Todd A. Shrader, M.D. has been an orthopedic surgeon since 1996. He specializes in sports medicine and total joint replacement. He is board certified.
Below, Dr. Shrader discusses the two shoulder repair surgeries of Mark Acres, a retired professional NBA athlete Mark's Story, and the two hip replacement surgeries of Mike Purpus, a former world champion surfer Mike's Story. Dr. Shrader also talks about what patients can expect from their orthopedic doctor if they sustain an injury that requires surgery, or if they are considering total or partial joint replacement for their hips, knees, or shoulders.
What are your orthopedic specialties?
Dr. Shrader: Sports medicine, which for me involves shoulder and knee reconstruction and arthroscopy, and I also do total joint replacement of hips and total and partial replacement of knees. I use the direct anterior approach for hip replacements, where I go in from the front of the hip instead of the back of the hip. It leaves all of the soft tissues in the back of the hip intact, which keeps it from popping out the back. That's why the dislocation rate is lower. Recovery is also faster because going in the front allows me to go between the tissues without detaching them.
Why did you become an orthopedic doctor?
Dr. Shrader: My Dad was an orthopedic surgeon and he had a huge influence on me. He took me down to see one of his patients who was involved in a motorcycle accident when I was in grade school to teach me not to ride a motorcycle. I saw this guy with a femur fracture and my Dad let me see him in the gurney and how much pain he was in, which made a huge impression. Then he took me into the operating room and let me watch him put the leg back together. When I saw what he did and all the tools he used, I thought that was really cool. I realized I wanted to do that, too.
Why are you still passionate about being an orthopedic doctor today?
Dr. Shrader: I'm an active guy. I like to do a lot of sports, and if you look at this type of work I get to treat a lot of athletes as well as people who are very active. They're trying to get back to their active lifestyle. I'm passionate about helping them do that, getting them back to doing what they want to do and getting their quality of life back.
What kind of sports and interests are your favorites?
Dr. Shrader: I enjoy surfing—it's probably my favorite thing to do and I've been doing it since I was a little kid. I enjoy skiing, bike riding, and running.
Talk about treating Mark Acres for his shoulder injuries.
Dr. Shrader: His first injury was what is called a labral (cartilage) tear in his shoulder, which he got playing basketball. He tore the right labrum and I went in arthroscopically to fix it. He recovered really well, and then years later he ended up injuring his left shoulder. He tore his rotator cuff on that side, which I also fixed arthroscopically.
The arthroscopic techniques I use today are newer technology. The incisions are smaller, so there is less blood loss and trauma to the area, and recovery is much quicker than it would be with an open surgery procedure.
Did you know right away what Mark needed?
Dr. Shrader: I took an MRI of his shoulder, which helped diagnose the problem immediately.
Do you treat all tears with surgery?
Dr. Shrader: It depends on the tear. Some are very obvious and significant and point toward surgical care. Others I can treat conservatively. I also look at each patient as an individual to determine a treatment course. Someone who is young and active and plays basketball is going to have problems living and functioning with a torn rotator cuff or torn labrum. Someone who is possibly older and has a less active lifestyle may be able to go with a non-surgical treatment plan. I put everything together and look at the patient's expectations and how active they need and want to be.
What would you say to patients who are in a similar situation as Mark?
Dr. Shrader: It depends on how bad someone's pain is. If something is really causing them significant pain and they do come and see me, they need to know that surgery is not necessarily the first tool that I think about. A lot of times people are afraid to come to an orthopedic surgeon because they think we are just going to operate on them, but many times conservative treatment is best. My rough estimate is that only about 10% of my patients actually end up needing surgery, which of course translates to 90% not needing it.
What did you think when you met Mike Purpus and heard about his hip problems?
Dr. Shrader: Mike's case is very interesting. I remember pulling up in my car to my office seeing this guy walk across the parking lot, and he walked like a penguin, leaned over and waddling. I thought to myself, "Oh boy, that guy is a mess." It turns out it was Mike and he was my first patient of the day. He had been referred by Harbor-UCLA Medical Center where I had been the Chief of Sports Medicine for five years, so the residents knew me and that I did total hips and total knees. I looked at Mike's hip x-rays and I'm not exaggerating, they were and still are two of the worst hips that I have ever seen. Mike was a world champion surfer at one time, but he could barely walk and he couldn't even straddle a surfboard. I really felt bad for him because he was in so much pain, and because I surf, too, I know that not being able to surf would be terrible.
Did Mike go straight to surgery?
Dr. Shrader: His need to have both hips replaced was so extreme that he had to. One of the bone spurs I took out was a few inches long. The bone actually grew so much it grew under his pelvis, so I had to dissect under his pelvis a little bit to get the bone spur out.
What else was unique about Mike's case?
