Has Digital Templating Become the Standard of Care in Orthopaedics? An Interview with 5 Orthopaedic Surgeons

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1 Has Digital Templating Become the Standard of Care in Orthopaedics? An Interview with 5 Orthopaedic Surgeons

2 Introduction Many orthopaedic surgeons in North America have either already made the transition to the digital environment and PACS or are currently dealing with the implications of having their traditional pre-operative planning method of using printed x-rays and acetate templates withdrawn. How does this affect the Standard of Care? Although it is not a legal requirement in the U.S. to use a digital pre-operative planning solution when only digital images are available, some feel that surgeons who do not adapt and use a dedicated solution for creating their pre-operative plans digitally could be unwittingly putting themselves at risk of a malpractice lawsuit when outcomes do not match expectations. We asked five orthopaedic surgeons for their views on this subject and asked them who they feel is responsible for ensuring access to digital planning and templating for orthopaedic surgeons in the U.S.

3 Meet the Surgeons Steven F. Harwin, MD, FACS Dr. Harwin is Chief of Adult Reconstructive Surgery and Total Hip and Knee Replacement at Beth Israel Medical Center in New York City, New York. He uses OrthoView s digital planning solution integrated with a McKesson PACS. Samir Metha, MD Dr. Mehta is Assistant Professor of Orthopaedic Surgery at one of the top U.S. medical facilities in Pennsylvania. He has been using OrthoView with a GE PACS since his facility converted to digital imaging in Brett R. Levine, MD, MS Dr. Levine carries out over 40 surgeries a month at Midwest Orthopaedics at Rush in Illinois. His practice focuses on complex primary and revision hip and knee reconstructions, and he has been planning and templating digitally with OrthoView since James Bicos, MD Dr. Bicos concentrates his practice on the specialized needs of athletes of all ages, in particular shoulder arthroplasty and knee procedures. Dr. Bicos is certified by the American Board of Orthopedic Surgery and is the consulting physician for the U.S.A. Olympic Gymnastics team. Stuart Gordon, MD Dr. Gordon is Director of Hip and Knee Replacements at Cooper University Hospital in Camden, New Jersey. He specializes in total-joint replacements and has a special interest in hip and knee replacements, hip and knee revisions and complex surgeries.

4 Interview Question 1 OrthoView: Is templating standard of care? Dr. Harwin: Pre-operative planning is critical to avoiding surprises in the OR. It is Standard of Care that surgeons should template, especially for total hip replacement procedures. In particular for patients with unusual anatomy, planning with OrthoView alerts the orthopaedic surgeon to potential sizing, fit and positioning problems, often seen in small patients, those with dysplastic anatomy and for those who have had prior surgery. Dr. Levine: I plan every case in order to be prepared in the OR for the size of prosthesis that I need and any potential anatomical variations that the patient may have. It is definitely Standard of Care to plan prior to surgery and hospitals should ensure they have a way for us to plan when they introduce digital radiology i.e. a digital solution. They generally don t. Dr. Bicos: Planning is at the heart of what we are taught. I have always used planning to be prepared for the needs of the patient in theater, especially for reconstructive surgery. My pre-operative routine includes printing a hard copy of the plan from OrthoView, but in effect, it doesn t matter whether the plan is recorded. It matters that it was done for the surgeon to be prepared. Although many decisions have to be made intra-operatively, surgical planning is undoubtedly Standard of Care and in the future, digital will be the default option. It provides an additional road map, a checking system and without a doubt helps to avoid complications for the patient as well as reduce overheads for the hospital by helping to narrow down the sizes needed. Dr. Gordon: Digital templating is enormously advantageous, particularly in a university setting. Every large community hospital should get digital templating. Digital planning is economical, improves communication and can improve patient care as the more pre-operative planning you do the better care you can provide. Page 1 Has Digital Templating Become Standard of Care in Orthopaedics Interview

