SHOULDER SURGERIES AND REHABILITATION
Mark Acres is a 50-year-old retired NBA basketball forward and center. He played for the Celtics and Magic before returning to live in the South Bay, where he grew up. He is 6' 9". Mark had bilateral shoulder arthroscopy surgery performed by board certified orthopedic surgeon Todd A. Shrader, M.D. Below, Mark talks about his injuries and experience with Dr. Shrader and the team at Torrance Orthopaedic & Sports Medicine Group. Click here to see Dr. Shrader's comments about Mark's case.
All parts of Mark's story are anecdotal and not meant to be taken as medical advice. See a doctor if you have any questions or concerns about your health.
Talk about your time in the NBA.
It was an unbelievable experience. Back in the late eighties I played with Larry Bird and the gang so it was quite exciting. The fans were into it, on the road and at home, and it was pretty special.
What sports and activities are you passionate about today?
Basketball was always my main sport growing up. I went to Greece recently and played in a fifty-and-over tournament, and when I got back I officially retired from the sport. Now I'm riding my bike, lifting some weights, and doing some running on my own.
How did your shoulder problems start?
The first one was pretty bad—after playing some basketball it just started hurting. I took anti-inflammatories for a while, but they didn't work. I knew something wasn't quite right because I couldn't even shoot a basketball anymore or get my arm up past my chin. After three months of this I finally decided to go see Dr. Shrader because I could tell it wasn't getting better.
What did Dr. Shrader do?
Dr. Shrader took an MRI and found that there was more damage than I had suspected, and that if I didn't have surgery I'd never be able to function properly again. I ended up needing what's called the SLAP repair, which fixes a torn labrum and reattaches the rotator cuff and biceps.
How did you feel once you got your diagnosis and learned you had to have surgery?
I was a little disappointed. You never think that your body is going to break down, but when it does you sometimes need a little help.
Did Dr. Shrader discuss options with you besides surgery?
Physical therapy and injections wouldn't have fixed my problem. He was pretty frank about surgery being my only option because I had a lot of damage.
What did you like about Dr. Shrader while you were going through this?
I felt I could trust him. He came recommended by a good friend who is a doctor, and I also know that he is one of the top orthopedists in the South Bay.
Were you scared at all about having surgery?
I was. Any time you go under anesthesia, you just never know. I was just hoping that I would be back to close to full capacity and be able to lead a normal life.
How long was it before you could get into physical therapy?
For my first shoulder I had to wait longer than my second because there was more damage. It was at least two weeks before I could do a little bit of stretching and flexibility exercises. Over time the therapy stretched out my muscles and ligaments and helped give me back my range of motion. From there I graduated to light weights and eventually got back to my regular life.
How long did it take to get back to normal?
As soon as I finished the full duration of my physical therapy I was allowed to ride a bike and do other normal things. Before that there was the risk of having an accident and falling and re-injuring the newly healed shoulder. It was a couple months, a little longer for the first shoulder. Going in, Dr. Shrader had given me a time table, so I knew what to expect for each of my shoulders to recover.
How do your shoulders feel today?
They feel great. I can do everything I need to do and I am pain free. I got my range of motion back and at least 95% of function on both.
What advice would you give to people in a similar situation?
Get yourself an MRI immediately. That takes all the guess-work out of everything and then you'll know whether you need surgery or not.
Would you recommend Dr. Shrader to other people?
I would highly recommend him. He did a great job for me. He did my surgery at Coast Surgery Center, which feels like a home away from home. It's a very nice building with nice landscaping, shrubs, and trees, and it's pretty relaxing. It doesn't feel like you're in a hospital. I also like his office with the physical therapy right there at Skypark and Madison. Everyone there was always very helpful and friendly, no doubt about that. They try to get you in and get you out according to your time schedule.
HIP REPLACEMENT SURGEREIS AND REHABILITATION
Mike Purpus is a 64-year-old former World and U.S. Surfing Champion. He was born and raised in Hermosa Beach and still lives in the South Bay. Mike had bilateral hip replacement surgeries performed by board certified orthopedic surgeon Todd A. Shrader, M.D. Below, Mike talks about his osteoarthritis and experience with Dr. Shrader and the team at Torrance Orthopaedic & Sports Medicine Group. Click here to see Dr. Shrader's comments about Mike's case.
Talk about some of your most memorable times as a surfer.
I started surfing when I was ten years old and by the time I was fifteen I was surfing in contests. In high school, I was on the water polo team and the diving team at Mira Costa. After high school, when I got to Hawaii and surfed there I was really glad that I had done water polo and diving because it teaches you endurance in your swimming and holding your breath. In Hawaii you are out so far that you can't even see the people on the beach. Fifteen- to twenty-foot waves catch you inside and they hold you under until you're talking to God, and when you come up you've got to swim right into the break of those big waves and swim all the way to the beach. If I hadn't had all that water polo and diving experience I might have drowned really easily in Hawaii. I have a thousand stories I could tell about surfing. I've spent every moment I could doing it.
How did your hip problems start?
