A Power Tool Wish List

Orthopods are surgery's carpenters, cutting and drilling into bone as they stabilize loose structures, repair broken parts and replace aging joists, er joints. Like any master craftsman, they want high-performance tools with features designed to maximize their skills as they ply their trade.

The weight of a tool can be a critical factor in how well it performs in surgeons' hands. If it's too heavy, they might tire quickly and be unable to apply the right amount of force needed to drill or cut through bone safely and effectively. Many surgeons therefore prefer lightweight options with the power to get the job done.

"If I'm scheduled to perform seven joint replacements in a day, working with comfortable, lightweight tools that don't tax my arm muscles prevents me from getting fatigued, which in turn helps me perform surgery and achieve the best possible outcomes for my patients," says Brandon Gough, MD, a joint replacement specialist at the Orthopedic Institute of the West in Phoenix.

Ergonomics is also an important consideration for surgeons and can also limit surgeon fatigue, according to John Keating, MD, SFOA, an orthopedic trauma surgeon who practices in Atlanta. Power tools should be weight-balanced and feature handpieces surgeons can grip comfortably and easily.

One quality you might not think about with power tools is how much noise they make. "Surgeons don't want to work with instruments that cause their ears to ring while they're operating," says Dr. Gough. "I've worked with tools that made so much noise, I didn't want to use them anymore."

The quieter the instrument, the less the stress surgeons will feel and the better they'll be able to think more clearly and precisely about how to perform the surgery.

Electric-powered tools tether surgeons to cords, limiting their freedom of movement. Many surgeons have therefore opted for battery-powered options, which give them the freedom to move around the table without worrying about a cord inadvertently entering the sterile field or becoming tangled on the floor, where it can become a tripping hazard for members of the surgical team. "I don't like working with corded tools because they clutter up the workspace," says Dr. Gough.

Battery life can be a problem with wireless tools, especially during long, intense cases. Dr. Gough says that's less of a concern now because newer, lightweight lithium-ion batteries provide plenty of power on a single charge to get through most cases. "I don't even worry about battery life at this point," says Dr. Gough. "The benefits of using cordless tools outweigh that potential drawback."

High-use and high-powered tools are at high-risk to break down at some point during their life span. Dr. Gough says it's important to have warranties for your fleet of power tools and ensure manufacturers offer responsive service and have the capability to quickly send loaners while the primary tools are out for repair.

Dr. Keating believes power tool vendors should check in frequently to ensure their devices are properly serviced and says buying a single fleet of tools from a single manufacturer simplifies servicing contracts and timely access to backup instruments.

"Smart" tools are available that automatically send usage and performance data to a cloud-based module, which presents the data in real time in an easy-to-understand dashboard on an online portal. You can use the information to monitor the usage of individual tools and schedule service or repair requests through the online portal.

A cordless battery-operated single-use drill is marketed as a viable backup to have on hand in the event a primary drill breaks or isn't available at the last minute because of sterility issues. The disposable drill is also handy in the event a battery-powered tool unexpectedly runs out of juice in the middle of a case.

There are two important elements in the performance of a tool:

• Speed is the amount of revolutions a drill bit makes or the number of cycles a saw blade completes in a given amount of time.
• Torque is the amount of force applied at the business end of the tool.

"High-speed power definitely makes tools accurate and easier to use," says Dr. Gough. "Torque is important to overcome friction when digging into bone."

During hip replacements, for example, he has to increase the torque on his reamer to overcome the reamer basket to prevent it from sticking against the bone.

Saws with high-speed oscillation let surgeons cut through bone efficiently and accurately and with very little physical exertion. It's helpful for surgeons to be able to toggle between the low speed and high torque needed to drill or cut through large bones, and the high speed and low torque best suited for smaller bones.

Meet the needs of surgeons who specialize in different procedures. A single handpiece on which you can easily switch out drills, saws and burrs adds to the versatility of a tool. "Surgeons like drills with quick exchange options, so they can switch out bits and screw drivers effortlessly," says Dr. Keating.

Conduct a trial to give surgeons who specialize in different orthopedic procedures the opportunity to use the tools and provide their feedback. Pay close attention to their thoughts on the accuracy and precision the tools afford. Securing the best possible price is important, but just as important is making sure your surgeons work with tools that enable them to be confident and capable providers who achieve excellent outcomes. OSM