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10 KNoWleDGe FRoM ABRoAD A nEw APPROACH TO SHOulDER SuRGERY AT MACquARiE uniVERSiTY HOSPiTAl kAlmAn And his fAmily dr lAurent lAfosse, ChAir of the AlPs surgery institute RECEnTlY TRAinED AT THE wORlD fAMOuS AlPS SuRGERY inSTiTuTE in fRAnCE, AuSTRAliAn SHOulDER SuRGEOn, DR kAlMAn PiPER, bRinGS THE lATEST SHOulDER SuRGiCAl TECHniquES TO MACquARiE uniVERSiTY HOSPiTAl. In the past, many shoulder conditions were managed without surgery. Now, researchers are finding that results from non-operative approaches are not always favourable in the long term. As a result, surgeons are offering surgical solutions earlier rather than later when a patient presents with certain conditions. Macquarie University Hospital offers patients the most innovative procedures in shoulder surgery. Many of these are now offered as keyhole and arthroscopy techniques – rather than as traditional surgery – where a camera and instruments are inserted through much smaller incisions around the shoulder. The surgeon then performs the surgery while watching an image of the shoulder on a monitor. Macquarie University Hospital orthopaedic surgeon, Dr Kalman Piper, has recently returned from Annecy, France, where he completed a year of training in Advanced Shoulder Surgery under the world-renowned surgeon Dr Laurent Lafosse, Chair of the Alps Surgery Institute and a pioneer of modern shoulder surgery. Dr Lafosse, regarded as one of the world leaders in arthroscopic shoulder surgery, is an international consultant and speaker and was recently invited to lecture in Australia. Dr Piper was one of the first Australian doctors to receive training from Dr Lafosse and now brings with him skills in several innovative techniques. “A lot has changed since I began my original orthopaedic training ten years ago,” said Dr Piper. “The latest developments are moving towards keyhole or arthroscopic procedures. The Alps Surgery Institute is one of the world leaders in developing new techniques and in training doctors.” One of the most common conditions that shoulder surgeons encounter is a rotator cuff tear. While it is often associated with an injury to the shoulder, tears are present in many patients over the age of 60 years with no history of shoulder injury. In the past, this condition used to be managed by physiotherapy, with open surgery reserved for those who had ongoing pain for many months. Now surgery is performed for more patients using keyhole techniques and is showing improved long-term outcomes. Another common condition – whose treatment has seen rapid advances – is shoulder dislocation. In young adult males who have had a shoulder dislocation, the recurrence rates are as high as 85 per cent. Surgery is now recommended for most
patients with shoulder instability. There has been an evolution in surgical techniques, tailoring surgical solutions to the severity of damage within the shoulder. Dr lafosse developed the innovative arthroscopic laterjet procedure that addresses the problem of recurrent shoulder dislocation. This French procedure has been performed via open surgery for about 20 years, and has a proven track record. Dr lafosse’s new arthroscopic technique is the next generation in the management of shoulder dislocation, and the newly developed instruments for performing the surgery using keyhole incisions became available in Australia earlier this year. The technique is now the most advanced procedure available for challenging shoulder dislocation patients, and is offered at Macquarie University Hospital. Dr Piper and his team at Macquarie University Hospital can also perform shoulder replacement using minimally invasive techniques. “Shoulder replacement traditionally involved cutting the tendons at the front of the shoulder to insert a metal prosthesis,” said Dr Piper. “The minimally invasive technique involves insertion of the prosthesis between the tendons, without having to cut them, allowing faster recovery and earlier rehabilitation.” Similarly, the reverse shoulder replacement is a new innovation in shoulder surgery. Used in the management of massive irreparable rotator cuff tears, the reverse shoulder replacement solves a very difficult management problem. “If damaged for a long time, it is impossible to repair the rotator cuff tendons,” Dr Piper explained. “The torn rotator cuff tendons retract, scar-up and lose strength, eventually leaving the patient with an arm that is stuck by their side and useless. The reverse shoulder replacement gives patients the chance to regain some shoulder function as it does not rely on the rotator cuff to work.” Dr Piper says that performing these procedures at Macquarie University Hospital is, in many ways, a surgeon’s dream. The brand new facilities at the hospital give him easy access to the latest equipment. “The surgical equipment is state-of-the-art, and the digital cameras and monitors used to perform keyhole surgery are of the highest available quality,” noted Dr Piper. “As a doctor, you can see so much more through enhanced imaging. Better imaging means safer surgery and better patient outcomes.” “The facilities also mean that we can provide better teaching opportunities. We can record images and use them when teaching. In addition, live surgery can be broadcast between MUH and other hospitals, not just in Australia but internationally. This allows the spirit of surgical education, training and sharing of knowledge to flourish.” “Macquarie University Hospital not only provides patients with the latest in surgical options utilising advanced technology, but as a surgeon, it is a very exciting place to work.” For more information on shoulder surgery visit Dr Piper’s website at www.kaliper.com.au or phone 02 9113 0606 for an appointment. 11
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