We recently had the opportunity to interview Dr. Walter Stanwood 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. Walter Stanwood:
I grew up in the Midwest, where my family owned an auto parts and air-cooled engine store with a machine shop in the back. From a young age, I was using many of the same tools that I still use today in orthopedics. The mechanical aspect of my life had a significant impact on me early on and continues to influence me today. Additionally, having a mother who was a nurse sparked my interest in science from an early age.
David Blue:
What attracted you to shoulder as a sub-specialty?
Dr. Walter Stanwood:
My family history naturally guided me toward a career in medicine and orthopedics. During my residency, I found myself drawn to the field because it was both intrinsically interesting and challenging. I was also fortunate to have a great mentor—a shoulder and elbow surgeon who was only a few years out of training. His energy and enthusiasm for his work were contagious, and that passion played a significant role in shaping my own path.
David Blue:
How long have you been using the InSet™ system, and how did you become familiar with it?
Dr. Walter Stanwood:
Over six years now. What really drew me to it was the InSet™ technology that Dr. Gunther had developed, which had already been around for at least a decade by the time I became aware of it. Educating myself on his technology and the biomechanics behind it was incredibly interesting and compelling, particularly from an outcomes perspective. The finite element analysis of this technology was off the charts compared to anything else available at the time, especially in terms of its resistance to edge loading and wear, and its implications for addressing the rocking horse effect that we often encounter with traditional anatomic glenoids.
David Blue:
What are the benefits you’ve recognized in utilizing the InSet™ Shoulder System?
Dr. Walter Stanwood:
On the anatomic side, the goal was always to move away from the traditional stem, which was central to the design philosophy at Shoulder Innovations. The team they assembled for the mini stem project, which eventually evolved into the InSet™ Stemless platform, focused on this concept from the start. There are many advantages to this approach — some theoretical, some anecdotal — but in my view, the most significant benefit is that the stemless design allow us to base the entire humeral site preparation on the center of the humeral head, with everything else following from that. This approach ensures that the fixation is centered on the humeral head itself, rather than the shaft of the humerus. By starting from a position that’s as close to perfect as possible, you reduce the need for reverse engineering to achieve the desired outcome.
Additionally, in my practice, I’ve observed that patients generally report less pain, likely due to the less invasive preparation of the humerus.
Another key advantage is that in the event of a revision due to infection or fracture, the Stemless implant preserves a significant amount of the patient’s native bone at the metaphyseal-diaphyseal junction. This preservation makes any necessary revisions on the humeral side much easier.
When it comes to the InSet™ Reverse, we can build on the concepts from the humeral side of the anatomic design. While I know this is off-label, in my experience the Stemless has demonstrated to be an excellent foundation for the Hybrid InSet™ Bowl which securely holds the polyethylene. This design works very well, and if needed, a small amount of cement can be used. This approach allows for initial stability while still enabling bony ingrowth, which I believe is a better option than resorting to a full stem, as it preserves the anatomic center of the head.
On the glenoid side, the base plate is very user-friendly. While several companies offer circular base plate designs, the Shoulder Innovations platform stands out in a couple of unique ways.
First, the way we create the eccentricity or angle of offset helps preserve glenoid bone. This ties into the off-axis reamers, which are crucial for preserving as much glenoid bone as possible. These reamers are elegantly simple, unlike the bulky alternatives some other companies offer, which can obscure visibility and make placement difficult. These reamers are straightforward, reproducible, and effective for correcting significant defects without removing excessive bone. This allows us to use our 15-degree offset base plate, providing incredible fixation in challenging cases.
Furthermore, the base plate is designed with a built-in offset, and by selecting from various glenosphere sizes, you can achieve additional degrees of lateralization depending on the option chosen . This provides substantial flexibility to achieve proper tensioning on the glenoid side. The trend toward lateralization is becoming more accepted, as it offers a more anatomical restoration of the center of rotation and a better reconstruction of the natural deltoid contour.
On the humeral side, the system allows for distalization up to 12 millimeters. This capability is particularly valuable in complex cases where standard options may be insufficient. The InSet™ Shoulder System isn’t just for straightforward cases; it’s versatile enough to handle more challenging situations as well.
Plus, with the single tray TSA and dual tray RSA setup, I can perform almost all of my shoulder surgeries efficiently, making it an all-in-one solution that simplifies the surgical process.
David Blue:
Continuing on with that, in what ways have you noticed an impact of the single tray TSA and dual tray RSA setup relative to efficiencies in the OR, cost savings, etc.?
Dr. Walter Stanwood:
On the efficiency side, even when you have a consistent team of techs and nurses in the OR week to week, they still appreciate the simplicity of a one- or two-tray system. It’s logically set up and avoids overwhelming them with cumbersome or overly complex options for reaming or other tasks. This streamlined approach is especially helpful when you’re working with a tech or nurse who might not be as familiar with the setup. It’s easy to guide them through it, although in most cases, you don’t even need to—the system is intuitive enough that they can work through it efficiently on their own once it’s set up.
From a cost standpoint, especially now that total shoulder procedures continuing to trend more and more towards ASC’s, the cost savings from washing one or two trays instead of three or four is significant.
We’ve recently received our determination of need here in the Boston area on the South Shore and are in the process of building an ASC. We have worked this out roughly and calculated that this could save around $300 to $500 per case. That’s not rocket science—just simple math reflecting the cost of sterile processing to cycle those trays through. The savings are compelling!
