We recently had the opportunity to interview Dr. David Adkison 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. David Adkison:
Well, you know, when I was in medical school, I was sure I was going to be a cardiologist. Then one of my intern mentors said, “You know what? You’re a surgeon, not a cardiologist.”
At the time, I was in the Navy on a scholarship and had been selected to do my internship at Bethesda National Naval Medical Center. I still thought I was going to be a heart surgeon. But then I did a rotation in orthopedics, and one day they let me take a rod out of a tibia. I remember thinking, “Oh my goodness, where has this been my whole life?”
In the Navy, you’re required to spend some time with the fleet, so I spent a year with the Fleet Marines in Okinawa. It was a great year. My wife and I had a wonderful time. After that, I returned to Bethesda to complete my training, stayed on staff for a while, and eventually did my fellowship in Salt Lake City at the Orthopedic Specialty Hospital.
From there, I was sent to Oakland, but that facility was eventually closed. I returned to Bethesda, where I finished out my career. For the last five years, I served as Chief of the Department. It was an incredibly rewarding time with amazing patients, a phenomenal team, and just a lot of fun overall.
When I was getting ready to retire, my daughter came up to me and said, “Daddy, can’t we just live closer to Grandma for a change?” My dad had been on the rocket team at Redstone Arsenal in Alabama, and my parents were still living there. So we moved back, and I took a job in Birmingham, where I’ve now been for 25 years.
My fellowship was in shoulder and knee surgery. In the military, everyone does a lot of knee work no matter what. But as I got older and grayer, I gravitated back to what I love most, which is the shoulder. Today, I have a 100 % shoulder practice. I do about 400 to 500 cases a year, depending on vacation schedules and how holidays fall on my OR days. And honestly, I’m having more fun now than I’ve ever had.
David Blue:
What attracted you to shoulder as a sub-specialty?
Dr. David Adkison:
There is no other joint on the planet like the human shoulder. When you think about everything it can do, the range of motion, there is nothing in the animal kingdom that even comes close. It is also the platform for your hand. Every time we use our hands, we are using our shoulders. Anytime we do something away from our body, it is the shoulder making that possible.
It is also an intrinsically unstable joint. The ankle, hip, and knee are all compression joints. The shoulder is a shear joint. It depends on many different factors to stay stable. There are 18 muscles around the shoulder joint, along with the labrum, which functions like an O-ring. The rotator cuff is phenomenal in how it pulls the joint together.
Unless you raise your arm overhead, reach out to the side, swing a tennis racket, or throw a baseball, you do not fully appreciate what the shoulder can do. Nothing else even approaches that capability.
That uniqueness also means the problems we see in the shoulder are different from any other joint. But that is part of what makes it such a great area to work in. When someone’s shoulder goes bad, it takes over their life. And we can help. We can fix that. It is an amazing thing to be part of. I really do love it.
David Blue:
How long have you been using the InSet™ system, and how did you become familiar with it?
Dr. David Adkison:
First of all, I have been doing reverse shoulders for 21 years. I did my first one in April of 2004, and I have been something of a sojourner, a wayfarer, through the reverse total shoulder world ever since. I have used almost all the major implants, but each one had something that I did not particularly care for. There was always some design feature I felt could be improved. Whether it was the shape of the stem, the shape of the sphere, or the base plate, there was always something I thought could be better.
I started using the InSet™ glenoid on my anatomic shoulders several years ago, and it completely changed things for me. I remember sending a video years ago of a gentleman at his two-week follow-up after receiving an InSet™ shoulder. He went from having no function to a full range of motion, and you could not wipe the smile off his face.
That kind of result made me a strong believer. When Dr. Gunther came up with that design, he really hit a home run. It has been a major advancement in my practice.
So when SI called and said, “We have an InSet™ reverse shoulder,” I was immediately interested.
These implants are unlike anything I have used before. Every step is logically designed. The way the base plate is inserted is incredibly effective. Whoever came up with the convex reamer deserves serious credit. It works beautifully! When the baseplate is placed, it is so secure that you cannot pull it off even before inserting screws. The technology is outstanding, and the InSet™ Reverse removes a lot of the uncertainty that exists with other systems.
