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AAOS Now

Published 9/13/2022
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Ronald A. Navarro, MD, FAAOS, FAOA; Robert Gillespie, MD, FAAOS; Cory Calendine, MD, FAAOS; Seth Sherman, MD, FAAOS; Nicole Stevens, MD

OrthoDome Offers a Novel High-definition Educational Experience to Annual Meeting Attendees

From residents encountering a technique for the first time to attending surgeons trying to refresh on a case they have not done in some time, orthopaedic surgeons use various multimedia platforms to learn surgical techniques. During the AAOS 2022 Annual Meeting in Chicago, attendees had the opportunity to experience the OrthoDome, a novel educational tool in orthopaedics, new for the 2022 meeting—and returning in 2023 (see Sidebar). OrthoDome’s name alludes to the classic and groundbreaking Cinerama Dome theater in Hollywood. 

The OrthoDome offered an immersive and comfortable video theater room showcasing orthopaedic surgical techniques and devices in 4K resolution and 3D video, narrated live by the experts. Twenty video presentations covered joint arthroplasty, shoulder and elbow, trauma, sports medicine, and more. The event was sponsored by Arthrex.

Shoulder and elbow
During the shoulder and elbow presentations, attendees heard and saw cutting-edge technology, complex instability surgery, navigation for severe glenoid deformity, and reverse shoulder replacement performed by leaders in the field, all in high-definition 4K resolution.

In one portion, Robert Gillespie, MD, FAAOS, of Case Western Reserve University, showcased the innovative InSet shoulder replacement implant from Shoulder Innovations. This implant is designed to improve one of the major complications of anatomic shoulder replacement: glenoid loosening. The video demonstrated the device’s simple instrumentation (one tray for the entire system), ease of use, enhanced fixation with bone preservation, and biomechanical and clinical advantages in all anatomic shoulder replacement patients, regardless of age. A recent multicenter study1 examining early outcomes in patients who received the InSet glenoid component found decreased rates of lucency and loosening compared with onlay implants, and outcomes were consistent with longer-term studies in smaller cohorts.

Total joint arthroplasty
Robotics are increasingly utilized in orthopaedic surgery, particularly in hip and knee replacements. Various robotic-assisted joint replacement platforms exist, each with its own complexity and nuances. Educational opportunities about these platforms are available via webinars, SawBones demonstrations, cadaveric experiences, and, more recently, virtual reality. However, as all surgeons know, there is nothing like real-world use.

The total joint arthroplasty OrthoDome presentation included a demonstration from Cory Calendine, MD, FAAOS, of the Bone and Joint Institute of Tennessee, about the Mako SmartRobotics™ platform for total knee replacement. The Mako platform is based on three core principles. First, start with the truth: Preoperative 3D imaging (e.g., a CT scan) creates a foundation for the case. The second principle is honing the ability to predict the future. A total knee replacement involves bones and soft tissue. The Mako software allows surgeons to intraoperatively adjust the bone cuts, at the surgeon’s discretion, to predict the final soft-tissue balance before cutting the bone.

The third principle is to execute with precision. The value of creating a perfect plan in 3D and adjusting based on the patient’s soft tissue is only realized with the precision of the bone cuts made with Mako’s robotic-arm assistance.

During the OrthoDome presentation, 3D footage, captured with the Vuze XR camera, showcased the room layout and the performance of the surgery itself. A GoPro Hero7 was mounted within the hood to provide viewers with the operating surgeon’s perspective. Attendees were also given a link to the Mako platform to view a picture-in-picture display of how the surgeon interacts with this technology intraoperatively, along with 3D glasses to optimize the experience.

Sports medicine
The OrthoDome provided an innovative and exciting forum to showcase an evolving surgical technique for tibial tubercle osteotomy (TTO), presented by Seth Sherman MD, of Stanford Medicine. TTO is a powerful surgical tool that can address patellofemoral malalignment and maltracking in the setting of symptomatic patellofemoral chondrosis, instability, or both. The 4K video demonstration highlighted use of the Multi-Directional Tibial Tubercle Transfer from Kinamed. The goal of the step-by-step video was to simplify and standardize the surgical approach, instrumentation, surgical correction, and fixation strategy for TTO. This novel technique for TTO has several potential advantages over classic osteotomy techniques and can be utilized for modular, precise, and reproducible patellofemoral alignment correction in up to three planes simultaneously.

