Breakfast with Field Orthopaedics
Good to catch up with Chris Jeffrey, CEO of Field Orthopaedics, this morning for breakfast.
He shares my enthusiasm for a new shoulder surgical procedure we have been discussing.
Why surgeons and device companies talk to each other
Most new surgical techniques need instruments that do not yet exist. A procedure might require a guide that holds a graft at a particular angle, a drill that works within the confines of a keyhole portal, or an implant shaped for a part of the bone that existing implants do not fit. The surgeon can describe the problem and the mechanical requirement, but turning that into a device that is manufactured to tolerance, sterilisable and reliable in use is engineering work. That is why conversations between surgeons and orthopaedic device companies sit at the start of most technique development, well before anything is used in an operating theatre.
How a new shoulder procedure is developed
Development usually begins with a clinical problem that current operations handle poorly. The idea is then worked through anatomically and mechanically, often in a laboratory, to establish whether it is sound in principle and what forces the construct would have to withstand. Cadaveric trials follow, which is where the steps of the operation and the instruments are refined and where unworkable ideas are usually abandoned. Only after that is the technique used clinically, in small numbers at first, with results recorded. Publication and presentation at meetings then allow other surgeons to scrutinise the method and report their own experience. Individual results vary.
What this means for patients
New procedures are introduced gradually rather than announced. A technique that has been through laboratory testing, cadaveric work and a reported early series is still a technique with a short track record, and surgeons weigh that against the established alternative when advising a patient. Anyone considering shoulder surgery is entitled to ask how long a proposed operation has been in use, what the alternatives are and what is known about each. Individual results vary.