How 2 total hip arthroplasty experts use a C-arm and Radlink to assure their procedures are safer than ever

Total joint arthroplasty has become commonplace in outpatient settings, with demand expected to rocket 146 percent in the coming years as the U.S. population continues to age, according to a study published in Value In Health.

This content is sponsored by Philips

With center and orthopedic surgeon caseload steadily expected to rise to meet this demand, being efficient while maintaining a high level of outcomes is of the utmost importance in any surgical setting.

Daniel Ward, MD, COO of North Atlantic Surgical Suites in Salem, N.H. and attending surgeon at Boston-based New England Baptist Hospital, along with Jason Snibbe, MD, an orthopedic surgeon at Los Angeles-based Snibbe Orthopedics, discussed how to best use technology to improve total hip arthroplasty efficiency during a workshop sponsored by Philips at Becker's 16th Annual Future of Spine + The Spine, Orthopedic and Pain Management-Driven ASC Conference June 15 in Chicago.

Dr. Ward performs total hip and knee arthroplasty procedures at New England Baptist Hospital. The hospital performs approximately 7,000 total joint procedures and large inpatient surgeries annually. Dr. Ward and his partners recently opened a surgery center to perform outpatient total joint replacements. Since opening in March, the total joint only center has performed about 145 outpatient total joints to date.

Dr. Snibbe, on the other hand, has practiced out of his surgery center for 15 years. He performs both joint replacements and sports medicine procedures, but specializes in Total Hip Arthroscopy. He also operates at Cedars Sinai Medical Center.

One limitation both physicians expressed was a lack of fully comprehensive intraoperative imaging technology at surgery centers. While patients could be sent for preoperative imaging, operating room size restrictions and time constraints in a surgery center setting frequently cannot accommodate several large pieces of X-ray technology. The Philips – Radlink solution delivers computerized implant verification data to the surgeon by means of a bracketed Surface Pro attached directly onto the C-Arm.

"To bring a big X-ray machine into an operating room is difficult; most surgery centers all over the world have fluoroscopy machines for fractures, for spine for pain management. Now you can have a machine [C-arm] that does that, but also does this [with Radlink]," Dr. Snibbe said.

Radlink stitches together C-arm fluoroscopy images to provide the physician a complete picture of the procedure. The software allows physicians to make sure every operation is done well, ensuring proper implant length and alignment in the hip. Radlink also allows physicians to identify unexpected complications like intraoperative fractures or improper placement during the procedure.

Ever since they started using the C-arm in combination with the Radlink technology, both Dr. Snibbe and Dr. Ward swear by it.

"For us, [Philips C-arm with Radlink] is the standard of care. I haven't done a single hip replacement in the last seven to eight years without the Radlink system," Dr. Snibbe said. "It's a device that allows you to be safe. … In the 90s when we started bringing all these operations [to the surgery center setting] we wanted to make sure the patient was safe and that they didn't have complications and problems. This covers the safety and accuracy part of the operation."

Radlink also covers the center in the event of legal claims. Dr. Snibbe relayed a scenario where a patient slipped and fell breaking their hip after surgery. The patient attempted to say their hip was broken during the procedure. However, Radlink was used during the procedure and the patient's surgeon was able to produce intraoperative and postoperative images disputing the patient's claim.

Dr. Ward and New England Baptist are also devout Radlink converts.

"I'm 18-years into practice and I never looked at an X-ray intraoperatively unless it was for a revision," He said. "I'm now 2,100-plus patients into the Radlink system and I have yet to not take [imaging] on a single hip patient [since installing the Radlink]."

The entire imaging process is fast too. Dr. Ward used the Radlink for 250 consecutive patients, compiled the data and presented a study at an International Society for Technology in Arthroplasty conference. He found Radlink added 68 seconds to the standard arthroplasty procedure. In a day, it added around four to five extra minutes. The benefits and assurance of knowing far outweighed the time commitment.

"In the cases where you don't know where your implants are or you think you know where your pelvis is in space — which is really the holy grail in orthopedics, to know exactly where the patient's pelvis is at the time you're operating. That was the problem we ran into, and that problem is what the [Radlink] eliminated," he said.

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