A look back at the dark ages of Orthopedics, back in 2020. |
An orthopedic surgeon is teleported from the future to today, 2020.
Our time traveling surgeon wants to discuss an upcoming elective procedure with you. The case in question is an elective procedure for severe medial knee arthritis, a routine total joint replacement, for 72 year old grandmother, Freda Smith next week.
The Q&A might sound something like this.
Surgeon: Will this be an on-site or remote procedure?
Device Manufacturer: On-site. We do all cases at the big university hospital because that’s where the trained staff is, and all the resources are. They can handle high volumes of total knees.
Surgeon: What global software platform will be used?
Device Rep: No software is needed for the procedure, but the hardware will be the Zimmer Persona Total Knee. It’s a great implant system.
Surgeon: Has the patient’s genome be mapped?
Device Rep: No, we don’t do that today.
Surgeon: Have the patient’s stem cells been harvested, grown and ready?
Device Rep: We don’t need any cells for a routine joint replacement.
Surgeon: Has the patient been 3D scanned?
Device Rep: No need for that. We have long films from Freda’s pre-op visit last month. Her 2D x-rays, both AP and lateral, will be available to you on screens in the OR during your case.
Surgeon: Who is making the implant, the hospital or a 3rd party?
Device Rep: Hospitals don’t make implants, we do. Hospitals don’t have enough expertise, and they don’t want the regulatory burden, and they really don’t want all the inventory costs.
Surgeon: Ok, when will the implant be here?
Device Rep: The day before your case, the device representative, Skippy Good, will bring an assortment of implant sizes the morning of the case. One of the implants usually fits the patient’s anatomy pretty good. Skippy will be there to make sure everything goes smoothly.
Surgeon: … but I don’t need Skippy in the OR, I just need need the implant that fits the patient.
Surgeon: I’m done. Beam me back up Scotty. Quick!
Our time traveler returns home and shares his experience with his colleagues.
“Back in 2020, these poor guys were in the dark ages. I’m glad I didn’t need a knee replacement back then.
The surgeon didn’t know the patient anatomy until he/she cut. The healthcare system didn’t know the patient’s anesthesia needs, healing profile or PT plan from DNA. The patient’s own stem cells were not available. An algorithm wasn’t used to design the implants, a manufacturer made a series of cookie cutter sizes. Then a rep had to bring all the implant options for the case and a the surgeon had to find the ones that fit the best with some mechanical trials.
Orthopedics was broken back then. Now I see why that joint replacement patients only had an 80% good results with re-admission rates of 10%.”