When To Change Your Surgical Hardware

We all have our favorite equipment for use during surgery and most of us probably use what we learned with during training with some variation. Do you ever question what is out there? Have you ever noticed your hardware is failing? Have you had screws or plates break, or do you routinely deal with non-unions? Do you ever struggle with plate sizing options or plate or screw profile? When do you decide to make a change? How do you make a change? How do you become comfortable with the new system?

What is out there? There are an incredible number of options. The foot and ankle is now getting the industry attention it has been lacking over the years. Small and mini-fragment systems have been increasingly replaced by dedicated foot sets and more commonly procedure specific sets. Contained within the set are all the essential instruments, plates and screws for the specific procedure. Does that make us spoiled? Yes and it is nice. However, this also benefits the patient, making the procedure faster, stronger, reproducible and, well, better.

Recognize the problem if there is one. As you add hardware to your cases, is the hardware performing to your standards on the table and postoperatively? Here are some of my thoughts on the available equipment.

Screws. I want my screws to bite. I want sizing options both in width and length. I want a low profile head but one that is sufficiently large not to pull through the proximal cortex. I want titanium versus stainless options, weighing the pros and cons of each metal for the procedure demands. I prefer the versatility of polyaxial capability, even for locking screws, when I use them with plating systems. I don’t want the screw to strip on insertion or removal. I want the perfect screw and not all screws are created perfectly.

Plates. I want options in the set. The size and cortical contour varies from foot to foot. Typically, I will try a few size options for the given procedure until I am confident I have chosen the best plate from the set. I want locking and non-locking options but as a general rule, I have moved to locking plates for most procedures. Most sets now have the option to non-lock one or all of the holes. I want both titanium and stainless steel options, although for me, titanium serves most roles. I want size and screw hole pattern variability. The perfect plate is sufficiently strong for the task at hand yet offers malleability to better contour to cortical bone in certain situations. I strive to find the perfect plate for the given procedure.

If you are completely satisfied with the performance of your hardware, do not switch. If there is a performance failure, then it may be a good time to make the switch.

There are many methods for seeking out new products. The numerous company representatives are more than happy to come to your office and discuss their options. Some reps will even bring a mobile lab right to your front door, and often all you have to do is ask. This allows the rep and surgeon to become familiar with each other and the equipment, and to practice applying the product to a cadaver or sawbone model. Another great option is to sign up for a mobile lab at one of the many regional and national meetings. The vendors in the exhibit hall may also provide enough insight and demonstration for you to feel comfortable making the switch at your next case.

Most companies also have thorough Web sites demonstrating sizing options and product videos. These sites can be great resources to determine the general offerings and what specifics you may ask a rep to show you in a face-to-face meeting. You can find the contact information for the rep in your area on the respective company Web sites as well. There is a good chance someone in your local surgery center or hospital already has a relationship with a rep and can help you establish a relationship as well.

Your colleagues are some of the best resources out there. Ask around, send e-mails, make phone calls and get a feel for what products may be working for your friends in the profession.

My typical routine when trying a new product starts with understanding the new product. Once I have conceptually wrapped my head around the product and my goals for its indication, I try it. I like to use it once or twice, and then avoid using it for a couple of months. I wait to make sure I obtain the optimal postoperative effect. If the product was surgeon-friendly in its application and performed well on X-rays and clinically, then I will be ready to make the switch … until the next product comes to market and offers easier use, better performance and improved patient outcomes.