We recently had the opportunity to meet with Robert Tashjian, M.D. specifically to talk about his background, the story behind how he became involved with Shoulder Innovations, and his experiences using the InSet Glenoid.
Dr. Robert Tashjian is a Professor of Orthopaedics at the University of Utah School of Medicine in Salt Lake City, UT specializing in shoulder and elbow surgery.
David Blue: Dr. Tashjian, would you please share your background with us, including how you became involved in healthcare and specifically orthopedics?
Dr. Tashjian: Yes, I’m an orthopedic surgeon, and I’ve been in practice for 12 years.
I am from New England, so I grew up around Boston.
My brother, who’s two years older than me, is a surgeon as well. We went to the same high school, the same college, did a lot of the same things and had similar interests. While he was going through the process of figuring out what he wanted to do, I was going through the same thing with him. I had a little preview of that based upon what he was doing, and that’s kind of how I fell into medicine at least.
Everyone in my family is an attorney, so it’s very different from what my brother and I do.
I went to med school and then with regards to orthopedics, I played football as a kid, and I continued that in college, so sports and athletics were important to me.
There was somewhat of a natural fit with orthopedics with that and from a surgical standpoint, for me, I knew I wanted to go into surgery even from the get-go as I had interest in being able to use my hands. I didn’t want to be just thinking the rest of my life; I wanted to be doing something physically.
At first, I wasn’t quite sure if it would be orthopedics or another surgical sub-specialty. However, orthopedics just kind of fit with the group of people that I worked with.
Medical students, meaning the residents and whatnot were going into orthopedics, it just kind of was similar interests. So that’s kind of how that happened.
Now in residency, you get exposed to everything. For me, when I was a third-year resident I had a shoulder rotation where we spent three months with a shoulder surgeon, and that is really where my interest in shoulder started.
I was able to do a lot of research with him, and the mentorship model with regards to how our residency was very strong in this one sub-specialty, so I felt like I walked away from the three months thinking that I could do this.
Then I, after residency, did a year fellowship in shoulder surgery and then I’ve been here, the University of Utah, for the past 12 years doing shoulder surgery.
David Blue: How did you first learn about and become connected with Shoulder Innovations and the team there?
Dr. Tashjian: I first came to know of the Genesis team from Don Running’s brother-in-law, who is a medical device representative that is with me in the operating room all the time.
As that project was moving along, Rob Ball asked if I had interest in participating further with Genesis as a company. I agreed, and as projects were rolling in, one of them was the Shoulder Innovations glenoid from Dr. Steve Gunther.
So I’ve been involved in Shoulder Innovations from in the initial meetings with Dr. Gunther, looking at the original designs of the implant, to then moving forward with redesigning the glenoid component, the initial stem that was developed in the current system, and then all the way to the kind of new iteration of the stem that’s going to come out pretty soon.
David Blue: What has been your experience using the inset glenoid?
Dr. Tashjian: I’ve found it extremely easy to place.
The surgical instruments are very straight-forward. They’re user-friendly. There are not a lot of surgical steps, which is great, so there’s not much complexity with regards to the process.
There’s also not a lot of kind of fuss factor with it if that makes sense.
From an engineering standpoint, they accomplish what the tools are supposed to accomplish in the operating room which is a good thing. That’s not necessarily always the case.
I believe that it’s a very well designed system.
David Blue: What types of indications do you primarily use this system with?
Dr. Tashjian: Not every glenoid I’ll use it for, but there are definitely cases where I’ve used it more. But I’m still expanding my personal use.
For right now, the main patients that I’ve used it for are basically concentrically-worn glenoids, so A-type glenoids, either A1’s or A2’s. And then C-type glenoids.
I think the C-type is really the one where it’s the dysplastic poster glenoid is the one that was really the initial application for this because there wasn’t really a good surgical solution for that, and this implant really fits that application perfectly.
Beyond that, can you translate backward from that, A-type glenoids are concentrically worn where there’s less of an issue with regards to instability of the shoulder.
To me, the potential benefit of an Inset is that it might last longer and not have as much with regards to loosening problems. That’s really where I believe the benefit of the inset is – the potential longevity as opposed to just the standard onlay.
The eccentrically worn glenoids, or B-type glenoids – those are the ones where I haven’t yet used the implant, although there’s a lot of people that have.
Dr. Chris Chuinard has experience using it. Dr. Peter Johnson has used it in B-type glenoids a lot.
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. Tashjian: I would tell them first that it’s different from what their perception of a kind of an inlay implant is.
Most people’s concept of kind of an inlay or an inset is that Arthrosurface device, which is very different from a technical standpoint and the bi-mechanical principles of it.
So I think that that is the first thing that I would tell people is that your preconceived notion with regards to what this implant is is not what is currently available on the market for public consumption.
The second thing I would say is that it really doesn’t change your surgical steps if you want to think of it. It doesn’t significantly alter the process of doing the standard total shoulder and the glenoid component.
Sometimes that can worry surgeons is that doing new things or multiple different steps or using extremely different types of instrumentation can be intimidating, and I tell them that’s not the case with this. It’s actually even simpler and more basic.
The third concern that people typically will have with this when I’m talking to them is bone removal. Their concern is that because this is an inset glenoid implant, they’re actually removing more bone than you typically would with an onlay implant and that is actually not correct.
Volumetrically, you’re probably removing less bone because with this implant, you don’t have to correct as much in terms of their version when you’re actually putting the implant in.
In many ways when we’re doing a typical onlay, we’re correcting and we’re moving bone, and so you have to correct some with this, but you probably don’t have to correct as much with this implant, and therefore the overall amount of bone that you’re actually probably removing is actually less than a typical onlay implant.
So those three things.
1). It’s not like what everyone else has. With the other implants out there, basically the Arthrosurface, which everyone kind of has this impression of what this really is, it’s a completely different design, mechanics are different, etc..
2. That it doesn’t add steps and it’s very similar to what you’re used to, and even probably more simple.
3. The concern about bone removal is that the relative amount of bone removal is probably the same or even less than a standard onlay implant.
David Blue: Would you have any tips or pieces of advice that you would give other surgeons when they’re first using the system?
Dr. Tashjian: Yes – use it in a simple situation first.
Don’t try to use it in a C-type glenoid or a highly subluxxed or highly eroded glenoid. Take the easiest glenoid, A-type, A1 glenoid that you can possibly get, and use that as the first cases, or case, or cases that you do to get comfortable with the instrumentation.