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Innovations in
Orthopedics
New ideas were everywhere
at the American Academy of
Orthopaedic Surgeons
annual conference.
David Geier, MD | Charleston, S.C.
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T
he expo hall at this year’s meeting of
the American Academy of Orthopaedic
Surgeons in New Orleans was filled
with innovations aimed at safer surgeries, improved outcomes and greater
patient satisfaction. In pictures and in words, here
are some of the neat new products that your orthopedic surgeons might find useful and interesting.
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REST EASY Allen’s advanced spine
tables offer a host of safety features.
REPRINTED
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Blue Belt Technologies
NavioPFS Surgical System
The Navio system is a light, extremely mobile and
easy-to-use planning and navigation platform that
gives surgeons a virtual cutting guide along with
detailed visualization. The company says it puts
the precision of robotics comfortably in the surgeon’s hand.
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FROM
EASY FIT Blue Belt Technologies promises robot
precision without the cumbersome robotic arm.
HOLY GRAIL? BioMet is betting that its new ACLpreserving implant will revolutionize total knees.
O U T PAT I E N T S U R G E R Y M A G A Z I N E | M AY 2 014
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O R T H O P E D I C S
It certainly seems like a viable alternative to
expensive robots, and it’s a technology I think you’ll
see more and more of, since unicompartmental
knee replacements are now being done frequently
in surgery centers. You certainly can’t complain
about how heavy it is, and it doesn’t take up much
space, which is a key feature in surgery centers.
Often, you’re constrained to a small area, so you
don’t want equipment everywhere clogging up the
room in a joint case.
At about half a million dollars, it’s a significant
capital purchase, and something most hospitals can
probably afford more easily, but it’s considerably
less expensive than some alternatives.
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Allen Medical
Advanced Spine Table
If you’re in the market for new tables for your spine
surgeons, there’s a lot to like about the features this
company has to offer. You probably won’t need the
600-pound weight capacity at most outpatient facilities, but patients are getting heavier and heavier,
and this table can accommodate just about anyone.
The upgraded head positioner, called a C-flex,
is an attractive safety feature. Making sure you
avoid sudden snaps of the head is definitely critical when you’re flipping and moving the patient.
And the range of motion it provides is helpful
with kyphotic patients, anterior artificial discs
and lateral procedures. Another nice safety fea-
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ture is that the table free-floats, but the moment
you let go, it stops and stays in place. Even if
you accidentally pull the wrong pins, the table
won’t collapse.
There’s 360-degree radiolucency. There are disposable pad covers that wick away moisture during
surgery to help prevent skin shearing. There are
both sling and flat-top options. And in an emergency, you can push a button and unlock all 4
wheels at the same time. That’s a time-saver if you
need to get a patient out of the room quickly.
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BioMet
Vanguard XP
Closing the satisfaction gap in total knee replacements was a big topic at the show, and this company is betting that it can advance the ball with an
implant that’s designed to preserve anterior cruciate ligaments.
A physician affiliated with the company
explained the theory, pointing out that a higher percentage of total-hip patients than total-knee patients
tend to be completely satisfied with the results of
their procedures. The theory behind this approach
is that when the ACL is removed, so are nerve
fibers that give the brain proprioceptive feedback.
As a result, even patients who are relieved of arthritis and pain say their knees just don’t feel right. The
hope is that by preserving the ACL, the patient will
retain normal kinematics and experience the total
PAIR OF TRAYS ConMed’s half trays can help
reduce reprocessing costs with power tools.
HOLE IN ONE Stryker’s Single-Portal
Arthroscopy System is a cool way to
get patients up and around more quickly.
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O R T H O P E D I C S
satisfaction that has been so elusive for 20% or 30%
of total-knee patients.
Could this be the Holy Grail of total knees?
Time will tell. It sounds like an idea with potential, and there’s a fair amount of anecdotal evidence to support the approach. But clearly, we
don’t know enough yet. We need hard data and we
need to have more surgeons who are comfortable
with the technique.
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ConMed
Hall 50 Powered Instruments System
With a modular handpiece that can be used across a
range of procedures, and customizable trays, this
company has upgraded and packaged its instruments
in a way that potentially reduces capital expenditures
and maintenance costs. The full set can be separated
into 2 half sets, when appropriate, saving on reprocessing costs, if, say, you’re working with a trauma
case, as opposed to a total joint. The lithium battery
is upgraded, too, so it’s less likely you’ll need to
change batteries in the middle of a procedure.
