Russell Nevins and David Backstein06.07.22
Nearly 1 million knee replacement procedures are performed in the United States annually, a number that is projected to grow to 3.5 million procedures per year by 2030.
Historically, these surgeries are performed using reusable metal jigs, which are expensive, cumbersome, and difficult to clean and transport. What’s more, the costs associated are high for both the hospital and payer.
Knee replacement surgery has long demanded something of an operational and technological overhaul. The high-volume, high-cost specialty is emblematic of the entrenched medical practices that many learn in medical school and rarely question throughout their careers. But after hundreds of such surgeries, one might ask, “How can we do this better?” As with most industries, technology can and should serve as the key driver for innovation and improvement to address the difficulty and costs associated with knee replacement surgery.
The idea started out simple: Orthopedics is right-angle oriented and mechanical. Eyeglasses are a relatively easy and rudimentary tool to support surgical guidance through the use of lenses with built-in right angles. The idea closely mirrors the transparent heads-up display feature available in many contemporary cars.
Next, Virtual Reality came into play with Microsoft’s HoloLens, an immersive mixed-reality headset that embeds holographic imagery and applications into physical surroundings. An overlay hologram with physical reference points in a patient’s body was created through this headset, thereby giving surgeons unparalleled real-time insights.
What really brought the idea to life was the support of specialized technologists. With over 20 years of surgical experience under our belts, we had the expertise to approach this idea from a medical perspective. We needed people who knew tech development—especially augmented reality—and user interface design. We found these people through Toptal, a network of highly skilled freelancers in tech, design, and business. Toptal had people with the technological expertise, design proficiency, and project management structure necessary to complete the Arthrolense vision.
With the development portion of the project well underway, the team had a Toptal designer create a cohesive aesthetic for the HoloLens interface and application that would accompany the device. It needed to be a HIPAA-compliant and user-friendly UI that doctors could easily navigate. Most importantly, it needed to allow for absolute precision because an incorrect measurement within millimeters could significantly impact any surgical operation.
The state-of-the-art Arthrolense surgical guidance system surpassed initial goals. It allows a surgeon to have visualization of a knee – or pretty much any joint – and it gives a degree of visualization that has never been possible before, including the ability to manipulate information before making irreversible cuts to a patient’s bone.
The cost savings derived from the Arthrolense device are extraordinary too. The solution eliminates the instrumentation, transportation, and sterilization of old-fashioned jigs, cutting the total cost of surgery by 75%. Technologically, the only thing that comes close is robotics and navigation. However, the cost of a robot to perform knee replacements is anywhere between $500,000 and $1 million; the robot takes up a lot of space in the surgical center as well. Compared to the cost of robotically navigated surgery, the Arthrolense device could save hospitals and surgical centers hundreds of thousands of dollars.
Looking ahead, knee replacements are probably going to be just the first use of this kind of augmented reality tool in the OR. There’s nothing about the technology that couldn’t be applied to virtually any kind of surgery, and that prospect bodes well for the millions of people who will likely undergo some sort of joint replacement surgery – or any other – in the future.
*The product concepts presented are not yet cleared by any regulatory agency for use in medical practice and this is not a solicitation or offer to sell a product.
Russell Nevins is a fellowship-trained, board-certified orthopedic surgeon. He is an active member of the American Academy of Orthopaedic Surgeons (AAOS) and the American Association of Hip and Knee Surgeons. Dr. Nevins specializes in hip and knee replacements and revisions, including muscle sparing and rapid recovery total hip arthroplasty, such as the anterior approach and percutaneously assisted total hip arthroplasty (PATH), and presently is the Medical Director of Surgical Services at Valley Specialty Health Hospital. He is dedicated to working with each of his patients individually to create a treatment plan tailored to their needs and lifestyle.
David Backstein is a full-time faculty member in the Division of Orthopaedic Surgery at the University of Toronto. Dr. Backstein completed his fellowship in 2000 under the supervision of Dr. Allan Gross and was a John Insall travelling fellow in 2003. Dr. Backstein has over twenty years of experience in hip and knee arthroplasty surgery with a particular focus on complex primary and revision reconstructive procedures. He has published over 160 peer reviewed studies. He is Associate Editor of the Journal of Arthroplasty and is a Deputy Editor of Clinical Orthopaedics and Related Research. Dr. Backstein has been active in the development of new technologies and has a number of patents in the field of knee replacement.
Historically, these surgeries are performed using reusable metal jigs, which are expensive, cumbersome, and difficult to clean and transport. What’s more, the costs associated are high for both the hospital and payer.
Knee replacement surgery has long demanded something of an operational and technological overhaul. The high-volume, high-cost specialty is emblematic of the entrenched medical practices that many learn in medical school and rarely question throughout their careers. But after hundreds of such surgeries, one might ask, “How can we do this better?” As with most industries, technology can and should serve as the key driver for innovation and improvement to address the difficulty and costs associated with knee replacement surgery.
