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Top mobile technology discoveries at the AAOS Annual Meeting
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As expected, there was a significant mobile technology presence at the American Academy of Orthopaedic Surgeons Annual Meeting. The following are presentations and posters at the meeting that we found most interesting in the mobile technology realm.
Apps to enhance your practice
This year, the Electronic Skills Pavilion was dominated by presentations specifically focused on mobile apps, accounting for seven of the 17 presentations. Attendees heard a variety of perspectives and advice regarding the best apps for 2014. For example, Insights Orthopedics has published a high-quality content aggregator for orthopedic surgeons and markets the app as your “personalized orthopedic magazine.” In addition to finding topic-specific abstracts, videos, podcasts and full-text articles, the app has a robust search feature, international journal club recommendations and an expansive calendar of orthopedic events worldwide.
We also saw increasing popularity of CARE for Patients, a patient education and content delivery company that focuses on personalized practice apps. For a nominal fee, the company will create a personalized app for your practice including patient education material, preoperative and postoperative physical therapy exercises with videos, and office/appointment information. The company then publishes the completed product to the app store for your patients to use.
Matthew DiPaola
Orrin I. Franko
Journal of American Academy of Orthopaedic Surgeons launched a new app that offers full-text access to anyone with a subscription to the publication. Although the app has limited functionality, it is a step in the right direction for mobile journal access.
OrcaMD has expanded the functionality of their “Decide” apps (Hand Decide, Shoulder Decide, Knee Decide, Foot Decide and Spine Decide) with an improved user interface, high-quality multimedia, and a new feature that allows for subscribers to annotate and share images and treatment information with patients.
Poster presentations
Through their poster, “Validation of an image-based iPad application to standardize the pivot shift test,” we learned about the work of Ohashi and colleagues and their development of an iPad application to quantitatively evaluate the pivot shift examination. The authors emphasized that the pivot shift test is a useful diagnostic tool, but suffers from subjectivity and variation between examiners.
The authors of the study attached visual markers to selected bony landmarks about the knee of normal and ACL-deficient subjects, while recording video during a pivot shift examination. The video was processed with image analysis software and successfully plotted normal and abnormal knee kinematics in various conditions. Because the computer analysis was labor-intensive and difficult to use in practice, the group developed a tablet application for the iPad based on their work. The app both captures video data and performs the image processing. They found the app to have 4.1% to 7.7% error from 1 meter to 2 meters distance from the subject and a max of 5.1% error at a 45° angle. Lastly, they performed a multicenter study to validate clinical efficacy and demonstrated statistically significant differences between ACL-deficient vs. ACL-intact knees and between ACL-deficient knees before vs. after reconstruction surgery. The iPad app was shown to be simple, quick, non-invasive, affordable and reliable.
We also were excited to find a poster titled, “Utilizing image recognition technology to identify the manufacturer and model of an orthopedic implant.” The authors recognized the challenge of identifying the manufacturer of an orthopedic implant based on radiographs in preparation for revision surgery. Thus, they sought to develop an “automated implant recognition application based on computer vision and image pattern recognition technology.” After reviewing various image recognition application programming interfaces (APIs), the authors concluded that no current API is available to identify orthopedic implants; but that Facebook’s image tagging algorithms are a good first step to developing a large implant image database, and that a custom API will likely be required in the future. Although the authors were not successful in creating the tool they desired, this has interesting potential.
A poster by Werner and colleagues validated the use of a smartphone as a tool for measuring shoulder range of motion. The authors stated that in the clinical setting, visual estimation is often used to assess shoulder motion, but that it can have a low interobserver reliability, especially in patients with shoulder pathology. As a result, they sought to validate the use of a digital clinometer smartphone application in hopes of identifying a potentially simpler method of collecting reproducible shoulder range of motion data. Orthopedic sports medicine providers of various levels of training evaluated the bilateral upper extremities of 23 healthy adults in abduction, forward elevation, supine external rotation at 0° and 90°, and supine internal rotation at 90°. They found a correlation of 0.65 for each examiner and 0.721 when compared between examiners. The authors concluded that smartphones have good correlation with the “gold standard” for shoulder range of motion and can serve as a good resource for motion measurements.
Overall, surgeons are implementing mobile technology to improve patient education and patient care in diverse and creative ways. While many of these technologies are in their infancy, we anticipate continued growth and development of these, and many other, mobile solutions for orthopedic surgeons.
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Matthew DiPaola, MD, is an assistant professor and shoulder and elbow specialist in the Department of Orthopedics at Wright State University in Dayton, Ohio. He is a writer for iMedical Apps and co-founder of Touch Consult, a developer of team-based medical software to improve signout. He can be reached at matthew.dipaola@wrightstatephysicians.org.Orrin I. Franko, MD, is a PGY5 orthopedic resident at UC San Diego. He has an interest in promoting mobile technology within orthopedic surgery and founded the website www.TopOrthoApps.com to help surgeons and trainees find the most relevant orthopedic apps for their mobile devices. He can be reached at orrin@toporthoapps.com.
Disclosures: DiPaola and Franko have no relevant financial disclosures.