HOLE TRUTH To an orthopedic surgeon, a properly working power tool feels like an extension of the hand.

The current generation of drills, saws and burrs deliver the power and precision that cutting-edge orthopedic surgery demands — as long as the equipment is working properly. You know you're due for an upgrade if drill bits or saw blades have dulled from repeated use, batteries fade in the middle of procedures, and tools jam or lock when they should cut and bore. When that time comes, consider the following factors to ensure your surgeons work with equipment that delivers consistent power where it's needed most.

1 Performance and feel
If orthopedic surgeons were to quantify the tactile "feel" of a power tool's operations into measurable physical conditions, it's likely they'd mention speed and torque. In this context, a tool's speed is the number of revolutions a drill bit makes or the number of cycles a saw blade completes in a specified amount of time. Torque is the amount of force that the tool's working implement exerts.

These 2 factors determine how quickly and efficiently a tool can place an implant screw or cut through bone, and different procedures require a different balance of the two. Large, dense bones such as the femur are most effectively handled at low speed and with high torque. Conversely, small bone surgeries such as hand and wrist cases demand low torque, but high speed. Equipment that's easy to set up can save you a lot of time, and easily adjustable or even pre-programmed settings can let surgeons rapidly adapt a tool to suit the procedure at hand.

There's more than one way a power tool can do the work for you. Many of the latest models have been designed with ergonomics in mind: lightweight, weight-balanced and fitting comfortably in the hand. By reducing the risk of fatigued hands, arms and shoulders, these user-friendly tools eliminate the adverse physical effects that heavier equipment can have during long cases.

The future of power tools may build further on the concept of steady hands. While most of the equipment surgeons use on a daily basis has not seen significant changes in essential functioning over the past 10 years, one advance currently under development would enlist robotic assistance in orthopedic surgery. Navigated freehand bone cutting puts the saw in a robot's precise hand to improve joint implant alignment. Driven by preoperative imaging data or other parameters, the systems provide haptic feedback to the surgeon at the controls and even stop the saw if it is directed outside the bounds of the planned cuts.

PLENTY OF OPTIONS Today's new power tools are designed ergonomically friendly — they're light and weight-balanced and fit comfortably in the hand.

2 Ease of setup
Putting your drills, saws and burrs into play shouldn't slow you down. Anything that makes a tool easier for the surgeon to set up and use will be beneficial in the long run, for the procedure as well as the patient.

Your choice of power source, for instance, can play a huge role in the efficiency of preparing for and performing surgery. Battery-powered tools have been widely adopted in orthopedic ORs on account of their freedom from the cords that tether electrically powered tools to an outlet (and, previously, the hoses that supplied compressed air to pneumatic devices).

Removing cords from the equation reduces the risk that your equipment will inadvertently contaminate the sterile field, and leaves one less thing to tangle and trip team members' feet. Keep in mind, however, that batteries require charging. So you'll want to know how long each tool's battery can provide power and how long it takes to fully recharge.

A battery that lasts through an entire case is essential, but you also need backup batteries on hand in case the tool is needed in back-to-back procedures, since it's unlikely that charging can be completed within the length of a room turnover. If instrument reprocessing might also limit the repeated use of a power tool, invest in enough inventory to accommodate your surgeons and scheduled cases.

If you're seeking setup efficiency, involve nurses and techs — even those working outside the OR — in your power tool trials and in-service training sessions. Their abilities to properly assemble, disassemble and track the components of these tools will be keys to case preparation and fast room turnover times. Find out how quickly and conveniently a tool's batteries can be replaced in mid-procedure. And make sure that your sterile processing department will be able to meet its reprocessing requirements.

3 Surgeon feedback
Surgeons have a tactile sense for how their saws, drills and burrs should be working. Ideally, the tools are an extension of their hands and their operation shouldn't require much in the way of deliberate thought. Surgeons also have an innate feel for when these power tools are not working properly.

Many surgeons will admit loyalties to particular manufacturers, but a power tool trial can still help them, and you, make the most intelligent purchase. If it's possible, arrange for several manufacturers to bring comparable products to your facility at the same time, and hold a product fair, so your surgeons can get their hands on each option. Make sure that the reps bring sawbones or cadaver bones to demonstrate the tools on, since your surgeons might not feel confident bringing them into the OR to use on a live patient without first getting a tactile feel for their abilities.

You should be concerned with the bottom line when it comes to selecting equipment and supplies, but factoring a surgeon's hands-on opinion about a power tool into the purchasing decision is essential. While the devices may seem the same in their outward appearances, the less expensive option may end up putting the quality of patient care at risk.

RIGHT ANGLES Ergonomically designed tools enable effective surgical technique while reducing fatigue.

4 Responsive service
Surgical power tools tend to deliver several years of use, but it's never too early to start thinking about the possibility of repair. You might even factor it into your purchasing decision.

Modular construction is a useful and economical quality in power tools. Just as a disposable saw blade ensures sharpness for every case, the ability to change out an individual component of a tool can provide improved performance without having to replace the whole unit.

Lastly, not enough can be said about the importance of a responsive rep and reliable service in the purchase of power tools. Surgeons have enough things to worry about during surgery without wondering whether they'll be able to get the tools they depend on serviced in a timely fashion if issues should arise. Ask administrators you know at other facilities about a company's quality of service, don't pinch pennies on service contracts and be sure to find out how quickly a company can loan you replacements when primary tools are sent out for repair. OSM