Latest / Becker’s Healthcare Podcast / Advancing Shoulder and Elbow Care in 2026 with Dr. Aaron Chamberlain of Intermountain Health: Part 2

Transcript

Advancing Shoulder and Elbow Care in 2026 with Dr. Aaron Chamberlain of Intermountain Health: Part 2 · Becker’s Healthcare Podcast

• 0:00
  Hi, everyone. This is Lucas Voss with Becker's
• 0:02
  Healthcare. Thanks so much for tuning in to
• 0:04
  the Becker's Healthcare podcast series. It's great to
• 0:06
  have you today. Excited and thrilled to be
• 0:09
  back for part two of our series with
• 0:11
  doctor Aaron Chamberlin, a board certified orthopedic surgeon
• 0:14
  with the Intermountain Orthopedic Specialty Group. And I'm
• 0:17
  excited to continue our conversation around the evolution
• 0:20
  of shoulder surgery today and also dive in
• 0:22
  on advancing shoulder care with the enhanced intact
• 0:25
  tissue sparing surgical technique. We'll hear a little
• 0:28
  bit more about that here in just a
• 0:30
  little bit. Doctor Chamberlain,
• 0:32
  great to have you again. Thanks for being
• 0:33
  back.
• 0:34
  Thank you. Good to good to see you.
• 0:36
  Good to be with you again, Lucas. Yeah.
• 0:37
  Absolutely. Excited to dive into a little bit
• 0:39
  more detail from our first conversation here.
• 0:43
  We've seen a lot of attempts over the
• 0:45
  last couple of years to develop a
• 0:48
  successful
• 0:49
  subscap sparing approach, really.
• 0:51
  What has your experience been with these previous
• 0:55
  techniques? Where is this space at now?
• 0:58
  Yeah. So I I first,
• 1:01
  explored the idea of subscap sparing many, many
• 1:03
  years ago in an attempt to try to
• 1:05
  help some of my patients where,
• 1:08
  their ability to heal a subscapularis
• 1:10
  repair would be is diminished due to some
• 1:12
  patient comorbidities or immune
• 1:14
  system deficiencies or medication management. So where I
• 1:18
  I'd explored historically with historical implants, the subscap
• 1:21
  sparing approach, which largely involved using a stem
• 1:24
  implant
• 1:25
  and then, you know, trying to
• 1:28
  do our best to
• 1:29
  execute some of the steps along the way,
• 1:31
  which
• 1:32
  without appropriate instrumentation,
• 1:34
  it just it was very time inefficient. It
• 1:36
  was extra time under anesthesia for the patient.
• 1:39
  Required a lot of extra steps to try
• 1:41
  to verify that what I was doing intraoperatively
• 1:44
  was,
• 1:45
  you know, exactly what I'd planned and intended
• 1:47
  to do from a surgical technique standpoint. We
• 1:49
  would never wanna compromise
• 1:50
  an outcome just to try a technique. And
• 1:52
  so, double and triple checking everything with historical,
• 1:56
  just implants and lack of instrumentation just took
• 1:58
  us quite a bit longer.
• 2:00
  What I've seen evolve and what we've done
• 2:02
  with the,
• 2:04
  the new evolution and intact,
• 2:07
  enhanced subscap sparing tissue sparing technique If we
• 2:10
  try to address the steps that really,
• 2:13
  we needed some extra aids to help us
• 2:16
  navigate and execute some of the steps, some
• 2:18
  of the key steps in the in the
• 2:19
  shoulder replacement, specifically the humeral head cut where
• 2:22
  we're not able to completely visualize and see
• 2:24
  the humeral head. We're able to use instruments,
• 2:27
  to, more quickly and efficiently and accurately
• 2:31
  perform that step. The other thing that's changed
• 2:33
  is is, you know, we've we've now,
• 2:36
  migrated as a profession largely to stemless implants.
• 2:40
  And so that changes the technique a little
• 2:41
  bit from historical,
• 2:43
  where we would use the stem and the
• 2:45
  intramedullary canal for alignment. Now the, the stemless
• 2:49
  implant
• 2:50
  can be placed in a variety of locations,
• 2:53
  which can add flexibility, but also,
• 2:56
  adds some variation potential, which in in a
• 2:58
  negative way where we wanna be reproducible.