With a variable-speed trigger, the handpiece now
has 400 levels of speed, which is pretty close to infinite control. It’s also been redesigned to reduce
vibration, allowing for more precise bone cuts.
The handpieces are also engineered with “triseal” technology, giving them IPX (water-resistance)
ratings of 6 and 8, which is both the highest possible rating and the highest on the market, and makTOUCH AND GO The compact Venue
40 from GE Healthcare (center, bottom) uses touch-screen technology.
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ing it safe to put them through washer/sanitizers.
I’ve used the precursor to this set and thought it
was really nice, so it’s exciting to see further
improvements and flexibility.
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Stryker
Single-Portal Arthroscopy
After 4 years of development, this company just
launched its new single-portal arthroscopic system.
The goal is to provide patients with a way to get
back to their daily activities quicker.
I admit I was skeptical at first. It’s a big change
when you’ve been doing something a certain way
for 10 years and all of the sudden you need to
adjust to a different feel. There can be a big learning
curve. But surprisingly, this was easier to use than I
would have thought.
The idea is there’s a parallel portal cannula that
slides onto the scope and locks in place. So instead
of making 2 or 3 portals, the surgeon has to make
only 1 incision. All of the instruments have a proximal bend, so the surgeon’s hands are on 2 different
planes and can rotate the instrumentation. There
are also proximally bent cutters, so surgeons using
angled blades can still use them with the system.
Having tried it out, I have to say it’s actually really
neat — an intriguing idea for sure. And of course every
time you make a hole, there’s a certain amount of trauma, so in theory, if you can eliminate holes, that’s a
good thing. Facilities will certainly want to advertise
SPACE SAVER Steris’s new
tables can accommodate
big patients with a small footprint.
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O R T H O P E D I C S
that you can do procedures in a way that reduces pain
and increases patient satisfaction. I question whether
the extra cost is offset by having a couple of fewer
weeks of discomfort. That’s something we’ll know better after there are more studies on the technology.
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GE Healthcare
Venue 40
One of the cool features on this compact point-ofcare ultrasound system is the addition of 4 programmable buttons on the probe. A physician who’s
doing a needle-guided regional block can control
the system from the transducer itself. If you want to
freeze an image and snap a photo, or increase the
depth or the focal zone, instead of having to ask
someone else in the room, you can do it yourself.
It has intuitive pre-configured applications and
a touch-screen interface that works with rubber
gloves. It’s compact design lets it fit into tight
spaces and it boots up in 14 seconds or less, says
the company.
ALSO ON DISPLAY
More Buzz-Worthy Products
1. CLEAN AIR The 3V UV Air Disinfection
System can kill more than 99.9% of viruses, bacteria and spores.
spores. Though the company is careful
to say there haven’t been enough
definitive studies to prove that reducing bacteria can reduce SSIs, it does
cite preliminary studies showing
cause and effect.
3. FLUID THINKING Cannuflow’s Entrevu helps
prevent fluid buildup while also providing an
access port for shoulder arthroscopies.
1. Aerobiotix displayed its new 3V UV
Air Disinfection System, which is
designed to virtually eliminate airborne
bacteria in the OR. The machine draws
in contaminated air at floor level,
where particulate is eventually pulled
by gravity. After going through a prefilter, the air goes through a UV reactor
with 4 bulbs and a quartz crystal
matrix that agitates it long enough for
the ultraviolet light to kill bacteria
viruses and spores. Finally, it goes
through a HEPA filter. In one test, the
device produced a 100% kill rate on
viruses, a 99.97% kill rate on bacteria
and a 99.91% kill rate on bacterial
2. BRACE YOURSELF Aspen’s Vista 180
Cervical Collar is adjustable, reducing the
need to store multiple collars.
2. Aspen Medical Products showcased its Vista 180 Cervical Collar,
which is really 6 collars in one, thanks
to a dial height adjustment capability
that can be set to fit 6 different sizes.
That’s critical, the company points out,
because in addition to restricting
motion, it’s important to address skincare issues. The collar can be worn
long-term, starting from the scene of
the trauma, and adjusted accordingly
as patients become more ambulatory.
3. Cannuflow’s Entrevu is a novel cannula
that provides an access port for instruments during shoulder arthroscopy, and
also works as an anti-extravasation tool.
