We recently had the opportunity to interview Dr. Kenneth Kearns 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 please share your background, including how you became involved in healthcare and specifically orthopedics?
Dr. Kenneth Kearns:
For as long as I can remember, I’ve been fascinated by orthopedics. Apparently, I had a thing for skeletons as a kid – my nickname growing up was “Dr. Bones,” and my dad still calls me that to this day.
I played hockey throughout my life and grew up in Cleveland before our family moved to Toledo. One of our neighbors, who we used to play street hockey with, had a dad who was an orthopedic surgeon. That connection sparked something for me.
As I got older, I started spending more time with my friend’s dad. He began taking me into surgeries while I was still in high school, which eventually turned into a summer job. I worked in his office and had the chance to observe procedures firsthand. That was the moment I realized, “This is actually really cool.”
If I wasn’t going to be a professional hockey player, orthopedics became the next best thing. My older brother got the size—he’s 6’1” and ended up playing professionally. I’m only 5’9”, and I don’t quite have Sidney Crosby’s skill set, so that path wasn’t in the cards. But orthopedics had always been there and had always been a real passion.
Even in college, that passion stayed with me. I majored in economics as a backup plan (I didn’t want to end up stuck in a lab if medicine didn’t work out) but all the pieces eventually fell into place. I got into medical school, matched into residency in Philadelphia, and that’s where I continue to practice today.
David Blue:
What attracted you to shoulder as a sub-specialty?
Dr. Kenneth Kearns:
Like most physicians, I was probably influenced by my mentors, and Dr. Gerry Williams was my mentor. You tend to have an affinity for the people you connect with, and for me, the personalities within the shoulder department just clicked.
I also liked that shoulder was sub-specialized enough to feel like I was truly a specialist, but still broad in scope. I didn’t want to go into hip and knee, where it often comes down to two procedures: ‘right or left.’ With shoulder and elbow, I could do sports cases, I could do fractures, I could do replacements. It felt like I was a general orthopedist who happened to specialize in a specific area.
The youngest patient I’ve ever operated on was 12, and the oldest elective replacement I’ve done was for a 95-year-old. So for me, it’s really the best of both worlds. I’m highly specialized, but still able to treat a wide variety of patients and conditions.
David Blue:
How long have you been using the InSet™ system, and how did you become familiar with it?
Dr. Kenneth Kearns:
For those familiar with Shoulder Innovations, you’ve probably heard the names Dr. Peter Johnston (Peter) and Dr. Rob Gillespie (Rob). I was a chief resident the year Peter and Rob were fellows. I already knew at the time that I was going into shoulder and elbow, and our personalities just clicked and we stayed in touch over the years.
Then during COVID, Peter and I began talking about options on the glenoid side. He told me, “You’ve really got to try this InSet™ glenoid.” I trusted him, so I said, “Alright, I’ll give it a shot.”
At first, I was doing combination cases, using the InSet glenoid but pairing it with a different humeral system. As Peter continued to more comfortable and see really good results in his patients, he said, “Look, I think the humeral side is really strong too. You should give it a try.” So I did.
Then, as you might guess, Peter came back and said, “Hey, the InSet™ reverse system is great too. You should try that.” So I gave that a go as well.
And now, a couple of years later – here I am, fully in!
David Blue:
What has been the feedback received from patients regarding their outcomes or comfort after surgery using the InSet™ system?
Dr. Kenneth Kearns:
My patients are doing great! As we all know, the humeral side usually isn’t the limiting step, it’s the glenoid. If you can get the glenoid right, you’re in a good place.
A lot of my patients are younger, and they don’t want restrictions. They want to be able to do whatever they want. And traditionally, if you look at the literature or talk to colleagues, the onlay glenoid is load-bearing. I explain it to patients like this: it’s like the brake pads on your car. If you take care of it, it’ll last 15 or 20 years. But if you beat it up, we could be having a revision conversation in a year or two.
I also have some experience with the ream-and-run technique through one of my mentors. I used that approach with patients who insisted on no restrictions. We even published results showing around a 15% revision rate. But I had a few bad outcomes that soured me on the technique. I wasn’t loving it anymore, and I started looking for another option.
I came across an article that talked about glenoids being constrained by the bone, and some surgeons using those implants weren’t placing any restrictions on their patients. That really resonated with me. The InSet™ glenoid seemed to offer that same potential. It’s recessed into the bone, and it gave me a way to give patients the freedom they wanted.
There’s definitely been an evolution in how we use it. When I first talked to Peter, we’d place it a millimeter proud. Now, after seeing more usage and results, it’s more common to place it around two millimeters in. Either way, it gave me a way to offer no restrictions—and the results were impressive.
I still remember the first patient I used the InSet™ glenoid on, a huge bodybuilder. He’s now back to benching 400 pounds and telling all his gym buddies about it.
At first, I was only using it in younger, highly active patients who wanted zero limitations. But after seeing how well they did, I started thinking: why am I limiting this to just a small group? If it works so well for them, why wouldn’t it work for everyone? And that was the shift. Like most orthopedic surgeons, I’m slow to change, but over time, I started using it more broadly. Now, I use it for everyone, and the results have stayed consistent. Patients love the idea of having no restrictions.
