The exhibit hall at the American Academy of Orthopaedic Surgeons' Annual Meeting in Chicago this March housed displays from hundreds of manufacturers and distributors, each promoting its latest additions to the orthopedic market. Some of the technology I saw while touring the floor with colleagues from the Skokie, Ill.-based healthcare consulting firm Sg2 has an eye on future use. Some, however, is available now for hospitals and surgery centers. Here are some of the new products that made an appearance at the conference.

Imaging devices
As the outpatient arena continues to harness the power of diagnostic imaging in its procedures, several companies have built imaging devices that are compact and portable enough that outpatient ORs can easily accommodate them.

Arthrotek says its InnerVue Diagnostic Scope System can supplement or even eliminate the need for MRIs by placing an active and immediate diagnostic test on site and in a physician's hands. Using a disposable scope 1.2mm in diameter, the size of an 18-gauge needle, the system is primarily promoted for use in the knee and shoulder, although the company reports that it's investigating wrist, elbow, ankle and other small joint uses. This product may also find its way into physician offices. List price for the InnerVue system is about $30,000.

The C-arm workstation on GE Healthcare's OEC 9900 Elite mobile imaging system allows up to six pre-set imaging profiles for quick setup and optimized image quality for different specialties. Its remote image access and dual flat panel monitors on an articulating arm offer the physician immediate information and better views in the OR, says the company. The OEC 9900 Elite lists at $155,000.

Hologic introduced its InSight mini C-arm, an office-sized system for extremity imaging. The company says that, at 45 microns, InSight has the smallest X-ray focal point in the industry for clarity and fine detail. Lightweight flat panel displays allow easy positioning for optimal viewing and advanced automation, including a wireless footswitch and the imaging arm's articulation, mean the user can focus on the procedure, not on adjustments. Hologic says InSight's suggested price is $60,000.

Philips also highlights the compact size of its BV Pulsera C-arm system. The mobile cart with a small footprint offers high quality images and information connectivity at the OR table, while still allowing access to the field. The dual flat panel monitors can swivel to different members of the surgical team, adjust to standing or sitting height and fold together like a book to protect the screens while the cart is moved. The company declined to provide pricing.

The Eastman Kodak Co. and Fujifilm, two companies traditionally known for their film processing, presented hospital-quality digital X-ray systems suitable for small practices. Kodak's Point-of-Care CR 260 has scaled the hardware down to desktop size in order to integrate the computed radiography process - from capturing, viewing and even enhancing the image to archiving and transferring it - within a practice. Pricing was not available for the Point-of-Care CR 260. Fujifilm promoted the speed of its FCR XC-1 and FCR XL-1 systems. The XC-1, which lists at $65,000, can process approximately 60 images an hour, while the XL-1, listing at $95,000, can produce 94 in an hour. At less than 2.5 square feet and 32 inches tall, Fujifilm's systems fit even crowded offices.

Scopes and lighting
Representatives from Carl Zeiss note that the technology featured in the OPMI Pentero surgical microscope means that it can reach out while it's looking in. While its state-of-the-art apochromatic optics and brighter light provide sharp images and natural color, an on-screen diagnostic and navigation system can provide pre-operative data and enhance images at the touch of an eyepiece button. An internalized video system can record procedures to DVD as well. The OPMI Pentero lists at $250,000.

Berchtold's Chromophare D660 surgical lighting uses a mirrored polygon reflector to return 98 percent of a bulb's illumination, shadow-free, to the surgical field, delivering an intensity of 160,000 lux from a 150-watt halogen bulb, says the company. A Thermosorb filter absorbs 99 percent of thermal radiation to limit the lighting's heat. Its lightweight construction makes it easy to position and reposition, says the company, noting that pricing depends on the configuration of lights purchased.

Designs For Vision, Inc., displayed its DayLite Metal Halide Light Source, a headlamp providing 18,000 footcandles of light and a 1,000-hour bulb life. A compact but rugged tabletop power unit with a quiet fan, the DayLite provides bright, white light for $1,795, several thousand dollars less than you might pay for a similar xenon light source.

