Joseph Burkhardt D.O. of Southern Michigan Orthopaedics and Becky Klein, Director of Clinical Operations for Brookside Surgery, discussed challenges related to knee replacement surgery, orthopaedic instrumentation, technological advancements, and more in a recent interview with Surgical Products.

SP: Traditionally what have been some of the challenges you experienced in the OR with knee replacement? 
Dr. Burkhardt: Traditionally, the instrumentation that was present for non-customized implantation was manufactured in volume and had to be placed with geometric cuts. The implants had to be designed for a range of patient sizes and alignment, so essentially patients were only able to receive the best average. Each patient received an implant that was a little big or small instead of an exact fit. Furthermore, traditionally, we had to verify the patient’s size during the operation. We would have to go pull the stock, pull it in the room and re-verify everything.

Becky Klein: From a facility standpoint, we were limited by what manufacturing could produce in a cost-effective manner; the OR staff was traditionally at the mercy of procedure representatives. We had long periods during which the staff had nothing to do but wait for trays to arrive so we could wash and process them. We also spent a lot of money on rental fees, which could be $150 for each tray. Not only was it cumbersome to finance all the trays, but it was also challenging to house them. We have limited space and it was difficult to make the room. Additional challenges arose when the representatives made a mistake and we received the wrong implant. 

SP: What new technology has been developed to alleviate some of these concerns?
Dr. Burkhardt: In the last decade, customized, one-time use implants have been developed. These implants also come with customized cutting jigs and instruments, which are disposable. It’s important to note there have been two major developments: customized cutting guides with off-the-shelf implants, and also customized implants with customized cutting guides. At my hospital we mostly use the latter because we found it’s better for the patient and for us. It’s just one small box that comes with an implant specifically designed to fit only that patient and cutting guides to match; it all comes pre-sterilized as  well. We used to have 20 boxes, but now we have one box that goes right in the patient’s basket and we are pre-sized and engineered before we even do the case; we are ready to go.

Klein: For the rest of the staff it’s especially beneficial because this surgical product saves us a lot of time and money; we don’t have to spend a lot of time sterilizing and we don’t have to pay a rental fee. In addition, traditionally, if something happened with the patient and they had to reschedule surgery, we had to redo the sterilization process all over again. However, a single-use, pre-sterilized product made to fit each patient exactly, eliminates these concerns; we can simply put the implant back on the shelf and use it when the patient is ready.

SP: What role do you think personalized medicine will play in the OR?
Dr. Burkhardt: In my opinion, it will become the standard of care. You’re always limited by what your manufacturing can do but now we can produce things that are economically viable. Fifteen years ago, this type of surgery just wouldn’t be viable; it was too expensive and the time frame was too long. Now, thanks to technological advancements, we can get images from a CT scan, transmit the data in seconds and produce an implant.

SP: In your opinion as an orthopedic surgeon, what has been the biggest advancement technologically in the past decade?
Dr. Burkhardt: The biggest advancement is the use of personalized implants and instruments in joint replacement.

SP: What are some of the challenges with all the instrumentation used in knee replacement? How is disposable instrumentation helping increase efficiency while minimizing infection?
Klein: It is difficult to manage all of the equipment. In one day we could have 160 different trays that we have to sterilize as well as store. In addition, we need to have a whole new set of trays for every case and each set costs $80,000. Personalized, disposable instrumentation has changed that. Now we are literally saving thousands per case and reducing this cumbersome cost. In addition, we are saving space and time because we don’t have to sterilize and we are not paying rental fees.

SP: What are the benefits of having more single-use personalized products?
Dr. Burkhardt: The exactness of alignment is the greatest benefit to having single-use personalized products. They are designed specifically for each patient so I don’t need to cut as much bone during surgery. I do not have to make a geometric pattern to contour the cut, so I can make much more conservative cuts and resect less. So overall, trauma is greatly diminished. In the short term this leads to a faster recovery. In addition, since the alignment is designed to match precisely to each patient’s knee, the implant has more longevity in the long term.

Klein: Now that we have one disposable tray per patient we can accommodate more surgeries. In addition, the risk of infection is greatly minimized.

SP: How did you make the decision to adopt this new technology?
Dr. Burkhardt: I studied it to see if it was better than current practices. I only adopt technology that improves the practice, never technology that is only as good as what already exists. When it comes to these kinds of decisions I do what’s called the “whiff test.” I give it a “whiff”—I poke around, I practice it outside of the OR to see how it works and then institute it. If it proves itself then I adopt it completely.
Before adopting the new completely personalized technology (personalized jigs and implants), I was using personalized jigs with off-the-shelf implants. This worked well but once I adopted a completely personalized approach, there was tremendous improvement in post-op and I was seeing things I had not seen happen in the last 12 years of my practice. It proved itself to me in patient recovery, not just the OR, and the overall satisfaction rate went up for patients. I’ve had referrals from five different states in the area that I work in. This is from patients who are excited about their outcome and have told their friends and family. It’s been impressive to have people who are willing to fly or drive to get in touch with the technology.
Joseph Burkhardt D.O., has been on staff at Southern Michigan Orthopeadics, formerly- Great Lakes Bone and Joint Center since 2001. He became a doctor of osteopathic medicine after graduating from Kansas City University of Medicine and Biosciences College of Osteopathic Medicine. 

As a board certified orthopedic Surgeon, Dr. Burkhardt has operating privileges at several hospitals including Bronson Battle Creek, Oaklawn Hospital, Brookside Surgery Center, Southwest Rehabilitation Hospital and Kalamazoo Surgery Center. Dr Burkhardt is a clinical professor at Michigan State University.

He has traveled throughout the country lecturing on total and partial knee replacement, as well as hip resurfacing. He is a member of the American Osteopathic Association, the American Osteopathic Academy of Orthopedics, the Michigan Osteopathic Academy of Orthopaedic Surgeons, the Wayne County Osteopathic Association and the Detroit Academy of Orthopedics.

Becky Klein is the Director of Clinical Operations at Brookside Surgery Center.