The_Invention_of_Surgery

of metal, plastic, synovial fluid (resembling apple juice), and fibrous
tissue. All the foreign implants had to be removed, and cultures of the
tissue and fluid were obtained to ensure that no occult infection was
present. I then placed a cement spacer, comprised of acrylic cement,
representing a marriage of liquid monomers and a powdered polymer mix,
similar to an epoxy project of my childhood, with the appearance of blue
Play-Doh. This spacer, which replicates the shape and function of a
regular shoulder bone, also contains powdered antibiotics, fighting deep
infection while we awaited the culture results from surgery. With the
cement spacer in place, we then do something miraculous: obtain a CT
(computed tomography), a sophisticated 3-D series of X-rays that
facilitates preoperative planning for the revision total shoulder
replacement.
One week after surgery, we obtained a high-resolution CT of his
shoulder. The computer is able to assimilate all the X-ray information with
visual-imaging software and construct virtual 3-D images. In the last
decade, the imaging software has become so good that surgeons and
radiologists are able to “subtract” all the surrounding tissues away
(muscles, ligaments, and tendons), and “build” the bony structures on the
computer screen. Using computer key strokes, the physician can spin or
rotate the images to get a sense of what the skeletal bones look like.
Imagine your car mechanic not lifting the hood of your vehicle; instead
conjuring what bedevils your engine with a magical tool that could see
through metal. In the last few years, technology has allowed us not only to
see the bones in three dimensions, but now to plan the surgery, virtually
implant the parts, and assess the placement. Even more mind-boggling, I
can now work with engineers to create custom shoulder replacement
implants that fit the specific defects of a particular shoulder.
My conference call with the implant designer from Quebec is about to
start. Using a link from an email message from the implant company
Zimmer Biomet, I connect to a Webex teleconference with an engineer in
Montreal. With a few keystrokes, I am able to navigate the layers of
protection to keep Stanley’s information completely private. The engineer,
Simone, speaks to me through my computer link, and she controls the
images on the screen. On a light gray background, a 3-D image of
Stanley’s scapula is presented. Simone controls the imaging software with
her mouse, although I can ask for different perspectives and orientations