• 3:00
  And so adding instrumentation
• 3:02
  and developing instrumentation help, be reproducible and accurate,
• 3:06
  and that is has been a a very
• 3:07
  positive evolution from from where we were historically.
• 3:10
  Now you are an innovator by passion,
• 3:14
  but also by trade. You've been part of
• 3:16
  the development
• 3:17
  of Intact. You were very involved in in
• 3:19
  the development of it itself.
• 3:21
  What sets it apart right now from other
• 3:23
  approaches that some of them that you've just
• 3:25
  described?
• 3:27
  Yeah. So what we've done now is we've
• 3:29
  compared to before where some other, iterations have
• 3:32
  tried to repurpose existing instrumentation
• 3:35
  in a way that was less than optimal,
• 3:37
  to try to help execute the subscap sparing
• 3:39
  approach. We've really changed and started from, you
• 3:42
  know, the beginning again and said, what instruments
• 3:44
  do we need to design,
• 3:46
  to try to make this, happen, in a
• 3:48
  more efficient and, reliable and predictable,
• 3:51
  manner. And so we've we've changed the instrumentation.
• 3:54
  We've changed retractors. We've designed retractors around this
• 3:57
  to help the surgeon,
• 3:59
  gain what, you know, visualization they need. We've
• 4:02
  changed,
• 4:03
  as I mentioned, we used to do subscap
• 4:05
  sparing mainly with just stemmed implants and using
• 4:07
  the interventricular canal. And now we've we've changed
• 4:10
  and altered that to,
• 4:12
  kinda meet the mark, in the current utilization
• 4:15
  of of stemless implants. And so being able
• 4:17
  to accurately reproduce, we place a stemless implant
• 4:20
  on the humerus,
• 4:22
  is is the other, one of the other
• 4:24
  key features.
• 4:25
  The last thing that I will say that
• 4:27
  I think is a real,
• 4:28
  game changer, for those that have tried subscap
• 4:31
  sparing,
• 4:32
  they'll tell you that the most challenging part
• 4:34
  of the procedure is how you manage
• 4:36
  the humerus. And and the the the instruments
• 4:38
  that I've mentioned where we can now more,
• 4:40
  timely and efficiently
• 4:42
  perform a humeral head cut without taking the
• 4:44
  subscap off or place the humeral implant more
• 4:46
  reproducibly are key steps. But the kind of
• 4:49
  maybe well, one of the bigger, changes is
• 4:51
  we've we've developed a mechanism by which we
• 4:54
  can access the glenoid through a transhumeral approach.
• 4:57
  So we don't need to move the humerus
• 4:58
  out of the way and retract it. We
• 4:59
  can just go right through the humerus, which
• 5:01
  opens up the the the realm of possibilities
• 5:04
  of what types of glenoid
• 5:06
  pathology we can manage,
• 5:08
  because it it, you know, it it improves
• 5:10
  our ability to access the glenoid,
• 5:13
  in a way that doesn't rely just exposure
• 5:16
  and some of the other factors out of
• 5:17
  our control.
• 5:18
  So I I think it's it's been a
• 5:20
  really rewarding experience to work with the design
• 5:23
  team and try to understand,
• 5:24
  what problems do we identify by leaving the
• 5:26
  subscap on and how do we design instruments
• 5:28
  and and leverage the implant of the intact
• 5:31
  to be able to execute that.
• 5:34
  I wanna jump back to something that you
• 5:35
  just touched on. You talked a little bit
• 5:36
  about the glen and your marrow piece here.
• 5:39
  When you see a patient that has glenoid
• 5:42
  meridural joint pain specifically, how do you determine
• 5:45
  whether that subscap sparing technique
• 5:47
  like Intact is appropriate for that patient?
• 5:51
  So,
• 5:52
  currently, my my surgical indications are around, you
• 5:54
  know, patients who have routine,
• 5:58
  primary glenohumeral osteoarthritis.
