Most foot, ankle and lower extremity surgeons have demonstrated success using off-the-shelf implants designed for generalized anatomy. However, as CT imaging, surgical planning software and 3D printed patient-matched implant creation has matured, a hard question has emerged: are current surgical outcomes still acceptable when more precise tools today can produce optimal outcomes for all surgeons?
Lower extremity surgery can be unforgiving and details matter when attempting to achieve optimal load distribution. Gait mechanics, joint stress, and long-term mobility can be altered with one small imperfection in alignment. Off the shelf implants are the current gold standard in clinical care, but they make surgeons become excellent at adaptation.
New 3D printing of patient-matched implanted devices and planning software allow surgeons to become architects of patient specific restoration. As medicine in general moves from generalized to specific care, the anatomy-specific treatment model should become the standard, not the exception.
The reason is simple: Complex and revision cases with co-existing pathologies receive particular benefit from this new model. For decades, these procedures required staged interventions and marathon-like operating sessions. Intraoperative decision-making was required to produce the desired outcome. Now, fore planning and the resultant patient-specific instruments and implants are designed to address multiple deformities as part of a single, streamlined procedure.
Fully customized guides and implants are now available within days of surgical plan approval. Previous divides between customization and timely delivery are beginning to disappear with the advent of 3D printing and the ability to produce complex shapes, especially for challenging anatomical situations. These advancements may reduce or eliminate complications, and allow for more predictable, durable outcomes.
Better tools are one aspect, but the overreaching idea here is the platforms are case-specific: combining imaging, surgical planning, and manufacturing into a unified workflow, signaling the rise of a generation of surgical approaches. Rather than treating bones in isolation, the system will be the new protocol.
This is merely the beginning of interactive technologies as the future unfolds with surgery driven planning and value-based care models. It sounds strange to say we’re achieving consistency through customization, but the use of personalized implants and guides can provide the reproducibility of standardized outcomes.
It makes economic sense for health systems and payers because shorter procedures, fewer revisions, and improved functional outcomes save money and improve quality. Value-based care will increasingly reward precision and predictability as healthcare is increasingly measured by value, and patient-specific solutions can deliver both better care and better outcomes, i.e., economics. Currently, personalized implants may appear expensive but will be proven to reduce downstream utilization costs.
Health systems that resist the shift from standardized reconstruction to anatomy-driven reconstruction risk falling behind as adoption increases.
In lower extremity surgery, the future may not belong to surgeons who reconstruct the body to implants, but to surgeons willing to demand that implants precisely fit the body.
Photo: Vithun Khamsong, Getty Images
Nancy Hairston is President and CEO of MedCAD, a medical technology company built on an innovative approach to the design and production of patient-matched medical devices. Harnessing precise imaging, surgical experience, and proprietary biomedical engineering technologies, MedCAD creates personalized, patient-matched medical devices and surgical plans for cranial defects, oral surgery, CMF trauma and reconstruction surgical procedures. The approach is 100% patient-customized, with every implant and every procedure planned and manufactured in-house in cooperation with a patient’s attending surgical team. By minimizing surgical complexity and procedure time, MedCAD technology enables superior patient outcomes throughout intervention, rehabilitation, and recovery.
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