Outpatient Minimally Invasive Total Shoulder Replacement
A revolutionary rotator cuff-sparing technique that enables same-day shoulder replacement surgery through a smaller incision—pioneered by Dr. Gobezie and world-renowned surgeon Dr. Laurent Lafosse.
Schedule Your ConsultationWhat Is Minimally Invasive Total Shoulder Replacement?
Minimally invasive total shoulder replacement (MIS TSR) represents a significant advancement in shoulder arthroplasty surgery. Unlike conventional total shoulder replacement, this innovative procedure enables the placement of metal and plastic prosthetic components through a smaller incision—all without cutting or moving any of the rotator cuff muscles surrounding the shoulder joint.
This groundbreaking technique was first defined by Dr. Laurent Lafosse, a world-renowned shoulder surgeon in France with whom Dr. Gobezie trained extensively. Together, they co-authored the first published description of this procedure in 2009, establishing the foundation for what has become an increasingly popular approach to shoulder replacement surgery.
Since then, Dr. Gobezie has continued working with a team of surgeons and biomedical engineers in the United States to refine and perfect this technique, making it safer, more effective, and accessible to patients who qualify for outpatient shoulder surgery.
Pioneering Rotator Cuff-Sparing Shoulder Surgery
Traditional total shoulder replacement surgery requires surgeons to detach and later reattach the subscapularis tendon—a critical component of the rotator cuff—to access the shoulder joint. This approach, while effective, carries inherent risks of rotator cuff complications and requires patients to follow strict activity restrictions during the healing period to protect the repair.
Dr. Gobezie's minimally invasive approach fundamentally changes this paradigm. By entering the joint through the rotator interval—the natural space between the rotator cuff muscles—the procedure preserves the integrity of all rotator cuff structures. This technical innovation eliminates the need for rotator cuff repair and its associated restrictions, allowing patients to begin their recovery without the limitations imposed by conventional techniques.
Key Advantages of Minimally Invasive Shoulder Replacement
This advanced surgical technique offers several potential benefits over conventional total shoulder replacement, particularly for patients who are good candidates for outpatient surgery.
Complete Rotator Cuff Preservation
Unlike conventional shoulder replacement that requires cutting the subscapularis tendon, MIS TSR navigates between the rotator cuff muscles without damaging any of these critical structures. This preservation eliminates the risk of rotator cuff-related complications that can occur after traditional shoulder replacement surgery.
No Post-Operative Activity Restrictions
Because there is no rotator cuff repair to protect, patients undergoing MIS TSR have no specific activity restrictions after surgery. Traditional total shoulder replacement requires weeks of limited shoulder movement and avoidance of certain activities to allow the repaired tendon to heal properly.
Smaller Surgical Incision
The minimally invasive approach requires a significantly smaller incision compared to conventional open shoulder replacement surgery. This results in less soft tissue disruption, potentially reduced scarring, and may contribute to faster initial recovery and reduced post-operative discomfort.
Outpatient Procedure Eligibility
The less invasive nature of this technique makes it a reasonable option for outpatient surgery in appropriate candidates. Many patients can return home the same day as their procedure, recovering in the comfort of their own environment rather than spending time in the hospital.
MIS TSR vs. Conventional Total Shoulder Replacement
| Feature | Minimally Invasive TSR | Conventional TSR |
|---|---|---|
| Rotator Cuff | Completely preserved | Subscapularis detached and repaired |
| Surgical Approach | Through rotator interval | Through subscapularis tendon |
| Incision Size | Smaller incision | Standard larger incision |
| Activity Restrictions | None required | 6-12 weeks of restrictions |
| Hospital Stay | Often same-day discharge | Typically 1-2 night stay |
| Rotator Cuff Complications | Risk eliminated | Potential for healing issues |
Who Is a Candidate for Minimally Invasive Shoulder Replacement?
While minimally invasive total shoulder replacement offers significant advantages, not every patient with shoulder arthritis is an ideal candidate for this procedure. Dr. Gobezie carefully evaluates each patient to determine the most appropriate surgical approach based on their specific anatomy, overall health, and the condition of their shoulder joint.
Generally, ideal candidates for MIS TSR include patients with:
- Primary glenohumeral osteoarthritis with intact rotator cuff
- Adequate bone quality to support the prosthetic components
- Good overall health suitable for outpatient surgery
- Sufficient shoulder anatomy that allows access through the rotator interval
- No prior rotator cuff repairs or significant rotator cuff damage
- Realistic expectations about the procedure and recovery process
Recovery and Rehabilitation
Recovery from minimally invasive total shoulder replacement typically follows a more accelerated timeline compared to conventional surgery, primarily because there is no rotator cuff repair that needs to heal.
Most patients can begin gentle range-of-motion exercises within days of their procedure. Physical therapy progresses based on individual healing and comfort levels rather than being constrained by the healing requirements of a tendon repair.
While every patient's recovery is unique, many individuals experience meaningful pain relief and improved function within the first few weeks following surgery. Full recovery and optimal strength typically develop over several months as the muscles around the new joint continue to strengthen.
Published Research: Primary TSA Through the Rotator Interval
Dr. Gobezie co-authored the landmark research paper describing this technique and its outcomes. The study documents the results of total shoulder arthroplasty performed entirely through the rotator interval with minimum two-year follow-up data.
Download Research PDFFrequently Asked Questions
Common questions about minimally invasive total shoulder replacement surgery.
How long does minimally invasive shoulder replacement surgery take?
The surgical procedure typically takes between 60 to 90 minutes, though this can vary based on individual patient factors. The total time at the surgical facility, including preparation and recovery from anesthesia, is usually 4-6 hours for outpatient cases.
Will I need physical therapy after MIS TSR?
Yes, physical therapy is an essential component of recovery for all shoulder replacement patients. However, because MIS TSR preserves the rotator cuff, your therapy program may progress more quickly without the restrictions typically required after conventional surgery.
How do I know if I'm a candidate for outpatient shoulder replacement?
Candidacy depends on multiple factors including your overall health, shoulder anatomy, home support system, and distance from medical care. During your consultation, Dr. Gobezie will thoroughly evaluate your specific situation to determine if outpatient MIS TSR is appropriate for you.
What are the risks of minimally invasive shoulder replacement?
As with any surgical procedure, MIS TSR carries risks including infection, blood clots, nerve injury, and implant-related complications. However, by preserving the rotator cuff, this technique eliminates the specific risks associated with subscapularis detachment and repair that exist with conventional total shoulder replacement.
How long do minimally invasive shoulder replacements last?
Modern shoulder replacement implants, including those used in MIS TSR, are designed for long-term durability. Studies show that 90% or more of shoulder replacements continue to function well at 10-15 years. Longevity depends on factors including activity level, implant design, and surgical technique.
Dr. Reuben Gobezie: Pioneer in MIS Shoulder Replacement
As co-developer of the minimally invasive total shoulder replacement technique and one of the highest-volume shoulder surgeons in the United States, Dr. Gobezie brings unparalleled expertise to every patient. His extensive training with Dr. Laurent Lafosse in France and ongoing refinement of surgical techniques ensures patients receive the most advanced care available.
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