He was in his late fifties, which isn't really that old. The bad, bad deformity and severe, advanced arthritis in his hips is not something I see very often, especially in someone so young.
Why is Mike such a success story?
Dr. Shrader: To have such a bad hip finally replaced was a huge relief for Mike. The pain he had endured over the years was severe. He obviously has a high pain threshold to have dealt with that. I know he also was very determined to surf again, so he worked hard in physical therapy. That helped him a lot.
What you would you say to patients in a similar situation as Mike?
Dr. Shrader: "When should I have joint replacement?" is a very common question, and the answer depends on quality of life. When people come to me with joint pain, I tell them it's not me who's going to say they need joint replacement, they're going to say it. They already know what's going on with their hip or knee or have been diagnosed with a problem, and they're going to know the right timing. When they can't really sleep at night, they can't walk very far, they can't do their normal, daily activities, and the pain is really taking them down, then it's time to get it fixed.
Mike focused on surfing. Did that make him more likely to have an orthopedic problem?
Dr. Shrader: No. His hips were bad because of his genetics or possibly an unknown reason. Some people just develop arthritis and we don't really know why. Presently we don't know of a genetic marker that causes osteoarthritis. But if someone has an injury, like a dislocated hip or major traumatic injury, that can make them more prone to getting arthritis.
Are any two cases exactly alike?
Dr. Shrader: Even though I see certain pathology that looks very similar, every person is an individual and everybody is different. How someone deals with the recovery process, what type of lifestyle they have, and what their expectations are vary from person to person. I treat each of my patients as a whole, considering treatments, possible surgeries, and which physical therapist would help them realize their expectations the best. It makes a big difference in what kind of experience they have.
Would you say that most patients come to see you long after they should have?
Dr. Shrader: That's probably true. They usually look back after they have their joint replacement and wish they had done it sooner, but they do need to go through a mental adjustment phase in order to move forward with having a joint replacement, which I respect.
What kind of pain should people not ignore?
Dr. Shrader: Any time there's an injury and the pain doesn't start to get better after a few days, it's good to have it checked out. Pain that makes it hard to sleep or keeps you from living your normal life should also be taken seriously. Range of motion issues also need to be looked at by a doctor. For example, a locked knee can be caused by something that is loose or torn in the knee. If we don't get to that within about seven to ten days, then it can be very difficult to rehabilitate the knee because it gets stuck and stiff, and you can't get that motion back.
Should people see an orthopedic surgeon before seeing a physical therapist?
Dr. Shrader: Most therapists that I know are not overly aggressive. When they have a sense that something is not right, they'll refer the patient to us. It's not foolproof to see a physical therapist first because they don't do the imaging that we do, but I think there are very good physical therapists out there that can treat straightforward conditions very well.
Do you ever see patients who have had the wrong diagnosis?
Dr. Shrader: A lot of my patients come from general doctors who diagnosed the patient correctly. The doctors send them to me so they can have specialized care aimed at getting the patients back as close to 100% of normal as possible. That's the real advantage to being treated by an orthopedic surgeon. It doesn't mean you need surgery. You're just in the hands of someone who is in tune with your problem and has a ton of experience helping people a lot like you.
What do you say to people who need surgery but are scared of it?
Dr. Shrader: Being scared to have surgery is so normal that if someone isn't scared I start to wonder what else is going on with them! To help people understand what's going to happen to them, I spend some time explaining things to them. The more knowledge and understanding they have, the more comfortable they feel about undergoing surgery. Sometimes surgeons can become somewhat cavalier about it because they are in the operating room so often. To effectively counter that, I put myself in my patients' shoes. I remember that each patient is someone's child or mother or brother, and I care for them like they were my own family.
What other courses of treatment do you recommend to patients who are not surgery candidates?
Dr. Shrader: Physical therapy and medications are usually the keys to treating things non-surgically. There are also injections we can give to help alleviate some of the discomfort, but those are mostly for knees. Hip arthritis is difficult to treat with physical therapy but shoulders and sports injuries respond well to it.
Does age have anything to do with considering surgery?
Dr. Shrader: It's part of looking at each patient as a whole, but no one is turned away or expected to have surgery purely based on their age. It is true in general that as people age they are more likely to have heart disease or pulmonary issues that would make them too high risk to have surgery. In those cases I find ways to avoid it. A fracture is something that usually requires surgery no matter the age of the patient. Elective surgeries are another story. I have a ninety-two-year-old patient who is in great health and likes to walk his dog every day. He's still married to his wife and they're both active. He broke his hip, so I fixed that and he healed fine. He also needed a knee replacement, and I was able to do that for him, too. I'm not worried about him because he's doing great and has a healthy lifestyle with all the walking he does. It's important that people are able to walk, or their health really suffers. It makes me happy to be able to restore something so vital to my patients.