Shoulder to Shoulder

"Therapy is the real key to healing. It's not always fun, but it's so necessary." - Jim Custer

At 79, he regularly spends time playing golf, shooting hoops, lifting weights and swimming. And he does so having had both hips, both knees and, most recently, both shoulders replaced — all at Eisenhower Health. What keeps him going…and going?

“I enjoy athleticism and have been active in a lot of sports all my life,” Custer says, with masterful understatement. Here’s a sampling of just how active. In high school, he played football until he broke his wrist doing gymnastic moves on a trampoline and had to sit out his last season. He was also a snow skier, and served on the national ski patrol. Plus, he water-skied in international competitions.

Immediately after high school, Custer joined the U.S. Coast Guard. During boot camp, there was a physical fitness competition and, while training for it on his own, he dislocated both shoulders when doing bench presses for the first time. While the injury healed on its own, he continued to suffer dislocations whenever he moved in certain ways, such as extending his arms to the front and raising them 45 degrees.

“I was eventually discharged from the Coast Guard Reserve because I couldn’t put on my jumper for dress-blues types of meetings — it required me to pull it on over my head,” he says.

"We were professional skaters from 1962 to 1968, and traveled throughout the United States and Canada/" - Jim Custer
“You think you’re infallible”

Custer’s injuries didn’t slow him down, however. “When you’re young, you think you’re infallible,” he says. “And if you don’t do things when you’re young, you won’t have anything to talk about when you’re old!”

He went on to join the renowned Ice Capades, where he met his wife, Jennifer. They’ve been married for 54 years.

“We were professional skaters from 1962 to 1968, and traveled throughout the United States and Canada,” he says, noting that, as part of the corps de ballet, he didn’t do lifts with his skating partner, but he pushed the proverbial envelope in other ways.

“I was also a gymnast and did the first non-skating act in the Ice Capades,” Custer says, referring to a diving board and trampoline routine that he performed during his last four years with the ice-skating troupe. His act was also featured on some top TV shows of that time, including “The Tonight Show Starring Johnny Carson” and several network specials.

After leaving the Ice Capades, Custer worked for a radio station before starting his own business, Jim Custer Enterprises, in 1974. Headquartered in Spokane, the company owns and promotes home, boat and antiques shows. In 2002, he sold the business to his daughter and son-in-law, and Custer and his wife began dividing their time between Coeur d’Alene, Idaho, and Palm Desert.

Joint replacements relieve pain

Two years into retirement, Custer’s early injuries — coupled with a predisposition to arthritis and its wear and tear on his joints — began to catch up with him.

“I started to have more and more pain,” he relates. “So I had my left hip replaced. Three years later, I had both knees replaced at the same time. Then I had my other hip replaced.

“It’s amazing, the technology they have today to replace your body parts,” he says.

“And it really does take away your pain.” By 2015, Custer’s shoulders were clamoring for attention.

“I was having trouble sleeping at night because of the pain,” Custer relates. “I’d use pillows to prop up my shoulder, and had to sleep on my back or stomach. But it was ruining my sleep, and that’s not healthy.”

For years, he’d also had to avoid throwing anything overhead, which meant he’d been unable to play basketball, or even skip rocks on the lake he lives on in Idaho.

So he went to see Patrick St. Pierre, MD, Board Certified Orthopedic Surgeon, who specializes in shoulder total joint replacement. Dr. St. Pierre performs more than 200 of these procedures a year at Eisenhower, making him one of the most experienced shoulder replacement surgeons in the U.S. [See sidebar for why volume is important when choosing a surgeon.] “When I started seeing Mr. Custer, he’d had significant loss of motion, pain and weakness, and he wanted to be more functional,” Dr. St. Pierre says. “In cases like his, first we try non-operative treatments, including cortisone injections, to manage the pain. But when these don’t work, we replace the shoulder.”

Custer underwent his first shoulder replacement, on his dominant right side, in January 2016, followed by replacement of his left shoulder in October of that year. The procedure he had each time is called a reverse total shoulder replacement.

