We recently had the opportunity to meet with Kyle McClintock, DO, specifically to talk about his background and his experiences using the InSet™ Total Shoulder System from Shoulder Innovations.
Dr. Kyle McClintock is an Orthopedic Surgeon in Modesto, CA
David Blue: Dr. McClintock, share your background with us, including how you became involved in healthcare and specifically orthopedics?
Dr. McClintock: As a kid, I was very active in many different sports year-round, and I eventually injured my ACL. During my experience as a patient, I became fascinated with anatomy and how doctors, especially orthopedic surgeons, could help people. From that time on, that interest propelled me to pursue a career in medicine and specifically orthopedics.
I graduated from Kansas City University Medical School and did my residency in general orthopedics, eventually opting to specialize in shoulder and elbow surgery. After residency, I went to Phoenix, Arizona, to work with the CORE Institute and spent a year focusing on how to manage complex shoulder and elbow problems. That included arthroscopy, sports medicine, fractures, and reconstruction with shoulder arthroplasty.
It’s been a very fulfilling and rewarding journey so far, and I have really enjoyed working with shoulder injuries on a daily basis and find them fascinating to treat.
David Blue: How did you first learn about the InSet™ glenoid and become introduced to the Shoulder Innovations team?
Dr. McClintock: During my fellowship, I trained with Tornier’s shoulder system and that seemed like a solid shoulder arthroplasty platform. Then in the course of my interactions in practice, I met one of the local Shoulder Innovations reps who happened to be a former Tonier employee. We had some long discussions where he introduced me to the benefits of the InSet™ glenoid system as opposed to the traditional glenoid design. I read up on the biomechanics studies and long-term outcome studies that SI had published.
I was intrigued by the flat back inset design because it intuitively made a lot of sense to me. I went ahead and used it in a lab setting to familiarize myself with it and once I saw it in action, I was immediately comfortable, so I started implanting it in patients. I’ve had great success with it, and feel very comfortable using the implant and confident with the outcomes it provides to patients.
David Blue: What types of indications do you primarily use the InSet™ glenoid with?
Dr. McClintock: I use the InSet™ glenoid for any person who’s undergoing anatomic total shoulder arthroplasty. Now that the augments have been developed, and released, I also use the InSet™ glenoid for those cases with defects, including B2 glenoids, and other deformities.
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. McClintock: I would highlight the simple design and instrumentation. There are only a few instruments necessary, and they are well-designed, have good functionality, and the technique is easy to produce. Something that surgeons strive for is reproducibility and the ability to recreate the anatomy and to restore that anatomic joint.
The process of preparing the native glenoid for the InSet™ is relatively quick. It was very easy for me to transition from a standard glenoid component to placing the InSet™ glenoid.
David Blue: Do you have any tips or pieces of advice that you would give other surgeons if they were using the InSet™ system for the first time?
Dr. McClintock: Honestly, the InSet™ uses such a straightforward technique that you don’t need a lot of tricks to make it work right every time. It’s low profile and very easy to use.
However, one thing I’ve learned is that the preparation of the native glenoid for the InSet™ will look slightly different than it does with a standard reamer. You need to take the entire glenoid down to a certain level, and at first, you may feel unsure if your pocket is prepared deep enough. It helps to rely on the standard principles of maintaining subchondral bone. As you generate the pocket, you’ll want at least 270 degrees of rim support around the implant.
I’ve been impressed with the initial stability of the implant, even in cases where building up that wall on the pocket gets a bit challenging for fear of violating that subchondral bone. But I’ve had great success even in challenging scenarios since it’s such a versatile implant.
In other shoulder systems, I’ve found the instruments to be finicky and not as precise. The great thing about the InSet™ is that the pegs are designed so that you can orient them anywhere. This means you’re not struggling with exposure and having a difficult time drilling your peg holes.
My main tip is to get comfortable with pocket depths, make you’re sure maintaining subchondral bone, and develop a nice rim around the implant for added stability. Both the flat back design and the solid rim is what gives the InSet™ its biomechanical advantages.
David Blue: Thank you Dr. McClintock. Do you have any closing thoughts today?
Dr. McClintock: The humeral component from the Shoulder Innovations’ system is also very impressive. I’ve done many operations with other shoulder systems, and what sets the SI humeral component apart is its amazing initial fixation no matter how soft or compromised the patient’s bone is. Sizing is never an issue, and I’ve never had to go up to a larger stem because I was worried about stability.
When I’ve used several other different designed systems, I’ve sometimes had to use the impaction of bone-grafting or size up to a larger stem. I have also had to minimally prepare the canal so that I can try and get a better press fit when I implant these other types of humeral stems.
I’ve found that the SI humeral component is by far the most solid option for both the goals of bone preservation and fixation. It’s something that I can trust to give me steady and consistent results over and over again. I’ve found this to be advantageous in treating patients with differing bone quality.
I’ve talked to many of my surgeon friends about the system, and I tell them that it’s not until you use it that you realize just how solid it is. I continue to be amazed by the amount of stability that is achieved with such a small implant simply because of its excellent design.