We recently had the opportunity to meet with Peter Johnston, M.D., specifically to talk about his background and his experiences using the InSet Glenoid from Shoulder Innovations.
Dr. Peter Johnston is an Orthopedic Surgeon at the Centers for Advanced Orthopedics, Southern Maryland Orthopedic and Sports Medicine Division.
David Blue: Dr. Johnston, would you please share your background with us, including how you became involved in healthcare and specifically orthopedics?
Dr. Johnston: I grew up in Michigan and completed my undergraduate and medical training there. While in medical school, I had decided that I wanted to either be a cardiologist or an orthopedic surgeon and after doing my surgical rotation, it was clear that I wanted to go the route of orthopedic surgery.
As I began to get a feel for people’s personalities around the hospital, it seemed like orthopedic surgeons were the happiest people and enjoyed their job the most. I liked the fact that orthopedic surgery was more “black and white” to me, in that someone presented themselves with an injury or a problem and I could present them and execute a solution that would greatly improve their quality of life and allow them to return to their hobby, sport. So, I chose orthopedics and have never regretted that decision.
From there, I went onto an orthopedic surgery residency at Chapel Hill, North Carolina, and ultimately decided to sub-specialize in shoulder and elbow and did a fellowship at the Rothman Orthopedic Institute in Philadelphia.
David Blue: What was it that attracted you to the shoulder and elbow as a sub-specialty?
Dr. Johnston: The shoulder and elbow can be very challenging joints to treat. Most general orthopedic surgeons, without a focus in shoulder and elbow, get a little squeamish or nervous when it comes to taking care of shoulders. So, that in itself intrigued me.
I had suffered a pretty bad shoulder injury in high school that required surgery. So, both of those factors led me down the path to deciding to focus on shoulder and elbow.
Also, I just think we’re learning so much about the management of shoulder and elbow conditions. We are seeing a real evolution, specifically in shoulder arthroplasty. We are gaining a better understanding of different pathologies and novel approaches for how we manage them.
David Blue: How did you first learn about the Shoulder Innovations Inset Glenoid, and the Shoulder Innovations team?
Dr. Johnston: I was first introduced to the InSet Glenoid when I was in fellowship with one of my mentors, Dr. Gerry Williams.
Later, I was introduced to the Shoulder Innovations team, and I met with one of the executive leaders at SI to discuss the details of the InSet Glenoid. The theory behind it really intrigued me.
David Blue: What were your initial impressions of Shoulder Innovations and the concept of the InSet glenoid?
Dr. Johnston: It just made real logical sense to me.
First, the fixation seemed very solid. We were in-setting the glenoid into the bone. When we look at what has been the “Achilles Heel” of shoulder arthroplasties, it has been the glenoid component failures at 7 to 10 years.
With the InSet Glenoid, that peripheral rim support, similar to a manhole cover just made sense to me.
The other thing that amazed me was the ability to treat patients with very severe arthritis and deformity on the glenoid with a total shoulder replacement versus doing a hemiarthroplasty, which previously was the only surgical option.
David Blue: What has been your personal experience in using the InSet Glenoid?
Dr. Johnston: I’ve been using the InSet Glenoid now for over three years.
In terms of indications, I use it in all of my primary anatomic arthroplasties, with the exception of patients with severe acquired posterior bone loss, in which case, I’ll use an augmented component. But in cases of mild B2s, I’ve been using the InSet Glenoid as well.
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. Johnston: I would first challenge them by asking, “What do you think are the weak points for total shoulder arthroplasty is? And what are your thoughts on creating a more durable component”?
Once you get through those pieces, the opportunity is there to highlight the excellent technology and multiple applications with the InSet Glenoid. In my view, it becomes clear how the InSet is going to solve a lot of those problems and provides surgeons with a durable solution for patients, including in the younger patients.
I think the theory behind the InSet Glenoid, preventing the rocking horse phenomenon that we see with a traditional onlay glenoid, has really solidified my opinion that the InSet was a great solution for an anatomic arthroplasty and overall longevity of the glenoid component.
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. Johnston: Well, I think besides this being the simplest glenoid on the market to use, it’s also about the beauty of the InSet implant, where the overall face of the pathologic glenoid with deformity doesn’t necessarily dictate where you put the implant.
So, the topography or the pathology doesn’t restrict you to placing the glenoid in a certain place. You have more freedom because you’re using a smaller glenoid with a unique shape that just really works.
I typically like to place the glenoid a little more superior than I would with a traditional onlay implant. I have become very comfortable using the InSet implant and not being concerned about trying to resurface the whole glenoid.
The instrumentation is very streamlined, very efficient, and the OR and the scrub techs love this too. Ultimately, the beauty of it in the operating room is being able to visualize a flat, reamed surface that the glenoid is going to sit down on, versus a curved, or rounded back for all the traditional onlay glenoid components.
I really believe that this InSet technology has the potential to be something that really changes how we approach total shoulder arthroplasty in the future.
InSet fixation versus a traditional onlay component has the potential to be the real game-changer in shoulder arthroplasty.