A Dozen Hot Orthopedic Products

The exhibits at this year's American Academy of Orthopaedic Surgeons conference in New Orleans took up enough space to fill more than a couple of football fields, and the convention center was teeming with activity. Suffice to say, it took a big block of time and some serious scrambling to make a complete pass through every aisle and every exhibit. Here are just some of the innovations and inspirations that caught my attention during an intensive and informative 2-day blitz. OSM

ConMed

Hall MicroFree Cordless Small Bone Power System

ConMed's Hall MicroFree cordless small bone power system provides the freedom of a cordless device, yet delivers the RPMs surgeons need. We surgeons have only recently become untethered from the cords we've dragged around for years (and sometimes through the sterile field), and this new system ratchets the convenience factor up a notch.

It's light and well balanced and has a pencil-grip design that fits easily in the palm of your hand. But it also packs plenty of power, with both medium-speed (25,000 RPMs) and high-speed (80,000 RPMs) drill systems. A rep says MicroFree uses the same technology that NASCAR drivers use to accelerate out of curves. It has a 3-volt battery with a voltage booster, so it goes from 3 volts to 10 volts in a snap, to provide increased torque when needed.

Another advantage is that the system is completely autoclavable, including the battery, which is wrapped in Insulfrax, a thermal material that can withstand heat up to 2,000 ?F.

It comes with a full complement of cutting accessories and the handpiece lists for about $6,000. But, says the rep, the increased speed and efficiency with which it can be reprocessed might let a facility get away with stocking 3 or 4 systems, instead of 6 or 7.

De Soutter

Osteodrive

The Osteodrive, intended for small-bone extremity cases in the surgery center market, is designed to be so "excruciatingly simple" that you can't mess it up, says a rep. That may be true.

It's an elegant and intuitive system, with a burr, a saw and a drill that are all contained in the same box and all formatted to use with the same handpiece. The "smart" attachments snap on and snap off, and they're magnetically controlled, so the handpiece tells the box which attachment is plugged in.

It turns on with the push of a single button, and you can control the power either by hand or with a foot pedal. The progressive trigger lets you start out slowly and increase the speed gradually as you squeeze more tightly.

The handpiece seems very ergonomic and the blades are small enough to get into very tight places. Overall, says the rep, it's both quieter and cooler than previous models, with increased power, increased functionality, increased torque and greater capability. Another convenient feature: It's completely autoclavable.

$GRPRO 2.\1$

Game Ready

GRPRO 2.1

I'm a great believer in this cold and active compression device, in part because I've had some personal experience with it. My wife had an ACL repair not long ago, and she loved how much GRPRO helped her recovery. Patients can take portable GRPRO home with them after total joint procedures, rotator cuff repairs or just about any other orthopedic case. There are wraps sized for every body part, from head to toe.

GRPRO delivers continuous cold and intermittent pneumatic compression therapies. Just fill it with ice and water and then customize the treatment by setting the time, the temperature (34 ? to 50 ?F) and the level of compression (high, medium or low). It can also be preprogrammed. The ice helps alleviate pain, and the squeeze and release action stimulates recovery by letting oxygen and blood flow back into the affected area. It's also been shown to increase flexion, extension and mobility. And maybe even more importantly, the company says 5 published papers show it decreases opioid use.

$PhotonBla\de$

Invuity

PhotonBlade

Invuity's PhotonBlade electrocautery device combines thermally cool, high-quality illumination that's sure to be helpful in deeper wounds, with enhanced energy to provide precise cutting and coagulation of tissue with minimal effect on adjacent tissue. I really like the fact that it doesn't require a proprietary generator. The PhotonBlade has been designed with a monopolar connector that is cleared for use with any 510(k)-cleared electrosurgical generator.

$PlasmaF\low$

Midwest Medical

PlasmaFlow

When it comes to preventing DVT, what could be easier for a patient than wrapping this device around his calf and pushing a button? The PlasmaFlow might be ideal for the less-compliant patient who's been told to get up and walk around from time to time to help keep blood flowing, but who's inclined to plant himself on the couch and watch TV all day instead. The battery can last up to 24 hours and can be recharged while the patient is moving around and wearing the device, which is a nice advantage. And as the rep points out, some patients may be coming from fairly remote areas with long car rides home. That's a scenario that can be very conducive to the formation of blood clots. It's classified as durable medical equipment, so the company consigns it to surgery centers and physicians, and bills payers. Medicare doesn't cover it, but most of its secondaries do, says the rep.

$Airloc\k GO$

Novastep

Airlock GO

For foot and ankle procedures, instead of 3 or 4 or 5 trays, Novastep's Airlock GO gives you one compact, sterile and very efficiently packed box. It's all there: implants, plates, screws, instruments — all very cleverly packaged. They even use the hollow of the handle to store some of the instruments. Everything is disposable, and when the procedure is complete, the sales rep picks up the box, and you get billed only for any items that were opened. The box is then restocked and replenished and goes back out into the field.

