Scripps First in State to Use New 3-D Software for Shoulder Replacements

New approach allows for more customized treatment and improved precision

Dr Hoenecke Software 2015-600×375

In a remarkable display of how 3-D technology is changing health care, a Scripps Clinic physician recently became the first in California to perform a shoulder replacement surgery aided by new software that allowed him to install a prosthetic joint with more precision than previously possible.


Using Blueprint 3-D Planning Software, Heinz Hoenecke, MD, studied the landscape of his patient’s worn arthritic joint, practiced the surgery on a computer model and fed the images into a 3-D printer to create a customized drill guide. The guide, designed to rest securely on the unique, uneven surface of the patient’s bone, helped Dr. Hoenecke drill and place screws for a prosthetic device at the optimal angle to restore the patient’s shoulder function and alleviate his debilitating pain.


“We’re using a combination of our laboratory research, our clinical experience and FDA-approved software to provide new options for our patients — options that help us personalize our treatments and make our procedures more efficient,” said Dr. Hoenecke, an orthopedic surgeon and sports medicine doctor who specializes in shoulder reconstruction and replacement.

More precise and customized

“The software and the tools that it allows me to create are helping us perform more precise and customized procedures, which should reduce the need for revision surgery down the road to reposition the prosthetic,” Dr. Hoenecke said.


His patient, William Weseloh, 76, was excited about the June 2 surgery at Scripps for several reasons. Most importantly, Weseloh said he’s looking forward to the elimination of the excruciating bone-on-bone grinding pain he has felt when doing ordinary daily tasks, such as washing and combing his hair, tucking in his shirt, or bringing a fork to his mouth and feeling the painful catch in his shoulder.


“It’s a lot of the things that people do and take for granted. For 76 years I’ve been able to do these things without thinking about it. But you can really appreciate how the body works when you start to have a problem like arthritis,” he said.


Weseloh has osteoarthritis in his shoulder, a breakdown of the cartilage that cushions the joint. A retired mechanical engineer, he said he appreciates the value of the 3-D technology in customizing surgery and joint replacement. “The science of 3-D molding and 3-D printing technology has really come a long way in the last few short years and it should have a dramatic impact on this type of surgery, making it more precise and resulting in better outcomes,” he said.

Scripps’ leadership in shoulder care

Weseloh had his right shoulder replaced about six years ago. When it was time to have his left shoulder replaced, he began researching surgeons online and learned that Dr. Hoenecke was one of the nation’s leaders in shoulder replacement surgery.


Dr. Hoenecke’s role as team physician for the San Diego Padres also influenced Weseloh’s decision: “Those are some pretty expensive arms he’s working on,” he said.


About 53,000 total shoulder replacement surgeries are performed each year in the United States, according to the Agency for Healthcare Research and Quality. They are highly technical surgeries complicated by a number of factors: each patient’s uniquely deteriorated joint and the mass of muscle and other tissue that covers the bone, blocking the surgeon’s view. About 10 percent of all shoulder replacement surgeries require revisions after 10 years, and that rate jumps to 15 percent at 15 years, and the most frequent cause is the loosening of the glenoid, or the shallow socket in the joint.

Virtual testing before surgery

The 3-D Blueprint Planning Software allows the doctor to practice each surgery virtually, including trying out different prosthetics to find the one that best fits the patient’s anatomy. He also feeds the shoulder dimensions to a 3-D printer to make a printed model of the patient’s shoulder, allowing him to physically practice the surgery and test the prosthetic’s fit before he even enters the operating room.


Dr Hoenecke began working with 3-D imaging several years ago, in Scripps’ Shiley Center for Orthopedic Research and Education (SCORE). At SCORE, Scripps clinicians and scientists conduct privately and publicly sponsored research and clinical trials, allowing consumers to gain access to investigational drugs and devices before they are approved for the marketplace.


Dr. Hoenecke had consulted with Darrell D’Lima, MD, PhD, Scripps Health’s director of orthopedic research, about the difficulty of locating and drilling precisely into a tiny spot in the shoulder joint where the prosthetic is attached. Traditional two-dimensional imaging technologies, including CT scans, provide distorted images of the bone because of the angle at which the scapula, or shoulder blade, is positioned when people lie flat for a scan. Dr. D’Lima suggested Dr. Hoenecke save the CT scan as a 3-D computer file. That would allow the doctor to study the landscape of the joint from all angles and practice the surgery virtually.


Cesar Flores, a SCORE bioengineer, worked with Dr. Hoenecke to design prototype software. But given its technological complexity, only Flores could run it and create the models.


Meanwhile, IMASCAP, a medical software company based in Brest, France, developed the Blueprint 3-D software that could be easily operated by physicians. Dr. Hoenecke voluntarily consulted with IMASCAP on progressive versions of the software. Blueprint 3-D was approved for use in Europe, Australia and Canada in 2014. The company licensed the software to Minnesota-based Tornier, which received 510(k) clearance from the FDA last April to aid doctors in anatomic shoulder arthroplasty, or total shoulder replacement. Dr. Hoenecke is a paid consultant for Tornier, but not on the 3-D Blueprint Planning Software.


“This is a terrific supplemental tool to augment my clinical decision making,” Dr. Hoenecke said. “I’m not relying solely on this, and I’m not using it for all patients, but it is particularly helpful in more complicated cases.”


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