While attending AAOS 2019 in Las Vegas, the Innovation Theater was a hot spot to visit where new technologies and devices were being featured. Here are a few I saw while at AAOS:
One of the inventors of SMARTdrill, a surgical drill that curtails drill and screw plunge, and measures depth, torque, and energy in real time, Dr. John “Jack” Perry, demonstrated how the device can help surgeons while improving the accuracy and safety of surgery.
“We orthopedic surgeons practice with decade old technology,” said Dr. Perry. “There’s no plunge prevention, no depth measurement, no bone strength measurement, and no drilling performance. This is frustrating.”
SMARTdrill converts tactile touch into something visual. By reducing dangerous drill bit plunge by robotically controlling drill bit feed rate and providing data to surgeons, surgeons can make more informed decisions while performing surgery.
The device has two motors. While all drills have a spinning motor, the SMARTdrill surrounds the spinning motor with torque sensors, and it’s constantly measuring torque. This allows the user to measure the strength of a patient’s bone.
“We can feel the bone, but usually we can never measure it,” Dr. Perry said.
The next motor is the feed motor, which replaces strain on the shoulder, elbow, and hand. This motor controls the device, while reference points and sensors provide measurements and additional information. These numbers are then delivered to a wireless tablet.
The drill can assess bone quality to determine the pull-out strength of screws, and provides information to vital questions such as how many screws are needed to stabilize the fractured bone or if the surgeon should use more expensive locking screws and plates because of a weak bone.
OSSIOfiber was designed for rapid bone in-growth, regeneration, and replacement. The OSSIOfiber implant material is stronger than cortical bone and doesn’t leave anything permanent behind in the body.
The company said metal has been the standard for well over a century, but permanent hardware in a person’s body can create a suboptimal healing environment, lead to patient dissatisfaction, and increase healthcare costs from secondary removal surgeries.
The desire to replace metal is not new to the industry. Providing strength and bio-friendliness—allowing the body to do what it was meant to do—has been quite elusive, the company noted.
OSSIOfiber is a bio-integrative implant that enables the body to heal naturally, where the implant is replaced by natural anatomy, leaving the implants completely behind.
In as little as two weeks the bone is growing into the implant, and by the end of 104 weeks, the polymer is completely gone.
Presenter David Mayman, MD, for the Augmented Reality Visualization and Information System (ARVIS) headset, which contains tracking and visualization capabilities that allows the execution of preoperative surgical plans, said, “There’s nothing worse as a surgeon than seeing your post-op Xray and thinking, ‘Oh, that’s not what I thought I was doing.’”
The ARVIS headset can project virtual models of the patient’s anatomy into a surgeon’s viewpoint during a surgical procedure. This allows the surgeon to see structures that are not clearly visible while performing surgery. Additionally, virtual models of the implants or instruments are projected so the surgeon can see their relationship in comparison to hidden anatomical structures.
Mayman said one of the challenges of robotics is there is a lot of stuff in the room and it’s hard to navigate the operating table and/or room. In response, places will have to start miniaturizing instruments and making operating rooms more ergonomic and efficient.
The integration of technological advances in the operating room poses numerous potential trends for the future of surgery, such as telesurgery, operating room equipment interfacing, machine vision, remote support, and more.
The technology that ARVIS uses is in no means new, Mayman said. Fighter pilots have been using this technology and kids use it for games.
“What we’re really talking about is taking technology that’s been developed across different fields and putting it together so it can be used in the OR,” Mayman said.
Additionally, the company hopes to impact how surgeries are done by allowing multiple surgeons to have access to an ongoing surgery whether they’re on the other side of the country or not.
“Imagine if I could see what a surgeon is doing. It’s very easy to do that with two people wearing the headset, but we want to expand the headset to be used anywhere in the world,” Mayman said.
For instance, if a surgeon has a question about the operation they are performing, an expert surgeon from another part of the world could walk them through a complex case. This idea of interfacing with operating room equipment despite a person’s location is something Mayman said fits naturally into the work flow of an operating room.
ActivArmor is a custom-made 3D splint that allows patients to maintain their active lifestyles.
Every cast or splint is precision fit, and any body part can be fitted with a 3D-printed exoskeleton mapping system. Once a digital image is created, the company can manipulate and design any sort of cast or splint onto the patient. They can also manipulate the thickness and thinness, the coverage area, positioning, and more pertaining to the splint.
The splint is waterproof and is made from the same plastics as Legos.
Presenter Diana Hall said normally every time a patient comes in for an Xray, the doctor has to cut the cast off and reapply it. The ActivArmor eliminates the need for this, and exposes the skin for incisions and easy pin insertions. By creating a custom cast, ActivArmor protects post-surgical hardware, gives physicians the ability to expose or protect skin lacerations, ulcers, and incisions.
“You don’t get the skin breakdown that you do with traditional casts,” said Jason Browder, PA, Alpine Orthopedics. “Less risk of infection; you can view the incision as well as pin sites, where you can’t monitor those in a traditional cast.”
Perhaps these Lego-based material casts will pave the way for splints and casts.
Although just a few of the technologies and products I saw at the Innovation Theater at AAOS, there were many more trends and innovations that lined the floor at AAOS.