Shoulder replacements are the third most common joint replaced, following hips and knees. While Dr. Izquierdo specializes in shoulder replacements, performing a high volume each full yr, most surgeons replace much fewer shoulders than hips or knees, he says. In fact, 75 % of all shoulder replacements are completed by non-specialists who perform two or fewer shoulder replacements a year. An option for reducing instant post-operative complication rate, consequently, is for patients in order to avoid shoulder replacement by surgeons performing less than two shoulder replacements a season. ‘One important collect message for a patient considering shoulder replacement therapy is to find a an orthpaedic cosmetic surgeon who is trained in shoulder replacements to reduce immediate post-operative complication prices.In this case, the new rule does not move such scrutiny and will not advance any federal government interest. On the other hand, the authorities's interest is in improving open public health even though keeping down costs – and refill reminders further these interests. The new regulation imposes limitations on Adheris because its reminder communications are funded by pharmaceutical manufacturers. The same reminder funded by the federal government, non-profit others or business is allowed without identical restrictions beneath the new rules. ‘We are asking the court to stop HHS in its attempt to restrict communications to patients in a fashion that is definitely high-handed and inconsistent,’ Sherbet said.