Al’s Story: Rethinking a Shoulder Replacement Surgery

The day after surgery to replace his right shoulder in 2021, Al Coccaro was sitting in his backyard in Westchester, New York, enjoying some yogurt, when a yellow jacket wasp showed interest in the snack. He gently shooed it away and tried changing seats, but the yellow jacket landed on the cup. Frustrated, Coccaro unleashed a left-handed swat but stopped short to save the yogurt—and wrecked his other shoulder.

“I felt a burning sensation that was unreal,” Coccaro says.

Up to that moment, Coccaro had already been through two reverse shoulder replacements on his right side. Unlike a traditional shoulder replacement (where the ball at the top of the arm bone fits into the socket of the shoulder blade), a reverse replacement switches those positions, so the ball is screwed into the shoulder blade, and a socket is attached to the top of the arm. This approach is used if a rotator cuff is severely damaged or if a previous shoulder replacement has failed.

The goal of shoulder replacement is to restore motion, strength, and function, as well as alleviate pain. But in Coccaro’s case, the need for repeated surgeries meant something was clearly going wrong.

Back in the hospital after the yellow jacket incident, he learned he’d need another surgery—this time on his left shoulder. He’d have shrugged if either shoulder was working.

Unfortunately, neither the right shoulder replacement he was recovering from, or the left shoulder replacement he was about to get would hold.

Seeking a permanent solution

When Coccaro found himself in need of a third right shoulder replacement in 2023, he made his way to Columbia, hoping to find new options.

“Other surgeons thought there was nothing more to do, that he’d have to live with a dysfunctional arm that couldn’t raise,” recalls orthopedic surgeon Charles Jobin, MD, a shoulder and elbow specialist.

That’s a terrible prognosis for anyone. Shoulders, explains Dr. Jobin, have more range of motion than any other joint in the body, and many muscles control their function. “It’s great for being able to accomplish amazing tasks and doing all the fun things in life, like playing sports, and taking care of yourself. But it’s bad for injury,” Dr. Jobin says.

Coccaro’s many previous surgeries had created a serious problem with no easy solutions. The prior replacements had used traditional implants that had fractured his shoulder socket and eroded bone, each new surgery wearing it down more and more.

Dr. Jobin knew a permanent solution would mean thinking outside the box.

Open to ideas

As a lifelong mechanical engineer and manufacturer who holds patents for design tools, Coccaro knows how to keep parts from falling out, which was essentially the problem with his previous procedures. Although he’d never expected to get involved in designing his own surgical repair, his expertise meant he had some outside-the-box ideas.

Other doctors might be dismissive. Dr. Jobin was intrigued.

So Coccaro approached the specifics of his situation like he would any other engineering problem, with research, ideas, and solutions. Drawing from years of experience designing and building equipment, including a patented automotive dolly called the Go-Jak, he studied human anatomy to see how it fits together and works. The nuances of the nerves he’d leave to the doctors. The fasteners he understood. Coccaro asked Dr. Jobin about something more secure than a screw, which can dislodge itself: a nut and bolt.

“I was just looking at how to improve connectivity between the plates. I look at everything mechanically.”

They discussed different kinds of fasteners, talked thread pitch and anchor strength, and began to devise a plan.

They also needed to rebuild the bone Coccaro had lost due to the previous procedures. The initial idea to take bone from Coccaro’s pelvis was dismissed because it could be more painful than the shoulder replacement itself. Another option—using bone from a cadaver—could be problematic because Coccaro’s body might reject it.

Coccaro had previously been told he would need a hip replacement at some point due to arthritis. Now he wondered if bone from his hip could be used for his shoulder.

“A brilliant idea,” says Dr. Jobin. “We do rare things when we have difficult, unsolvable problems.” 

A team approach

Enter orthopedic surgeon Jeffrey Geller, MD, Chief of Columbia’s division of Hip & Knee Reconstruction and a hip and knee specialist.

Together, the shoulder and hip teams used three-dimensional software to plan the surgeries and understand the shapes and sizes of the bone graft and replacement parts.

On the day of the surgery in April 2024, Coccaro had both procedures at the same time. A typical shoulder replacement takes up to two hours; a typical hip replacement takes up to an hour and a half. The surgical team moved Coccaro in between procedures—from laying on his back for his anterior hip replacement to a sort of sitting position for the shoulder.

Dr. Geller, a surgeon for 22 years, says he’s been part of thousands of surgeries but never anything like this. “It just shows the collaboration and team approach of working together and thinking out of the box a little bit for what patients need to help get them back in the game,” he says. “I don’t know if I'll ever end up doing one again for another patient, but it’s an interesting solution that made all the sense in the world.”

Coccaro has boundless love and admiration for Drs. Jobin and Geller, gushing in appreciation. He credits his own problem-solving mindset to a 1937 book about success: Think and Grow Rich. “Conceive. Believe. Achieve,” he says, explaining the message. “You have to conceive of an idea. You have to believe you can do it, which is the most important one. And you have to do the work.”

He’s not trying to take credit for the surgical fix, though both doctors praise his contributions, but he’s proud of how his mindset helped. “Thoughts are things—real, actionable.”

Since the surgery, it seems Coccaro has the permanent solution everyone was hoping for. Next action: Riding a mule down to the base of the Grand Canyon to celebrate his 80th birthday in March.

“If he didn't have a shoulder that worked, he couldn’t do it,” says Dr. Jobin. 

And if a yellow jacket appears? Shrug.

Charles Jobin, MD, is the Louis U. Bigliani, MD, Professor of Orthopedic Surgery at CUMC, and specializes in shoulder and elbow disorders. He is the team physician for Riverdale Country School and the rugby, lacrosse, and club sports players at Columbia University.

Jeffrey Geller, MD, is the Nas S. Eftekar Professor of Orthopedic Surgery at CUMC, Chief of Orthopedic Surgery at NewYork-Presbyterian Lawrence Hospital, Chief of the Division of Hip & Knee Reconstruction, and Director of Research at the Center for Hip & Knee Replacement at Columbia. He specializes in arthritic disorders of the hip and knee and joint replacements.