Having been in the orthopaedic profession for a long time, I have occasionally been confronted with an implant that I did not recognize and either did not have enough time or was unable to find out what it was. Who hasn’t seen or heard of a bent femoral rod from trauma? How about the intramedullary rod that had been in a femur for thirty years and had to be removed for a total knee replacement? There have been a few knee and hip prostheses that had been implanted at “Elsewhere General” and needed to be revised.
When I looked for a source that listed implants, I couldn’t find one. That’s when OrthopaedicList.com was conceived. It has proved to be immensely popular and useful for finding sources of implants, but we needed more. You still had to know what you were looking for. The next evolution brought “X-Ray Identification”.
As orthopaedic surgeons and operating room nurses know only too well, removing implants can be tricky and is not always as easy to do as the x-ray might “suggest”. Various rods have a variety of cap screws, removal threads, locking screws, etc. You must have compatible instruments. If you are revising a total joint replacement implant and don’t need to revise all components, it is essential to know the brand and model of the device. That way you can match compatible components and preserve that which seems better left in place than removed.
It’s always good to get the operative notes from the original surgery, but too often they don’t describe the implants. The best source I’ve seen are the implant package labels that the OR nurse affixes to the operating room record, but they are not always available either.
For these reasons, at the suggestion of an orthopaedic professor, we started collecting x-ray images of identified implants on OrthopaedicList.com a few years ago. Since this is something that will always be evolving and since we wish to provide free access to our colleagues throughout the world, we chose the Internet as our venue. Our library of implants has grown quite a bit, but to reach its true potential it needs to grow a lot more. To do so, we need your help. Why would you wish to go to the trouble?
1. More devices are being implanted in younger as well as older patients. Many will live into old age. When the time comes to do something, records may be unavailable, the surgeon may no longer be in practice, the surgeons and product representatives who could recognize these implants may be gone, and so on. By going to our library of X-Rays (“Implant Identification“), you have a fighting chance of figuring it out.
2. Please remember that what is familiar to you in your time and locale may very well be unfamiliar to someone else in another place or time. Thus, we are not just looking for what you consider uncommon, but we’re looking for what you implant in your everyday practice.
3. Some implant companies have their own library of images of their implants, but they are predominantly specific to their implants and not necessarily available to everyone.
4. Privacy rules are making it harder to obtain records, even with signed releases from our patients. I know about that from experience.
5. The world population is aging and people move around. There will be more and more people with implants. Add those and you’ll realize that a growing number will need second surgeries in places different from the original hospitals.
6. The educational benefit has been an unanticipated bonus. We have word that nurse and technical schools use our images to train their students. We hear that medical schools in some countries do the same. We even know of at least one large orthopaedic manufacturer who uses our service to train their new representatives. Furthermore, surgeons can send their patients to the site to see what various implants look like, including some cases that they have performed.
7. Those who give presentations need illustrations for their slides. You/they can copy the images from “Implant Identification” for those presentations.
8. You can post “unknowns” yourself in hope that our colleagues will help you identify your inherited, troublesome implants.
So, how does one submit an x-ray? Go to www.orthopaediclist.com and “roll over” “Implant Identification” on the blue navigation bar near the top of the page. Click on “Submit an X-Ray”. The rest should be easy. If you have problems, please let us know at email@example.com.
Oh, what about HIPPA and patient privacy? Before submitting images, please crop out any information that may identify the patient. That way we protect patient privacy. We have a legal opinion that Implant Identification does NOT violate HIPPA policy.
Thanks for your help. We’re all in this together to the benefit of our patients.
Dr. Hundley is a retired orthopaedic surgeon with forty years of experience. He is the president and a founder of OrthopaedicList.com.