LESS STRAIN Smaller and lighter tools help reduce fatigue during longer procedures.

Aging Baby Boomers and their increasingly creaky joints have helped create a huge demand for orthopedic power tools and consumables. Demand has sparked innovation, with one improvement after another aimed at providers who want to shorten the duration of procedures, improve turnover time and enhance OR efficiency. That doesn't mean your equipment is obsolete as soon as the new version comes out. Most equipment is forecast to have about a 4-year lifespan. And chances are, just like your 2014 car or your iPhone 4, the tools you bought a couple of years ago still work very well. But if you fall 2 or 3 generations behind, you're bound to miss some significant recent advances.

1. Smaller and lighter
The common theme as technology improves is that everything is becoming lighter and more ergonomic. Smaller is better in the world of orthopedic tools. Smaller devices are easier to manage and sterilize, they don't take up as much room on the back table and they're lighter, so you can handle them for longer periods of time without fatigue.

If I'm doing a rotator cuff repair and have a much lighter handpiece running my motorized shaver or bur, it makes the case much easier. If I'm doing internal fixation during a trauma procedure with a plate and screws, and I have to drill multiple holes, the lighter the drill, the easier it is on me. The smaller tools even have increased speed and torque now, which lets us complete larger procedures with much less strain and discomfort.

Thinking back to the reamer I used as a resident in training — it was a really big, bulky power driver. Now we can run a reamer down a femoral shaft to nail a femur fracture with a much smaller device that also offers more torque and more power. The trend is much more ergonomically friendly to the surgeon.

2. The speeds you need
Many of the handpieces we use now for trauma, especially for small and medium fracture cases (ankles, wrists, hands and feet, for example) let you vary the drill speed with your handpiece. Squeeze the trigger halfway, you get half speed; squeeze it all the way, you get full speed. And of course you can get every speed in between.

That ability to access a vast range of speeds is extremely helpful. If I have a long way to drill, I may want to use high speed initially. But if I get near the end of the bone and don't want to power through it and hit a nerve or blood vessel behind it, I can slow it down as much as I need to prevent overpenetration.

Several handpieces now also offer oscillating drilling, instead of just spinning, and that also allows more control. If, for example, you're trying to put screws through a plate and bone during a trauma case, drilling at even a fairly low rate of speed can create problems, especially if you have a fragile bone or there's soft tissue in the way. You can end up wrapping up the soft tissue in your drill bit. If you oscillate instead, that won't happen. That's huge.

3. Intuitive instruments
Equipment is getting smarter, thanks to manufacturers who've come up with some ingenious ways to help both the surgeon and the OR team.

In a typical arthroscopic procedure, I might change tips back and forth several times. But I don't have to think about changing my settings, because the handpiece recognizes the different attachments and responds accordingly. It recognizes whether a shaver or a bur is attached, what size it is and the most common setting for that particular tip. If I plug in a shaver, for example, it automatically tells the power source to run the handpiece at "oscillate 1500 RPMs." If I plug in a little barrel bur to, say, help create a tunnel for ACL surgery or to decorticate bone in preparation for a rotator cuff repair, it recognizes it and runs it in unidirectional mode. Since those are tools we use in almost all outpatient procedures, that's immensely helpful.

Also ingenious and helpful, especially from a support standpoint, is that the handpiece communicates information on battery life. Every time a battery's placed, it lets the system know how many times that battery has been plugged in, and it helps diagnose both its life span and whether there are any maintenance issues. That's great for any facility trying to keep costs down. You can get a sense of usage data and there's usage tracking, so you can see how equipment is being used and what the life span is. That can help you better forecast your needs regarding those power tools. Plus, if the system alerts the OR crew that there may be a problem, you can diagnose and address it before the patient comes into the OR. That gives the surgeon confidence that the equipment is reliable and that it's going to come on when you pull the trigger.

4. Easy to join
For high-volume surgeons trying to get through a lot of cases, the ease with which you can put power tools together and how efficiently the scrub team can process and prepare them for use in the OR is key. Fortunately, manufacturers have realized that the devices are often handled by scrub nurses and others who don't have the same experience level as the surgeons. So manufacturers are developing quick-coupling technology to make power tools easier than ever to put together. And with oscillating and motorized shavers and burs, it's a straightforward plug-in and push-button release.

PERCEPTIVE CHOICES Newer handpieces can recognize attachments and adjust speeds and modes automatically.

5. Cordless Power
There used to be a tradeoff when it came to power sources. Pneumatic-powered instruments were very popular for a long time, but they have lots of limitations. For one, they're corded, and surgeons are always concerned about sterility. A cord to the instrument has to travel across the sterile field, then down and out to an air supply. In that situation, you have to be concerned about the cord creeping into the sterile field and causing contamination. There's also a tripping hazard with cords (I've seen people trip over cords on more than one occasion). And pneumatic-powered instruments don't always have the torque you sometimes need from power tools.

Battery power was an alternative, but a lot of drivers relied on nickel-cadmium batteries. The big problem with those is memory. If a surgeon is doing multiple procedures in which the instrument is operating for a short time, eventually the instrument learns as it's recharged that it only needs to run for that short period of time. Then, when you suddenly find yourself in a longer procedure, the battery doesn't last.

But battery technology has also improved. A lot of companies have gone to sterilizable lithium-ion batteries, so the battery is charged, processed and opened onto the back table. You simply connect it to the driver. And battery lives have improved in several ways: The duration of full power is longer, there's more consistent power throughout the length of the procedure and there's increased shelf life.

6. Improved packaging
Manufacturers are also increasingly aware of potentially wasteful reprocessing costs. A lot of instruments are now packaged and parceled in such a way that you only have to open the instruments that you need, not the whole set. One system we use has 20 or 30 different tip options with different configurations of blades, shavers, resectors and burs. But we only have to open the 1 or 2 that I may use. The rest can be saved for the next procedure.

7. Ways to save
Speaking of reprocessing, while all this technology is helpful, it isn't cheap. So a lot of facilities are looking for ways to save on accessories like saw blades, drill bits, oscillating motorized shaver blades, tips and burs. One way is to take advantage of many companies that reprocess tools. They take them apart, clean them, sterilize them, re-lubricate them and send them back to you, all for substantially less than the cost of a new instrument.

You can also reduce costs by bundling purchases, which is what we did when we renovated 2 of our ORs a little more than a year ago. We listened to a lot of sales pitches, experimented with a lot of equipment and ultimately went with a company that bundled everything — drills, saws, handpieces, motorized shavers, burs and so on. That helps mitigate costs while you try to stay on the cutting edge of surgical tool technology.