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What I Saw at AAOS
A look at the newest products for orthopedic surgery.
, Shelley Herlihy, Pam Pope
Publish Date: October 10, 2007   |  Tags:   Orthopedics

If you want to see the latest and greatest in orthopedic surgery equipment, implants and technology, the best place to see it is the American Academy of Orthopedic Surgeons annual meeting. But if you didn't have the time to get away to Washington, D.C., in February, or if you just didn't make it all the way through the two exhibit halls, don't sweat it. We did the legwork for you - literally - visiting the vendors to find what's new for outpatient orthopedic surgery applications since last year's show. Here's your tour of the floor, broken into nine sections:

  • Power tools
  • ACL navigation
  • Arthroscopy pumps
  • Autoclavable cameras
  • OR tables
  • Pins and screws
  • Plate systems
  • Sutures, suture passers, suture anchors
  • Other supplies and equipment

Power tools
Soon to hit the market is Brasseler USA's modular battery-operated Orthopaedic Power System, which features a sterile transfer system for batteries. When electronic components are put through sterilization, they have a greater tendency to fail; with a sterile transfer system, the battery doesn't have to be sterile.

The scrub tech or circulator attaches the sterile transfer device - a sterilizable sleeve that keeps the unsterile battery from touching any of the sterile outer surfaces of the power tool - on and drops the battery in. The Orthopaedic Power System features a safety lock so that, once the battery is in, if the bottom of the device opens, the battery won't fall out. This was a neat feature.

A company rep says the batteries are pre-conditioned to go back to full charge each time you charge them, and that you can get at least 500 charges out of each battery. We were also told the cordless tools, made of durable plastics, can be used for drilling, intramedullary reaming, sawing or inserting pins, thanks to a variety of attachments that were pretty user-intuitive. The tools seemed a little on the heavy side, but our surgeons would probably be comfortable with the weight through shorter procedures.

Conmed/Linvatec also unveiled new handpieces with sterile transfer systems for its battery-operated, autoclavable power tools. The best thing about these new handpieces was the Power Pro battery system; there are three sizes of batteries, depending on your needs. For shorter procedures, you can use the smaller, lighter, shorter-life batteries. We found that, even with the largest battery, these instruments were relatively light.

According to a company rep, you shouldn't have problems with the development of battery memory, because the charger deconditions and re-energizes the batteries back to full charge each time.

Some other features your surgeon might like: All attachments made by the company are interchangeable on all the handpieces (whether battery, pneumatic or electric) reverse, forward and speed can all be operated one-handed; and, the company says, the battery-powered instruments provide enough power for ACLs, shoulders, hips and knees.

To power your instruments, Stryker offered its Core Arthroscopic Shaver System, which lets the surgeon use two handpieces simultaneously. The system is completed by the Formula Shaver handpiece, which offers up to 12,000 RPMs, shaver blade recognition and ergonomic design. Stryker has also updated its Serfas RF system; it now has 11 probes, ablation and coagulation modes and more power.

Both systems can be used with the iSwitch, a three-button, two-pedal footswitch that communicates wirelessly with the Core or Serfas systems. The battery-operated footswitch can be bagged to simplify cleanup after a case, and its large handle makes it easy to carry, even when bagged.

ACL navigation
Several manufacturers had new ACL navigation machines on display. Several studies show that surgeons' tunnel placement in ACL repair is better when they are computer-assisted, leading to better tendon placement and smaller chance of impingement. Through the use of GPS technology (instead of CT or MRI) and sensors placed on the patient, image-guided surgery systems let a surgeon track the position of implants and instruments in a virtual-reality display relative to the patient's anatomy. As a result, surgeons can visualize tendons, bone thickness and other factors three-dimensionally.

Aesculap/BBraun's OrthoPilot ACL navigation features navigated setting of distance from the PCL and distance from the medial tibial margin; navigated setting of entry angle and distance to the over-the-top position of the femoral drilling tunnel; intraoperative isometric data and impingement checking; and an easy-to-use footswitch for operating the system, the company says. The OrthoPilot has been used in 38,000 cases, 6,000 in the last year alone, in Europe; it was just approved for use in the United States in February.

The StealthStation from Medtronic now boasts an ACL-navigation module. The StealthStation previously had applications for ENT, spine and brain surgery. For orthopedic purposes, it can be used in both reconstructive procedures and traumatic bone repair, the company says.

