We recently had the opportunity to interview Dr. Marion “Moose” Herring and learn more about his background and experiences using InSet™ Systems from Shoulder Innovations in his practice as an orthopedic surgeon.
An edited version of our interview led by David Blue follows.
David Blue
Thank you for joining us today. Would you share your background with us, including how you became involved in healthcare and what attracted you to orthopedics?
Dr. Herring
I grew up in a small town in North Carolina, where my father was an orthopedic surgeon and an inspiring role model. I had the opportunity to accompany him on medical missionary trips to Zaire, Africa where I witnessed firsthand how he used his faith, skills, and knowledge to make a profound impact on people’s lives. Additionally, I often joined him on the sidelines of Appalachian State football games where he was the team physician. These experiences led me to aspire to become a surgeon myself, driven by the desire to follow in his footsteps and bring positive change to people’s lives through the field of medicine, particularly in orthopedics.
David Blue
What attracted you to shoulder as a subspecialty?
Dr. Herring
The shoulder is arguably the most fascinating joint in the human body. I was intrigued by the remarkable stability of the joint facilitated by muscles, ligaments, and cartilage. I had great mentors in my residency and my fellowship. I have been able to focus on the treatment of shoulder pathology and sports medicine my entire career.
Throughout my sports medicine/shoulder fellowship at Duke University, I had the privilege of focusing on a high volume of knee and shoulder procedures. I experienced a high volume of shoulder arthroplasties.
Moreover, the diversity of acute and chronic conditions associated with the shoulder meant that I could address a wide range of pathologies in a diverse patient population, making it an even more compelling field of study.
This shoulder focus continued into my own practice first in Boone, North Carolina where I joined my father, followed by a short stint at UNC Chapel Hill, and then finally to Richmond, Virginia.
David Blue
Your passion for shoulder surgery is evident, Dr. Herring. Can you share your journey to the InSet™ Shoulder System? What were your initial impressions?
Dr. Herring
I began using the InSet™ glenoid system several years ago, primarily with stemless implants for bone-sparing total shoulder procedures in younger patients. The concept of preserving bone and maintaining stability with a smaller implant appealed to me. The inset glenoid in younger patients was a good solution to a difficult problem without “burning bridges.”
I found the system’s design to be scientifically sound, and my use of the InSet™ Anatomic shoulder continued to expand. And then the InSet™ Reverse came out. This was a game changer for me.
David Blue
Can you elaborate on how the InSet™ Reverse system made a significant impact on your practice?
Dr. Herring
The InSet™ Reverse system offers the advantage of a consistent stem design across both anatomic and reverse components. This interchangeability simplifies revisions from primary to reverse procedures. What truly impressed me was the baseplate’s adjustability, allowing precise customization of glenosphere positioning and lateralization. This design optimizes stability and eliminates notching*, a common issue in some other systems. Furthermore, the ability to add a 5° or 10° constraint liner for specific cases ensures versatility and enhanced stability.
David Blue
For surgeons exploring Shoulder Innovations products, any tips or pieces of advice?
Dr. Herring
Absolutely. I’ve found the InSet™ system offers a range of advantages, from its roll-in stem design and bone-preserving approach to its stability-enhancing features and the flexibility to address specific patient needs, making it a game-changer in shoulder surgery.
So first off, there can a be bit of a learning curve when it comes to the stem placement. Unlike some other systems where you place the stem straight down, the InSet™ system features a roll-in stem design. This allows for easier implantation in larger patients because you’re not working in a straight downward trajectory; you’re essentially rolling it into place. I find this feature to be helpful in larger more muscular patients.
Next, one of the things that sets the InSet™ system apart is that it requires less removal of humeral bone. In my experience, this translates to reduced immediate post-operative humeral bone pain for my patients.* It provides a very stable construct, and the fin design contributes to excellent stability. I am excited to become more proficient with the stemless.
In terms of the Reverse, it’s important to note that the same humeral component is used. The baseplate offers the flexibility to customize glenosphere positioning, allowing adjustments from 0°, 5°, or 10° that can be dialed into any rotation on the glenoid surface as per your preoperative planning. This feature enables precise lateralization and optimal placement, enhancing stability.
Additionally, the InSet™ Reverse system provides the option to incorporate a 5 or 10° constraint liner. This feature is valuable when dealing with patients where there’s concern about anterior superior escape, indicating a potential issue with subscapularis function. Starting with a 130° inclination, you can adapt by adding the constraint liner to address anterior superior escape instability concerns.
David Blue
As we’re all discussing these days, efficiency in the operating room is crucial. Have you noticed any efficiency improvements, especially with our single-tray system for the total anatomic and dual-tray system for the reverse?
Dr. Herring
No question! The introduction of the single-tray system for the total anatomic and dual-tray system for the reverse has had a significant impact on efficiency in the operating room. Particularly during the COVID-19 pandemic, when outpatient procedures became a priority, the single tray reduced sterilization requirements and costs. In a high-volume setting, this streamlined process is invaluable. Other systems with multiple trays added complexity and increased the risk of tray misplacement. The ease of managing the Shoulder Innovations trays has been a game-changer for us.
David Blue
Considering the recent Medicare ruling on total shoulders, this efficiency can make a substantial difference.
Dr. Herring
We have already been doing outpatient shoulder replacement surgery for Medicare patients at the hospital, and the response has been overwhelmingly positive. The use of a single tray system has generated tremendous enthusiasm among our team. This streamlined approach has significantly reduced the complexity and cost associated with sterilization, especially when compared to our colleagues in knee and hip surgery who often deal with many more trays per procedure.
David Blue
Any closing thoughts, Dr. Herring?
Dr. Herring
As surgeons, we build on the knowledge and experiences of those who came before us. The collaboration and knowledge-sharing among surgeons using the Shoulder Innovations system have been remarkable. The humility and expertise of the individuals involved have made a profound impact. Shoulder Innovations offers exceptional implants, but it’s the people and their willingness to share and teach that truly set this system apart.
Dr. Marion “Moose” Herring is an orthopedic surgeon in Richmond, VA.
* There is currently no available data to support these claims; they are based entirely on Dr. Herring’s personal view