Joseph Burkhardt D.O. of South- ern Michigan Orthopaedics and Becky Klein, Director of Clin- ical Operations for Brookside
Surgery, discussed challenges related
to knee replacement surgery, orthopaedic instrumentation, technological
advancements, and more in a recent
interview with Surgical Products.
SP: Traditionally what have been
some of the challenges you ex-
perienced in the OR with knee
Dr. Burkhardt: Traditionally, the instrumentation that was pres-
ent for non-customized implantation was manufactured in volume
and had to be placed with geometric cuts. The implants had to be
designed for a range of patient sizes and alignment, so essentially
patients were only able to receive the best average. Each patient
received an implant that was a little big or small instead of an exact
fit. Furthermore, traditionally, we had to verify the patient’s size
during the operation. We would have to go pull the stock, pull it in
the room and re-verify everything.
Becky Klein: From a facility standpoint, we were limited by what
manufacturing could produce in a cost-effective manner; the OR
staff was traditionally at the mercy of procedure representatives. We
had long periods during which the staff had nothing to do but wait
for trays to arrive so we could wash and process them. We also spent
a lot of money on rental fees, which could be $150 for each tray.
Not only was it cumbersome to finance all the trays, but it was also
challenging to house them. We have limited space and it was difficult
to make the room. Additional challenges arose when the representatives made a mistake and we received the wrong implant.
SP: What new technology has been developed to alle-
viate some of these concerns?
Dr. Burkhardt: In the last decade, customized, one-time use implants
have been developed. These implants also come with customized cutting
jigs and instruments, which are disposable. It’s important to note there
have been two major developments: customized cutting guides with off-the-shelf implants, and also customized implants with customized cutting
guides. At my hospital we mostly use the latter because we found it’s
better for the patient and for us. It’s just one small box that comes with an
implant specifically designed to fit only that patient and cutting guides to
match; it all comes pre-sterilized as well. We used to have 20 boxes, but
now we have one box that goes right in the patient’s basket and we are
pre-sized and engineered before we even do the case; we are ready to go.
Klein: For the rest of the staff it’s especially beneficial because this
surgical product saves us a lot of time and money; we don’t have to
spend a lot of time sterilizing and we don’t have to pay a rental fee. In
addition, traditionally, if something happened with the patient and they
had to reschedule surgery, we had to redo the sterilization process all
over again. However, a single-use, pre-sterilized product made to fit
each patient exactly, eliminates these concerns; we can simply put the
implant back on the shelf and use it when the patient is ready.
SP: What role do you think personalized medicine will
play in the OR?
Dr. Burkhardt: In my opinion, it will become the standard of care. You’re
always limited by what your manufacturing can do but now we can produce things that are economically viable. Fifteen years ago, this type of
surgery just wouldn’t be viable; it was too expensive and the time frame was
too long. Now, thanks to technological advancements, we can get images
from a CT scan, transmit the data in seconds and produce an implant.
In the last decade, single-use instruments have been a game-changer for orthopedic surgery.
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