Implant Waste

Every day hospitals discard thousands of dollars worth of orthopaedic implants rendered useless by operating room miscalculations.1 The SMARTdrill® reduces waste by providing depth and density measurement to allow optimal implant selection.

Specifically, use of the SMARTdrill® with vTorq™ technology helps surgeons, hospitals and health care institutions control both the financial and biological costs of orthopaedic surgery. The SMARTdrill’s ability to accurately measure depth and provide energy feedback will save hospitals and doctors millions of dollars previously spent on screws, implants and other related components wasted due to inaccurate measurements and/or errant placements.2,3 These savings also correlate to overall surgical efficiency, productivity and better patient outcomes. The costs related to biological wastage may be evident immediately if bone or tissue is damaged during surgery. Iatrogenic complications can also occur later if screws and implants fail to fixate due to diminished pullout strength. With the SMARTdrill’s vTorq™ technology and accurate, real time depth measurement, the surgeon knows the potential screw length at any time in the drilling process so that the first screw placement will be the right screw placement. Bone density determination and drilling energy will also help surgeons determine whether locking plate constructs are truly needed. Today, the decision to use these expensive implants is not supported by objective intra-operative data, but solely by the surgeon’s subjective concerns for fixation strength. SMARTdrill® technology empowers surgeons to eliminate guesswork when they select and place hardware.

Biologic Cost - Replacement Screw Loses POS

These graphs demonstrate the biological costs of having to remove and reinsert a screw into the same bone hole. Prior studies have shown that the pullout strength (“POS”) of the second screw can be reduced by up to 35%.4 It is thought that this is from stripping of the bone threads, mainly in the proximal cortex. The top graphs demonstrate the rpm and torque plots for inserting a 4.5 mm self tapping screw 18 mm (2 m’s proud and snug against a washer) into and through a 3.2 mm hole drilled through a 16 mm bi-cortical Sawbones (50/15 PCF) block. The total energy for the process was 6.4 Joules. This particular model was repeated in triplicate with reproducible curves and energies.

The torque peaks represent the leading edge of the screw inside of simulated cortical bone. The terminal peak is related to the screw setting against the washer. This also can be seen by the rpm dip in the “Spindle Speed Plot.” The lower set of graphs represents the rpm and torque plots for the second insertion of a screw, after the first screw has been carefully removed. The total energy for this model (again reproducible) is about 2.2 Joules. From the torque plot and the energy plot (not shown), it is evident that indeed the proximal cortex is contributing less to the work burden when the second screw is placed.

Red Box

Our data show that for ORIF surgeries, nearly 30-percent of screws placed during surgical procedures are determined to be the wrong size and therefore need to be removed and replaced. Of these removed screws, approximately 50-percent will be discarded as they cannot be reused in that operation. In this photo you see a typical “Red box” used for the disposal of wasted hardware during surgery.

All images Copyright Smart Medical Devices Inc. 2015