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Robert Purchase
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Shoulder, Knee, and Sports Medicine Specialist
Shoulder, Knee, and Sports Medicine Specialist

91 followers
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Check out this video about one of my total shoulder replacement patients made by Dignity Health for Saint Francis Memorial Hospital which serves San Francisco and the wider Bay Area. I think it came out great, probably because this patient is the best.

Shoulder replacements are done to treat pain from shoulder arthritis. To get the best outcome, find an orthopedic surgeon who does this type of surgery regularly.
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certificate of excellence. top 3 doctors in San Francisco.
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A new study published online in Arthroscopy: The Journal of Arthroscopic & Related Surgery, suggests that suspensory fixation may offer improved tendon-to-bone healing compared with interference screw fixation in tunnels for ACL reconstruction.

I switched to suspensory fixation for my anterior cruciate ligament (ACL) reconstructions a couple of years ago. This is just one of the reasons why I think it is better.
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The surgical outcome following total knee replacement has shown to be inferior in those patients who used pre-operative pain medicines. This study suggests that pre-operative opioid use may be linked to significantly lower preoperative baseline and final outcome scores after total shoulder arthroplasty or replacement (TSA), compared with patients who do not have a history of preoperative opioid use.

There are so many factors that go into making great surgical outcomes, this one factor needs more study so that we truly understand the why's and how's.
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This is a really exciting early development that MAY revolutionize the way we treat anterior cruciate ligament (ACL) tears. Investigators utilized advanced biologic techniques to get the injured ACL to heal instead of reconstructing it with a graft.

Consistent with the goals of a preliminary study, they found it to be safe. While data to show that it does not work well can come at any point in the process, tt will be at least 3-5 years before there is early data to suggest that this new way is better than the old way. So just don't tear your ACL in the next 3-5 years.
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Here is an important but, let's face it, boring paper that looks at the risk factors for infection after a rotator cuff repair.

I think that the overall rate of infections is more striking than the risk factors. After looking at 1,822 surgeries, the authors found a 0.77% infection rate. While zero infections is the goal, <1% is pretty impressive.
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There has been an important discussion occurring in the literature about subacromial decompression.

Subacromial decompression is removal of the "bone spur" in the shoulder. That bone spur is thought to cause shoulder pain and be one of the reasons why rotator cuff tears develop. For many years, it was gospel to remove the bone spur by performing a subacromial decompression.

For the last 10 years or so, we have been critically looking at the outcome data so that orthopedic doctors can offer their patients great outcomes.

This study, which looks at 20 YEAR DATA, suggests that subacromial decompression is a part of the surgical approach that your orthopedic surgeon should consider in providing patients with shoulder pain the best chance of a great result.
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It is great when patient's have choice and best when doctors and surgeons have options to present. This article validates my approach to treating patients with knee pain from arthritis who are not ready or are looking to avoid a total knee replacement.

It shows that Platelet Rich Plasma (AKA PRP) can decrease pain and result in significant clinical improvements up to 12 months postinjection. Clinical outcomes and functional scores are significantly better after PRP versus hyaluronic acid (AKA synvisc, supartz, etc.) at 3 to 12 months postinjection.
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Proximal humerus fractures, aka shoulder fractures, can be very tricky to treat and get a great outcome. A study published online in the Journal of Shoulder and Elbow Surgery finds that reverse total shoulder arthroplasty (RTSA) may be a cost-effective intervention in the surgical treatment of complex proximal humerus fractures. This suggests that it may be the best choice in many patients with this kind of injury.
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Subscapularis tears have long been a mystery and have been a special interest of mine for some time. More than a decade ago, I asked a residency mentor of mine, how many subscap tears did he see during shoulder arthroscopy. He said "not as many as see me." Unfortunately, the diagnosis of subscap tears remains a challenge.

This study looks at the coracohumeral distance to correlate it to tears of the rotator cuff tendon in the front of the shoulder, the subscapularis. The authors found that a coracohumeral distance of < 6 mm was always occurs alongside a degenerative subscap tear.
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