Technology Drives Innovation
A meeting of the minds between us, two orthopedic surgeons, produced the idea for a 3D spatial mapping device that would ultimately bring unparalleled insight and real-time coordinates to high-volume surgical procedures—as well as decrease costs and improve outcomes. Arthrolense, the product of this meeting, is scheduled for a US Food and Drug Administration 510(k) package filing.*The idea started out simple: Orthopedics is right-angle oriented and mechanical. Eyeglasses are a relatively easy and rudimentary tool to support surgical guidance through the use of lenses with built-in right angles. The idea closely mirrors the transparent heads-up display feature available in many contemporary cars.
Next, Virtual Reality came into play with Microsoft’s HoloLens, an immersive mixed-reality headset that embeds holographic imagery and applications into physical surroundings. An overlay hologram with physical reference points in a patient’s body was created through this headset, thereby giving surgeons unparalleled real-time insights.
What really brought the idea to life was the support of specialized technologists. With over 20 years of surgical experience under our belts, we had the expertise to approach this idea from a medical perspective. We needed people who knew tech development—especially augmented reality—and user interface design. We found these people through Toptal, a network of highly skilled freelancers in tech, design, and business. Toptal had people with the technological expertise, design proficiency, and project management structure necessary to complete the Arthrolense vision.
With the development portion of the project well underway, the team had a Toptal designer create a cohesive aesthetic for the HoloLens interface and application that would accompany the device. It needed to be a HIPAA-compliant and user-friendly UI that doctors could easily navigate. Most importantly, it needed to allow for absolute precision because an incorrect measurement within millimeters could significantly impact any surgical operation.
The state-of-the-art Arthrolense surgical guidance system surpassed initial goals. It allows a surgeon to have visualization of a knee – or pretty much any joint – and it gives a degree of visualization that has never been possible before, including the ability to manipulate information before making irreversible cuts to a patient’s bone.
About the Arthrolense Surgical Guidance System
The benefits of the device are numerous. Not only will surgeons be able to operate with absolute precision, they will also collect invaluable data every time they use the device. This accumulation of biometric data enables surgeons to make data-driven decisions about bone preparation, implants, and equipment placement in real time. Thus, the outcomes of surgeries are improved across a varied patient population.The cost savings derived from the Arthrolense device are extraordinary too. The solution eliminates the instrumentation, transportation, and sterilization of old-fashioned jigs, cutting the total cost of surgery by 75%. Technologically, the only thing that comes close is robotics and navigation. However, the cost of a robot to perform knee replacements is anywhere between $500,000 and $1 million; the robot takes up a lot of space in the surgical center as well. Compared to the cost of robotically navigated surgery, the Arthrolense device could save hospitals and surgical centers hundreds of thousands of dollars.
Conclusion
Embracing technology has and will continue to be how the medical field best improves outcomes and decreases costs. Arthrolense was made a reality thanks to the expertise and hard work of people highly specialized in their field—both from the surgical perspective and the programming and design side.Looking ahead, knee replacements are probably going to be just the first use of this kind of augmented reality tool in the OR. There’s nothing about the technology that couldn’t be applied to virtually any kind of surgery, and that prospect bodes well for the millions of people who will likely undergo some sort of joint replacement surgery – or any other – in the future.
*The product concepts presented are not yet cleared by any regulatory agency for use in medical practice and this is not a solicitation or offer to sell a product.
Russell Nevins is a fellowship-trained, board-certified orthopedic surgeon. He is an active member of the American Academy of Orthopaedic Surgeons (AAOS) and the American Association of Hip and Knee Surgeons. Dr. Nevins specializes in hip and knee replacements and revisions, including muscle sparing and rapid recovery total hip arthroplasty, such as the anterior approach and percutaneously assisted total hip arthroplasty (PATH), and presently is the Medical Director of Surgical Services at Valley Specialty Health Hospital. He is dedicated to working with each of his patients individually to create a treatment plan tailored to their needs and lifestyle.
David Backstein is a full-time faculty member in the Division of Orthopaedic Surgery at the University of Toronto. Dr. Backstein completed his fellowship in 2000 under the supervision of Dr. Allan Gross and was a John Insall travelling fellow in 2003. Dr. Backstein has over twenty years of experience in hip and knee arthroplasty surgery with a particular focus on complex primary and revision reconstructive procedures. He has published over 160 peer reviewed studies. He is Associate Editor of the Journal of Arthroplasty and is a Deputy Editor of Clinical Orthopaedics and Related Research. Dr. Backstein has been active in the development of new technologies and has a number of patents in the field of knee replacement.