$OIC Imp\lants$

OIC Implants

"Rep-less model"

By simplifying instrumentation and eliminating the need for reps, OIC says it can save hospitals and surgery centers 50% or more on implant costs. The idea definitely makes sense. Honestly, in the vast majority of cases that I do, I feel as if I don't really need a rep in the room. There was a time when there was a lot of new technology and variability, and having the rep present was a value proposition. But now, most concepts are pretty entrenched, so having a rep present for every case can be overkill.

OIC's approach is to create modular sets and trays that are color-coded and "dummy-proof," so you can't put 2 things together that don't go together. And they simplify the instrumentation so that, for example, whether you're working with a tibia nail, a hip nail or a femur nail, you pull the same base tray. That's pretty clever, and it's a case of less being more, as sterile processing doesn't have to deal with as many trays.

The company's goal is to spend sufficient time onboarding, making sure everyone, including support staff, understands how everything works, then to get out of the way. The clinical outcomes, they say, are the same or better, and the instruments they deliver, they promise, are every bit as high quality as those of the competition.

$Patient experience pl\atform$

Orca Health

Patient experience platform

As physicians, our online reputations are more important than many of us might realize or perhaps would have expected a few years ago. This platform from Orca Health is designed to increase patient understanding about procedures and treatments, improve compliance with post-op care plans, and potentially provide a big boost in patient satisfaction and retention. Physicians can subscribe to this service (orcahealth.com), which provides a free downloadable app for patients, with instructional videos intended to be used at the point of care, as well as hundreds of videos that show them how to do the rehabbing exercises they've been assigned. Physicians can also upload handouts, which, because they're digital, you won't have to worry about patients losing. The platform even tracks adherence to the home exercise program. It also asks patients how likely they'd be to recommend their doctor to friends or family. And if their answer meets a certain threshold of positivity, they're invited to leave ratings on one or more of the rating websites. In a highly competitive environment, that sounds like a great way to really boost your online presence.

$PX5 Surgical He\adlight$

Ronin

PX5 Surgical Headlight

Normally, I don't wear a surgical headlight, but I might consider wearing this one. It's extremely lightweight (6.2 ounces) and I can see how it would be helpful during hip replacements, or hip and shoulder arthroscopies, especially with larger patients.

The light is extremely bright. The company says it delivers more than 350,000 lux over an adjustable diameter, making it brighter than competitive LEDs or fiber optic lights. It's also adjustable, with brightness levels that go from 1 to 10.

It's wireless, so mobility isn't an issue. The battery holster clips on under your scrubs and is also very light — about a pound or two, depending on the size of the battery. On average, surgeons change sides 3 times during procedures, says Ronin, so easy mobility is important.

The standard battery lasts up to 3 hours, more than enough for the typical outpatient procedure, but there's also an extended battery that lasts up to 6 hours. And the unit warns you audibly, visually and haptically when the battery is getting low. A full recharge takes about 3 hours. Another nice feature: You don't have to re-glove to turn it on and off. Just press the switch through your surgical gown.

$iFuse-3D\ Implant$

SI-BONE

iFuse-3D Implant

This clever technological achievement was made possible by the advent of 3D printing, says the company. For sacroiliac (SI) joint fusion, it's a porous and fenestrated triangular implant that can be completely incorporated into the host bone. The objective is to let bone literally grow through the implant. It can also be packed with autograft and allograft to provide added insurance to the healing process. I don't do spine or SI work, but this makes a lot of sense when it comes to treating patients with SI problems who no longer respond to traditional non-surgical treatments.

WALKING THE EXHIBIT HALL

The Orthopod's Wish List

Here are 8 more cool products we saw on display at the American Academy of Orthopaedic Surgeons conference in New Orleans.
— Compiled by Jim Burger

$InternalBrace Ligament Augmentati\on Repair$

Arthrex

InternalBrace Ligament Augmentation Repair

The InternalBrace is basically a seat belt for repaired ligaments, and the rep says there's data showing that it's helping surgical patients rehab quicker and get back into action sooner. It also helps prevent secondary injuries. The idea of shielding the repaired ligament from excessive stress and helping to augment healing makes sense. It's an interesting innovation that started with feet and ankles, but there are a tremendous number of potential applications that cover just about the entire body.

DePuy Synthes

Purevue

DePuy's Purevue system delivers both HD and 4K images in real time, with a compact system that combines a light source, an image processer and local image management into one device. Images can also be transmitted to secondary surgical displays with little or no signal interference. As the only system on the market that's both a fluid management system and a shaver system, it's the piece that completes the company's total visualization solution, says the rep.