The novel TTO system is less invasive, sparing the anterior compartment and protecting the nearby neurovascular structures. It allows for less cortical disruption with opportunity for improved time to osteotomy stability and shorter time to union, especially for the notoriously worrisome distalization-type TTO. Reduced cortical disruption has implications for early pain control and accelerated rehabilitation and recovery.

Trauma
Humeral shaft fractures account for approximately 3 percent to 5 percent of all fractures; of those, 30 percent occur in the proximal one-third of the humeral shaft. During OrthoDome’s trauma segment, Nicole Stevens, MD, of NYU Langone performed a video and case presentation on a technique for managing proximal one-third humeral shaft nonunion. Nonunions are relatively common in humeral shaft fractures, with rates reported to be as high as 15 percent. Risk factors for nonunion include motion at the fracture site, avascularity, fracture gap, and infection.

Dr. Stevens’ team utilized an anterolateral approach to gain access to the nonunion site. The nonunion site preparation was described in detail for attendees, including removal of fibrous tissue, reconstitution of medullary canals, and nonunion reduction. Fixation was achieved with lag screws and a neutralization plate. Biologic augmentation included iliac crest autograft. Dr. Stevens also described the technique for obtaining a bone graft. Then, viewers were shown follow-up imaging, demonstrating eventual union and positive clinical outcomes.

The video presentation also included a review of the literature on humeral shaft nonunion, which demonstrates good clinical outcomes with plate osteosynthesis and biologic augmentation.

The importance of high-quality surgical video demonstrations cannot be overstated. The way orthopaedic surgeons learn new techniques continues to evolve, and these videos have become integral in both resident and continuing education. With excellent videos, experts in the field can continue to share new and evolving techniques to further elevate the field of orthopaedic surgery.

Visit https://disclosure.aaos.org/search to view the authors’ disclosures.

Ronald A. Navarro, MD, FAAOS, FAOA, was the chair of the 2022 AAOS Annual Meeting OrthoDome High Tech 4K and 3D Video Room and a moderator for the event. Drs. Gillespie, Calendine, Sherman, and Stevens were presenters at the event.

Robert Gillespie, MD, FAAOS, is the vice chair of education and the Drusinsky Endowed Chair in Orthopaedic Surgery and Sports Medicine at University Hospitals Cleveland and Case Western Reserve University School of Medicine. He is also the program director for the orthopaedic surgery residency program at University Hospitals Cleveland.

Cory Calendine, MD, FAAOS, is an orthopaedic surgeon specializing in adult hip and knee reconstruction and robotic-assisted procedures at the Bone and Joint Institute of Tennessee in Franklin, Tenn.

Seth Sherman, MD, FAAOS, is an associate professor of orthopaedic surgery and the sports medicine fellowship director at Stanford University. He serves as the head team physician for the Stanford Cardinal football program.

Nicole Stevens, MD, is an assistant professor of orthopaedic surgery at NYU Langone Hospital—Long Island.

References 

  1. Johnston P, Strony J, Churchill J, et al: Clinical and radiographic outcomes following anatomic total shoulder arthroplasty utilizing an inset glenoid component at 2-year minimum follow-up: A dual center study. Submitted for publication (J Shoulder Elbow Surg), 2022.
  2. Gunther SB, Tran SK: Long-term follow-up of total shoulder replacement surgery with inset glenoid implants for arthritis with deficient bone. J Shoulder Elbow Surg 2019;28(9):1728-36.

Submit Surgical Videos for OrthoDome 2023

During the AAOS 2022 Annual Meeting in Chicago, attendees had the opportunity to experience the OrthoDome, a novel educational tool in orthopaedics, new for the 2022 meeting. The OrthoDome offered an immersive and comfortable video theater room showcasing orthopaedic surgical techniques and devices in 4K resolution and 3D video, narrated live by the experts and covering topics such as total joint, shoulder and elbow, trauma, and sports medicine. Attendees gave this new educational format resoundingly positive reviews, ensuring its return at the AAOS 2023 Annual Meeting, March 7 to 11, 2023, in Las Vegas. OrthoDome 2023 is co-chaired by Ronald A. Navarro, MD, FAAOS, and Lisa K. Cannada, MD, FAAOS.

Video submissions for OrthoDome 2023 are now open through Nov. 30. Submit applications at https://bit.ly/3cCE1i3.

Begin making your plans now to attend AAOS 2023 in Las Vegas. Visit www.aaos.org/annual/ to learn about the meeting and get the best selection of hotel options at flexible, discounted rates.