New Era In Caribbean Medicine As Surgeons Repair Rugby Player’s Shoulder

Through a rare surgery not commonly practiced in the Americas, Health City Cayman Islands’ orthopedic surgical team, led by Chief Orthopedic Surgeon and Joint Replacement Specialist Dr. Alwin Almeida, repaired a rugby player’s shoulder with a minimally invasive arthroscopic procedure utilizing an advanced technique not yet available in the United States or Canada.

The surgery is called an arthroscopic Latarjet, and is the minimally-invasive adaptation of a commonly-used surgical procedure in orthopedics and sports medicine.

The beneficiary of this surgery was Cayman Islands national rugby player Edward Westin whose shoulder had dislocated more than 100 times after years of repeated injury. Even after corrective surgery, the joint was so damaged that it would dislocate in his sleep.

Dr. Almeida explained: “They do Latarjets in the U.S., but arthroscopic Latarjet is less common. The technique that we used was a special technique, which was [first] described by Dr. Pascal Boileau (from France). This is probably the first time it has been done in the (Caribbean and Latin American) region.”

The Latarjet operation, also known as the Latarjet-Bristow procedure, is a surgical procedure used to treat recurrent shoulder dislocations, typically caused by bone loss or a fracture of the glenoid. The procedure was first described by French surgeon Dr. Michel Latarjet in 1954.

The arthroscopic Latarjet is one of the most difficult surgeries in shoulder arthroscopy and only a few surgeons in the world have the training to perform this technique.

The arthroscopic Latarjet procedure debuted at Health City Cayman Islands this year.

The Health City orthopedic surgical team used both surgical implants and techniques which have been pioneered by the UK-based global medical device company Smith & Nephew and used throughout Europe.

Dr. Almeida explained: “It hasn’t been done in the U.S. with that particular implant. The ‘double button’ technique is not available in the U.S. yet … it’s only going to be launched there next year.”

After examining Westin and reviewing his medical records, Dr. Almeida thought he was a good candidate for the surgery. Westin had a condition called recurrent dislocation of the shoulder. He previously had surgery on his left shoulder which failed. He was reluctant to try again, but then he met Dr. Almeida at a 2017 press conference where Health City Cayman Islands announced the hospital’s sponsorship of the “Big Game”, an annual rugby event in the Cayman Islands.

Westin described the process that led him to the pioneering procedure: “He (Dr. Almeida) actually goes to the same church as me, and so I explained … my injuries. I have dislocated my shoulders multiple times over the last few years, and he said whenever I have a break in my playing just to get ahold of him and come down to Health City and get them checked out.”

“Edward is a special guy, he was one of my most challenging cases so far,” Dr. Almeida said.

Ninety percent of the body’s dislocations are shoulder-related since it’s the most unstable joint in the body. Once the shoulder is dislocated, there is a 40 to 50 percent chance that the shoulder can dislocate again. Dr. Almeida noted the severity of Westin’s condition: “It got to a point where it would dislocate even in his sleep, and he told me that it had dislocated probably more than 100 times.”

After going over his records, the surgeon decided on the best procedure to help treat Westin’s condition. “I studied the images and the surgery that was done on the left side and we realized he had undergone a surgery known as arthroscopic Bankart surgery. But the problem with him was really the bone loss. His glenoid socket was so small, and to add to that, the added bone loss that he had made it even smaller. So he had a very unstable shoulder,” Dr. Almeida explained.

Dr. Almeida detailed how the arthroscopic Latarjet procedure surgery is performed: “In these kind of procedures, we take the coracoid process with the attached tendons to it and we transfer this. We saw it off and we transfer this coracoid to the glenoid base, because this glenoid socket has lost bone in the front, and we put this coracoid bone at that point. That gives the stability and makes up for the bone loss, and it gives added stability from the ligaments and the tendons attached to it.”

Westin was confident in the Health City team’s expertise going into the surgery, and is pleased with the results. “Dr. Alwin was pretty great and you can tell the amount of knowledge that he has about the subject,” said Westin, who has been on the road to recovery since March this year, and has not ruled out playing rugby again in the future.

“That’s the plan right now,” he said. “I still want to get back on the field, but I guess I have to assess after that year of recovery (and) make sure I’m ready for it, first of all.”

For now, Westin is coaching younger children in the Cayman Islands’ national rugby program. After his experience at Health City Cayman Islands, he said he would definitely recommend the hospital to his rugby teammates. “I’ve mentioned it to a few people already. I know other rugby players that have already had procedures done there and with good results,” he said.

About Health City Cayman Islands

Health City Cayman Islands, the vision of renowned heart surgeon and humanitarian Dr. Devi Shetty, is supported by Narayana Health, one of India’s largest private health care systems. Health City, only the second hospital in the Caribbean to receive the Joint Commission International’s “hospital accreditation”, provides compassionate, high-quality, affordable health care services in a world-class, comfortable, patient-centered environment. Offering health care to local, regional and international patients, Health City Cayman Islands delivers excellence in adult and pediatric cardiology, cardiac surgery, cardiac electrophysiology, medical oncology, orthopedics, sports medicine, pediatric endocrinology, gastrointestinal and bariatric surgery, neurology, interventional neurology and neuro-diagnostics, neurosurgery, minimally invasive spine surgery, gynecology, urology, pediatric allergies, colorectal surgery, dental, sleep lab and pulmonology services.

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