Advances in Medical Technology

Advances in Medical Technology

James Andry, Chief of Orthopedic Surgery, Integrated Medical Services

Since the turn of the century, the medical technological advances that have been developed and continue to evolve have been nothing short of impressive. These tech-driven advances have greatly impacted a multitude of industry sectors, particularly the field of medicine, from the da Vinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, Ca.) impacting cardiac and abdominal surgery to extracorporeal membrane oxygenation (ECMO) impacting our ability to take care of critical patients. Orthopedic surgery is no different in undergoing its own chapter of advancement and evolution with medical technology. One of the more exciting areas in orthopedics that is currently witnessing this, is the world of shoulder reconstruction.

Up until about 20 years ago, preoperative workup in most cases usually involved basic x-rays, and then using the x-rays in planning out surgical maneuvers by hand or on the computer. We now have CT-based preoperative planning software that receives CT scans of the affected joint, which are then used to produce 3-D reproductions. These digital reproductions can be manipulated in 360 degrees on the computer as well as used to template the implants to help create custom cutting guides. A great example is the Blueprint 3D Planning software (Wright Medical, Memphis, TN).This software, which can be loaded onto your personal computer, will have preoperative CT scans that enable a surgeon to precisely plan hardware placement with the anticipated function of the shoulder. All before the surgeonsteps into the operating room.

“The ability to identify and diagnose the abnormal and diseased characteristics of the joint we need to reconstruct is the key first step to the process of correcting it”

We have also greatly advanced intraoperative technology to assist with our procedures. ExactechGPS (Exactech, Inc., Gainesville, Fl) is an advanced computer technology that allows the surgeon to monitor the placement of the implant during the operation. This allows the surgeon to place the hardware, as well as facilitate the necessary adjustments in terms of depth and angle in real time with excellent precision and accuracy.

These technologies more accurately optimize the placement of the implant to the appropriate angle and depth, peg placement in the glenoid vault, backside contact, and the amount of corrective reaming.

The ability to identify and diagnose the abnormal and diseased characteristics of the joint we need to reconstruct is the key first step to the process of correcting it. These technologies allow us to make critical decisions prior to surgery. More often than not, a surgeon will encounter significant deformity of the socket of the shoulder. This deformity can be particularly difficult to appreciate intra-operatively as well as appropriately adjust from a technical standpoint. Malpositioning of the components leads to unacceptable early failure of the surgery. Now we have the ability to evaluate the deformity down to the millimeter and design a custom guide to appropriately correct the deformity prior to entering the operating room. In addition, we can also make real time adjustments to correct error in placement of our hardware, and ensure that the procedure is executed with significantly greater accuracy and precision while reducing surgical time. This leads to a great improvement of the care of the patient, reduced risk to the patient, greater patient satisfaction, and greater surgeon satisfaction.

As a surgeon who is heading into the peak years of his career, it is very exciting to have the opportunity to use this technology. I cannot wait to see the technologies that will be developed in the future. These advances on the technological side of our profession will make difficult and complicated problems more easily manageable.

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