Praxim Medivision has added an ACL logic to its Universal Surgetics Station. The company says the Surgetics Station's top features are precise navigation of the tibial and femoral drill guides with respect to the plane, its ability to help you check for potential graft impingement, and its versatile navigation of all instruments and guides for tunnel drilling.

Arthroscopy pumps
Two new arthroscopy pumps were on display in the exhibit hall: the PowerPump LT by Arthrotek and the 10K Fluid System from Conmed/Linvatec.

The PowerPump LT has inflow-only capabilities, two pressure sensors, and a software-controlled instrument-recognition system that adjusts to different endoscopic brands by measuring the flow resistance of the instrument. It lists for $5,900. The 10K Fluid System had one of the easiest set-ups we've ever seen on an arthroscopy pump, with its one-handed cassette loading and no tube set to hook up. Small and compact, it can be mounted on any standard IV pole. The 10K Fluid System lists for $10,000.

Autoclavable cameras
At the show, we got a preview of Conmed/Linvatec's new IM3300 autoclavable camera, a small handpiece that offers progressive scan technology (to work better with flat-screen monitors) as well as outputs for DVI, SDI, RGBS and S-Video and up to four custom presets. List price is $12,000.

Karl Storz has improved its one-chip Telecam camera by coming up with an autoclavable version that's also flashable. Because it's all one piece, it helps prevent fogging from vapor entry. The autoclavable Telecam still offers the high-light-transmitting parfocal zoom lens with up to double magnification.

OR tables
We were in the market for a table that can accommodate special positioning requirements for our facility's ortho cases as well as those for everyday cases. So it was our luck that quite a few new options were on display.

Allen Medical's new Shoulder Positioner with Lift Assist adapts to many tables and attaches at either break of the seat section on a surgical table. Rated for patient weights of up to 500 pounds, it includes a security strap and choices for the headrest, brace and arm support. Weighing 27 pounds, the attachment can be set up by one person. It simply slides onto the table and is tightened by hand. The chair lies flat for clear anesthesia access; Lift Assist reduces the effort to lift heavy patients into the beach chair position by using gas pistons to support some of the patient's weight. Once patients are in position, the surgeon has unobstructed posterior access. The Shoulder Positioner lists for about $7,000.

For knee arthroscopies, Allen offers a knee table with the Figure Four, a separate leg holder. The knee holder's metal baseplate is shaped to slide into the table's V-groove, where it locks in. The knee can be held in place bent more than 90 degrees, eliminating the tiring job of standing and holding the patient's leg throughout the procedure. Squeeze levers for adjusting the Figure Four can be easily used under the sterile drape.

Finally, for $10,000 - less than the price of a C-arm table - is Allen's Universal Imaging Extension, which lets you turn your standard OR table into an imaging platform. The leg of the extension doubles as a cart. Rated for 500 pounds, the UIE can achieve 20 degrees of lateral tilt and can be put into Trendelenburg and reverse. Because it comes in two pieces, it's easy to store, and one nurse can set it up on her own.

If you want one do-it-all table, Getinge/Maquet's Alphamaquet 1150 operating table system might be the answer. Made of carbon fiber to keep it light and strong, the table boasts full articulation, 800-pound weight capacity, fully electric operation and radiolucence. It can be controlled via a corded or infrared remote.

Because the fully convertible tabletop can be changed to accommodate any number of procedures, you don't need a dedicated fracture, shoulder or hip table. The convertible tabletop also eliminates disposable padding. The Alphamaquet 1150 starts at about $9,000 and, depending on the options and accessories you choose, can cost up to about $15,000.

Pins and screws
Manufacturers exhibited dozens of new pins and screws for a variety of applications and in several different materials. For easy reference, we'll classify them by material here.

Composites
ABS Advanced Biomaterials has a PLLA absorbable interference screw with a bullet-point design to optimize penetration while minimizing the risk of graft laceration.

Athrex's amorphous PLLA RetroScrew comes in versions for tibial and femoral placement in transtibial ACL reconstruction. The inverted retrograde insertion provides maximum fixation of the tibal RetroScrew in proximal cortical bone, while the in-line insertion of the femoral screw helps assure parallel placement to the graft and femoral tunnel.

