Pyrocarbon shoulder replacement offers lasting freedom to younger patients

In 2016, Liisa Anderson was an active, healthy 50-year-old well on her way to achieving her dream of becoming a full-time massage therapist. Working as a health imaging scheduler while also advancing her massage therapy education, she had a busy and physically demanding schedule. So, when she couldn’t shake persistent pain in her left shoulder, she assumed it was due to her lifestyle. “I thought I must have damaged it somehow or that I just needed to strengthen it and get stronger at massage,” she explains.

But, on the cusp of an exciting career change that required healthy, strong shoulders, Liisa decided to undergo an MRI for a more detailed look inside the joint. The test revealed that the source of her pain and dysfunction was more complicated than muscle weakness. “[My provider] said, ‘well there’s a lot going on in your shoulder and it’s not just the muscle.’” He recommended seeking care from an orthopedist who specializes in shoulder treatment—and, in his eyes, the best provider for the job was Armodios Hatzidakis, MD, of Western Orthopaedics.  

Liisa met with Dr. Hatzidakis who explained that he saw severe osteoarthritis with painful wear of the joint. This diagnosis made sense to her as her family has a history of significant arthritis, “My father had a knee replacement; my grandfather had two hip replacements, and my aunt had two hip replacements—apparently for me, the arthritis chose to attack my shoulder.”

Given her young age and high level of activity, Dr. Hatzidakis recommended a new treatment option to Liisa—a “ball only” shoulder replacement (hemiarthroplasty) using a pyrocarbon implant. “In the past, shoulder replacement surgery for younger patients with severe shoulder arthritis was not recommended. We saw high failure risk due to the socket component loosening, which would cause a younger patient to need repeated surgery,” Dr. Hatzidakis explained. 

At that time, Dr. Hatzidakis was the leader of an investigational device exemption (IDE) study with the Food and Drug Administration (FDA) which evaluated outcomes and safety of a newly pioneered pyrocarbon humeral head. Pyrocarbon is an advanced bearing material that is more similar to bone than traditional metallic bearing surfaces. The carbon-ceramic composite with graphite is longer-lasting and more compatible with bone than more traditional metal on plastic replacement; research suggests it could last a lifetime for a young adult.

For Liisa, it was a game-changer. “Within about six months, I was back to massaging… and it would have been sooner if they’d let me. Then, about a year after surgery I joined a women’s health studio with a personal coach having me do things like burpees, HIIT exercises and TRX machines—and that left side did not give me any trouble at all.” Thanks to her experience, and others in the trial, the implant was granted full FDA approval in 2023. 

In the years since her pyrocarbon implant surgery, Liisa and her husband relocated from Littleton, CO to Kenai, AK where she accepted a dream job massaging full-time. And, while her left shoulder has remained strong and pain-free, the arthritis in her right shoulder has now reached a point that needs addressing.  “It’s been since 2020, 2021 when I started noticing the grinding in the right shoulder—at that time it was just mild to moderate. But now it’s gotten progressively worse,” she details. She especially has noticed it when participating in dip net fishing (or dipnetting) near her new home on the Kenai Peninsula. This traditional form of fishing, which is a privilege reserved for Alaskan residents only, is quite physically demanding. Sometimes described as an “epic tug of war,” dipnetting requires the use of large-handled nets up to five feet in diameter that are thrown into the ocean and pulled back against the current, capturing salmon as well as hooligan and flounder. “The first few years I did it, I didn’t notice any trouble with my shoulders. But this year, I’ve found a lot more difficulty with the right shoulder. My left doesn’t give me any trouble at all, but my right is hurting.”

And, despite the physical distance, she will only trust Dr. Hatzidakis with the repair as he is a recognized national and international expert in shoulder surgery and pyrocarbon replacement. She’s working to fit the trip to Denver, surgery and recovery into her schedule so her next dipnetting haul can be the best one yet.