Advances in Exotic Animal Osteosynthesis.

Exotic animal orthopedics has not incorporated the most recent progress made in small animal surgery or human medicine. Although minimally invasive osteosynthesis has been incorporated as a routinely used alternative in small animals, its use in exotic animals is still in its infancy. This article compliments the reviews of orthopedics in small mammals, birds, and reptiles in the previous issue. It reviews relevant recent studies performed in laboratory animals about new orthopedic materials and techniques showing potential to become incorporated into the routine orthopedic treatment of exotic animals in the coming years.

Consolidation and maturation of the orthopaedic medical device market between 1999 and 2015.

Orthopaedic surgeons often require highly specialized medical devices, implants, and equipment, which are usually offered by several vendors/companies. This study assesses long-term market trends for orthopaedic medical device companies and examines various implications for healthcare cost. Using S&P Capital IQ, a Wall Street database, financial data were gathered on orthopaedic device companies, ranked by worldwide sales, from 1999 to 2015. Annual sales were aggregated to calculate market share and compounded annual growth rates (CAGRs). Overall, the global orthopaedic device market grew at 12.0% CAGR from 1999 to 2008, before slowing to 2.8% from 2009 to 2015. Between 1999 and 2015, the top 5 companies increased total market share from 52.8 to 62.2%. The orthopaedic device market is not only consolidating under a few dominant players, but also growing at a decreasing rate, both of which signal a maturing industry. These trends are likely to shape patient care and healthcare costs in orthopaedic surgery in years to come.

Recent coating developments for combination devices in orthopedic and dental applications: A literature review.

Orthopedic and dental implants have been used successfully for decades to replace or repair missing or damaged bones, joints, and teeth, thereby restoring patient function subsequent to disease or injury. However, although device success rates are generally high, patient outcomes are sometimes compromised due to device-related problems such as insufficient integration, local tissue inflammation, and infection. Many different types of surface coatings have been developed to address these shortcomings, including those that incorporate therapeutic agents to provide localized delivery to the surgical site. While these coatings hold enormous potential for improving device function, the list of requirements that an ideal combination coating must fulfill is extensive, and no single coating system today simultaneously addresses all of the criteria. Some of the primary challenges related to current coatings are non-optimal release kinetics, which most often are too rapid, the potential for inducing antibiotic resistance in target organisms, high susceptibility to mechanical abrasion and delamination, toxicity, difficult and expensive regulatory approval pathways, and high manufacturing costs. This review provides a survey of the most recent developments in the field, i.e., those published in the last 2-3years, with a particular focus on technologies that have potential for overcoming the most significant challenges facing therapeutically-loaded coatings. It is concluded that the ideal coating remains an unrealized target, but that advances in the field and emerging technologies are bringing it closer to reality. The significant amount of research currently being conducted in the field provides a level of optimism that many functional combination coatings will ultimately transition into clinical practice, significantly improving patient outcomes.

Development trends of custom-made orthopedic implants.

Concepts for selection of the metallic materials and design required for the fabrication of custom-made orthopedic implants (osteosynthetic materials and prosthetic joints) and examples of methods for assessing the mechanical compatibility of bone plates are given to aid understanding of the possibility of producing custom-made orthopedic implants. Depending on the clinical case, there are problems in relation to production cost owing to situations in which the shape of the bone is altered to accommodate the implant. Therefore, there is potential for the development of custom-made orthopedic implants that optimally suit the patient's needs and bone structure, have practical uses, and are affordable.

Sistema de entrenamiento para operaciones de reemplazo total de rodilla / System training for operations of total knee replacement TKR