Even the surgical techs in my operating room comment on how logical the process is. Everything flows step by step. After just a couple of cases, even junior techs are confident with it. It has been a great experience. Patients love the results. The x-rays look great. The clinical outcomes have been the best I have ever had. I have done close to 4,000 reverse shoulders over the course of my career, and what we are seeing now is truly remarkable.
It has been amazing. I am completely in love with the Shoulder Innovations products. Everything about it just works.
David Blue:
How would you compare Shoulder Innovations’ approach to project management and execution with other companies you’ve worked with?
Dr. David Adkison:
Working with the SI team has been truly outstanding. It has been the best experience of my career.
They are the most responsive and brilliant group I have ever worked with. The designs they come up with are so well thought out, and that does not surprise me after seeing how everything has been engineered.
We recently designed some new devices to help seat the humeral baseplate into the stem. It took about two weeks from concept to completion. The tool was done, it fit, and it worked perfectly on the first try. You really cannot beat that.
It is such a refreshing change compared to spending years in committees just to hear why something cannot be done. Working with everyone at Shoulder Innovations has truly been a delight.
David Blue:
Have you noticed an impact of the one tray TSA and two tray RSA setup?
Dr. David Adkison:
It has made a big difference. There are fewer things that can get mixed up in the back rooms. And everything we have tried to develop has been designed to fit into the existing system without taking up extra space. I have completely bought into that concept.
When you understand what it costs to sterilize a single tray, it becomes clear how inefficient it is to have eight or ten trays out. That not only eats into the hospital’s profits but also creates confusion for the staff who have to clean, manage, and account for every part. It makes everything harder for everyone involved.
So I think the goal of limiting it to one or two trays is not only practical but also admirable. It has been achieved, and it truly simplifies things. There is a lot less anxiety when you walk into the room and see just those trays open, knowing you have everything you need. It makes the whole process easier to manage.
I say bravo to that concept, and bravo to the execution.
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. David Adkison:
I would have to say that you can have a lot of confidence in this prosthesis. That has certainly been backed up by Dr. Gunther’s publication in JSES, especially regarding the InSet™ glenoid for anatomic shoulders. I believe that same thought process and design philosophy carries over directly into reverse arthroplasty.
I was at a meeting in Destin a few weeks ago, presenting some papers, and I found myself acting like a town crier. I went into the vendor room and just started telling people, “This is the best thing I’ve ever used.” Once you get used to the idea that everything has been carefully designed and accounted for, it really takes the anxiety out of post-op day. You do not worry about seeing some malposition on the X-ray, because everything about the system is so well thought out.
If you follow the steps and truly embrace the philosophy behind the system, it becomes very straightforward. The easier something is, the more likely it is to turn out well. Surgery does not have to be unnecessarily difficult.
We do our surgeries with the patient sitting up in the beach chair position. There is very little tension and we do not use a lot of aggressive retraction. Regardless of whether you are using a more traditional technical approach or my method, the exposure is excellent and you feel very confident putting the implant in. It just works, and the whole experience has been outstanding.
I know I sound like a broken record when I say this, but it really has been amazing. To be able to go through surgery and have patients come back for their first post-op check sometimes showing near-normal motion is incredible. It does not happen for everyone, but it probably happens in about 25-50% of patients, depending on the age group.
Even more striking is the lack of pain. Many patients tell me the same thing. They say, “It didn’t hurt.” They might take some pain medication the first day, as we recommend for preemptive pain control, but then they stop. They just do not need it. That part has been truly stunning.
David Blue:
Do you have any closing thoughts today?
Dr. David Adkison:
I probably sound like a cheerleader over here (Go SI Team!), but I am genuinely enthusiastic about what we are achieving intraoperatively and what we are seeing postoperatively. Our patients are doing incredibly well. We were already used to good outcomes from the approach we use, but this has brought it to an entirely new level of comfort and function for our patients. Thank you for letting me share. I know I have been cheering it on quite a bit, but I truly am excited about this system. I plan to use it for the rest of my career.
Dr. David Adkison is an orthopedic surgeon in Birmingham, Alabama