We recently had the opportunity to meet with Amit Nathani, M.D., specifically to talk about his background and his experiences using the InSet™ Total Shoulder System from Shoulder Innovations.
Dr. Amit Nathani is an Orthopedic Surgeon in Santa Barbara, CA
David Blue: Dr. Nathani, would you please share your background with us, including how you became involved in healthcare and specifically orthopedics?
Dr. Nathani: I come from a medical background where my dad and my older brother are physicians. I started interested in global humanitarian healthcare, which still plays a small part in my practice. I then did my residency at the University of Michigan, and then my fellowship in Sports Medicine and Shoulder Surgery at Stanford University.
I became excited about how orthopedics can improve patient quality of life for athletes and people who want to stay active. But orthopedics also allowed me to continue the global humanitarian work that first drove me to medicine, as there’s quite a need for orthopedic surgeons abroad.
So, orthopedics is a nice marriage between two things I’ve always been passionate about: an active lifestyle (I was a tennis player in college) and my desire to work abroad.
I became interested in shoulder surgery, specifically because it seemed to be the specialty where the greatest amount of innovation was happening. There are many advances taking place in shoulder replacement, fracture care, more recently the reverse shoulder replacement, and even the biologics realm. Biologics has to do with how we leverage biologic therapy or stem cell therapy to try to prevent you from needing surgery.
David Blue: I’d love to learn a little bit more about your humanitarian focus. Share a little bit about how and why you became so passionate about that work?
Dr. Nathani: What draws most surgeons to orthopedic surgery is that they enjoy seeing a problem, being able to fix it, and note immediate results. It’s satisfying to replace someone’s joint and note that they had an improvement in their quality of life and were able to return to activities that they enjoy.
The same thing happens everywhere else in the world, and there’s a great need for our skillset in places where access to care is more limited. My work has taken me primarily to Haiti and the Dominican Republic over the years, for cases such as traumatic injuries to the leg or arm, sometimes after a natural disaster. It is really gratifying to be able to restore someone’s function and ability to work and to give them access to the same technology that we use here. I’ve enjoyed helping to create a sustainable program where we recruit and teach local physicians. These are cutting-edge procedures, and I believe that everybody deserves that kind of care. Being able to see improvements in quality of life, function, and ability to work is important for everybody. There’s a great need for it.
David Blue: How did you first learn about the InSet™ Glenoid and the Shoulder Innovations team?
Dr. Nathani: I pride myself on being a comprehensive shoulder surgeon from pediatrics all the way to our elderly population. That’s allowed me to come across a variety of interesting people and companies, particularly startups, that are driven by innovation for improving patient care and quality of outcomes.
Genesis has their hands in many different exciting and innovative projects, so along the way, I interfaced with some members of their leadership teams in regards to shoulder fracture care. This led to my involvement with Shoulder Innovations.
I’ve really enjoyed working on this project with Genesis and the Shoulder Innovations team. They’re innovative, not afraid to think outside the box, and they have a proven track record of being able to bring ideas to market.
David Blue: What was your first impression when you saw the InSet™ Glenoid?
Dr. Nathani: My initial impression was they solved a real problem, solved it simply, and had the data to back it up.
One of the early findings with our prosthetic implants was glenoid loosening. Even though this was somewhat uncommon, Shoulder Innovations and Genesis saw that was a problem and set out to find a solution.
Most surgeons are a bit cautious of new technology, and they want to see data and a proven track record. With the InSet™ Glenoid, it intuitively made a lot of sense to me from the beginning.
It was clear to me that this was an answer to how we can shield the glenoid from the forces that are causing early loosening, improve the outcomes for patients, and increase the longevity of the implants. Oftentimes, the best solutions are the simplest ones.
Shoulder Innovations has a commitment to collecting data, both in the and also clinically. The data has been a great confidence booster because we now have evidence that we’re on the right track to solving that problem.
But Shoulder Innovations didn’t stop there. They said, “We’ve made the glenoid better, but how can we make the humeral side better? How can we create an entire portfolio to address all shoulder solutions? Let’s make it surgeon driven. Let’s put our orthopedic surgeons at the forefront because they’re the ones who know what is necessary and useful.”
David Blue: What has been your personal experience in using the InSet™ Glenoid?
Dr. Nathani: My experience has been very positive. We’ve used it primarily for the standard shoulder arthritis patient who has failed non-operative treatment for many years and has a poor quality of life due to pain, difficulty with simple activities, and would love to resume an active, healthy lifestyle.
We’ve used the implant in both the hospital setting and the ambulatory or outpatient setting, which is a novel thing in shoulder arthroplasty. We’ve had excellent results.
We’ve made a commitment in my practice to collect data prospectively. We’re collecting our own data to prove that we’re also seeing shorter recovery times, quicker discharge to home, better range of motion, and lower pain scores and that these results are durable.
The system that Shoulder Innovations’ has designed is very simple. This means that integration in a hospital system or an outpatient setting has been well accepted, not just by surgeons but by the support staff as well. This makes all the difference because you need nurses, scrub techs, and an army of people to perform the procedure effectively.
To be able to perform surgery paired down to one tray makes everyone happy. And it affects areas that I’m not able to see, from processing and sterilization to the amount of inventory costs, patient costs, and costs to hospital systems.
Any new technology should have the goal of decreasing costs and increasing patient outcomes, and the InSet™ Glenoid does both.
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. Nathani: My advice to surgeons starting out with this is to make sure you go in with a good preoperative plan. Critically look at x-rays, CTs, or MRIs to judge deformity and version, to gauge sizing of the implant, and to look at bone stock.
Particularly with this system, be careful with glenoid sizing. If a patient is between sizes, opt for a smaller size. That way, you’ll get a full cortical rim and really see the benefit of an in-set design, rather than trying to push the limits of the glenoid.
Whenever you’re evaluating a new system, get it in your hands. Look for a system that’s dedicated to both education and data. Make sure a system can show you the data behind why this is worth trying and why it might be better for your patients.
Also, look for a system that’s comprehensive and can address all the issues you may encounter intraoperatively. Look for a support team that has experience. Oftentimes, they’re your greatest ally in the operating room when you encounter something that’s complicated or unexpected. Ultimately, you want to align yourself with a group that makes the best interest of the patient their highest priority too.