We recently had the opportunity to meet with Robert Gillespie, M.D., specifically to talk about his background and his experiences using the InSet™ Reverse from Shoulder Innovations.
Dr. Robert Gillespie is an Orthopedic Surgeon and the Chief of Shoulder and Elbow Surgery at University Hospitals in Cleveland, OH. He is a member of the American Shoulder and Elbow Society and has published more than 30 papers in peer-reviewed journals and textbook chapters and has presented over 50 times at national and international meetings, including the American Academy of Orthopedic Surgeons (AAOS), American Shoulder and Elbow Society (ASES) and European Society for Shoulder and Elbow Surgeons (SECEC). In 2015, he was the principle investigator on a paper that was awarded the Charles S. Neer Award, which is the most prestigious award for research given to a shoulder and elbow surgeon. He has served as co-chair for the Ohio Shoulder and Elbow Society and is a reviewer for Clinical Orthopedics Related Research and the Journal of Shoulder and Elbow Surgery.
Dr. Gillespie, tell us about your practice as it pertains to reverse shoulder replacement.
I am fellowship trained in shoulder and elbow surgery and shoulder arthroplasty is a large part of my practice. In the past year, I performed over 200 shoulder replacements and of those, approximately 60% were reverse total shoulder replacements.
What has been your experience using the InSet™ Reverse Shoulder System by Shoulder Innovations?
The InSet™ Reverse platform was FDA approved in the fall of 2021, and as of May 2022, I have used it on approximately 30 of my patients.
I have come to recognize that a more lateralized center of rotation is key to a successful and durable reverse shoulder replacement according to literature. With the InSet™ Reverse, the combination of glenosphere offset options and baseplate thickness options result in a, center of rotation that very closely approximates what we all want to see in terms of lateralization of that center rotation. This promotes improved rotation, both internal and external, as well as continues to maintain the forward elevation that we love to see in our patients with reverse shoulder replacements.
Additionally, I have found from my early experience, the InSet™ Reverse seems to minimize post-operative pain in my patients, they also seem to get greater external rotation and forward elevation. I am really happy with the postoperative range of motion my patients get with the InSet™ Reverse.
There have been many reverse systems that have come to the market over the past 20 years. In what ways have you found the InSet™ Reverse to stand apart from what the other systems have to offer?
One of the most exciting things about InSet™ Reverse is the ability to treat deformities that we typically see in a patients with cuff arthropathy or severe arthritis with augmented baseplates. These augmented baseplates are unlike anything else on the market. It is essentially an inset, based on the deformed anatomy, and augmented down with an implant, providing 100% backside coverage, and without the need for a bone graft. What’s really nice is, there is just one simple surgical technique for all the different baseplate options.
The InSet™ augmented baseplate is placed within the subchondral bone, inside a ring of bony containment that really stabilizes the implant while bringing the inclination down to a neutral or inferior inclination, which preserves valuable bone stock. It is essentially an off-axis metal augment which makes it a little different, in a good way. There are many augmentation options out there, and most are based on changing the backside of the implant. However, with the InSet™ baseplate, the front side of the implant is changed much like the anatomic InSet™ glenoid component.
Slightly off topic but worth mentioning, on the anatomic side, the InSet™ polyethene glenoid component works in the same way, it is placed within a bony ring of containment that stabilizes the implant and reduces micromotion and stresses that causes rocking horse loosening.
What are some tips or pieces of advice you would give to other surgeons when using the system?
I believe a common misconception with the InSet™ glenoid and baseplate (and the InSet™ system in general) is that it takes away more bone than other available systems. I would argue the counter to that, in that we are preserving a fair amount of cortical bone with minimal bone removed within the vault due to the small central post. Thus, I believe this is a bone-preserving option, not just on the humeral side, but also on the glenoid side.
Furthermore, when reviewing the InSet™ Reverse System, surgeons will notice that the stem geometry on the humeral side is not as substantial, from a metaphyseal filling perspective, as perhaps seen on other systems, and this too, is a good thing! I believe that the rotational control that the finned design of the InSet stem provides is superior and that the overall fixation is exceptional. On the glenoid side, the quality of fixation with the center post and screw combination, along with the peripheral locking screws is unparalleled. Also, the Morse taper on the glenosphere is a lot like a hip stem Morse taper, it is very robust, secure and easy to get on, and that makes the operation less stressful for me. Finally, surgeon feedback during our limited release has allowed us to execute even better instrumentation.
As we conclude this interview, are there any final insights you would like to share?
Anytime a surgeon changes implants, there will always be slight differences in how the surgeon and instrumentation work with the patient’s anatomy. However, I believe the learning curve is fairly short with the InSet™ Reverse.
Any new user that who is considering using the InSet™ Reverse shoulder system should note that it is going to act more like a lateralized center of rotation implant and less like a Grammont-style prosthesis, which can take a little bit of “getting used to.” But as surgeons become more familiar and comfortable using the InSet™ Reverse System, I believe, the more their patients will appreciate its utilization because they could ultimately get more range of motion and have less risk of complications that can come with reverse shoulder replacement, like acromial stress fractures and dislocations, among others.
Finally, one of the most groundbreaking aspects of the InSet™ Shoulder System is that it is literally contained in just two trays, one for an anatomic and one for reverse. Delivering the system to my OR in this way really improves our efficiency and greatly minimizes the risk of critical components being contaminated and/or being misplaced. This is quite different from most other systems, where there are many trays in the field, limiting work space, and back table organization which can lead to an inefficient work flow and dropped instruments.