Objetivo: Desarrollar un simulador para las operaciones de reemplazo total de rodilla (TKR) que sirve además como base para el estudio de otras intervenciones como reemplazo total de cadera (THR). Material y Método: Se describe una aplicación que integra el modelado de objetos óseos y tejidos blandos con el procesamiento de imágenes médicas y la tecnología háptica para aumentar las propiedades de inmersión. El sistema esta compuesto por dos etapas, primero se analizaron imágenes medicas de la articulación y se estableció un plan intraoperatorio para seccionar los tejidos. En una etapa posterior, se integró la información de los huesos seccionados para interactuar con modelos virtuales de prótesis e instrumental quirúrgico, añadiendo sensaciones de contacto. Resultados: Se generó un modelo mixto superficial-volumétrico que simuló un hueso mediante la separación de secciones definidas por el usuario como la sección superficial sobre la cual no se proponen deformaciones o modificaciones (cortes, taladrado, fresado) y sección volumétrica compuesta por primitivas superficiales (puntos, esferas, o cubos) con propiedades de transformaciones geométricas y reportes de colisión independiente. Conclusion: El simulador presentado se puede usar para el entrenamiento de cirugías ortopédicas utilizando imágenes, modelos e instrumental 3D que complementa los métodos clásicos de enseñanza (AU)

Objetive: To develop an orthopedic surgery simulator for operations for total knee replacement (TKR), this also serves as the basis for the study of other interventions such as total hip replacement (THR). Material and method: Is described an application based on open source software that integrates the modeling of bone and soft tissue objects in medical imaging and haptic technology to enhance the properties of immersion. The system consists of two stages; first, medical images of a joint are analyzed, and a plan for intraoperative 3D sections is established. At next stage, the user integrates information from the different objects previously generated from the sectioned bones to interact with virtual models and prosthesis. Results: The main contribution of this work is the generation of a mixed model surface and volume to simulate the machining of a bone by removing user-defined sections such as section surface on which no deformation or proposed modification (cutting, drilling, milling) and volumetric section consists of surface primitive (points, spheres, or cubes) with properties of geometric transformations and independent collision reports. Conclusions: The simulator can be used to train other orthopedic cases considering the use of images, 3D models and specific instruments, becoming a training tool that complements traditional methods of medical education (AU)

Experiencia en la utilización de bisturí de ultrasonidos en cirugía ortopédica / Experience in the use of ultrasonic scalpels in orthopaedic surgery

Objetivo. Comparar el efecto de la aplicación del bisturí eléctrico monopolar y el de ultrasonidos sobre el tejido muscular en cirugía oncológica. Material y método. Se recogieron muestras de tejido muscular de 6 pacientes. En cada uno de ellos se obtuvieron 2 muestras: una mediante corte con bisturí eléctrico y otra con bisturí de ultrasonidos que se analizaron en anatomía patológica. Resultados. Observamos una menor profundidad de necrosis y mejor viabilidad tisular en las zonas de corte con bisturí de ultrasonidos, respecto a las zonas en las que se empleó el bisturí eléctrico. Conclusión. El bisturí de ultrasonidos proporciona una capacidad de corte y hemostasia comparable a la del bisturí eléctrico, ocasionando un menor daño a los tejidos sobre los que se aplica (AU)

Objective. To compare the effects using the monopolar electric and ultrasonic scalpel on muscle tissue in oncological surgery. Material and method. Muscle tissue samples were collected from 6 patients. Two samples were obtained from each one of them: one using an electric scalpel and another with an ultrasonic scalpel, which then analysed in histopathology. Results. Less necrosis and better tissue viability was observed in the areas cut with the ultrasonic scalpel compared to the areas where the electric scalpel was used. Conclusion. The ultrasonic scalpel has a cutting capacity and haemostasis comparable to the electric scalpel, causing less damage to the tissue on which it is applied (AU)

The natural history of new orthopaedic devices.

Each year, hundreds of new devices and implants are introduced for orthopaedic surgeons. However, the proportion of new devices which ultimately will be successful is unknown. We investigated the natural history of new devices introduced to the orthopaedic market. From a list of all devices approved for use by the Food & Drug Administration 5 and 10 years before, a cohort of 100 devices was randomly selected using a random number list. Companies were contacted regarding the safety record and current availability of these devices. The company response rate was 93%. Forty-seven percent of devices approved 10 years ago and 25% of devices approved 5 years ago no longer were on the market. Of the 55 companies studied, 18 (33%) were out of business and their devices no longer were available. Devices approved 10 years ago were more likely to be unavailable than devices approved 5 years ago. Devices introduced by smaller companies were more likely to be unavailable. The majority of unavailable devices were discontinued not for clinical problems, but for poor market performance. Only 2% of devices studied had safety problems. Approximately 50% of devices approved for introduction to the orthopaedic marketplace no longer are available 10 years later. However, major device-related problems seem uncommon.