OR table accessories
Allen Medical Systems' Spinal System includes an assortment of OR table attachments - ranging from a flexing frame and support pads to head positioner and arm supports - that lets a standard table handle spinal cases. At $29,995 list, the system adds spinal capability at about one-fourth the cost of a spinal table, says the company. A carbon fiber frame with a weight capacity of 400 pounds extends 48 inches from the table to accommodate C-arm use and setup and removal is facilitated by an integrated cart and locking clamps.

As a safety issue, patient lifting has been gaining traction in recent years as the toll it takes on staff becomes apparent. Oakworks' Orthopedic Hi-Lo Casting Table offers one solution. The transfer device can be lowered to 17 inches above the floor or raised to twice that height, with a lifting capacity of 550 pounds. The table is operable by footswitch or hand-held control. Its backrest, midsection and casting section are made of 2-inch multi-density padding and covered with easy-to-clean, heavy duty upholstery. The table's list price is $2,595.

A surgery center could spend $70,000 for a specially articulating fracture table in order to perform hip arthroscopy, says a representative from Smith & Nephew Endoscopy, or it could consider the company's hip distractor at about $14,000. The device, which attaches to an OR's existing table, adjusts and locks to provide patient positioning angles for hip arthroscopy.

Power tools
Conmed Linvatec introduced two power tool sets, the Hall MPower and the Hall Micropower. The MPower, a comprehensive large and small bone procedure tool system, offers enough torque for larger cases as well as the speed required for the smaller, says the company. The compact pistol grip handpiece is battery-powered and sealed for sterilization. The batteries themselves can be installed through a sterile transfer system. The MPower system, which includes drill and saw attachments and a battery charger, lists for $26,000.

The Hall Micropower, on the other hand, is designed for small bone, plastic and reconstructive procedures. Its electrically powered pencil grip handpiece is lightweight and runs quietly with minimal vibration, says the company, and is fully encapsulated against fluid and moisture. List price is $18,000 for the handpiece, console, cord and footswitch.

Plates
Inion presented an alternative to titanium fixation with its OTPS Hand System, a set of biodegradable plates, screws and pins. Made from a composite of three polymers, the material is strong yet thermally contourable, doesn't interfere with imaging and biodegrades beginning in 18 to 36 weeks, says the company. The polyaxial screws can be adjusted up to 10 degrees in the plates. Pricing for the set was unavailable.

MedArtis' Aptus Hand and Aptus Radius 2.5 fixation systems feature smooth, rounded, low profile titanium plates for long-term implantation, says the company. The double-threaded locking screws are able to be inserted at up to 15 degrees in any direction. They feature rounded heads for minimal projection, even at an angle, and blunt tips to avoid soft tissue irritation at their exit points. While pricing per set was unavailable, a representative estimated the cost for a radius case's plates and screws at $1,000 to $1,500.

InteliFuse claims that its StimuLink shape-memory alloy mini implants do the job of plates, screws and other fixation hardware more efficiently. Somewhat resembling wire staples in shape, the implants align, fix and fuse bones in the hand, wrist, ankle and foot, applying continuous compression. The implants, and the amount of compression, can be adjusted toward a predetermined geometry with a thermoactivation electrode that warms the implants in seconds, says the company. A list price was not available, though a company official estimated StimuLink's cost at 30 to 50 percent less than plate-and-screw systems.

Interference screws
Smith & Nephew Endoscopy launched its Calaxo Osteoconductive Interference Screw, a bioresorbable alternative to metal screws for ACL reconstruction. Made from compounded polymers and calcium carbonate, the device is designed to stimulate bone regrowth in the tunnel drilled to anchor a ligament graft and, after 12 months, end up replaced by new bone. List price for the Calaxo screw is $310.

Conmed Linvatec's Matryx Interference Screw is also bioabsorbable, made from polymer and beta tricalcium phosphate, says the company, to provide strong hardware that assists in bone redevelopment after ACL or PCL procedures. The Matryx sells for $200.

When it comes to implanted surgical hardware, less is more, says Arthrotek, whose Bio-Core Interference Screw features a hollow core and an open lattice structure along the screw's threads. As a result, the screw can be filled with bone graft material that makes direct contact with the bone that the screw is implanted into. Addition-ally, the open design means there's 20 percent less material to absorb. The Bio-Core has not yet been priced.

