We recently had the opportunity to meet with Nick Capito, M.D., specifically to talk about his background and his experiences using the InSet Total Shoulder System from Shoulder Innovations.
Dr. Nick Capito is an Orthopedic Surgeon in Agusta, GA.
David Blue: Dr. Capito, would you please share your background with us, including how you became involved in healthcare and specifically orthopedics?
Dr. Capito: I was introduced to the field by one of my uncles who is an orthopedic surgeon. For a period of time he was involved with some of the pro sports teams in Pittsburgh. From early grade school I was enthralled with his interaction with the players and would periodically spend time observing him in the OR.
With that background, I honestly went into college and medical school with the intent on pursuing that specialty. For me, it was orthopedics or bust.
David Blue: Can you tell us about your training and what attracted you to shoulder and elbow as a sub-specialty?
Dr. Capito: During residency at the University of Missouri, I gradually found myself reading more of the journal articles related to shoulder and elbow. I immediately was interested in the sports and fracture side, but saw what appeared to be a very quickly evolving field in arthroplasty. Overall, I liked the concept of managing all types of joint pathology in all age groups.
After residency, I started fellowship at Brown with Dr. Andy Green and Dr. Scott Paxton. Dr. Green was very well experienced in shoulder arthroplasty. He is a skillful surgeon with great wisdom as he’s witnessed a lot of the evolution of this area. Dr. Paxton is also very well trained between notable people at both Wash U and Rothman. He provided a different perspective, was willing to tackle some very bizarre cases, and was more interested in the new technology that was being released in regards to implants styles and computer based preoperative templating. I like to think I became a hybrid of the two.
Now just four years out of the training, I’ve seen my own technique evolve and change as well.
David Blue: How did you first learn about the InSet Glenoid, and the Shoulder Innovations team?
Dr. Capito: In fellowship, we performed “ream and runs” on younger patients. Overall, I felt they did fine but they struggled during their rehab, which was just difficult to see. It just took a lot longer for them to get their full range of motion. It was not as gratifying as a post-op total shoulder. Something that always concerned me was the longevity of that procedure and what would happen to the glenoid over time.
Then, I had a 37-year-old nurse at our hospital come in with advanced glenohumeral arthritis. He had previous instability surgeries and an intraarticular pain catheter in his early 20s.
Based on his imaging, I felt that arthroscopy or hemiarthroplasty were not an option.
Currently, I participate in an online case sharing group known as CASES, which is made up of a number of younger shoulder surgeons. It was there that I heard about Shoulder Innovations and the inset glenoid. I did some research of my own and was impressed with Dr. Gunther’s biomechanical studies.
That first patient is about three years out now, and he’s doing fantastic!
David Blue: That’s great to hear! Since then, what has been your personal experience in using the InSet Shoulder System?
Dr. Capito: I was really pleased with how quick his recovery was, and his pain relief was just as? immediate. His motion was fantastic. Since then, he has been doing whatever he has wanted to do without any issues. I see him regularly in the hospital, so I have a good idea of what’s going on with him.
And since then, I’ve really expanded my use of the InSet System.
I gave up the ream and run, and just used the inset glenoid on my younger patients. Then I just really grew to love this system so much, that I said, “Why do I even have a narrow indication for its use in my patients? If it’s good enough for the younger patients, or the more challenging patients, why not for my typical older patients?”
Now, all my anatomics are with the Shoulder Innovations InSet system, because I believe it’s the most stable and gets them the most predictable results.
I have several patients who I originally put an onlay glenoid on one side, and now have an SI InSet on the other side, and it’s just interesting; each of these patients have commented about how much faster they are progressing post-operatively. It may have something to do with less exposure necessary to put in the implant. My incisions have become almost half the size of what other surgeons in the area are doing.
I’ve also just been extremely pleased with the InSet Humeral Stem too. The fixation has been excellent!
In fact, I did my first revision with the system recently. I had a 50 year old female with a painful resurfacing. Despite making adjustments to version and the neck-shaft angle, a small humeral stem had an incredible bite. I’m very grateful for this technology.
One other important thing to note, and it has to do with our inventory at the surgery center. Before Shoulder Innovations, we had a lot of vendor trays to manage, which was difficult and expensive.
Now that I’m using Shoulder Innovations and it’s just the one case, my staff is extremely pleased. It can be perceived as a small thing, but this really allows for more efficiency, which then allows for better outcomes, in addition to it being less expensive.
David Blue: If you were sitting down with a fellow surgeon to talk to them about this technology for the first time, what would you tell them?
Dr. Capito: I would start with the main concern we have with anatomic shoulders, which is the glenoid. We want to be able to give patients one procedure that lasts them the rest of their life.
From the biomechanical standpoint, comparing the InSet glenoid to a standard onlay glenoid , it’s just so dramatic to see how much stronger and much more stable the InSet glenoid is.
So that is encouraging, and gives you the confidence to tell the patient, “I have a procedure for you that could potentially last the rest of your life and allows you to do the things that you want to do, without being as concerned for the restrictions that we’ve had with our other onlay glenoids.”
Second, the inset glenoid allows for a more limited exposure necessary to perform the procedure. This makes the case slightly easier and quicker, with less concern for traction injury of the nerves.
Lastly, if they have an interest in performing shoulder arthroplasty at their ASC, you have to consider what you are bringing into your facility. You want your techs to feel comfortable with an easy system to understand. You need your sterile processing to be able to efficiently clean and turn over the trays. Time is money and Shoulder Innovations reduces the burden we have seen with other companies requiring 5-6 trays.
The one tray from Shoulder Innovations provides the solution to make your anatomic arthroplasties all around more effective and more efficient!