seattle to Miami, from SanDiego to Portsmouth, New Hampshire. Almost all of our graduates are members of the American Shoulder and Elbow Surgeons (ASES). One-quarter of our graduates have been recruited to university faculty positions. 

Here are a few of our "senior" fellows, perhaps you recognize some of them.


From left to right, Steve Lippitt, John Sidles, Mark Lazarus, Kevin Smith, David Duckworth, the late Doug Harryman, Michael Pearl, Rick Matsen, Dean Ziegler, Craig Arntz, and Tony Romeo. A complete list of our alumni can be seen in this link.


Our goal is to enable our fellows to master advanced skills in diagnosis and surgical management of both common and rare conditions that prevent patients from enjoying their lives.  In addition, we will provide opportunities for them to help answer some of the major questions faced by our specialty, such as
(1) when is rotator cuff repair not in the best interest of a patient with a cuff tear?
(2) what can be offered to a patient with arthritis who wishes to pursue activities beyond what is recommended for a conventional total shoulder?
(3) how can surgeons monitor the quality of their practice outcomes to identify what is working and what is not?
(4) how can we avoid unnecessary expenses of imaging - a cost that consumes much of the resource spent on shoulder and elbow care?
(5) how can we evaluate the many new orthopaedic implants and products brought to market each year to determine if their increased cost results in increased benefit to our patients?
(6) how can we make shoulder and elbow surgery safer from the risk of infection?

We are excited to be tackling these and other 'big questions'. We are excited to have the partnership of our fellows, who help us and who end out teaching us as well. For sure, the future is brighter because of them.

Here are the publications of our core faculty
    Jason Hsu
    Jonah Hebert-Davies

Here are some of the approaches we share with our fellows


How to get the most information out of plain x-rays (see this link)

Managing irrerparable rotator cuff tears (see this link)
How to do a robust anatomic totals shoulder (see this link).
The ream and run technique for active individuals (see this link).
The cuff tear arthropathy arthroplasty (see this link).
A straightforward approach to reverse total shoulder arthroplasty (see this link).

Here are some links that may be of interest: