FROM THE SECRETARY GENERAL OF THE INTERNATIONAL SOCIETY FOR TECHNOLOGY IN ARTHROPLASTY (ISTA)
APPROPRIATE TECHNOLOGY
Anybody who attended the American Academy of Orthopaedic Surgeons meeting in San Diego in September 2021 must have been amazed at the extent of the new technology on display in the commercial Exhibit Hall, as well as in many of the lectures, posters and instructional videos. While many of these technologies had been in evidence for a number of years, the blazing eye-catching visuals on many of the Exhibits gave the distinct impression that here was the future of arthroplasty. Moreover, the future was not only the technology itself, but the collection and utilization of the data of the complete patient experience, from diagnosis to surgery and to rehabilitation. Even the materials and manufacturing processes were in a state of transition. Three-D printing of anatomic shapes with structured bone-ingrowth surfaces, some using advanced polymers, made the extensive use of uncemented components more of a reality, while mass customization was feasible. This situation raises important questions: in the next few years, will there be a rapid increase in the adoption of such technologies, and what will be the benefits? The answer to the first question may depend upon the answer to the second question!
Having been immersed in technology since 1988, ISTA should be able to provide some clues. But so far, the widespread adoption of particular new technologies has not been easily predictable. In some cases, factors have emerged after a few years of use which did not provide strong enough support. At the same time we can safely say that SOME of the technologies will be widely adopted. However there is one factor that needs to be considered; what is the ‘Appropriate Technology’ for a particular medical care environment? Even in countries which can afford high technology, it may still not be feasible to adopt high technology for the entire patient population. For many countries, a low cost solution is the only feasible option. For these scenarios, what is needed is technology which will still produce a high quality result but at a low cost. This is just as much a challenge as a technology solution which is more advanced but expensive.
However, we need evidence that any simpler, less expensive technology can actually produce the quality results that are required, or that high technology does indeed provide capabilities which are not possible with simpler technologies. These are just two of the reasons that technology will keep advancing, not only for the implant designs and surgical techniques, but for planning, outcome analysis and surgical training. The upcoming ISTA meetings will serve as a forum for these important discussions.
On behalf of ISTA, I wish everyone a happy and successful year, even in these difficult times.
Peter S Walker PhD, December 2021