Nanobiotechnology: implications for the future of nanotechnology in orthopedic applications.

Nanotechnology involves the use of materials with components, such as fibers, grains and particles, that have dimensions of less than 100 nm. While numerous advantages of nanomaterials have been elucidated for catalytic, processing, mechanical, electrical, and optical applications, few have been described for orthopedic applications. Better orthopedic biomaterials are needed since the average lifetime of a bone biomaterial is less than 15 years. This review discusses recent studies that have been conducted to determine the efficacy of nanophase materials as bone implants. In doing so, it is suggested that nanophase materials can be synthesized to possess similar nanometer dimensions to components of bone tissue to promote new bone formation, compared with conventional orthopedic implant materials.

Medical devices, health care, and consensus standards.

ASTM Committee F04 on Medical and Surgical Materials and Devices has been creating standards for this field since 1962. Dr. Jack Lemons provides a quick overview of the past, present, and future of this committee.

Technology evolution: the technology spectrum and its application to orthopedic technologies.

The evolution of clinical technologies presents potential adopters with considerations in planning for clinical program development that include the stage and the rate of a technology's evolution. This paper presents a conceptual framework for these considerations and applies the framework to orthopedic technologies. Eight orthopedic surgeons were asked to assess 14 orthopedic technologies and position each of them along a spectrum of research, clinical, and adopted technologies. The distribution of responses for each technology-year combination is presented, and estimates of central tendency, dispersion, and variances provide measures of the change in the distribution of responses over time for each technology and the change in the degree of rater consensus over time for each technology. While orthopedic trauma was chosen to illustrate the technology spectrum model, the model and assessment methodology is applicable to other medical specialties as well. Adoption of this framework in a hospital setting should enable more systematic and effective clinical program development.

Review of orthopaedic manipulator arms.

Trajectory planning and implementation forms a substantial part of current and future orthopaedic practice. This type of surgery is governed by a basic orthopaedic principle [1] which involves the placement of a surgical tool at a specific site within a region, via a trajectory which is planned from X-ray based 2D images and governed by 3D anatomical constraints. The accuracy and safety of procedures utilising the basic orthopaedic principle depends on the surgeon's judgement, experience, ability to integrate images, utilisation of intra-operative X-ray, knowledge of anatomical-biomechanical constraints and eye hand dexterity. The surgeon must remain as the responsible medical expert in charge of the overall system. At the same time the surgeon covets the accuracy offered by Computer Assisted Surgery including a manipulator. A summary of current inadequacies of manipulators indicates that the main drivers for future work are that accuracy is critical in close contact with the environment, safety concerns dictate manipulator geometry and technological limitations are many. In any effort to develop an optimal manipulator to guide surgical instruments and tools it is an obvious first step to review and categorise current manipulators. The aim of this paper is to review all aspects of manipulator design against the five main criteria of ergonomics; safety; accuracy; sterility and measurable benefits such as reduced operative time, reduced surgical trauma and improved clinical results.

A perspective on recent trends for scoliosis correction.

The basic principles for scoliosis surgery learned during the Harrington era are still valid today. Experience has confirmed the need for careful selection of the vertebrae to be instrumented, the value of anterior release for rigid curves in imparting convertibility of the deformity, and the importance of careful fusion techniques. During the last decade, further development has occurred because of an increased knowledge of the biomechanical needs for the internally instrumented spine and a three-dimensional appreciation of the scoliotic curve. Biomechanical advances have centered on an understanding of the load-sharing properties afforded by the multiple spinal purchase sites (segmental spinal instrumentation) and the value of two-rod systems linked by couplers. These advances have provided an increased stiffness of the instrumental spine, a reduction in correction loss, improved fatigue properties of the implant, and fewer pseudarthroses. The most important advance of the last decade is an improved awareness of the three-dimensional approach to the scoliotic deformity with the need to preserve or improve sagittal contours. In particular, the importance of the loss of normal thoracic kyphosis or lumbar lordosis has been emphasized. These conceptual gains have led to the development of many new instrument systems to correct deformity. Each is associated with advantages, problems, and risks that must be understood to make intelligent choices for treatment.