We recently had the opportunity to meet with John Macy, M.D. specifically to talk about his background, and his experiences using the InSet™ glenoid from Shoulder Innovations.
Dr. John Macy is Chief of Orthopaedics at Mansfield Orthopaedics. He specializes in treating disorders and injuries of the shoulder.
David Blue: Dr. Macy, would you please share your background with us, including how you became involved in healthcare and specifically orthopedics?
Dr. Macy: I’m a fellowship-trained shoulder surgeon, practicing orthopedics at a community hospital in Vermont. I did my shoulder fellowship with Dr. JP Warner, at UMass General and with Dr. Christian Gerber, at Zurich, Switzerland twenty years ago. I have been doing shoulder arthroplasty ever since and I love it.
David Blue: What was your initial impression of Shoulder Innovations and the concept of the InSet™ glenoid?
Dr. Macy: My initial impression was that I really liked the biomechanics of the fixation. Thinking about the Shoulder Innovations InSet™ Glenoid as a “manhole-cover” analogy which was explained to me, really made sense. Not only does the InSet™ have a flat back surface on the back of the glenoid but having the InSet™ Glenoid be able to be embedded and encased in a bony bed, along with a bony rim around the periphery, really gives this a stable fixation, and this just made a lot of sense to me. I also started looking at it and said, “Wait a minute… this also offers me a much smaller reamer, with this little bow-tie reamer, and this is probably going to make this easier and straight forward with my glenoid prep.”
David Blue: What has been your personal experience in using the InSet™ glenoid?
Dr. Macy: I do approximately 100 total shoulder replacements a year, and my experience over the last decade had been mostly with the standard onlay glenoids. After my first completed case that I did with this SI InSet™ Glenoid, I said to myself…”Oh my” “if this works as well as it just went in and felt after implementation, and it continues to have this same good stable fixation, then I’m sold.” I now have done approx. 80 cases using this Shoulder Innovations InSet™ Glenoid, and I can tell you that this glenoid is rock-solid, and it has been working awesome. Patients do dramatically well with these glenoids. Anecdotally, I see less pain, and perhaps even some earlier motion from not having to ream the entire glenoid down and create more bone loss and more blood loss and I think it is an overall less morbid procedure. In fact, it is my primary go-to glenoid now, and in a straightforward, standard glenoid case, I see no reason for me to use an onlay glenoid component ever again. I think what is outstanding about this InSet™ glenoid component is, not only the biomechanics on it but the stability of this InSet™ glenoid and the ease of insertion. That to me is a huge part of this success. The insertion of the Shoulder Innovations InSet™ glenoid and the instrumentation is so straightforward. Not having to ream the backside of the glenoid and the back rim all the way and hitting into, typically, a Fukuda or some other retractor that’s in the back helping with exposure is the biggest advantage.
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. Macy: Well, I think the number one biggest concern that we have today in shoulder arthroplasty is about the glenoid component and its longevity. If these are not done well or right, or even with the right type of glenoid component, there’s certainly a higher chance of failure. In addition to having the right type of glenoid to use, (which is now for me, the Shoulder Innovations InSet™ glenoid), a lot of surgeons still struggle with getting glenoid exposure and being able to properly implant the glenoid. What I like is with the use of the InSet™ glenoid, you don’t necessarily have to obtain the best glenoid exposure to be able to successfully put the implant in properly. I think that the number one thing for me related to this issue, is the ease of insertion and use with the glenoid instrumentation, and this needs to be a simple, straightforward technique with well-designed instrumentation to do this, and the way that the Shoulder Innovations instrumentation has been designed just makes this very easy to get really good results.