The patented design includes perforations in the threading that draw fluid from
the interstitial space up and out through a
separate channel. By eliminating fluid
buildup and the associated risks, it can
shorten recovery time, reduce pain and
significantly reduce the incidence of
comorbidities such as compromised vasculature or fluid in the neck or chest cavity. Additionally, anesthesiologists don’t
have to reduce blood pressure to accommodate fluid retention. It costs a little
more than other cannulas, but shorter
procedures, faster recovery and quicker
discharge can result in a significant ROI.
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O R T H O P E D I C S
4. UNIQUE APPROACH Smith &
Nephew’s knee system is based on
newly available virtual data.
4. Smith & Nephew touted the
Journey II Active Knee Solutions,
its second-generation knee system. The company has devised a
system that meets the needs of
the 2 major approaches to the
joint — procedures that retain the
posterior cruciate ligament, and
those that don’t. Testing is still in
the early stages, but a rep says
there’s strong anecdotal evidence
that the new system is closing the
satisfaction gap with total knees
— that patients are able to
engage in higher activity post-op
than ever before.
5. ALL IN ONE Arthrex’s Synergy Matrix seamlessly
integrates video through 48 inputs and outputs, and
can cover multiple ORs.
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Steris
OT 1200
I was impressed by the ease of use with this company’s new table. Any movement you do is all in a single button, and it locks the moment you let go.
It can accommodate today’s bigger patients (up
to 7-feet tall and 500 pounds), but as the rep put it, a
98-pound nurse can easily move a 200-pound
patient. There’s also a drive feature, so you don’t
need 3 or 4 people to maneuver the patient or to
wheel the table from the hallway into the OR.
The table is easy to position for optimal intraop-
5. Arthrex showcased its
Synergy Matrix,
a video input
management
system that
uses a single
fiber-opticbased router to
control up to 48
inputs and outputs and cover
multiple ORs —
all at what the
company says is
a fraction of
what it would
cost to wire
each OR individ-
ually. With touchscreen capability
and multiple feeds in each OR, the
surgical team can choose to simultaneously view the PACS, the Carm and the surgical camera, for
example, and manipulate the
images in real time by dragging
and dropping. The company also
offers a software package that
manages all of the incorporated
video systems, and that can be
used to store and mine data, communicate with patients and more.
6. Zimmer’s new A.T.S. 4000
Tourniquet System is designed to
reduce the risk of nerve-related
injuries and other complications, in
addition to minimizing post-op pain.
With new technology and contoured cuffs, the system delivers
personalized pressure — the lowest limb occlusion pressure needed to occlude blood flow, which
can dramatically improve patient
satisfaction. Along with various
safety features, the touch screen is
easy to operate, and the displayed
numbers are large enough to see
from across the room. There’s also
a protective sleeve to help eliminate wrinkles and pinches that can
cause blistering.
— Jim Burger
erative imaging. Its boot is designed around ski-boot
technology, so you can pull all sorts of traction
without the patient’s foot slipping.
The company says it was designed with everyone
in the OR in mind — not just surgeons, but also
nurses, anesthesia, the maintenance crew, the cleaning crew, anyone who’s going to be touching the
table. I believe it. If you’re buying a new table, this
looks like a really nice option. OSM
Dr. Geier (david@drdavidgeier.com) is an orthopedic surgeon
and sports medicine specialist based in Charleston, S.C., and blogger at drdavidgeier.com.
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LOOKING TO BUILD AN
ORTHOPEDIC ROBOTICS
PROGRAM? WHAT’S
STOPPING YOU?
Introducing Navio
TM
There’s simply no substitute for offering your patients the precision
of robotics-assisted partial knee replacement. Navio enables you to get your joint
program up and running with a low cost of entry and minimal per-case consumables.
Now with enhancements like STRIDETM
, the proprietary implant optimized for use with
the system, Navio is easy to integrate into any Ambulatory Surgery Center.
Talk to an expert about
crafting a program that fits
your facility’s growth plan and
the needs of your patients at
outpatient@bluebelttech.com.
bluebelttech.com
©2013 Blue Belt Technologies, Inc. Blue Belt Technologies uses or has applied for the following trademarks or service marks: NavioPFS, Navio, PFS, Handheld Intelligence,
and the “b” logo. All other trademarks are trademarks of their respective owners or holders. Blue Belt Technologies does not dispense medical advice and recommends that
surgeons be trained in the use of any particular product before using it in surgery. Please contact your Blue Belt Technologies representative if you have questions about the availability
of Blue Belt Technologies products in your area.