We recently had the opportunity to interview Dr. Hilary Malcarney and learn more about her background and experiences using InSet® Systems from Shoulder Innovations in her practice as an orthopedic surgeon.
An edited version of our interview led by David Blue follows.
David Blue:
Thank you for joining us today. Would you please share your background, including how you became involved in healthcare and specifically orthopedics?
Dr. Malcarney:
My name is Hilary Malcarney. I am an orthopedic surgeon and shoulder specialist. I’ve been in practice for about 20 years.
I went to Princeton University for my undergraduate degree, then attended Jefferson Medical College for medical school. I stayed on there at the Rothman Institute for my orthopedic residency, followed by a shoulder fellowship at the University of New South Wales in Australia. After that, I completed a sports medicine fellowship close to where I practice now, in Lake Tahoe.
I’ve been a practicing orthopedic surgeon in Reno, Nevada since 2006. I started out as a generalist sports medicine doctor doing some trauma work, but I’ve focused my practice on shoulder surgery for over a decade now. Currently, I do shoulder arthroscopy and shoulder arthroplasty.
David Blue:
What drew you to specialize in shoulders?
Dr. Malcarney:
The shoulder is such an interesting joint. There is certainly enough pathology and enough technically challenging work in the shoulder to really fill a practice, and so that’s what I’ve done. I’m still learning every day, developing my skills, and figuring out new and better ways for patients to be treated.
David Blue:
How did you first learn about the InSet® system from Shoulder Innovations, and what prompted you to evaluate it?
Dr. Malcarney:
The word “InSet®” has been a buzzword at shoulder conferences for the last several years.
When a patient is presented at a national meeting, whether there are podium speakers or a panel discussing how to treat a certain patient in terms of their shoulder pathology and arthritis, the questions are always the same:
- Are you going to do a primary?
- Are you going to do a reverse?
- What shape or type of glenoid is it?
- How old is the patient?
- What are the goals?
So over time I naturally became very interested in the InSet® technology and I was drawn to making the glenoid component more stable.
Plus, I really wasn’t thrilled with some of my Pyrocarbon results, primarily because of how long it took patients to experience pain relief and achieve a good outcome post-op.
When I initially made the switch to Shoulder Innovations, I focused on patients who needed an anatomic or primary replacement, especially those who were younger and that I didn’t want to use an onlay glenoid for.
However, once I learned what the InSet® really was and how I could plan it in the software, I quickly jumped on board with using it for my reverses as well.
David Blue:
How has your experience been with the InSet® system?
Dr. Malcarney:
There are a lot of things that I really like. I’ve been very pleasantly surprised with the humeral side. In my view, the glenoid side is the star of the show.
One thing I really like is planning all of my cases in ProVoyance®. I’ve really been able to dial in the accuracy with the InSet® system.
When I plan a case in ProVoyance®, I have in mind the guides in the set that I can use to correct the deformity. I correct sometimes with the guide and sometimes with the implant itself. I also use a caliper. I think this is hopefully going to be something that can be digitized in the future with robotic feedback, but today it’s a simple caliper. In terms of the anterior-to-posterior and inferior-superior coordinates of the glenoid, I use the caliper to get my starting point, and then I use the guides and my ProVoyance® plan to get my angle.
This has been far more accurate than what I’m used to doing with other systems.
David Blue:
What has been the feedback received from patients regarding their outcomes or comfort after surgery using the InSet® system?
Dr. Malcarney:
I think there’s a lot of excitement, and I’ve created some excitement in my clinic, even with my PAs and my staff about what InSet® truly is.
Being able to feel confident telling a patient that there are essentially no lifting restrictions because of the increased stability has been huge.
I can say that as an MD and feel good about it and I’m never thinking, “I hope this glenoid doesn’t loosen or fail to heal because it’s an onlay design.”
That’s really been the number one reason for my enthusiasm. Plus, it’s borne out in the data that this implant is going to be stable and isn’t going to loosen, even with a pretty significant amount of exercise, activity, sports, etc.
David Blue:
What have been the impacts relative to the one tray TSA and two tray RSA in terms of efficiency and cost savings to the facility?
Dr. Malcarney:
It is definitely a very ASC-friendly system.
Even in the hospital setting, nobody wants to be lugging around these heavy trays, even if some of those techs are used to doing big revisions with our hip and knee surgeons. It’s nice to keep things organized and as easy as possible.
From a surgical tech standpoint, it’s always nice to see people relaxed and smiling when I say, “Hey, we’re going to do a reverse here. The initial plan was a primary, but I found something I didn’t like during the procedure.” The nice thing is that we’re not dragging in several heavy trays from the hallway. The transition is really easy.
David Blue:
How does the instrumentation and software planning compare to other systems you’ve used in terms of ease of use, precision, and surgical workflow?
Dr. Malcarney:
The system on the humeral side is quick and straightforward. I usually do my humeral preparation first in both the anatomic and the reverse. I do use the cutting guide and then put a cut protector on top of the broach and move to the glenoid.
As I mentioned, all of my shoulder replacement cases are planned in ProVoyance®, the CT planning platform. Once you understand what the guides can do in surgery and how to apply that knowledge to the ProVoyance® plan, you can really get these things spot on.
David Blue:
Shoulder Innovations prides itself in having surgeon-driven innovation. How would you compare your experience with SI to other companies you’ve worked with?
Dr. Malcarney:
That’s something I noticed right off the bat.
I’m a community orthopedic surgeon, so I don’t work in an academic center. I work for a large multi-specialty practice that doesn’t have a university affiliate, so there’s not a lot of research or podium speakers at the practice where I work.
However, I’m fairly high-volume in the Reno-Tahoe community, and I was constantly knocking on the door and asking questions with other larger companies: “Hey, what’s next? I’ve got something I don’t really like about this system. Is there going to be an answer or response?” I just wasn’t given any answers or a peek behind the curtain with other orthopedic companies.
However, in working with Shoulder Innovations, I’ve found you all to be incredibly open. I’m asked a lot of questions about what I need, for my feedback as an early adopter and user. We’re even constantly talking in the room with the reps to make things even easier for all of us to get in and do this procedure accurately. It’s been great.
David Blue:
If you were sitting down with a fellow surgeon who was ready to use InSet® for the first time, what advice would you share them?
Dr. Malcarney:
Once I highlight the many advantages of the system, my number one piece of advice is to get a CT scan and plan every case in ProVoyance®.
Planning the case in ProVoyance® allows for specific measurements to be taken and for angular deformities to be well understood. You can see how the guides in the system and the InSet® options work together to correct the deformity and place the implant in the proper position within the glenoid vault. I think that’s a key advantage.
Planning cases in ProVoyance® and using a measurement caliper system is my major piece of advice. Not only is this all very reproducible but InSet® is a significant technology advantage over the onlay systems we’ve been using in the past.
David Blue:
Do you have any closing thoughts today?
Dr. Malcarney:
I also want to mention that there are some pressures on surgeons today with hospital and ASC contracts to use a certain implant for pricing and financial reasons.
We all need and want to be financially sensitive with our hospitals and ASCs. However, when there are products like the InSet® Shoulder System that offer clear clinical advantages, I think it’s worth advocating for yourself and for the patient. Being able to choose an implant that you truly believe is better for the patient, in terms of stability, longevity, range of motion, and outcomes, is important – even if it means stepping outside of existing contracts.
That’s one of the reasons why I decided to make a change in my practice: to be able to offer something to my patients that’s simply better.
Dr. Hilary Malcarney is an orthopedic surgeon in Reno, NV