David Blue:
Do you have any tips or pieces of advice that you would give other surgeons?
Dr. Walter Stanwood:
When it comes to the software used for templating, especially before my involvement with SI, there were some legacy programs out there that were considered solid options. Over time, templating software has become almost a commodity—everyone in the space has one because it’s essential to be a player now. However, the evolution of SI’s ProVoyance surgical planning software has truly changed my approach to both anatomic and reverse shoulder arthroplasty.
Back when I started, we only had X-rays and clear onlay sheets — like overhead projector sheets — that we’d line up on the images. Then came the early versions of computer software, which was a step forward but still left a lot to be desired. For surgeons my age or older, especially those who are still high-volume users, there can be some reluctance to make the leap to new software. I encounter this often when I give talks at conferences. Many surgeons approach me afterward, expressing concerns that the new software seems complicated or unsure how it will fit into their established practices.
I always tell them that relying solely on the “thumb test” or visual estimation is far less accurate than they might think. I used to believe I was quite good at it — I’m fellowship-trained and have a strong background — but even I was shocked at how off my estimates were before using advanced software. I remember asking a colleague who was a fellow a couple of years ago if he noticed a difference with software planning, and he admitted that it was “disgusting” how inaccurate he was before. Fortunately, our patients did okay, but the difference with precise planning is remarkable.
My advice to surgeons is about taking that first step — spending just half an hour getting familiar with the software. Once you do, I can say that ProVoyance is one of the most intuitive programs I’ve used. It’s a game changer. Now, I can translate what I see on the software directly into surgery. For instance, I use calipers to ensure my base plate center is exactly where I want it to be. With this software, I can consistently position the inferior rim of the glenoid in the perfect spot, which used to be more of a guess.
The same applies to anatomic shoulder procedures. The ability to precisely rotate a component within a specific range—especially when dealing with a large defect in a young patient—allows for much finer control. I can now dial in adjustments within five degrees based on reference points on the glenoid, something I never could do before. This software has made true precision a reality.
David Blue:
How would you compare Shoulder Innovations’ approach to project management and execution with other companies you’ve worked with?
Dr. Walter Stanwood:
The difference is truly like night and day. To give credit where it’s due, the larger companies I’ve worked with inevitably have more layers, which is a natural result of their size. However, this structure often stifles innovation and limits the ability to enact change within the team.
In contrast, working with Shoulder Innovations has been a completely different experience. They’ve built a team of leaders who are not only knowledgeable but also humble. Leaders who recognize that they aren’t the only experts in the room. This culture of mutual respect and open communication allows us to accomplish far more in less time than any other project I’ve been involved with. Among the surgeons, this collaborative atmosphere fosters efficiency and productivity.
On the administrative side, SI’s responsiveness is incredible. For example, we can go from discussing an idea in a meeting to having a 3D model and a prototype in my hands within just two weeks. That kind of turnaround is unprecedented. The entire process, from submitting an idea to the FDA, to achieving an early release, and eventually full market launch, is significantly faster than anything I’ve seen in the past.
SI is nimble, agile, and efficient, not just in product development but also in their ability to raise funds and execute their strategies effectively. This combination of speed, innovation, and teamwork is what sets them apart.
David Blue:
In your experience, how does SI handle surgeon interactions and feedback compared to other companies?
Dr. Walter Stanwood:
The reason I can speak to this so clearly is because of the feedback I hear firsthand during our two or three annual conferences. When I talk to new surgeon users, I see that refreshed look on their faces. They consistently express two key points: first, they love the product, and second, they’re impressed by the rapid response from their local reps.
Even in a more rare event where the reps can’t immediately provide the solution they’re looking for, they communicate in near real-time, which is incredibly valuable. Any changes that are made happen quickly and in a manner that’s both respectful and timely. Many surgeons describe this as “refreshing,” as it’s not something they’ve experienced with other companies.
This level of engagement speaks volumes about SI’s approach to hiring and their ability to put the right people in the field. These reps are not just dedicated but genuinely interested in what’s happening with the surgeons they support. This commitment permeates the entire SI culture and naturally extends into the surgical practices of the users. It’s almost an organic process—word spreads quickly among surgeons as they share their positive experiences. Surgeons who have only been using SI products for a couple of months often remark that the responsiveness and feedback they receive far surpass what they’ve experienced with other companies like Tornier/Stryker or others.
David Blue:
Do you have any closing thoughts today?
Dr. Walter Stanwood:
I think the biggest standout, from a personal standpoint, is the unique culture at SI—it’s unlike anything I’ve seen before. That’s a real testament to Rob Ball, Dave Blue, and the entire team they’ve built. Their collective experiences seem to have culminated in this remarkable company. I wouldn’t be surprised if, one day, SI is used as a case study at places like Kellogg School of Management on how to design and execute an orthopedic startup the right way.
In the six years I’ve been involved with SI, I’ve been consistently impressed. Whether it’s making key decisions, addressing issues, or handling hiccups, their dedication and knowledge shine through. They don’t just talk the talk—they’re on the next flight out if there’s a problem, ready to do another case and work through it with you. Their ability to execute, in a way that few companies can, is truly unique.
I’m genuinely happy to be part of this journey. I think this feedback is valuable not only for SI but also for other surgeons who might be on the fence about making a change. In my view, SI is a truly compelling company, and I’m glad they’ve taken the time to gather this feedback.
Dr. Walter Stanwood is an orthopedic surgeon in Plymouth, MA