Creating new opportunities
Technology has evolved at an incredible pace during the last 30 years. As computer speeds have increased and hardware sizes have decreased, exciting new opportunities exist in medicine. Medical imaging has benefited greatly in this area. Orthopedic surgery is a specialty which is very dependent on imaging or body pictures to help make the diagnosis and guide treatment.
Radiographs, or x-rays, have been available for over 100 years. are the backbone of orthopedic radiology and are available in most offices. The bone structures create shadows on x-ray and allow us to determine whether fractures and arthritis are present. Quite often, treatment can be guided without resorting to more expensive and specialized techniques. Incredibly, arthritis is often better evaluated with a plain old fashioned x-ray than a more expensive MRI or other high tech imaging.
Ultrasound, or sono, uses sound waves to take pictures within the body. It is comparable to radar. It is the same technology used to monitor pregnant women and their babies. In orthopedic surgery, this is helpful for evaluating the rotator cuff for tears. Other tendon structures, such as the Achilles tendon at the ankle and patellar tendon at the knee, can be easily evaluated this way. It can also be used to find a foreign object within the soft tissues of the body. An advantage is its relative inexpense as well as availability in the office. I often refer to it as a poor man’s MRI.
CAT scans, or CT imaging, are another exciting technology. A scan can be obtained in 5 to 10 seconds now. Although radiation is still a concern, it involves much less exposure than even 10 years ago. Most commonly, CT scans are used to confirm whether or not a fracture has healed when this is not clear by the history, physical exam, and regular x-ray. It can also provide better detail in a complex fracture pattern. This includes the tibial plateau at the knee or carpal bones in the wrist. This helps decide whether or not surgery is necessary. Further, it is possible to generate 3D pictures, or even models, using the CT scan images by manipulating the data on the computer.
MRI imaging was in its infancy when I entered medical school in 1985. Now, it is hard to imagine practicing orthopedic surgery without it. It uses a giant powerful magnet to spin hydrogen atoms in the water within our bodies. Different tissue types respond differently. These changes are used to make a picture. It is extremely useful to evaluate soft tissue structures, including the meniscus or knee cartilage. The ligamentous and tendon structures at all joints are also easily evaluated with this technology. It can be useful if one suspects an abnormal growth or mass. It can even help rule out an occult or hidden fracture. Again, the technology continues to evolve rapidly with pictures becoming clearer. The accuracy with better scans is routinely 95% for typical orthopedic applications. In certain situations, that yield can be increased by injecting the joint with an MRI contrast called gadolinium.
Finally, the other common orthopedic diagnostic test to evaluate the joint structures involves surgery with an arthroscope. When first used, this required the surgeon to look through an eyepiece of a rigid scope and was only useful for diagnostic testing. Today, we use high tech scopes that measure less than ™ inch in size. It transmits images to a large high definition television screen.
This allows surgeons to make the most accurate diagnosis available in 2017. At the same time, it assists many surgeries that used to require a large open incision. This allows for less invasive surgery and quicker healing.
2017 is an exciting time to practice orthopedic surgery. I look forward to new technologies that are only in their infancy at this point.