• 6:00
  So it's just, you know, loss of cartilage
• 6:01
  in the glenohumeral joint. Their shoulder, otherwise, is
• 6:05
  is normal, and then they've got a rotator
• 6:07
  cuff that's attached and functioning well.
• 6:09
  They don't have a lot of extreme deformities
• 6:12
  with bone resorption or or anything like that,
• 6:14
  but they've got, you know, some routine osteoarthritis.
• 6:17
  With that, any any patient that fits within
• 6:20
  that category in my in my practice, I
• 6:22
  would consider this for.
• 6:24
  The the benefit of it is by by
• 6:27
  not detaching and then reattaching the subscapularis,
• 6:30
  the risks that are associated with that, like
• 6:33
  not healing the subscapularis
• 6:35
  drops substantially.
• 6:37
  And and in addition to that, I'm able
• 6:38
  to help my patient recover a little more
• 6:40
  quickly. And so,
• 6:42
  for any patient with run of the mill,
• 6:44
  glenoid humor loss or arthritis,
• 6:46
  I will consider that. I will say that
• 6:48
  we're early enough in the learning curve. There
• 6:50
  are some patients where it may be challenging.
• 6:51
  So for surgeons who are listening who might
• 6:53
  consider this in their own practice, I would
• 6:55
  say, you know, patients with a significant amount
• 6:57
  of glenoid,
• 6:58
  deformity,
• 7:00
  where they might be considering a reverse shoulder
• 7:02
  replacement or substantial amounts of osteophyte formation or
• 7:05
  bone spur formation on the humeral side that
• 7:07
  might be challenging to remove
• 7:09
  in a predictable way by working under the
• 7:12
  subscapularis, I think, would be some other considerations.
• 7:16
  You mentioned one important thing here, which is
• 7:18
  really key, I think, the learning curve. Right?
• 7:21
  I think that's hap that happens with every
• 7:23
  new procedure, every new technique that comes into
• 7:26
  the into the marketplace, into health care, whatever
• 7:28
  it may be.
• 7:29
  Can you walk us through what sort of
• 7:31
  your first few enhanced intact cases looked like
• 7:34
  for you? What was your experience there? What
• 7:36
  did recovery look like for your patients? What
• 7:39
  was that learning curve like?
• 7:41
  Yeah.
• 7:42
  I think that's really key to consider. And
• 7:44
  as I mentioned before, we really wanna make
• 7:47
  sure that as we're considering a new technique,
• 7:49
  we are trying to solve a problem for
• 7:51
  the patient to help their outcome,
• 7:53
  and we don't want to
• 7:54
  sacrifice any potential, you know, positive outcome just
• 7:57
  for a technique. And so I think what
• 8:00
  we're,
• 8:00
  what in my own experience with my learning
• 8:03
  curve, I focused on, number one, patients who
• 8:05
  don't have a lot of deformity where, technically,
• 8:07
  I have a clear understanding of the anatomy
• 8:09
  I'm working with,
• 8:11
  despite not taking the subscapularis
• 8:13
  off. And when I got started with this,
• 8:15
  I started with some of the first few
• 8:16
  steps just to kinda make sure I was
• 8:18
  comfortable. I had a low threshold to use
• 8:20
  more X rays in the in the Operating
• 8:22
  Room where I would check and double check
• 8:24
  what I was using with the instruments,
• 8:26
  and making sure that I was,
• 8:29
  you know, performing or executing the step as
• 8:31
  I would as I plan to. And so
• 8:34
  when I put a cutting guide up and
• 8:35
  I would before I made the humeral cut,
• 8:37
  I would check it with an x-ray and
• 8:38
  make sure it looks like, I would expect.
• 8:41
  Or before doing a final implant placement in
• 8:43
  the Operating Room, I would get an x-ray,
• 8:46
  rather than wait until the recovery area. But
• 8:47
  the nice thing about the intact enhanced technique
• 8:50
  is that during the learning curve, I I
• 8:53
  and I did this, but I would go
• 8:54
  as far as I felt the patient's anatomy
• 8:56
  would allow me to go and my my
• 8:57
  learning curve would allow me to go. And
• 8:59
  if at any point, if it became clear
• 9:01
  that it'd be better off to just take
• 9:02
  the subs cap off, I went ahead and
• 9:04
  I did that. By by starting out with
• 9:06
  the technique,
• 9:07
  you don't burn any bridges to then just,
• 9:10
  your bailout procedure is what you've always done.