By he time I was fifty, after I couldn't make my entire living on surfing anymore, I got a job bartending. I was working until 3:00 in the morning every day, going to bed when I got home, waking up and having to go right in and open the bar and start all over again. That schedule really did me in, and after a while I was about a hundred pounds overweight and wasn't surfing that much. I saw my doctor, who told me I was going to wind up getting diabetes and having a heart attack before the next two years were up. I said, "Oh, my God," and so I started going up and down the hundred steps that go down to the beach at Knob Hill in Redondo Beach. I dropped ninety pounds in four months by doing that and changing my diet. But I tried to surf and I couldn't stand up. I couldn't move. My legs were killing me and I went back to my doctor, who said, "I forgot to tell you that you need two hip replacements, too." I asked him why he didn't tell me that to begin with and he told me that he thought I wouldn't have lost all that weight and that no surgeon would take me seriously if I went in a hundred pounds overweight and with heart troubles and diabetes.
How did you meet Dr. Shrader?
My doctor sent me to Harbor-UCLA Medical Center to get me started on the process of getting my hips replaced. Dr. Shrader had been the Chief of Sports Medicine there for five years, and the residents knew him. When they saw how bad my hips were, they sent me to him.
What did Dr. Shrader do when he saw you?
He did his own exam and imaging and scheduled surgery. He said he'd never seen hips as bad as mine. He didn't offer any options except surgery. That's how bad it was.
How long was your first surgery?
It was way longer than a normal hip replacement surgery because of how big my bone spur was.
How did you feel afterwards?
Four hours after the surgery, they woke me up and told me to get up and start walking. I thought they were crazy, but they said if I got out of bed right then and started using it, it would hurt, but it would hurt five times worse if I waited. I had to walk around the bed two times just four hours after the surgery. Every day I had to walk around in the hospital until I could walk better and better. After four days they took me into a room with nothing but different staircases and they told me I had to walk up and down them before I could get released. I said, "Give me twenty minutes, this is a piece of cake," and I whizzed through that and went home.
What about the other hip?
A year went by and it was time to do the other hip. It was my good hip, so I wasn't worried. A few days before the operation I met with Dr. Shrader and all the doctors who would be assisting in my surgery. They put up my x-ray and said, "Mike, look at this bone spur. This is the biggest bone spur we've ever seen. It's impossible for a bone spur to be this size." I said, "What are you talking about? This is my good hip." They said, "Don't worry about a thing, Mike. This time we're taking the whole day off just for you."
When I woke up after the second surgery, they were all standing around me looking at my bone spur in a bunch of pictures they took because they couldn't believe how big it was. They said it took three and a half hours to dig it out before they could even start to put in my new hip.
How long was it before you could surf again?
Two months later I went in for a follow-up appointment and Dr. Shrader asked if I was back in the water yet. I said no and he said that after two months it was time for me to try, because he knew how much my life had revolved around surfing. I was really scared to do it again after six years off. I had been U.S. Champion for five years and World Champion for two years, and when I go down to the beach I have people following me and expecting me to do something amazing. It took me two months to be able to stand up on a surfboard again. I had to completely retrain myself from the very beginning, and then sure enough I started getting better and better and it started coming back to me really fast. Last year I wound up winning a contest and right now I'm rated number three in the fifty and over category. At 64 I'm the oldest guy in all of these contests and am surfing against a lot of retired pros that are about fifteen years younger than I am.
How much did physical therapy help you right after the surgery?
It helps a lot. You have got to have the physical therapy just to start getting those muscles limber, no matter how bad it hurts, and you have got to do it every day. It really helped me to have a sport that I love as much as anything else in the world, that I was born to do, to try to get back to. The second week after surgery I took my last painkiller and haven't had even an aspirin since to this day. Before surgery I was going through fifteen aspirin a day and it still hurt. That was just so I could get the pain level down to a seven or an eight on a scale of one to ten, and I was going through five Advil a night just so I could get a couple of hours sleep. You can imagine what that was doing to my stomach lining.
How do you feel today, more than five years after your surgeries?
I'm brand new. It's like I've been reborn. I know that Dr. Shrader did his fellowship at the Kerlan-Jobe clinic for all the pro athletes, so that's why he's one of the elite out of all the surgeons up and down the coast that do replacement surgery. He protected my tendons and muscles with the way he did the surgery, and that's why I can surf again. I'm so happy to be able to surf and do other stuff because I've seen people who had their hips replaced with other techniques and they have scars running all the way down to their knees.
What advice would you give people in a similar situation?
Get it done as soon as possible, as soon as the pain starts keeping you up at night.
Did you like Dr. Shrader's staff?
His secretary Patti is doing paperwork all day long and all night long, trying to figure out the best deal for everybody going through the hospital, whether it's an insurance company, Medicare, Medi-Cal, or SSI disability. She works her tail off and loves doing it. Everyone, the people at the front desk, the physical therapists at TOSMG are great, and they all love working for Dr. Shrader.
What else did you like about Dr. Shrader?
He'll tell a skeptical patient who says they're not sure if they want to have a hip replacement that they're right, they're not ready. He sends them away and tells them to come back when they're ready. He doesn't try to hard sell anything. Everybody calls him "Dr. Shrader" until they have their hips done, but right after surgery they call him their guardian angel and everybody thinks of him the exact same way. He has the ultimate bedside manner of any doctor I have ever met. He could go around the world just lecturing on bedside manner. He's sharp as a tack and knows exactly what he's doing. He's not afraid to bring in the best other professionals if he has any kind of a question at all, to assist or help him do it because he doesn't really care about the money. He cares more about the patient and it really shows.
MARK’S AND MIKE’S SURGERIES
Todd A. Shrader, MD 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.