WARNER'S CORNER

How Hospitals Confront New Technology

Dear CSS Members and Colleagues: As the next annual meeting of the CSS will consider Disruptive Technologies for Shoulder Arthroplasty, I thought it appropriate to share an article with you about how hospitals must deal with the dilemma of technology adoption and return on investment. We can consider many recent technologies which have benefited patients, such as cross-linked Poly for joint replacement. Initially hospitals had to consider the added cost over conventional poly. In my opinion, the central problem to adoption of all new technology is one of value creation. The issue is how do we measure the value and who captures it. Moreover, if you are the customer, namely the hospital, how d

Immersive Virtual Reality

Dear CSS Members and Colleagues: As our next Annual Meeting this June will consider the disruptive impact of Digital technology, I’d like to share with you recent work by Danny Goel which shows the Immersive Virtual Reality (VR) offers the potential to greatly impact value of shoulder arthroplasty as well as other shoulder procedures. It has been well documented that learning curves affect value due to errors in surgeons make early in their experience. Immersive VR may improve value by shortening this learning curve. Moreover, customer acquisition costs for companies seeking to gain acceptance of their technology and implants, may be much lower than current training methods such as cadaver l

Discussion: [J.P. Warner] "L’episcopo or Latissimus Dorsi (Double Incision) Transfer?" on

Dear CSS Members and Colleagues: The discussion below reflects some controversy as to the need for tendon transfer along with Reverse prosthesis in patients with profound ER weakness. Enclosed is a video (https://www.vumedi.com/video/failed-reverse-lag-sign/) and an article from Hartzler, Frankle and colleagues which deals with this. Perhaps you can decide for yourselves about the need for tendon transfer. Eric Wagner has suggested a multicenter study and this is a great question for the CSS to address going forward. Kind Regards, “JP” Warner, MD Founder, CSS Click here for the original posting Here is the prior discussion: 1/6/20 Reuben Gobezie Thank you JP! I completely agree with you that

The Jupiter Effect

Dear CSS Members and Colleagues: It is my great pleasure and privilege to post on the life and accomplishments of a truly exceptional individual who is certainly on the short list of innovators in Upper Extremity Surgery in the past Century. Usually such postings honor a life after the fact, but we are fortunate that is not the case with this post, and more so, excellence of such magnitude deserves recognition now. This individual is Dr. Jesse Jupiter, who is the current Hansjorg Wyss AO Professor of Orthopedic Surgery at Harvard Medical School. He is also the former Chief of Hand Surgery at MGH and past President of both the American Association of Hand Surgery and the American Shoulder and

[Pierre Henri Flurin] "Reverse Total Shoulder Arthroplasty Using Navigation" on VuMedi

Dear CSS Members: As our meeting this year will deal with the impact of digital technology on shoulder surgery I share with you a video on Vumedi which deals with Navigation for Reverse Total Shoulder Replacement. You may have missed this and it is important to understand different approaches which are aimed at reducing errors and improving outcomes. Keep in mind the Value Proposition of this technology as we’ll discuss this at our annual meeting in June just after the San Diego Shoulder Institute Course. Kind Regards, “JP” Warner, MD Founder, CSS "Reverse Total Shoulder Arthroplasty Using Navigation" by Dr. Pierre Henri Flurin. Click here to view: Reverse Total Shoulder Arthroplasty Using N

On Bankart to Remplissage - A Conversation

Dear CSS Members: The enclosed link is to a recent conversation Jon Ticker had with Eugene Wolf, the originator of Remplissage for management of instability. This is from the AANA Newsletter. I thought it would be of interest to our group for those who had not yet seen it. Kind Regards, JP Warner, MD Founder, CSS

A Recovery Squandered

Dear Colleagues: Enclosed is a document created by Michael Porter and Colleagues. As physicians we often fail to recognize we provide services and work in the context of an overall economic and political environment. As we are in the midst of a socioeconomic transformation in healthcare this is essential background reading to understand where we are going in the USA and what impact this may have on the number one cost to the American taxpayer, namely healthcare. Michael Porter and colleagues state: “Despite a decade of steady economic growth since the Great Recession, America has done remarkably little to address underlying structural weaknesses in the country’s economy and society. Surveys

[Christian Gerber] "Anatomy and Treatment of the Rotator Cuff" on VuMedi

Dear CSS Members and Colleagues: In case you have not seen it this is a unique and thoughtful consideration of Rotator Cuff Anatomy and relevance to treatment of cuff failure. You won’t find such a consideration anywhere else as Professor Gerber has been a pioneer and leader of his generation in establishing “bench to bedside” understanding of rotator cuff disease treatment. All he presents is predicated on the principles of Codman which include the best available clinical evidence + the best available scientific evidence. This is essential viewing for all who consider treatment of rotator cuff disease. Kind Regards, Jon JP Warner, MD Founder, CSS "Anatomy and Treatment of the Rotator Cuff"

[J.P. Warner] "L’episcopo or Latissimus Dorsi (Double Incision) Transfer?" on VuMedi

Dear CSS Members and Colleagues: Enclosed is a video on our experience with Latissimus dorsi transfer for cases with complete absence of the posterior cuff and undergoing Reverse prosthesis. Both Gerber and Boileau have published on their method and my presentation highlights each. Not surprisingly, both obtain excellent outcomes with their chosen technique. Our paper on this experience is enclosed and this accounts for about 14% of all the reverse prosthesis I do. It is essential to recognize this entity as failure to do so is correlated to an inferior outcome with reverse prosthesis due to an ongoing external rotation lag sign that eliminates useful external rotation required for good func

[Jost Bernhard] "Pectoralis Major Tendon Transfer for Irreparable Subscapularis Tears" on

Dear CSS Members and Colleagues: Enclosed is a very nice presentation of the outcome of Pectoralis Major tendon transfer for Irreparable Rotator cuff tears. Prof. Bernhard Jost presents outcome of this technique with long term results similar to what we have observed. In the attached paper written by Bassem ELHassan, we observed good outcomes only in the setting of isolated subscapularis tendon tears. More recently Bassem ELHassan has shown the biomechanical advantage of Latissimus dorsi transfer for subscapularis insufficiency when compared to Pectoralis Major transfer. Indeed, this is what I currently use. It is curious that our results and Bernhard Jost’s were similar in the case of isola