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Shaping Surgical Innovation and the Future of Orthopaedics

March 11, 2021
by Matt O'Rourke

Lisa L. Lattanza, MD, FAOA, FAAOS, Chair of the Department of Orthopaedics and Rehabilitation, recently sat down for an interview about technology in orthopaedics and how she sees the department pushing forward with new technological advancements to benefit patients.

What are some of the latest technological advancements for orthopaedic surgery specifically here at Yale, and how might they impact the future of orthopedics?

In orthopaedic surgery, we are interacting with new forms of technology daily, whether it is implants or new devices. Our 3D surgical innovation program and research are really at the forefront of this.

Accurate correction of acquired and congenital bony deformity is a common problem that orthopaedic surgeons and their patients face. We can actively model surgical and normal anatomy in 3D before surgery so that we can better understand and correct the problem. We can also virtually plan surgery in 3D with specific software (Materialize Mimics) and have jigs and guides created to be used in the operating room so that the surgery is accurately executed.

The next step will be the 3D printing of patient-specific implants for all different types of surgical correction. We will get to a point where we will no longer be taking a tray of metal implants off the shelves, like plates and screws for fractures or implants for joint replacements. Instead, we will print the exact plate or implant that will work the best for the individual patient for that problem. This is happening already at a small scale in Europe and other countries but will likely become the standard of care.

Another procedure we’ve begun to use here that is also used in specialty centers around the country are magnetic growing rods for correction deformity correction and lengthening in children. The rods are inserted during surgery, and then special magnetic instruments are used to slowly pull the rods in precise directions. This technology minimizes the number of operations a child needs to allow correction, for example of a spinal deformity while the child is still growing.

Robotics is another growing area in orthopaedic surgery specifically for total joint arthroplasty and various types of procedures where precision is paramount. Several of our surgeons use this technology currently.

Biologics are another area of advancement. We are working to develop exosomes, which are types of biologics that would deliver specialized treatments into our joints and soft tissues and make them usable by our bodies. If successful these types of treatments may allow some patients to forego surgeries and heal without it.

There are also technological advances in the diagnostic equipment that we use every day. We use flouroscan portable xray machines now that fit in a suitcase-sized container and can be taken right on to the athletic field or training room for immediate diagnosis of fractures and dislocations. From CT scans to MRIs, all of these technologies are being made smaller so we can do more in the office much more rapidly. There are even CT scans now that we can use in real-time to look at the bones and joints while we move them. This allows for a more functional diagnosis in less time.

Where do you see Orthopaedics in five to ten years?

One of the most significant issues we face in healthcare is cost. Any technology that can help drive great outcomes while lowering cost is going to be the focus in the future. I believe that we will see less use of inpatient care and advances in procedures where we can perform more surgeries in an ambulatory setting. Programs such as “hospital to home,” where we’re using technology to help us monitor people at home, will help healthcare professionals supplement their care, keep costs down, and provide excellent care.

More and better use of virtual reality and artificial intelligence for education, research, and treatment are definitely in our future.

Researchers in our basic science division are also working on advancing 3D cellular printing, which is an area of focus for us. We are looking to the not-too-distant future in being able to replace cartilage or bone defects by growing new tissues in the lab. This would revolutionize the treatment of many orthopaedic problems. We are not there yet but perhaps in a decade or two from now metal implants for joint replacements may become a thing of the past.

Technology impacts patients beyond the operating room too: we have faculty members studying the use of wearable technology to help monitor, diagnose and guide treatment and recovery from orthopaedic injuries outside of the clinic while at home and in their daily lives.

What do you think makes Yale Orthopedics & Rehabilitation a leader in surgical innovations?

Yale is a phenomenal research institution so there are many intelligent people here who are willing to collaborate on any number of these different ideas. We have assembled a department full of both experienced and young, energetic physicians and surgeons with great ideas that have trained all over the country and bring a diversity of thought to the department. I think all of those things come together to foster a culture and environment for collaboration and innovation.

How is technology changing and shaping the way Yale teaches medical students, residents, and fellows?

The COVID-19 pandemic has accelerated some of the ways we are using new technologies for education and training. We’ve begun incorporating virtual reality as part of their training, which doesn’t replace the operating room experience, but it can provide additional perspective for residents and surgeons alike. They get to experience surgery virtually and perform that surgery in a low-stakes setting, which adds another element to their education. I think it’s more applicable for medical students and residents in their early years, but I’ve used the technology myself, and certain things about it carry over into the operating room.

I think 3D printing has a substantial educational benefit. As a resident, if you can see in 3D what an injury, a fracture, or a deformity looks like, your visual perspective grows. In the past, we have always only had the capability of teaching these concepts in two dimensions from x-rays, or maybe CT scans. Now you can hold that deformity and a broken bone in your hand. We can also re-use 3D printed structures from our patients as case studies to be taught to peers, students, residents, and fellows. I believe residents that are training today will have a deeper understanding of the pathology and will be able to obtain that knowledge more quickly because of the use of 3D printing in surgical planning.

Submitted by Matt O'Rourke on March 11, 2021