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We recently had the opportunity to interview Dr. Brad Brautigan and learn more about his background and experiences using InSet™ Systems from Shoulder Innovations in his 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 share your background with us, including how you became involved in healthcare and what attracted you to orthopedics?

Dr. Brautigan:

Like many others, I decided to pursue a career in orthopedics after a significant personal experience. When I was 14 years old, my brother broke his leg, and he was taken care of by an orthopedic surgeon who left a lasting impression on me, and from that moment, I knew that orthopedics was the path I wanted to follow.

My journey into this field was relatively straightforward. I attended medical school at West Virginia University, completed my residency in Akron, Ohio, and further specialized by doing a sports medicine fellowship at the University of Kentucky. Since 2000, I have been practicing orthopedics in central Ohio. 

David Blue:

What attracted you to shoulder as a subspecialty?

Dr. Brautigan:

My specialization in shoulder was greatly influenced by mentorship. During my residency, I had the privilege of being mentored by outstanding individuals, Dr. Jeff Noble and Dr. Rob Bell, who left a lasting impact on me. Their expertise and experiences as residents inspired me to try and be like them.

Additionally, after completing my fellowship, I had the opportunity to further develop my skills and knowledge under the guidance of Dr. Gary Gartsman. I did a sort of mini fellowship with him, which included courses on arthroscopic rotator cuff repair, arthroscopic glenohumeral reconstruction, and eventually arthroplasty. This exposure played a pivotal role in shaping my practice.

I became an early adopter of arthroscopic rotator cuff repair, which opened doors to various other aspects within the field of shoulder orthopedics. As a result, my practice grew rapidly, and I attribute much of my success to the strong leadership and mentorship I received along the way.

David Blue:

Can you share your journey to the InSet™ Shoulder System? What were your initial impressions?

Dr. Brautigan:

Upon meeting the Shoulder Innovations team and exploring their concepts, particularly the InSet™ glenoid for anatomic total shoulder replacement, I immediately recognized it as a game-changing innovation. The design made perfect sense to me from a technological standpoint, and the early studies validating the design rationale and proof of concept were compelling, thanks to the contributions of individuals like Dr. Steve Gunther.

From there, I understood that the reverse prosthesis would become a significant platform in shoulder arthroplasty, complementing the anatomic side. What intrigued me about the reverse prosthesis platform was the idea of maintaining the same stem when transitioning from an anatomic to a reverse procedure. The InSet™ design, with its mini stem and low-profile features, made practical sense.

So, my journey began with an interest in the InSet™ glenoid for anatomic procedures but evolved into embracing a comprehensive system that promised to be a game-changer, all while fitting efficiently into the ambulatory surgery center model.

David Blue:

Speaking of shoulder replacement in ASC’s, how has the introduction of single tray technology for TSA and dual tray technology for RSA from Shoulder Innovations impacted efficiency and economic benefits in your experience?

Dr. Brautigan:

The reduced tray count is a crucial factor that often goes unnoticed by many surgeons and surgery centers when evaluating costs per case. Typically, cost evaluations primarily focus on implant costs, while tray counts remain underestimated. Tray processing costs are significant, ranging from $150 to $300 per tray, and each tray used in a case is processed twice, resulting in substantial expenses.

Some systems involve up to 10 trays, which, when multiplied by 20 (considering both pre- and post-case processing), can become cost-prohibitive for for-profit surgery centers. It’s essential to educate surgeons and surgery center managers on the actual cost of sterilization, considering factors such as staff salaries, potential overtime, energy costs, overhead expenses, and the resources required for sterile processing.

Shoulder Innovations (SI) recognized the importance of minimizing tray counts from the outset to keep costs down. On the implant side, SI remains highly competitive in terms of cost, offering a cost-efficient model solely for implants. Moreover, SI’s platform requires the smallest number of trays for procedures, making it particularly appealing to surgery centers.

In addition to cost efficiency, clinical effectiveness is, of course, a vital consideration. SI’s platform boasts a proven clinical track record, distinguishing it from mere “me too” products. One standout feature is the InSet™ glenoid, which is considered the best glenoid component for anatomic prostheses due to its compatibility with any humeral head, eliminating mismatches.

From an implantation and biomechanical perspective, the InSet™ glenoid is likely to offer superior longevity, as indicated by lab studies showing reduced rocking horse motion. This unique marriage of cost efficiency and innovative technology sets SI apart from other systems. 

Furthermore, SI’s humeral stem, used across both anatomic and reverse platforms, is regarded as the best on the market. Its low-profile design ensures easy implantation and secure fixation within the humeral canal, even in cases with softer bone. The humeral stem’s innovative features, such as three fins and appropriate porous coating, contribute to excellent fixation and stability. Additionally, the mini stem component prevents overstuffing of the humeral canal.

In conclusion, SI’s platform excels in combining technical innovation with cost efficiency, making it an attractive option in the shoulder surgery market. With Medicare allowing total shoulders in surgery centers, SI’s unique cost efficiency in terms of both tray counts and implants positions it as a standout player in the field.

David Blue:

Any closing thoughts, Dr. Brautigan?

Dr. Brautigan:

There is a wonderful opportunity for enhanced education among surgeons and healthcare stakeholders to fully grasp the remarkable benefits offered by the SI platform. It has the potential to significantly enhance their profit margins, particularly for shoulder replacement procedures while delivering terrific patient outcomes.

There has been a notable increase in the number of total shoulders performed in outpatient settings, specifically at ambulatory surgery centers. However, it is essential for doctors to recognize that simply transferring their hospital practices to surgery centers may not be cost-effective. Working in a surgery center requires a different mindset, one that prioritizes cost-effectiveness and maintains a cap on overhead to avoid financial strain.

Using certain platforms that rely on excessive trays in the surgery center for shoulder replacement procedures can result in financial losses, particularly with Medicare reimbursement rates. In contrast, the SI platform offers the potential for substantial margins. Many surgeons, including those who typically performed these procedures at hospitals for Medicare patients, are now performing them at surgery centers and achieving remarkable margins.

Surprisingly, many surgeons remain unaware of the true cost of their procedures, despite performing them regularly. Recognizing and understanding these cost dynamics is becoming increasingly important in the evolving landscape of outpatient surgical procedures.

Dr. Brad Brautigan is an Orthopedic Surgeon in Zanesville, Ohio