We recently had the opportunity to meet with Michael Purnell, MD, specifically to talk about his background, and his experiences using the InSet Glenoid from Shoulder Innovations.
Dr. Michael Purnell is an Orthopedic Surgeon at OrthoMed Center in California.
David Blue: Dr. Purnell, would you please share your background with us, including how you became involved in healthcare and specifically orthopedics?
Dr. Purnell: I really made the decision when I was 16 years old.
I was an athlete in high school and as such, sustained my share of minor injuries. The idea of sports medicine became attractive very early on.
The concept of being able to make a living while continuing to be able to act on my interest in sports, and turn it into something that could extend beyond my career as an athlete, was very appealing.
David Blue: What was it that attracted you to the shoulder as a specialty?
Dr. Purnell: It was because my background in orthopedics morphed into sports medicine, which was the shoulder and the knee.
The shoulder seemed to be the last bastion of uncharted territory. It seemed like a lot of the things that we do in orthopedics are based on common sense, and yet we had a lot of workarounds in the shoulder prior to figuring out how to address things anatomically.
The shoulder became a much more fascinating subject because there is so much room for new development and technology and the application of it.
David Blue: How did you first learn about the Inset Glenoid, and the Shoulder Innovations team?
Dr. Purnell: I’ve known you Dave for a long time. Also, I had followed Rob, Jeff, and some of the other engineers when they were with previous companies.
When I was introduced to Dr. Steve Gunther’s InSet Glenoid design, it just had a very intuitive appeal. I was hooked pretty fast.
David Blue: What has been your personal experience in using the InSet Glenoid?
Dr. Purnell: At this stage, I’ve been using it now for over 18 months, and I tend to have a patient population that has a lot of significant deformity.
By nature, I’m relatively conservative, so a lot of people that don’t have a lot of deformity or a significant amount of pain, I look for non-surgical alternatives first.
When I end up with a lot of glenoid deficiency, I’ve found that I can make this InSet Glenoid work well.
I feel really confident and comfortable with the InSet Glenoid with regard to the stability and how it works with the host bone compared to a lot of the onlay glenoid designs.
I’m using the InSet for pretty much all of my primaries now at this point.
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. Purnell: The ease of use, the simplicity and elegance of the InSet design, and the confidence that they’ll have in its application is where I would start.
Most importantly, are the results.
My experience has been that the patients seem to feel much more comfortable and have a more natural range of motion and a quicker recovery than with other glenoid designs.
I think that’s a tribute to the preservation of and the respect for the host bone and the native tissue because we’re not removing as much glenoid bone.
Because the exposure can be more respectful of the tissues as well, you preserve the natural feeling in the shoulder. So patients feel like it’s their own shoulder when they’re done.
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. Purnell: I still think it’s important that they have a good preoperative plan. “Well begun is half done.”
Ask a lot of questions before you start. Use the experience and the wisdom of the many surgeons who have performed a lot of these, and it will be pretty straight forward to execute.
The system itself is very simple in its application, but it’s important to understand what the InSet means and how to respect the native bone, where to place it.
Because of its design, it works well with any humeral side system with which you are comfortable.
However, I think there are clear advantages to using some of the newer ones like the Shoulder Innovations platform, which is essentially a stemless application.
The other thing and this is sort of a visceral, emotional thing for me…
For those of us who have experience with traditional glenoid systems, even well done ones – when you see a glenoid fail, and what’s left behind with the polyethylene wear, debris, and the bone loss that can occur, and the challenges of a revision, it really makes you want to seek out a better answer.
With the InSet, I feel very confident that I’m not going even to be seeing these revisions anymore. And if I do, I have not burned any bridges.
I think it’s a wonderful way to provide patients with a really comfortable, highly functional shoulder with good proprioception. It feels normal, it acts normal, but if something were to happen down the line, you don’t have to create a salvage situation necessarily. You might be able just to go in and fix it with some of our standard tools.
I think it’s just a real confidence-builder in doing the operation. I’m not just telling you this because we’re talking. I’m saying this because I really believe it.
I feel like this is a big game-changer for me in terms of shoulder arthroplasty and what I can tell my patients. I’m very happy with it.