"When you can see a specialist who's doing this kind of volume, the process is streamlined and more efficient, the procedures are shorter, there are fewer complications and, most importantly patients do better." - Patrick St. Pierre, MD
What shoulder replacement involves

A traditional shoulder replacement uses a metal ball on the top of the arm bone (humerus), and a plastic socket on the shoulder blade. This mimics the body’s natural ball-and-socket shoulder joint. While the reverse shoulder joint replacement also uses a balland- socket joint, the ball is placed on the shoulder blade, and the socket is placed on top of the arm bone. This reversal improves the mechanics of the muscles that surround the shoulder, particularly in patients who have rotator cuff tear arthropathy, as Custer did. Rotator cuff tear arthropathy is the medical term for the condition in which there is shoulder arthritis as well as a significant rotator cuff tear . The reverse shoulder replacement is designed to make the deltoid muscle, the triangular muscle that forms the rounded contour of the shoulder, more efficient, to make up for the rotator cuff deficiency. By reversing the ball and socket, the deltoid muscle is better able to lift the arm overhead, compensating for the torn rotator cuff.

“With each surgery, I had the procedure in the morning, stayed overnight, and was home the next afternoon,” Custer relates. The total recovery period is generally four to six months long. “Patients usually wear a sling for one month, and then we start them on an exercise program right away,” says Dr. St. Pierre. “Someone like Mr. Custer, an athlete who routinely exercises, was able to do the entire rehab program on his own.”

Therapy is key to healing

“Therapy is the real key to healing,” Custer affirms. “It’s not always fun, but it’s so necessary. They told me what to do and how to do it, and I did it.”

The results were everything Custer hoped for. “Before my first operation, I asked Dr. St. Pierre if the surgery would enable me to skip rocks on the lake in Idaho, something I hadn’t been able to do for years,” he relates. “He said yes, and he was right — now I can.

“I also can shoot baskets without pain,” he continues. “Plus, I was chipping and putting on the golf course within six weeks of surgery, and with the motion I have now, I can play an entire round. “The surgery didn’t lower my score, but I can play again!” he laughs.

“Mr. Custer is a special individual and very motivated,” says Dr. St. Pierre. “Results can vary, but patients who do best follow the advice we give. There are a lot of patients out there who continue to swim, play golf, tennis and pickleball.

“That’s my job — to keep them out there on the course and on the court,” he says. “You shouldn’t have to give up on the activities you’ve loved all your life because of arthritis. Shoulder replacement allows you to return to those activities and enjoy them, without pain.

“Although surgery doesn’t make you 20 again, it can make you more active and happy,” he adds.

Why surgical experience matters

Patients who undergo elective orthopedic surgeries at highvolume, regional hospitals have better surgical outcomes and experience fewer complications than those who undergo those surgeries at lower-volume local hospitals, according to research presented at the 2011 annual meeting of the american academy of Orthopaedic Surgeons. the study specifically looked at total shoulder and total hip replacement procedures.

Many other studies since then have affirmed that volume matters when it comes to patient outcomes in orthopedic surgery. Put another way, results can vary significantly based on the experience of your surgeon and the hospital where they perform surgery.

“about 70 percent of shoulder replacements are performed by surgeons who do fewer than 15 a year,” says Board certified Orthopedic Surgeon Patrick St. Pierre, MD, noting that “part of that statistic is due to shoulder arthritis not being as common as knee arthritis.”

Because he specializes in shoulder replacement surgery, Dr. St. Pierre performs upwards of 200 of these procedures a year. this volume means he is among the top ten most experienced orthopedic surgeons performing shoulder replacement surgery in the country. and experience translates into better patient outcomes.

“When you can see a specialist who’s doing this kind of volume, the process is streamlined and more efficient, the procedures are shorter, there are fewer complications and, most importantly, patients do better,” he says.

To make an appointment with a physician at Eisenhower Desert Orthopedic Center, call 760.773.4545, or learn more at