We recently had the opportunity to interview Dr. Kyle Shepperson 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 please share your background, including how you became involved in healthcare and specifically orthopedics?
Dr. Kyle Shepperson:
When I first started university, I was considering a degree in engineering. However, during my early years there, I became intrigued by the health sciences, particularly pediatrics. As a young man, the idea of improving people’s health resonated with me. My interest shifted when I learned about orthopedic surgery, which combines elements of engineering and biology to repair parts of the human body, like knees and shoulders. This occurred while I was at Stanford University. Subsequently, I attended medical school at the Mayo Clinic and remained there to complete my residency in orthopedics.
David Blue:
What attracted you to shoulder as a sub-specialty?
Dr. Kyle Shepperson:
In my initial anatomy course, where we studied cadavers, I became fascinated with the shoulder’s complex structure and its extensive range of motion. This interest deepened when I served as a teaching assistant, helping to educate first-year medical students about the shoulder. The complexity of its anatomy, coupled with the surgical challenges it presented, really captivated me.
David Blue:
How long have you been using the InSet™ system, and how did you become familiar with it?
Dr. Kyle Shepperson:
It’s been several years now, even before the introduction of the Reverse. Dr. Tom Norris first mentioned it to me, as he had a real interest in it. After meeting with the Shoulder Innovations team, everything clicked immediately.
David Blue:
What were your initial impressions?
Dr. Kyle Shepperson:
One of my main concerns, which many in the field share, was glenoid fixation—a persistent issue that seemed to be the weakest link in shoulder surgery. However, my introduction to the InSet™ concept, with its resemblance to a manhole cover, intrigued me. Once I physically examined a model and felt its stability under pressure, I realized that this would fundamentally change my approach to and increase my confidence in the anatomical shoulder surgeries I perform.
Initially, I didn’t think much about the humerus until I encountered the innovative design for the Shoulder Innovations stem. It was curved in such a way that it allowed for increased contact in the metaphysis and enhanced stability with less bone removal. This piqued my interest, and I started using it as well.
From my own experiences and cases, I’ve dealt with a few periprosthetic fractures with shorter stems from other systems. I’ve also managed cases from other surgeons with longer stems, some of which had been in place for many years, presenting a challenging problem. The Shoulder Innovations stem design offered the potential to preserve more bone, which was a significant advantage. By potentially reducing the risk of fractures, it presented a solution to a problem that had caused considerable trouble in the past, making it very appealing to me.
David Blue:
Have you noticed an impact of the single tray TSA and dual tray RSA setup relative to efficiencies in the OR, as well as cost savings?
Dr. Kyle Shepperson:
The system I used before, had a great deal of trays, and this was also true for other systems I considered. However, once I switched to Shoulder Innovations and started using just one tray for TSA’s, the benefits became immediately clear—it was obviously quicker.
The setup at the back table and the turnover times have been significantly reduced. The fixed costs of time required to open multiple trays have been minimized to handling just one, simplifying the back table setup, which I appreciate.
The feedback from our staff and managers regarding the reduction in the number of trays has been very positive. Although I don’t directly deal with this aspect, I’m aware of its impact. It’s well received based on the positive comments and the lack of complaints from the operating room personnel. The scrub techs, in particular, appreciate the streamlined process.
David Blue:
If you were sitting down with a fellow surgeon to talk to them about this technology for the very first time, what would you tell them?
Dr. Kyle Shepperson:
There are so many things but first, I would say that as a company, Shoulder Innovations responsive, energetic and very creative. It’s a great team to be part of.
The InSet™ glenoid component exemplifies the ideal glenoid implant, providing excellent stability and ensuring the longevity of shoulder replacements, which greatly enhances peace of mind. As a surgeon, you end up feeling just that much more comfortable that your patients are going to have a durable shoulder replacement.
The design facilitates easier insertion by eliminating the intricate positioning required by other models and simplifies the reaming process. This reduces much of the stress associated with the surgery and leads to improved outcomes, thanks to the simplicity and predictability of the procedure.
On the humeral side, focusing on more anatomical positioning has enhanced my surgical precision, leading to outcomes that more closely match the desired anatomical structure, especially in reverse procedures.
Regarding the reverse procedures, the design of the reverse implant is exceptionally well-suited for modern surgical needs, particularly in terms of lateralization on the glenoid and the humeral stem. The system allows for the use of an essentially stemless option, even though a small stem is available, preserving the same bone-conserving techniques used in traditional procedures. This uniformity extends across both anatomic and reverse implants, maintaining the same workflow and technique. This consistency simplifies the surgical process for me, improving my performance. I use the same technique and make the same bone cuts, which leads to very consistent results. I appreciate this aspect of the procedure, and I believe other surgeons would value it as well.
Overall, the system’s flexibility and bone-preserving qualities meet all the criteria a surgeon could want: a simplified back table setup, intuitive instrumentation, and a forgiving implant that performs exceptionally well over the long term.
Additionally, the ProVoyance software provided by Shoulder Innovations has been a game changer. It allows for pre-surgical planning, making the actual procedure more predictable and efficient. The consistent results, both radiographically and clinically, underscore the effectiveness of this tool.
David Blue:
Do you have any tips or pieces of advice that you would give other surgeons if they were using the system for the first time?
Dr. Kyle Shepperson:
I do continue to use the external guide for aligning varus, valgus, and the version during surgeries. I attach both version rods to the guide, and generally go between 20 degrees and 30 degrees, giving me a window to work with.
In cases of any uncertainty with the humerus, I use bone grafting, particularly in the medial calcar area, to reinforce the structure. This technique has proven effective, as the majority of the stems are very secure with a press-fit and do not require cement, except in extreme cases of soft bone.
For the glenoid or base plate, I prefer using augmented base plates. These allow for a slight inferior tilt, which is beneficial even in non-worn shoulders. By using an augment, I can minimize bone removal from the glenoid, which is especially crucial in osteopenic patients without significant wear or massive cuff tear arthropathy.
Additionally, I’ve adopted some newer practices, such as using a slightly smaller and higher-placed InSet™, based on insights gained from attending specialized Shoulder Innovations courses. These modifications have helped refine my surgical technique.
David Blue:
Do you have any closing thoughts today?
Dr. Kyle Shepperson:
I think I am still in the process of trying to maximize the use of the ProVoyance surgical 3D planning software. I find myself wanting to spend more time on trying to leverage all the features and benefits of this software by experimenting with it, exploring different surgical scenarios by rotating the implants, and trying various options. This hands-on practice with this software has been incredibly beneficial as it aids in visualizing and planning surgeries more effectively, which, in turn, improves the outcomes. I believe it’s time very well spent.
In closing, I would just say that I love the InSet™ Shoulder System, and my patients are doing really well.
Dr. Kyle Shepperson is an orthopedic surgeon in Maryville, IL