ExplORer Surgical

Interactive surgical playbook

This is an intriguing idea to try to improve operating room efficiency. It's a subscription-based software package that, according to a company rep, creates role-specific workflows for every member of the OR team, based on surgeon preferences. ExplORer Surgical can also show photos of how the Mayo stand should look, how the patient should be positioned, and so forth. Time is money, especially in the OR, and they say they can save a lot by reducing delays and disruptions, cutting down on wasted disposables and reducing setup time. As an educational tool for OR personnel who want to see how a procedure is going to work from start to finish, I think it has the potential to be hugely helpful.

Hydrocision

TenJet

This is an interesting entry that's designed to provide a minimally invasive option for tendinitis patients who don't respond to standard conservative treatments. TenJet is an ultrasound-guided needle that shoots highly pressurized saline solution at the diseased tissue and creates a suction effect, so you get lavage, debridement and evacuation at once. It's a very quick alternative to more invasive surgery — about 3 minutes — and can be performed under local anesthesia.

OMNI

OMNIBotics Active Spacer

This remarkable technology is like a miniature GPS system for total knees. Instead of a static patient-specific-information approach based on a single MRI scan, the Active Spacer lets you adjust on the fly, based on readings from devices that are screwed into the femur and tibia. Readouts clearly show the full motion and precise balance of the knee in real time, allowing the surgeon to make adjustments that optimize function. It's complex and probably not for everybody, but it might be very beneficial for high-volume surgeons who deal with a lot of complex knees.

$Bioind\uctive implant$

Rotation Medical

Bioinductive implant

Designed to help augment your repair when you're dealing with poor quality rotator cuff tissue, Rotation Medical's implant is derived from bovine Achilles and has 99% porosity. We know that when trying to repair a tendon that's degenerative or of poor quality, the odds of having a desirable outcome go down substantially. If this works — and it's an interesting idea — it can revascularize and form new tissue, which would then theoretically become part of the new tissue base and promote healing.

$Cellular Alloge\neic Bone Graft$

RTI Surgical

Map3 Cellular Allogeneic Bone Graft

This may open some doors for surgeons who are performing superior capsular reconstructions (SCRs) to try to reverse pseudo-paralysis of the shoulder caused by large rotator cuff tears. The company produces decellularized human dermal allograft in a variety of sizes and thicknesses. There's some data and some anecdotal evidence to suggest that SCRs can help restore lost function, but that tissue thickness may be key to success or failure. That being the case, the more options we have, the better.

Verasense

Orthosensor

Verasense is trying to take most of the guesswork out of total knees, and it hopes to have FDA approval this summer. Instead of relying on feel to determine whether an implanted knee is too tight or too loose, Orthosensor's internal sensor quantifies soft tissue tension and gives you a number. From there, you can adjust cuts or adjust soft-tissue releases to make sure you have the desired balance. Once you're where you want to be, the sensor comes out and the permanent polyethylene bearing goes in.

$Single Use Negative Press\ure Wound Therapy$

Smith & Nephew

PICO Single Use Negative Pressure Wound Therapy

Smith & Nephew's battery-operated wound dressing comes with a small pump and is comprised of 4 layers: One layer pulls fluid out and away from the wound, a second layer evenly distributes negative pressure over the entire area, a third holds the fluid or bacteria that's pulled out and the fourth layer evaporates it all.

I usually change the dressing with my patients a day or two after surgery, when draining has diminished, but the company says the PICO dressing is designed to manage leakers. You put it on right after surgery and can keep it on for 7 days. It can hold up to 300 mls of fluid, they say, which is impressive.

It's pretty ingenious, and the company says it has data showing that it reduces hematomas and readmission rates. I'm interested to see how data develops over time. If it reduces infections, and it certainly makes sense that it would, the roughly $250 price tag will be a good investment.

$Hip \Distraction System$

Pivot Guardian

Hip Distraction System

I put this ingenious innovation into the why-didn't-anyone-think-of-this-before category. It's a hip distraction system that uses a Trendelenburg approach, taking advantage of the patient's weight rather than a perineal post, to get distraction across the hip joint during arthroscopy procedures. It's another classic case of less being more, and I think it's bound to help minimize complications, nerve palsies and other problems that can crop up.

The rep quoted research showing that when there's a post, there may be anywhere from 75 to 150 pounds of pressure on the groin area throughout the procedure. That's a lot, especially when the patient is under for an hour or more. He also mentioned a study of 1,000 hip arthroscopies performed without a perineal post, all of which were successful, and none of which resulted in soft tissue or nerve complications.

Because there's no post, the Pivot Guardian System also allows for more flexible C-arm positioning, increased intraoperative range of motion and improved ease of movement for the surgeon and clinical staff. I think the concept would be useful for hip fractures, too.

A look at some of the attention-grabbers at this year's American Academy of Orthopaedic Surgeons exhibit hall.