Better function, faster recovery after shoulder replacement

Total shoulder replacements are becoming more common and more complex. Patients are staying active later in life and need relief from painful shoulder conditions that may once have gone untreated. At the same time, many patients have more advanced arthritis, bone loss or past injuries that make surgery more challenging than ever.

Orthopedic surgeons at WellSpan Health are meeting these needs with two innovations: 3D CT-based planning that customizes procedures with precision and Exparel®, a long-acting, non-opioid anesthetic that supports smoother recoveries.

“We’re using better tools before and during surgery — and patients are often surprised to feel less pain and recover faster than they expected,” says Matthew Reish, MD, orthopedic surgeon and director of the shoulder arthroplasty program at WellSpan Evangelical Community Hospital. The program is part of WellSpan Orthopedics, Pennsylvania’s first DNV Orthopedic Center of Excellence. WellSpan Evangelical Community Hospital and WellSpan Surgery and Rehabilitation Hospital are the only two hospitals in Pennsylvania to earn this distinction.

Planning with 3D imaging improves surgical precision for better patient results

Shoulder surgeons traditionally relied on X-rays or 2D CT scans to assess joint damage and plan for surgery. But 2D imaging can miss key details, especially in patients with severe wear, bone loss or structural damage.

With 3D CT-based software, WellSpan Health orthopedic surgeons can create a digital model of the patient’s shoulder joint. We can rotate the model on screen to view the joint from every angle and see the ball and socket separately. The software allows us to pinpoint areas of joint damage, select the optimal implant size and position for each patient, and even simulate parts of the procedure — all before stepping into the OR.

“Even in patients I’ve treated for years, the 3D planning reveals structural issues that wouldn’t be clear on X-ray,” Dr. Reish says. “It helps me see the patient’s needs so I can tailor their surgical plan ahead of time and avoid surprises in the OR.”

The 3D CT technology is especially valuable in complex or revision cases. For example, patients with a history of dislocation or rotator cuff tears may develop unusual patterns of arthritis that affect both sides of the joint. With 3D modeling, surgeons can simulate how much tissue to remove and test different implant options to predict how those may improve strength and movement. This planning helps tailor the procedure to the patient’s specific anatomy and goals, whether that means reducing pain, restoring function or both.

An active patient in their early 50s came to Dr. Reish after years of pain and limited mobility. Initial X-rays showed a bone spur about the size of a golf ball. What wasn’t immediately visible was that the spur had broken off, blocking the view of the socket. With 3D imaging, Dr. Reish saw that the socket had worn into a double-curved shape (a biconcave glenoid). That insight helped Dr. Reish choose the right implant type and size before surgery. “The 3D model gave me a more complete picture before surgery,” he says. “Without it, I would’ve been making key decisions about the type and size of implant during the procedure, and the surgery would have taken longer. More efficient surgeries can help patients recover faster with less pain.”

Managing pain with Exparel reduces opioid use

After surgery, many WellSpan Health patients benefit from a new advance in pain management. We use Exparel, a long-acting numbing medication given during surgery, to help control pain afterward.

Unlike traditional anesthetics that wear off quickly, Exparel is designed to release medication gradually to manage pain. For patients, this extended pain relief means avoiding the abrupt “crash” that often follows shorter-acting nerve blocks.

“With Exparel, we’re able to carry patients over the peak of the pain curve,” Dr. Reish says. “Instead of going from numbness to pain when the nerve block wears off, they’re already on the other side — and often managing with just over-the-counter medication.”

In a one-year review of WellSpan Health’s shoulder replacement patients who received Exparel, we found that 50% didn’t need any opioids after surgery. And the other 50% needed less pain medication and for a shorter time than those who didn’t receive Exparel. “Patients were expecting more pain,” Dr. Reish says. “They kept saying, ‘I thought I’d need something stronger, but I’m just taking Tylenol® or ibuprofen.’ It was a relief for patients to have a non-opioid option that really worked.”

Using innovative tools improves shoulder replacement recovery and results

3D planning and Exparel are helping Dr. Reish and his colleagues deliver safer, more effective care in shoulder replacement surgery. These innovations help patients achieve what matters most to them: better movement, more strength and less pain.

“When people wake up comfortable and start moving again, faster than they thought possible, it changes what they believe recovery can feel like,” Dr. Reish says.