Arthrotek displayed its AXL Cross Pin, made of LactoSorb L15; SureFire Hybrid Meniscal Staple, made of two LactoSorb Resorbable Anchors linked with a 2-0 MaxBraid Co-Braid Suture; LactoNail Bone Fixation, which comes in a variety or lengths and diameters; and Rattler interference screw.

DePuy Mitek debuted its MicroFix Absorbable QuickAnchor Plus, which is made of radiolucent PLA, and MiniLok QuickAnchor Plus, a PLA anchor with the option of 2-0 Panacryl long-term absorbable suture. Both come prepackaged with suture, needles and drill bit. In addition, the SpiraLok, an absorbable dual eyelet threaded suture anchor, and the Milagro Interference Screw, now with Biocryl Rapide, were on display.

Future Medical Systems showed a new bioabsorbable, tricomposite screw that is gone within a year of implantation, says the company.

Smith and Nephew's bioabsorbable PLLA Bioraptor 2.9 lets the surgeon close the tear or tighten the tissue of the labrum around the humeral head. In addition, the company showed its new GTS System for ACL repair which consists of a woven mesh sleeve with three lumens, one of which is secured by a PLLA tapered fixation screw that, when tightened, presses the graft tissue against the sides of the tibial tunnel.

Polyester
Smith and Nephew's Endo-Button CL BTB Fixation System, used in ACL reconstruction, restores stability using a bone-tendon-bone graft harvested from the patient's knee. The bone block at one end of the graft anchors in the tibia. The bone at the other end rests within the tunnel drilled through the femur. It connects the graft to the polyester Endo-Button, which holds the graft in place.

Metal
ABS Advanced Biomaterials also had a titanium interference screw with the same bullet design of the absorbable version.

Acumed's Acutrak, which comes in several versions for different procedures, is a headless compression screw with the following features: wider thread pitch at the top, tapered profile and cannulated design.

Arthrotek showed its AXL Cross Pin in titanium and EZLoc Femoral Fixation Device.

Plate systems
Acumed debuted three new plating systems: Acu-Loc (targeted distal radius), the Modular Hand System and the Lower Extremity Congruent Plating System. Acu-Loc includes a titanium alloy plate and precisely positioned screws for stability and minimal soft-tissue irritation, says the company. The modular hand and lower extremity systems consist of plates pre-bent and color-coded for each application.

The Metafix from Merete is expected to gain FDA approval this summer, according to the company. The plates for hand and foot surgery are pre-bent but flexible enough to be bent further for customization. They are interlocking for stable fixation and uncannulated.

With Trimed's Volar Bearing Plate for wrist fixation, you simply angle the pegs into the fracture and lock them in. The plate is now a part of the company's wrist fixation system tray, which runs about $27,000.

Sutures, suture passers and suture anchors
There were many new options in this department as well. Because suture passers and suture anchors are often integrated in one package, we'll look at the choices alphabetically by company.

