We recently had the opportunity to meet with Chris Jones, M.D., specifically to talk about his background and his experiences using the InSet™ Total Shoulder System from Shoulder Innovations.
Dr. Chris Jones is an Orthopedic Surgeon in Colorado Springs, CO
David Blue: Would you please share your background with us, including how you became involved in healthcare and specifically orthopedics?
Dr. Chris Jones: When I was 6, I tumbled down the steps and broke my proximal humerus. When I went to visit the orthopedist, he made quite an impression on me and I remember thinking, “That would be a really cool job to have.” Then I had several sports injuries through high school and college and those experiences solidified in my mind that orthopedic work was what I wanted to do.
I was matched with an excellent orthopedic program while doing my residency at Duke and that’s where I became interested in the shoulder. One of my mentors was Dr. Kevin Speer, a leading total shoulder arthroplasty surgeon who was performing over 300 total shoulders a year at that time.
The shoulder intrigued me because of its complexity, its difficulty, and the attention to detail it required. I’m really drawn to challenges and the shoulder seemed like the greatest challenge in orthopedics.
David Blue: How did you first learn about the InSet™ technology and the Shoulder Innovations team?
Dr. Chris Jones: I’m constantly on the lookout for improved systems and I’m never satisfied with the status quo.
David, you were actually the first person to introduce me to this InSet technology. (For the readers, David Blue and I have known each other for 17 years, ever since I’ve been in Colorado Springs.)
As soon as I saw the research, I wanted to know more. Two years ago, when you and Rob Ball showed me the biomechanical studies and outcomes, I was very impressed with the data and how it suggested that this was a new, effective solution to an unsolved problem. I began using it right away and have been exceptionally happy with it.
Biomechanically, it makes sense that it would be more stable, since it has not only a flat back support structure, but it is also encased inside a rim of bone, which no other glenoid component has. It’s primarily these two features that adds that extra stability. The biggest issue with shoulder arthroplasty long-term is the glenoid survival and the data suggests this is by far the best option for my patients.
David Blue: What has been your personal experience in using the InSet™ Shoulder System?
Dr. Chris Jones: I began using the InSet™ System on younger patients since their activity level places more force on the replacement which can lead to higher rates of early failure. But after I had put in 15 or 20 of them, I liked the system so much I decided to use it on everybody. The only time I won’t use it is if I’m really concerned about a patient’s bone quality. If they don’t have a very thick subchondral bone plate, then I will consider something else. Otherwise, it’s my go-to for all my anatomic arthroplasties.
David Blue: If you were sitting down with a fellow surgeon to talk to them about this technology for the first time, what would you tell them?
Dr. Chris Jones: I would start by explaining that the InSet™ glenoid is based on a different concept than what they’re used to. Whereas the traditional glenoid gets its support from perfectly matched curvilinear backside support and from the pegs, the InSet™ relies on multiple fronts for fixation. The InSet™ does get its fixation from a flat backside support, along with the peripheral rim support, and the cement interdigitation that comes from both the short pegs, but additionally from the I-Beam cement channels on the backside of the flat surface. From a biomechanics standpoint, the InSet™ provides much more support than the onlay glenoids. Also, you remove less bone with the InSet™ than almost any other glenoid component on the market.
Regarding the SI humeral short stem, when I first began looking at it, I thought it would be good for younger patients with solid bone. But what I have found as I’ve used the humeral short stem, is that there are very few people who do not get amazing fixation and rotational stability from it, even female patients in their sixties and even seventies. It has huge advantages over some of the traditional humeral stems because it sacrifices almost no bone.
We do what is called the thumb test. After you make your head cut, you take your thumb and press on the cut surface of the metaphasis to see how hard the bone is. Sometimes your thumb will just fall in. That is not the patient that we would want to use the SI system on. But it’s very rare to see that. Occasionally, when somebody has been borderline, I’ve taken some bone chips from the head and packed my humerus where I prepped it, and I’m able to get great fixation with the stem even in the much older patients. I have now moved towards making the SI humeral short stem, the only stem for primaries, because it’s a great stem for all ages.
David Blue: What are some tips or pieces of advice you would give to other surgeons when using the SI system?
Dr. Chris Jones: I have two pearls of wisdom. First, I’ve found that when we’re eyeballing the glenoid and picking the center point, we’re not as good at that as we think we are. Oftentimes, I would put the pin in and start to ream and then wish I was one-millimeter posterior. So, what I do now is I take a surgical ruler and I lay it on the glenoid and definitively identify the posterior rim and anterior rim. Then I mark the center point with the ruler. It takes an extra 30 seconds but is well worth the effort. It’s more important with the InSet™ to make sure that you are dead center so you can get a solid peripheral rim.
Secondly, after you drill your center pin and you’re violating the medial cortex of the vault, when you go to cement your component into place, make sure you plug that hole or else cement will shoot out and you’ll get cement on the medial glenoid or medial scapula. But more importantly, you won’t get good pressurization. So, after I fully prep the glenoid and drill my peripheral pegs, I take a chunk of bone from the humeral head and put it in the center hole. Then I impact it with a trial to plug that hole. With that, I’ve been able to see better cement mantle and also prevent that cement from extruding out that hole along the medial scapula.
David Blue: Anything else you’d like to add that we haven’t already covered about the InSet™ technology?
Dr. Chris Jones: I’m very pleased that SI also offers their InSet™ PLUS augmented glenoids, which are very useful for patients who have glenoid erosion. I can make the decision and simple conversion to use augments even after I have already prepared for a neutral glenoid, and I can literally just dial in the amount of correction that I need.
I’d like to encourage other surgeons to make use of the surgical planning tools to plan your surgery three-dimensionally. That way you can go into surgery knowing exactly where your starting drill point needs to be, and you are ready to simply execute the plan you’ve outlined ahead of time.