Evo Terra (Host): This podcast is for informational purposes only and is not intended to be used as personalized medical advice.

Welcome to Be Well with Skagit Regional Health. I'm Evo Terra. And with me is Dr. Camille Connelly, an orthopedic surgeon at Skagit Regional Health. Today, we'll be discussing how technology is changing orthopedics. Thanks for being here, Dr. Connelly.

Dr. Camille Connelly: Hi. Thank you for having me on.

Host: So, let's get into this by talking about maybe some of these new technology trends in orthopedics that are really changing how you treat patients. What are some of those trends?

Dr. Camille Connelly: Well, the orthopedic field continues to make advancements in technology for the goal of achieving return to function faster and safer for patients. Advanced imaging, like CT scans and MRI, help surgeons formulate surgical plans before stepping into the operating room. While intraoperative tools and imaging like robotic assistance and minimally invasive tools and techniques help us to provide more predictable outcomes with less risk of wound complications and less postoperative inflammation and swelling. Additionally, 3D printing makes options for customized implants for complex reconstructions and revisions for otherwise abnormal anatomy for which there is not a good off-the-shelf solution.

Host: Well, I'm quite interested in that last bit, because speaking of abnormal anatomy, boy, is that me. But we'll get there in a minute. I want to go through these in a logical order. So, great, lots of new technology coming out to help us patients recover better from this, obviously. Can you talk about maybe some of these new technologies and how they help identifying potential risks, maybe complications in orthopedics early on?

Dr. Camille Connelly: Sure. Especially in complex cases, advanced imaging, meaning the CT scans or MRI scans, can help quantify the quality of the bone or the tissue that a patient has. Defects or tissue loss can impact the surgical technique and the implants needed to accomplish the surgery. By predetermining this need with the advanced imaging, surgeons can plan for devices or grafts needed as well as more appropriately plan for the surgical time needed for the reconstruction and, in turn, counsel the patients more accurately on the treatment options and the outcome and the recovery expectations.

Host: That makes a lot of sense to me. I mean, if you know all these things going in, it's going to be better for everybody on the outside. Perfect. Okay. I hear the word minimally invasive surgical options quite a bit. And my mother, 77 years old, clearly has a different version of what that than anybody else that I know of. But nonetheless, minimally invasive surgical options. These are, I know, contributing to better recovery outcomes. But I'm assuming they also help with prevent future issues because they're better. Can you talk about that for just a little bit?

Dr. Camille Connelly: Of course. Minimally invasive surgical techniques allow for both small and large procedures through relatively small incisions. The main advantage of the small incisions is a reduced risk of wound complications, including wound healing time, along with less swelling and inflammation. Not no swelling or inflammation or recovery time, but less. By combining the small incisions with robust fixation when appropriate, surgeons can also advance the recovery timeline of patients back to weightbearing activities. For instance, with minimally invasive Achilles reconstruction and minimally invasive bunion correction, using small incisions and robust fixation, we can often return patients to progressive weightbearing within a few weeks. The soft tissue and the bone healing will continue on much longer, but the patients do not have to be off of their feet all of that time.

Host: All right. Now, I want to get into this 3D printing stuff because that sounds pretty fascinating, especially for me. You said earlier for abnormal-- I'm not exactly sure what you said, but I'll use the words that my doctor said-- "You were born with a defect in your shoulder. My shoulders are tilted forward." And so, they're talking about doing things to kind of help some of this impingement here, but I hadn't even considered 3D printing might be an option rather than, I guess, an off-the-shelf new shoulder socket.

Dr. Camille Connelly: So yes, so depending on the deformity, there may not be good off-the-shelf options for someone's orthopedic problem. 3D printing allows us to rebuild joints that once had no reconstructive options, including custom total ankle implants, including total talus implants where the whole bone has been destroyed and you're actually making a 3D metal bone implant. This happens after bad traumas or sometimes after cancer resections in what used to be non-reconstructible joints.

 In my practice, what I use 3D printing the most for is creating cutting guides to streamline surgical reconstructions. I use it in my total ankle arthroplasties. But I actually use 3D customized implants in some complex or revision ankle and foot reconstructions, or the case of a catastrophic talar osteonecrosis. That's a bone death of the talus bone, which is the ankle joint bone. And you can actually print a 3D model of the bone that was supposed to be there before it was damaged and replace that. And what that can do for a patient is can give them an option for maintaining function and range of motion, where previously the only solutions in a bad talus osteonecrosis was a complex fusion that takes away motion or an amputation. And these implants can be combined with ankle replacements and allow patients to have a chance at a much more normal function.

Host: Earlier you said that these aren't the plastic 3D printers that we have on our desks, right? That's not what we're doing here. When we're putting it inside the body, you said that we're actually utilizing metal to do that. Do you think-- and I know this is a crazy question-- I'm not asking you to predict the future here, but do you think we'll get to the point where we can 3D print new bone material?

Dr. Camille Connelly: So, that is actually being done in a way. There are 3D printing setups to make customized, we call them cages in orthopedic surgery, where they are a structure that we typically fill with bone graft and combine them with internal fixation. So if a person is missing a section of their tibia, that's a section of the long bone, their long shin bone, you can actually make a cage out of a metal in the shape or size of their bone defect that you would implant during a surgery and fill with bone graft to give a structure and containment to that bone graft to heal along that defect. You can, again, like the total talus implant, that is basically making a metal bone, which is metal, but it's in the shape of a bone and you can do that customized for mostly any bone in the body with the technology we currently have. There are some places that it is being used more commonly than others just based on need. The needs for kind of these procedures, it really depends on what the defect is and what other options are kind of on the shelf or appropriate.

Host: Right. Well, clearly, obviously, this technology is advancing at a rapid pace. I mean, who knew? Well, I didn't know 3D printing was actually a thing that we're doing now, but That is lovely. Anything else you would like to add to this conversation, Dr. Connelly?

Dr. Camille Connelly: Yeah. So, a lot of this advancement has been made over the last 10 years. Some of these technologies started much longer ago than that. But over the last 10 years, and especially the last five years, the access to the technology, the access to be able to get 3D reconstructions, 3D cutting guides and custom printed implants has become much more widespread.

And so, things that I had to really fight or work very hard to make accessible five years ago, I have a easier time accessing for my patients now, or that once you could only get at a few centers, you can get much easier in the community at large. And one thing for our patients to know is that we have a lot of these technologies available here at Skagit Regional Clinic. And being able to get these types of surgeries closer to home certainly has advantages for our patients and we're very happy to offer them here. So, we use robotic-assisted guidance in knee replacements. You use minimally invasive techniques when they're appropriate. And we use the advanced imaging to help us plan our procedures all to help optimize outcomes for our patients.

Host: Well, it sounds like you're saying I need to go to Skagit Regional Health and see someone about this shoulder that I've been ignoring for the last five years.

Dr. Camille Connelly: We'd be happy to see you.

Host: Oh, thank you very much for all the information today, Dr. Connelly.

Dr. Camille Connelly: You are very welcome. Thank you for having me.

Host: That was Dr. Camille Connelly. For more information, please visit skagitregionalhealth.org. If you enjoyed this episode, please share it on your social channels and check out the entire podcast library for topics of interest to you. I'm Evo Terra, and this is Be Well with Skagit Regional Health. Thanks for listening.