  • Arthrex's Meniscal Viper lets you pass a double vertical loop of 2-0 FiberWire using an all-inside technique. A tech can reload it in the OR to complete the repair without additional instrumentation costs. Each sterile kit contains a small or medium disposable Meniscal Viper with preloaded 2-0 FiberWire, small-diameter, flexible Small Knot Pusher and small-diameter 2-0 Suture Cutter. In addition, the Scorpion suture-passer was on display. It fits in a 5.75mm cannula, grasps up to 16mm of tissue, and can be used for single-row, double-row or margin convergence. The one-handed device had no shuttle step and can be used in arthroscopic and mini-open procedures.
  • Arthrotek had the pre-tied Autoknot, which seemed very easy to pull tight, eliminating the need to tie in the OR. It consists of a Duncan loop, MaxBraid Suture braided with Dyneema Purity fiber, LactoSorb L15 screw and LactoScrew Suture Anchors. The MicroMax Suture Anchor is also loaded with MaxBraid Suture; the material of this anchor is shown to disappear in nine months to 15 months.
  • Pre-threaded titanium and bioabsorbable suture anchors were on display from Axya as part of the company's Shoulder Fixation System. The one-pass system features a disposable sleeve that captures the suture on one pass, performs ultrasonic welding, then releases, leaving behind knotless fixation. This looked like something our surgeons would be interested in, and the company says a study looking at one-year post-op results is under way.
  • For shoulder applications, the UltrafixKnotless Anchor from Conmed/Linvatec lets surgeons perform Bankart repairs arthroscopically while eliminating the knot-tying process.
  • DePuy Mitek had a new suture called Orthocord that was shown in a clinical analysis to be 45 percent less stiff than fiber wire, with slightly better tensile and knot strength, the company says. Your surgeon can pass all 2-0 to No. 2 suture with the company's new ExpresSew flexible suture passer. The one-pass device simultaneously grasps tissue and delivers the needle, and is compatible with 5mm cannulas.
  • The SmartStitch from Arthrocare (formerly Opus Medical) is a one-handed suturing device that offers adjustable tissue grasping while delivering a secure Incline Mattress stitch - which throws up the stitch in two places, resulting in a subcortical stitch that leaves no residual stack of knots. This seemed conducive to patients' post-op comfort. The SmartStitch is reloadable with No. 2 braided polyester or ultra high tensile strength MagnumWire suture cartridges. The cost is about $400 per shot for the passer, suture and implant.
  • There were several arthroscopic suturing innovations on display from Smith and Nephew. First, the Elite Pass Premium Arthroscopic Suture Shuttle lets surgeons pass sutures one-handed; the device grasps tissue adjacent to a tear, pushes a loop of suture through healthy tissue, hooks the suture loop and pulls the suture back out of the surgical opening. From there, the surgeon performs the final knot. Ultrabraid, a high-strength polyethylene suture for attaching soft tissue to bone, comes loaded on the company's TwinFix range of suture anchors for rotator cuff repair.
  • Tyco Healthcare/Syneture introduced its Indermil Tissue Adhesive for orthopedic use. For use on low-tension areas, it offers complete wound closure within 30 seconds, the company says. On larger or more high-tension areas, a subcuticular stitch might be necessary, but you can use the adhesive on top so the patient has potentially smaller scars and better aesthetic results.
  • The Herculon soft-tissue reattachment system from Tyco Healthcare/USS Sports Medicine integrates suture management and passing in one-handed operation. Atraumatic eyelet design protects the suture.

Other supplies and equipment
Didn't see what you were looking for in the previous sections? We saw some things that weren't quickly classifiable or that were the only products in a general category group. So it might be here, again listed alphabetically by manufacturer.

  • Want a C-arm with enough juice for hand surgery and other small-bone procedures that's easy to move and doesn't take up too much valuable OR space? The 7700 Compact from GE is one option, and we liked what we saw here. It's versatile and incorporates everything that would otherwise be on a separate workstation: monitor, hardcopy printer, CD burner. Everything is connected via USB ports. The 7700 Compact lists for about $80,000.
  • Kinetikos Medical Incorporated displayed a new mini carpal tunnel release system comprised of its SafeGuard Guide and SafeGuard Knives, which are provided sterile and designed as single-use disposables. The guides are non-sterile and must be autoclaved before surgery.
  • With the Clear-Trac Complete Cannula System from Smith and Nephew, surgeons have the option of nine cannula sizes for customizing care to the procedure and patient. Made from a tinted transparent polyester that enables surgeons to distinguish between different cannulae during surgery, the Clear-Trac features a dam that prevents fluid from escaping during the procedure. The cap is also removable, in case surgeons need to clear bone or soft tissue from the treatment area - without having to remove the cannula.
  • Your physicians might like the head-mounted Varioscope optical system from Synovis as a way to increase visualization of the surgical site. Weighing only 300 grams, the Varioscope features a miniature high-end microscope that offers variable magnification, autofocus, integrated coaxial light and a camera system. In addition, it comes with a footswitch that controls the microscope, hands-free.
  • A nifty new shoulder retractor from Tiemann was on display; the Seitz Barrakuda retractor comes in 31mm and 38mm sizes, has a slightly curved blade and two prongs for better fit and additional grip.
  • Tyco Healthcare/USS Sports Medicine's Polysorb Meniscal Stapler XLS is preloaded with a low-profile delivery system - no extra instrumentation is needed, the surgeon simply points and shoots. The resultant two point-fixation simulates a horizontal mattress stitch without knots. The staple has a soft, braided backspan to minimize damage to articular cartilage.

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