We recently had the opportunity to meet with Gerald R. Williams, Jr., M.D. specifically to talk about his background and his experiences using the InSet™ glenoid from Shoulder Innovations.
Dr. Williams is a board-certified shoulder specialist in Philadelphia.
David Blue: Dr. Williams, would you please share your background with us, including how you became involved in healthcare and specifically orthopedics?
Dr. Williams: Well basically, I thought I was interested in orthopedics when I was in high school, because I was good at science, and it seemed like orthopedic surgery was a pretty cool thing. When I got to medical school, orthopedics was the rotation I liked the most.
Then, when I got to residency, I actually thought I was going to be a knee surgeon. Then Dr. Rockwood convinced me to be a shoulder surgeon.
David Blue: What was it that attracted you specifically to the shoulder after speaking with Dr. Rockwood?
Dr. Williams: Honestly, it was Dr. Rockwood.
I didn’t know much about shoulders, to be honest with you. However, I knew I liked Dr. Rockwood, and that’s what he wanted me to do, so I decided to become a shoulder surgeon.
That’s actually when I first met Jeff Ondrla was through Dr. Rockwood, as they were working on the Global Shoulder system.
David Blue: How did you first learn about the InSet™ Glenoid, and the Shoulder Innovations team?
Dr. Williams: Well, to be honest with you, I had these patients that had really deficient glenoids that I didn’t think hemiarthroplasty worked very well. They seemed to still have pain, and I really thought that resurfacing the glenoid worked better.
But there were really no standard glenoid implants that you could put in these really deficient glenoids. So, I said to myself, “You know, it seems like using some sort of ‘mini glenoid’ would be reasonable.”
I forget what meeting it was, but I saw Dr. Steve Gunther present his original cases with his glenoid. I came up to him, I said “Listen, I’ve got some patients with deficient glenoids that I think could use this. How do I go about using it?”
So, in the beginning, every one of them, as you may know, was custom created by Biomet for us. I started using them, and I kept using them until the federal government finally said, “You’ve had enough customs.”
Then, it kind of went by the wayside as Dr. Gunther was exploring business opportunities relative to having someone acquire the glenoid technology.
Then I looked into using Ascension at the time. However, after I looked at their glenoid, I didn’t really like it that much, because they actually asked you to completely bury it in the bone. It was more of an inlay than an InSet™.
Then I ran into a company whose glenoid was basically a portion of a sphere. So, since it’s a portion of a sphere, it didn’t matter what angle you drill it from. They sold this with the idea that you could ream the glenoid at 30 degrees from the surface, and I think it aimed at sports surgeons who couldn’t figure out how to expose the glenoid.
So, I looked at it, and it was the only one on the market, so I started using it, but I just didn’t use the 30-degree deal. However, I was never really that happy with it, because I thought it removed a lot of bone.
Later, I learned about the Genesis family of companies, and that Shoulder Innovations had acquired Dr. Gunther’s glenoid. So I called Rob Ball and said, “You know what, I like that glenoid. Why don’t you show it to me?”
David Blue: What types of indications do you primarily use this system with?
Dr. Williams: I basically use them for type C glenoid, and younger patients where the humeral head is centered on the surface of the glenoid.
I use them for young patients who are going to do weight-bearing activities, and I think are far enough along so that an InSet™ glenoid is better than a hemiarthroplasty with reaming or no reaming.
Those are basically the two patient populations that I use them in. That probably represents 10-15% of all of my totals.
David Blue: Do you also see B1’s and B’2 as applications?
Dr. Williams: I think the B1’s yes. Those would be muscular males, as you point that out, I think would be decent for a total shoulder. Maybe they’re 55 or 60, and they’re still lifting a lot of weights, and I don’t know, they’ll probably get 10 years out of it.
I don’t try to put the glenoid down on the bottom half of the glenoid. I put it up top, and I usually make it as small as it needs to be to sit right at about the base of the corticoid, and usually it’s around the 27mm implant.
The idea is that when it wears out, I still have the bottom half of the glenoid that’s pristine. So, that’s where I put them.
The B2’s are limited by how much the defect is. However, if it’s a mild B2, I think that works.
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. Williams: Really the only data that you have that supports it right now is the biomechanical data that shows that the time zero loading characteristics are better than an onlay glenoid. So, for me, I sort of accepted the biomechanical times zero data and believe it at least has a chance of translating into a lower lucency rate at a given time.
I’m hoping that when it wears out that the deficiency left behind will be more manageable than a deficiency left behind by standard glenoid components.
For me personally, if you believe that then it makes sense to use it in younger people, and it makes sense to use it in patients who maybe need a revision at some point in the future, and you find it desirable to leave the inferior glenoid alone, like reverse and stuff like that. So, those are the advantages.