Physicians and surgeons are beginning to recognize the unique role mobile devices such as smart phones and tablet computers can play in health care. In response to these new devices the term “mHealth” is now used to describe the functions that mobile communications devices can serve as health information tools.

The current market leader in the tablet format is Apple’s iPad, the most recent version of which includes a 9.7-inch touch screen and enough onboard memory to store potentially hundreds of hours of video, thousands of audio clips, and tens of thousands of PDF articles. Application (or “app”) developers have capitalized on the device’s computing speed and memory to create interactive, three-dimensional (3D) teaching tools that can be used by patients as well as providers. This article aims to identify currently available apps for the iPad that could be valuable to residents and practicing orthopaedic surgeons.

The iPad comes with an array of preinstalled apps that perform many basic computer functions such as email access, calendar, and web browsing. In addition, the iTunes App Store currently has more than 500,000 apps, including 15,000 medical apps; many are available for free and most others cost less than $20.

Generally speaking, third-party applications can be classified into three broad categories: clinical education (journals and articles), surgical preparation (devices and techniques), and patient education (anatomy and pathology).

A mobile library
The iPad can serve as a mobile library, storing thousands of resources such as books, videos, and journal articles. For physicians with an electronic collection of peer-reviewed literature, apps such as GoodReader and iAnnotate are available at minimal cost and offer significantly improved library management and annotation tools compared to Apple’s own iBooks app. iAnnotate also offers a full text-search feature.

Surgeons who do not maintain digital article libraries may be more interested in free apps offered by journals such as Acta Orthopaedica, Spine, Plastic and Reconstructive Surgery, and Journal of Trauma. Although such journal content is currently free, paid subscriptions may be required in the future.

In addition, Current Concepts in Joint Review (CCJR) has released a searchable app that includes more than 125 video lectures from the Spring 2011 CCJR Conference, all available at no cost. The Orthopaedic Surgery Board Review Manual, published by Hospital Physician, offers free issues, each on a single orthopaedic topic.

Commercial potential
Recognizing the promotional and advertising potential of the iPad, several orthopaedic device manufacturers have released apps that demonstrate new orthopaedic implants and enable users to download technique guides along with other information (Table 1). Some even include 3D animations depicting the procedure.

Acumed, for example, offers a full-product guide that includes a complete listing of implants, images, video tutorials, and technique guides. DePuy’s PFC Sigma app contains a plethora of technical information about that company’s products, including surgical technique guides, animations, and videos. Another DePuy app, Spine, uses 3D animation to demonstrate surgical techniques while allowing the observer to change the camera angle, see “through” objects, and select items for more information.

Other apps with equivalent and impressive features include Stryker’s Op Tech Live, Synthes, Stryker ARIA, Stryker Studio 3, Zimmer’s Arthritis 411, I.T.S. InfoPoint, and Aesculap OrthoPilot U.S.A. All of these apps are free, and each offers a variety of tools designed to educate surgeons about that company’s products and techniques.

Interactive patient education
Health providers and commercial companies have begun to address patient education as well, creating apps to assist surgeons in teaching patients about their disease, demonstrate anatomy and pathology, and depict operations. For example, OrcaHealth apps include joint-specific 3D animations, pathologies, radiographs, computed tomography and magnetic resonance images, and narrated information about the most common pathologies specific to a particular field. Such apps can be used to provide interactive patient education in the waiting room or serve as an interactive demonstration tool during a consultation.

DrawMD Orthopedics is a free app that includes a number of anatomic templates for various body regions (such as the hip, knee, or shoulder), as well as an expansive collection of “stamps” that can be placed on the image to simulate pathologies (such as fracture or arthritis) as well as surgical treatments (screws, plates, prosthetics).

Some of the most feature-rich patient education apps have been created by orthopaedic device companies. For surgeons who already use a particular company’s implants, these apps offer the opportunity to provide pre- and postoperative patient education specific to the implant and manufacturer at a level that cannot be matched by paper- or web-based educational resources. Companies may include patient stories, educational animations and images, a description of treatment options, and even anatomic models that can be manipulated in space to demonstrate how arthroplasty implants are positioned in the hip or knee.

At this time, the most useful apps address educational functions, but app developers are working on mobile picture archiving and communication software, mobile electronic medical records, and even exploring the use of the iPad in the operating room. Physicians stand now at a technology crossroads, and the use of tablet computers in healthcare settings is likely to continue to expand and be refined.

Orrin I. Franko, MD, is a PGY3 resident at the University of California, San Diego department of orthopaedics and founder of the website, TopOrthoApps.com