Suturing instruments and anchors
Arthrex promoted its 5.5mm Bio-Corkscrew FT suture anchors, which come preloaded with #2 FiberWire, along with 3.5mm PushLock knotless anchors as the keys to the SutureBridge Double Row Rotator Cuff Repair, a quick maneuver that minimizes knot tying but maximizes the tendon's contact with the bone. The anchors list for $285 each.

Arthrocare Corp. also demonstrated a rotator cuff repair procedure with its LabraFix System. The system simplifies a complex procedure, says the company, with its SpeedStitch Suturing Device for fast, single-step suture placement and its Mini-Magnum Implants for knotless suture fixation.

Conmed Linvatec's Spectrum II Soft Tissue Repair System features an ergonomically designed handle and 12 variations of suture hooks for precise placement in arthroscopic shoulder procedures, says the company. The hooks include 45-degree, 60-degree and 90-degree angles right and left as well as straight, crescent and corkscrew hooks. The handle lists at $2,200, the hooks at $125 for limited-reusable and $85 for single-use.

Conmed Linvatec also displayed Bio Mini-Revo, a 3.1mm bioabsorbable polymer suture anchor for shoulder instability procedures. The anchor, purple in color for visibility in the joint, is preloaded with #2 Hi-Fi suture on a disposable driver. Price range for the Bio Mini-Revo is $200 to $225.

DePuy Mitek describes its ExpresSew Flexible Suture Passer as a one-pass, one-portal device that doesn't require suture shuttling. In a single step and through a small incision, it grasps the tissue and needles the suture through it. Its 4.5mm tip profile is compatible with 5mm cannulas, 2-0 suture and #2 suture. The reusable handle, which uses sterile, single-use needles, lists at $2,400.

Stryker Endoscopy's Champion Shoulder Instrumentation System includes three new tools for suture passage without disposable accessories, says the company. The StabiliHook, designed for suture passing in the glenoid labrum, employs a rotating, twist-in, twist-out motion for instability repair. The Cuff Hook, for rotator cuff procedures, also pierces tissue with rotation of its sharp distal tip. The StitchBlade Suture Cutter's transverse loading technique allows the distal tip to be used as a knot pusher and suture strands to be cut without removing the tool from the joint.

Stryker Endoscopy also featured the BioZip Absorbable Suture Anchor in 5mm and 6.5mm sizes. Both are preloaded on a trocar tip inserter and prethreaded with Force Fiber suture. The anchors' separate suture channels allow for easy knot tying, says the company. Pricing was not available.

Miscellaneous equipment
Smith & Nephew Endoscopy introduced the Dyonics 25 Fluid Management System, a pump for all arthroscopic applications. The company highlighted the ease with which the system is set up and used. No calibration is required; the user simply inserts a tubing cassette, selects the cannula size and presses start for consistent flow rates up to 2.5 liters per minute. The pump system lists for $13,300, with additional tubing options and accessories available.

DePuy Mitek's VAPR S90 Radiofrequency Electrode System, developed for soft tissue ablation, coagulation and thermal modification in multiple arthroscopic procedures, creates a vapor pocket at the electrode tip to precisely remove targeted tissue and minimize damage to other tissue. As a safety feature, the VAPR's bipolar RF generator shuts down the electrode if it moves too close to metal implants, powering up again at a safe distance.

Distributor Medical Products Resource showed manufacturer Medical Innovators' Bone Shark Bone Mill, a compact and single-use alternative to larger and more expensive reusable graft material preparation devices. Pre-assembled and ready to use, the Bone Shark saves setup and sterilization time, especially for smaller facilities. The device lists at $425.

The LapWrap Positioning Pad by Innovative Medical Products, Inc., is an H-shaped sheet of soft foam designed to help position and secure patients' arms by their side. Laid beneath the patient, its ends wrapped around the upper and lower arm and fastened with Velcro, the pad can also hold IV tubes and anesthesia leads in place. The latex-free, single-use pads are list priced at $280 for a case of 10.