We know that orthopedic patients and their families benefit greatly from
advances in orthopedic technology. In an effort to help our readers understand
more about how such advances are made, we requested an interview with
Dr. Steven L. Barnett. Dr. Barnett is a board certified orthopedic surgeon
with a practice specializing in joint replacement and adult reconstructive
surgery for arthritic conditions. Dr. Barnett is involved in community
and physician education and has presented at numerous conferences nationally
on arthritis and new advances in joint replacement technique. He has published
multiple articles in the orthopedic literature.
HOI: Thank you for your willingness to speak with us Dr. Barnett. Our readers
know there have been many exciting changes in orthopedic technology. In
your view, what are the most beneficial changes in the last ten years?
Dr. Barnett: We have seen significant changes with both implant technology and instrumentation
in the last ten years. With respect to hip replacement surgery, there
have been advances in biologic fixation as well as bearing surfaces. It
is now rare that an Orthopedic Surgeon needs to use cement fixation when
performing hip replacement surgery. With the development of porous titanium
surfaces and trabecular metal, we can now achieve rapid, robust biologic
fixation of hip implants to host bone which potentially will last throughout
the patient's life. There have also been advances in the durability
of the actual articulation (ball and socket) of the prosthetic hip joint.
Historically this has been the weak link in total hip replacement surgery
and patient's prosthetic hips would wear out after 10-15 years because
the socket liner would become too thin. Now with more durable bearing
surfaces, total hips may last 20-30 years which allows us as orthopedic
surgeons to offer this procedure to younger patients.
On the knee side we have seen the development of computer navigation as
well as customized patient-specific instruments. We know from outcomes
studies that one of the most important steps in knee replacement surgery
is achieving neutral alignment of the leg after the knee replacement is
completed and the patient's preoperative deformity corrected. Historically
surgeons have relied on various jigs and alignment rods to complete this
process. We now have the ability to create a computer model of the patient's
knee at surgery and use 3-dimensional navigation techniques to achieve
neutral alignment with more precision. More recently technology has been
developed to create custom cutting blocks for specific patients based
on preoperative MRI exams which take into account knee deformity and allow
the surgeon to make the appropriate cuts at surgery in a minimally invasive
HOI: Does orthopedic technology change quickly, or is there a lengthy process
of experimental trials, testing and approvals?
Dr. Barnett: The degree of changes we see in orthopedic technology can be variable,
but overall this is a gradual process which comes about through research
and development as well as trial and error. Any new technology brought
forth by manufacturing companies must go through extensive testing both
in the laboratory and then eventually in human subjects before it can
be released for widespread use in to the general public. This testing
ensures that the devices we implant are safe. Often times, companies can
piggy-back their advances on to previously investigated devices as long
as they are similar. For new technology it takes between 7-10 years for
the process to be completed and cleared by regulatory agencies in this
country. This is not an inexpensive process for companies to embark on
and is one reason for the high cost of these implants.
HOI: Are orthopedic patients ever concerned about their surgeon utilizing new
technology? And how does a surgeon learn to use and become proficient
with new technology?
Dr. Barnett: Because of the increased access to electronic media and the internet,
many patients are very well informed about advances in technology which
may impact their treatment. Additionally, many of the implant manufacturing
companies are now marketing directly to the consumer (i.e. patient) with
respect to hip and knee replacement devices. This was unheard of even
five years ago. Although this can be both good and bad, patients definitely
are more informed these days prior to discussing potential surgery with
their orthopedic surgeon.
Sophisticated new techniques with computer navigation, minimally invasive
techniques, and robotic surgery have placed the burden for continuing
education on the surgeon himself. These days it is probably not realistic
that a surgeon can read about a new technique in a journal one day and
be performing that procedure on an actual patient the next. Most companies
that are promoting new surgical techniques and technologies will provide
surgeons with the ability to visit a course where they can review the
literature supporting the procedure as well as practice on human cadavers.
Many hospitals will also require surgeons to be certified on new orthopedic
techniques through a licensed course before they can perform it at their facility.
Dr. Steven Barnett is a board certified orthopedic surgeon with a practice
specializing in joint replacement and adult reconstructive surgery for
arthritic conditions. He is a general partner of the Orthopaedic Specialty
Institute in Orange County, and a member of the American Academy of Orthopaedic
Surgeons, the California Orthopaedic Association, and the Western Orthopaedic