Just today, I saw a guy who owns a construction company. He has terrible arthritis, but he told me, “Look, I still do heavy labor. I don’t want any limitations.” I told him, “You won’t have any with this.” And he said, “Great. Sign me up!”
David Blue:
Have you noticed an impact of the one tray TSA and two tray RSA setup?
Dr. Kenneth Kearns:
It’s been huge for us! We opened our own surgery center right as COVID hit. So the timing wasn’t ideal, and it made for a rough start. There were delays, and the financial burden of opening during a pandemic slowed things down more than I would’ve liked. But we stuck with it, and now, we’re finally in a great place.
I’m doing shoulder replacements at the surgery center, and honestly, it’s been a game changer. The team there loves it! Some of my partners do total hips and knees, and they come in with four to six trays. Meanwhile, my rep walks in with two trays, and they’re like, “That’s it?” And I say, “That’s all I need.” The efficiency is a big win for the surgery center.
I still do some of my more complex cases, or patients with challenging insurance or health issues, in the hospital. But even there, (without naming names) there are four different shoulder systems in use. And the feedback I get across the board is that the SI system is by far the easiest to work with.
Everyone, from scrub techs to scrub nurses, says the same thing: it’s just simple. It’s easy to manage, easy to understand, and doesn’t require a lot of extra thinking or setup. And that kind of consistency matters in a busy OR.
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. Kenneth Kearns:
What I’d tell other surgeons is this: nobody likes to slow down. I get that. Especially in the OR, we all want things to move efficiently. Some people are slow to adopt the system because they don’t want to wait for the cement to harden. But in my experience, if you can just take those few extra minutes and let the cement set, it’s absolutely worth it.
I’ve been using the InSet™ glenoid for several years now, and so far I’ve had zero failures. Zero loosening. I don’t restrict my patients post-op, and they’re doing great!
One thing I’ve started doing, which might be a bit controversial, is I’ve completely stopped correcting version in most cases. My reasoning is pretty simple: if the glenoid is stable and the patient has lived with that anatomy for years, why are we correcting it?
Historically, we corrected glenoid version to prevent loosening by achieving better force balance across the joint. But with the InSet™, I’ve found the fixation to be so solid, cemented or not, that I’m not sure there’s much to gain by altering the version. So now, if I can physically get the implant in, I just leave it as is.
Anecdotally, the outcomes have been very good. That’s actually the next research project I’d like to take on—looking more closely at outcomes without correcting version.
What I’d tell other surgeons is that this system gives you the freedom to do that. You can place the glenoid component exactly where you want it. If you believe that posterior-superior wear leads to cuff tears down the road and you want to adjust for that, you can. If you prefer to go dead center, that’s just as easy. The ability to dial in the implant positioning based on your own philosophy, that’s a real beauty of this system.
David Blue:
Do you have any closing thoughts today?
Dr. Kenneth Kearns:
The phrase going around is, I came for the InSet™, but I stayed for the entire system. That stuck with me, and it’s held true.
I still remember the first reverse I did with the system. Peter had told me ahead of time, “It’s going to feel different.” And he was right, but it’s hard to put into words what that actually means. I had a fellow in the room with me, and we both had the same reaction. As we worked through the case, it just felt… different. It didn’t feel like a traditional reverse, it felt like an anatomic shoulder. Even the fellow said, “That just felt right.”
I try to follow the guidance of my mentors, who’ve always said that if a patient is coming back for the other shoulder, you stick with whatever implant they had on the first one—even if it’s been 20 years. Pull the box off the shelf, find the right instruments, and match what they’ve already got.
Well, I had a patient who had a reverse done with a different company on one side, and we had originally planned to use the same system on the other side. But this was around the time I was transitioning fully over to SI. As it happens, there was a bit of a mix-up with inventory. The old system wasn’t available, but the SI system was. I told her, “This is the new system I’m using. I believe in it. I feel very confident with it, and that’s why I made the switch. But if you want to delay surgery and wait until we get your original system back in, we can absolutely do that.” She looked at me and said, “You trust it? Then I trust it. Let’s just move forward.” And I’m glad we did. She did phenomenally well! She told me, “When I look in the mirror, this new shoulder (SI) just looks really good, and my bra strap doesn’t fall off anymore.” It’s a small thing, but it matters. She may not fully understand the biomechanics, but when you look at her X-rays, you see what people are talking about when they describe an “anatomic reverse.” And those little improvements, those day-to-day things that make life easier, that’s what people remember.
Again, I don’t want to overstate it, but the reverse system has really stood out. It’s unlike any other reverse I’ve used. Patients are genuinely happy, and I feel confident that I can address whatever issue they bring to me, whether it’s an anatomic case, a reverse, or a more complex reconstruction.
What’s also remarkable is how Shoulder Innovations has managed to offer such a broad range of options with so little instrumentation. Two trays, occasionally a third if you’re using the I-95—yet you have the flexibility to do so much.
That kind of efficiency and versatility is rare!
Dr. Kenneth Kearns is an orthopedic surgeon in Philadelphia, PA