• 9:12
  And so I think that's a that's a
• 9:14
  key part in the early part of learning
• 9:16
  curve is give yourself permission to take more
• 9:18
  time in the Operating Room, get X rays
• 9:20
  in the Operating Room, and then realize that
• 9:22
  you can bail out to what you've always
• 9:23
  done,
• 9:24
  at any point, depending on your learning curve.
• 9:27
  Well and, again, it benefits the patient. It
• 9:29
  trickles down to the patient outcome, which is
• 9:32
  ultimately the biggest piece that you've mentioned. The
• 9:34
  patient is the central part of this. We
• 9:35
  wanna make it easier, which is so important
• 9:37
  for it. Yep.
• 9:39
  As more surgeons adopt these techniques, it's more
• 9:42
  widely adopted across different ASCs in the country.
• 9:46
  What do you think the future of anatomic
• 9:49
  shoulder shoulder atherplasty
• 9:51
  will will look like with that subscapularis
• 9:54
  sparing innovation?
• 9:56
  Yeah. As we as we continue to, proceed
• 9:59
  down our learning curve and and see how
• 10:01
  patients, you know, can recover more quickly, get
• 10:04
  back to work more quickly, and and we
• 10:06
  don't have to concern ourselves with the subscapularis
• 10:10
  healing after surgery, I think we're gonna see,
• 10:12
  I think, more of a demand, on the
• 10:14
  patient's side. And I've had some patients already
• 10:16
  come to my office, and they need a
• 10:18
  shoulder replacement. They'd ask, can you do this
• 10:20
  without taking off the rotator cuff? Because they
• 10:22
  they they understand, and they've read, and and
• 10:24
  understand that it's a much shorter recovery period.
• 10:27
  It's less complication regarding the subscapularis.
• 10:30
  So I think we're gonna see more patient
• 10:32
  demand. We're going to see more surgeons learning
• 10:35
  and needing to become more comfortable with the
• 10:37
  technique as far as the differences in surgical
• 10:39
  exposure.
• 10:40
  But I do see I see that it's
• 10:41
  gonna become,
• 10:43
  a bigger part of our practice more generally.
• 10:45
  The interest is high from the patient perspective,
• 10:48
  and I think we can make a good
• 10:49
  use case for it. I do think with
• 10:51
  innovation and technology, we probably will see a
• 10:53
  continued evolution of the instrumentation we have. So,
• 10:56
  you know, as as more digital guidance or
• 10:59
  navigation opportunities become available, we might see that
• 11:02
  help us with some of the steps that
• 11:03
  we've designed instruments around, and and that will
• 11:06
  only help us become more efficient and more
• 11:08
  accurate and precise as we work. But I
• 11:10
  do see,
• 11:12
  us you utilizing more surgeon technological
• 11:14
  aids as we move forward.
• 11:16
  And we did talk, specifically about the patient
• 11:19
  experiences in our first episode as well. If
• 11:22
  you've missed it for the audience, it is
• 11:23
  available on demand as well. Highly recommend you
• 11:26
  listen to that. Again, we talk quite a
• 11:27
  bit about the patient experience and and the
• 11:29
  expectations that patients have today, which is certainly
• 11:32
  critical to the these techniques and advancing these
• 11:35
  techniques. Doctor Chamberlain, it's so great to have
• 11:37
  you. Thanks again for taking some time and
• 11:39
  sharing your insights with us today. It's great
• 11:41
  to have you. Thank Thank you very much.
• 11:42
  Good to be with you, Lucas. Absolutely. And
• 11:44
  we also want to thank our podcast sponsor,
• 11:46
  DePuyis and Thies. You can tune in to
• 11:47
  more podcasts from Becker's Healthcare by visiting our
• 11:50
  podcast page at beckershospitalreview.com.