Recent advances in hardware development and integrated software have unleashed a wave of creativity and innovation in the technology industry, resulting in new approaches and devices that can be applied to orthopaedic practices. The digitization of health care offers the possibility of faster, cheaper, and better care for patients, and advances outside the traditional orthopaedic arena can be applied in new ways to improve practice logistics within the framework of healthcare reform. This article introduces some of the mainstream emerging hardware that may help improve the clinic and operating room (OR) environment.
Gesture-based PACS navigation
The use of digital radiography, advanced imaging, and templating software in orthopaedic surgery continues to expand every year. Advances in picture archiving and communication system (PACS) technology, combined with government initiatives to reduce healthcare costs, have turned digital radiographs into an essential component of the surgical plan. PACS allows images to be accessed at multiple locations at different times, increasing multidisciplinary collaboration and the exchange of information between physicians and patients.
Currently, intraoperative use and manipulation of digital radiography has been limited by sterility concerns. Surgeons may often need to scrub out of surgery or have an OR circulating nurse manipulate the PACS machine so that the surgeon can evaluate images or perform measurements.
As a result, some of the potential advantages of real-time PACS navigation in the OR—such as close reevaluation of fracture patterns and pathology, intraoperative templating, and simultaneous comparison of multiple imaging studies—are not being used. This barrier to efficient intraoperative PACS use can be overcome with the recent introduction of gesture-based computer navigation (Leap Motion Controller, Leap Motion, San Francisco).
Gesture-based technology allows users to manipulate desktop software without touching a mouse, keyboard, or screen. Using a peripheral attachment, the device can track the natural movement of both hands and all fingers for precision control of digital images by surgeons under sterile conditions (Fig. 1). Motion controller technology has the potential to change the way surgeons incorporate computer use in their surgical plans, both in clinic and in the OR.
Head-mounted augmented reality system
Intraoperative photos and videos are invaluable educational tools for both surgeons and patients. The growing popularity of online physician resources—such as digital textbooks, case discussion websites, and surgical technique video sharing—has increased the demand for quality intraoperative images. However, similar to PACS navigation, documenting cases has been limited by sterility and functionality in nonarthroscopic cases.
Video cameras mounted on OR lights are often limited by distance to the area of interest; camera angle and focus are also limited. Changing gloves to manipulate a digital camera, scrubbing out and in, or having assistants reach over the sterile field to gather images can increase surgery times and subsequent costs. Such practices may also unintentionally contaminate the surgical field.
A potential solution is in the use of wearable digital cameras to capture first-person point of view during surgery (Google Glass, Google, Mountain View, Calif.). One system uses a voice-activated interface and a lightweight, glasses-shaped augmented reality system to capture pictures and video. The images are exactly what the wearer sees, captured in a sterile fashion and able to be shared instantly with other physicians.
The possibility of sharing real-time intraoperative information with other orthopaedic surgeons and consulting physicians is an unprecedented and revolutionary way of furthering case discussion and collaboration. Another feature with unlimited potential is the ability to tap into Internet resources in clinic and during surgery simply by using voice command. Basic questions can be answered, recommendations made, and tasks performed by requesting the web server to provide relevant, personalized results to the physician.
Rapid 3-D scanning and prototyping
The design of orthopaedic hardware, implants, and surgical tools is an important aspect of orthopaedic surgery. Over the years, advances in device design have brought operations such as hip and knee arthroplasty to the forefront of medicine with excellent clinical results and patient satisfaction.
Until now, the ability to transform two-dimensional drawings into three-dimensional (3-D) implant prototypes has been both limited and expensive. However, advances in desktop 3-D scanning and printing are enabling individuals to create high-resolution replicas, models, functioning prototypes, and visual aids faster and cheaper than ever before (Makerbot Digitizer; Replicator 2, Makerbot, Brooklyn, N.Y). Recently, 3-D printing has been applied to bioengineering, using real human cells to create living body parts in a process known as bioprinting.
3-D printing is based on the principles of additive manufacturing, using thousands of layers of composite material to build a 3-D object, as opposed to traditional machining, which subtracts material to obtain a desired shape. This tool has previously been cost-prohibitive to the individual surgeon without financial assistance from large device manufacturers.
Decreased prototype costs now provide the opportunity for physicians to create and further expand upon their ideas with greater efficiency. An idea can be conceived, drawn, edited, and made into a tangible 3-D object in a single day. Although the long-term implications and purported benefits of new technology and implants in the surgical arena remain a concern, the move toward the individual surgeon as inventor and developer has never had greater resources and potential.
Musculoskeletal disorders are an increasing portion of the U.S. healthcare burden and are a leading cause of disability and chronic ailments in the aging population. Now more than ever, cost-effective innovation utilizing technologic advancements is key to keeping orthopaedics at the forefront of modern medicine.
The technologies mentioned in this article can push the boundaries for what is achievable in health care. Their broader applications are only limited by the imagination of the user. The future of an increasingly digital practice is becoming more of a reality and, in the process, individual physicians now have the ability to learn, connect, and create in previously unimaginable ways.
Disclosures: Dr. Hsu reports no conflicts.
Andrew R. Hsu, MD is a PGY-4 resident in the department of orthopaedic surgery at Rush University Medical Center, Chicago. He can be reached at email@example.com