We recently had the opportunity to interview Dr. Patrick Hayes 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. Patrick Hayes:
I went to college on a military scholarship, and from there, I attended medical school at Duke on a Health Professions Scholarship. After graduating from med school, I completed a civilian residency in orthopedics at Chapel Hill, which lasted five years. In 1994, I returned to the military to repay them for the education they had supported.
Following that I spent four years in Northern California and another four years at Bethesda Naval Medical Center as an orthopedic surgeon with the Navy. While at Bethesda, I served as an assistant residency director and on staff. During that time, I also had the opportunity to complete a fellowship in shoulder surgery with Dr. Evan Flatow at Mount Sinai in New York.
In 2001, I moved to Shelby, NC to work as a general orthopedist with a focus on shoulder surgery. I’ve been with the same practice ever since — 24 years now, plus the years I served in the military. I started performing reverse shoulder replacements shortly after they were introduced in 2005 and have refined my approach through experience with various companies and techniques. Currently, I perform about 100 shoulder replacements a year, including both anatomic and reverse procedures.
David Blue:
What attracted you to shoulder as a sub-specialty?
Dr. Patrick Hayes:
When I was going through residency, arthroscopy was still a bit of a mystery. Back in the late ’80s and early ’90s, it was just starting to be developed, and no one had really figured it out yet. I remember there was a well-known surgeon in Texas who used to say that the arthroscope was “the tool of the devil.” That shows you how much things have changed since then!
I saw shoulder as an exciting and rapidly evolving field with a lot of potential for growth and innovation over the coming decades, and I was eager to be part of that.
David Blue:
How long have you been using the InSet™ system, and how did you become familiar with it?
Dr. Patrick Hayes:
I started using the InSet™ early 2024 and learned about it through a rep I’ve worked with for about 15 to 20 years who moved over to SI. We met and talked about the anatomic shoulder replacement, and when I saw what it was, my first reaction was, “Why hasn’t anyone thought of this already?” When you really look at it, it makes total shoulder replacement so much easier and more reproducible. The mechanics of it just make so much more sense.
For me, it really opened up the range of patients I could consider for an anatomic total shoulder replacement. It gave me a better solution for cases that used to keep me up at night — like the 47-year-old laborer who wants to go back to pounding metal with a sledgehammer despite having arthritis, or the 55- or 60-year-old patient with a big B2 glenoid and significant posterior retroversion and bone loss.
In the past, I was doing hemiarthroplasty for younger, active patients and reverse shoulder replacements for those with significant glenoid deformities. But we all know that an anatomic replacement works better if you can get it positioned correctly and make it last — it’s the best solution.
So when I saw the InSet™ glenoid, I thought, “That’s it! That’s the answer.” I was, and still am, genuinely excited about it.
David Blue:
What has been the feedback received from patients regarding their outcomes or comfort after surgery using the InSet™ system?
Dr. Patrick Hayes:
I’ll admit, I was a little worried about switching to the InSet™ because it’s such a different approach. I was concerned about whether the pain relief and the overall feel would be the same.
But these patients are coming back at two weeks and telling me, “I only took one or two pain pills at most, and after that, I’ve just been on Tylenol — and I feel great!” So the pain relief has been excellent. The early motion at six weeks has also been impressive. If anything, I’ve had to slow some patients down to protect their subscapularis as it heals because they’re feeling so good so quickly.
Overall, it’s been really impressive. I’ve been able to expand my patient pool significantly and bring more patients into the anatomic total shoulder arena — patients I would have previously treated with hemiarthroplasty or a reverse due to bony deformities. That’s been really exciting!
David Blue:
What has been your experience with the InSet™ Reverse?
Dr. Patrick Hayes:
One of the key differences with this approach — and something I think really contributes to the longevity of the components — is the amount of backside coverage and the fact that the post goes directly into the bone, even with the angled components. You’re getting 100% backside coverage, which is a big deal. That’s especially exciting for me when dealing with really deformed shoulders without a cuff, where glenoid implant stability can be a concern.
I’ve also seen increased external rotation, even early on, with the lateralization. Patients who came in with zero or maybe 5 to 10 degrees of external rotation are coming back with 45 degrees at six weeks — and they’re thrilled about it. That translates into meaningful improvements in daily living, like being able to feed themselves or, for older women, being able to fix their hair — which, for many of them, is really important.
I see the InSet™ Reverse as both a problem solver and a real game changer.
David Blue:
Have you noticed an impact of the one tray TSA and two tray RSA setup?
Dr. Patrick Hayes:
The OR staff really like it! It’s definitely easier to get through the case — there are fewer trays, and it really lives up to its name. It’s simple and innovative, and people appreciate that.
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. Patrick Hayes:
From a surgeon’s perspective, as an end user, I’d say the InSet™ anatomic total shoulder solves a lot of problems that have been difficult to address with other systems. The way the glenoid sits in the bone gives me a lot of confidence in its longevity, even in demanding patients — whether they’re young, have physically demanding jobs, or present with significant bony deformities that would otherwise be tough to manage with an anatomic component.
To me, it’s a no-brainer on the anatomic side. It practically sells itself — it’s simpler, easier to implant, more reproducible, and more stable.
From the Shoulder Innovations courses I’ve attended, I’ve learned that you don’t need to overcorrect. If someone has 20 or 25 degrees of retroversion, you can correct maybe five degrees in the bone and another five degrees with the component — and that works. It’s a balanced approach of slight correction and ‘playing it where it lies.’ You don’t need to use big 15-degree wedges to address bone loss in a shoulder with an intact cuff where you’re aiming for an anatomic replacement despite significant bony deformity.
That’s been a big advantage — and the mechanics work, too. As shoulder surgeons, we always worry about the ‘rocking horse’ glenoid, but with InSet™ glenoid, you’re not going to lever it out. Plus, since it’s ‘InSet,’ the stresses are more evenly distributed through the bone. Mechanically, it just makes sense.
It’s exciting to be able to solve these difficult problems with a solution that’s actually easier to use. I’m genuinely fired up about it!
David Blue:
Do you have any closing thoughts today?
Dr. Patrick Hayes:
I really appreciate Shoulder Innovations — it’s a great company, and I feel like they’re very responsive. It’s not one of those big corporations where you get the runaround. If I have a question or a suggestion about a tweak to one of their instruments, I can just pick up the phone, talk to an engineer, and have a real conversation about it. That kind of direct access and responsiveness is rare and really valuable.
I also really appreciate the opportunity to learn from others who have been doing this longer. The courses Shoulder Innovations sponsors are fantastic! It’s always great to be part of that and to continue improving from shared experience.
Dr. Patrick Hayes is an orthopedic surgeon in Shelby, NC.