5 Interview Question 2 OrthoView: Is a surgeon who does not plan, because they do not have a digital templating solution, at risk of a malpractice lawsuit? Dr. Harwin: They may well be. Most lawsuits originate because it is felt that the surgeon did not diagnose and treat in accordance with the Standard of Care. In a digital environment, templating is no less a key element of Standard of Care than with conventional x-rays. Using a digital planning and templating solution offers a degree of protection for an orthopaedic surgeon against the risk of a malpractice lawsuit based on these issues. There are specific benefits with digital planning. For example, a key issue regarding potential malpractice lawsuits for hip replacement surgeons is leg length discrepancy. This is something that is quick and easy to correct in OrthoView. Dr. Metha: I believe a surgeon who is not planning because they have only digital x-rays but no digital planning tools could be unknowingly and unnecessarily putting themselves and their patients at risk. I understand planning in a digital environment is a huge challenge for many orthopaedic surgeons, but I am concerned that, in the evolution to digital imaging, the skill of templating has been overlooked, including the need to provide access to digital templates. Dr. Bicos: I firmly believe that having and using a digital planning solution would go some way to protecting surgeons who are using digital imaging against a malpractice lawsuit. Page 2 Has Digital Templating Become Standard of Care in Orthopaedics Interview

6 Interview Question 3 OrthoView: Whose responsibility is it to ensure surgeons have access to a digital planning solution? Dr. Harwin: Now that the majority of private practices and hospitals are converting, or have already converted, to digital radiology, you shouldn t go to a digital PACS system without having digital templates available. If a surgeon is not templating because they have digital images but no digital planning solution, they are at risk of being confronted with situations during surgery that they have not anticipated. Dr. Mehta: The responsibility for insisting on a digital planning solution lies firmly in the hands of surgeons. Surgeons who cannot template because they do not have a digital templating solution should never have accepted a PACS system without digital templates. When my own division was faced with the withdrawal of printed x-ray film, I insisted that the hospital provide a digital templating facility. Templating is an essential part of any pre-operative plan when using implants and being able to plan for the unplanned is something that benefits the patient, the surgeon and the hospital. Dr. Levine: Many orthopaedic surgeons were initially resistant to the concept of digital planning, but slowly the realization is dawning that you cannot use acetate templates with digital images because of the scaling issue and that digital templating is here to stay. A digital plan can contain a considerable amount of detail and constitutes more than just notes on an x-ray. Dr. Bicos: Planning is an important issue currently but there is also a lot of complacency. More needs to be understood about the risks of not having a digital planning solution but the message must come from the surgeons and staff about those risks. Academic and busy replacement practices in particular should have a digital solution. Page 3 Has Digital Templating Become Standard of Care in Orthopaedics Interview

7 Interview Question 3 Continued Dr. Gordon: I would encourage every orthopaedic surgeon to have digital templating. It is the ace in the hole when you have digital imaging. The objective is the best, most excellent care for each patient. Having a digital plan also helps me explain the procedure to my patients, show them how I plan to optimize their biomechanics and match their expectations for physical activity after the procedure. Planning helps to achieve a better outcome and improves the intra-operative decision-making. I believe that digital templating is economical, improves communication and can improve patient care as the more pre-operative planning you do the better care you can provide. It is enormously advantageous in a university setting and every large community hospital should get digital templating. Page 4 Has Digital Templating Become Standard of Care in Orthopaedics Interview

8 Final Thoughts Summary Based on these five interviews, we summarize: 1. Pre-operative planning and digital templating are considered to be part of the Standard of Care in orthopaedics. 2. When only digital images are available, a digital planning solution is required. 3. Any surgeon that does not plan because he or she does not have a suitable digital planning solution could be putting himself or herself at an increased risk of a malpractice lawsuit. 4. In the transition to digital imaging and PACS, orthopaedic surgeons are responsible for ensuring they have access to a digital planning solution. Conclusion Returning to our initial question, Has digital templating become the Standard of Care in orthopaedics?, we conclude that pre-operative planning is the Standard of Care. For those surgeons that have digital x-rays, digital templating is the Standard of Care. For those surgeons that have yet to make the transition to digital x-rays, digital templating will become imperative once the switch is made. OrthoView is the dedicated orthopaedic digital pre-operative planning and templating software used by surgeons worldwide. Surgeons use OrthoView s vast array of planning tools and wizards, and extensive prosthesis template library, to create detailed pre-operative plans quickly and easily from digital x-ray images. OrthoView facilitates digital planning and templating for joint arthroplasty and revisions, orthopaedic trauma, limb deformity correction, osteotomy and pediatric and spinal assessment and is chosen by hospitals worldwide to meet their target of film-free radiology. To explore OrthoView, request a free software trial or demo: Request a Trial or Demo OrthoView Southampton, Hampshire, UK t. +44 (0) e. info@orthoview.com