ADAPTABLE® in joint surgery: easy to use, easy to integrate

Since March 2023, the first fully sterile, surgeon-controllable limb and retractor holder for safe hip replacement, highly efficient knee and shoulder surgery as well as comfortable patient positioning during joint surgery has been available in Europe. Prof. Dr. Michael Nogler and Prof. Dr. Martin Thaler report on development and initial experiences.

Prof. Dr. Michael Nogler

Prof. Dr. Michael Nogler is a specialist in orthopaedics and traumatology and tenured professor for experimental orthopaedics at the Medical University of Innsbruck. In the course of his training, he completed numerous research stays and further training at international universities. His research interests include minimally invasive arthroplasty, revision arthroplasty, as well as orthopaedic infectiology, computer-assisted orthopaedic surgery, and robotics. Prof. Nogler is the recipient of numerous research awards and has an international track record.

Prof. Dr. Martin Thaler

Prof. Dr. Martin Thaler is a specialist in orthopaedics and traumatology, head physician of endoprosthetics and centre director of orthopaedics and trauma surgery in Upper Bavaria, Helios Klinikum München West. Concomitantly, he teaches at the Medical University in Innsbruck, where he graduated and spent many years working. Prof. Thaler is a member of various national and international professional societies. He is currently a member of the board of the European Hip Society.


Prof. Thaler, you were involved in the development of ADAPTABLE, as was Prof. Nogler. What were your reasons for this participation?

Prof. Thaler: Today, the shortage of qualified operating theatre staff is a key issue for which we need innovative solutions. This is where a tool like the ADAPTABLE positioning arm can make a decisive contribution. For it can keep the patient’s limb stably in one position during surgery, support me as the operating surgeon, and replace the assistant in this role. This is very helpful and enables the scarce staff to take on other important tasks.

Prof. Nogler: Here I would like to add that in past years we would always work on the standard surgical tables without limb positioners. That was feasible, but we saw benefits in an instrument that could, for example, keep the leg stable, in a position specified by me as the operating surgeon. The technical solution offers full control over the position and forces acting on bones, muscles and tendons.

In addition, we wanted to develop a device allowing us to release and reposition the limb at any moment during the surgery without much ado. This offers the possibility to perform mobility tests and leg length measurements during the surgical procedure. A further benefit: ADAPTABLE can be used for various applications. We can use the positioning arm for hip and knee surgery as well as for arthroscopy and arthroplasty of the shoulder. I was happy to participate in order to include all these requirements into the development.


“The ADAPTABLE limb holder developed by Mathys is easy to use, and the handling quick to learn.”


ADAPTABLE is unique – to what extent can you confirm this claim?

Prof. Thaler: The simplicity of ADAPTABLE is indeed something special: The instrument can be easily attached to any operating table. It is compatible with any surgical system. It does not require any special devices to use ADAPTABLE. In addition, it is widely applicable, without much engineering, purely mechanical, sterile, easy and space-saving to store. So there are many arguments for the positioning arm.


Would you concur with that, Prof. Nogler?

Prof. Nogler: Yes, absolutely. I would like to add that the positioning arm holds not only limbs, but also instruments. Moreover, as the operating surgeon, I can control the system all by myself. No assistance is needed for this. I only have to squeeze the handle, which makes the arm supple and flexible in all directions. When I release the handle, the arm is immediately arrested and remains precisely and stably in this position. So much flexibility in use and simplicity in operation is exceptional.


Do you have any tips for those who want to start with ADAPTABLE?

Prof. Nogler: The good thing is: ADAPTABLE is not rocket science, but simple and intuitive to use. In this respect, no special training is required, and there are no workarounds or tricks to be heeded. But what I do recommend: Before the first use, practise the handling outside the operating theatre and discuss the application in the team so that everyone is familiar with the technique.

Prof. Thaler: Yes, that is what I would recommend, too. It makes sense not to test ADAPTABLE immediately in the sterile operating area, but to familiarise yourself with the positioning arm and accessories in advance with a few dry runs first. It is ideal if you have the opportunity to experience ADAPTABLE in action together with a colleague. Consult and visit colleagues who already work with it and are familiar with the instrument. You may also be able to ask experienced surgeons to accompany you during the first procedures. I think this is the most promising way to successfully introduce ADAPTABLE into the daily routine.


ADAPTABLE is suitable for all surgical techniques”


Do surgical techniques need to be adapted to enable use of ADAPTABLE?

Prof. Thaler: No, not at all. ADAPTABLE is compatible with any surgical technique and easy to use. Like I said, no special training is required, just a little bit of practice. Of course, as always, there are small practical tips that can be shown in practice or even more easily imparted by experienced colleagues.


Specifically what distinguishes ADAPTABLE from other positioning aids?

Prof. Nogler: ADAPTABLE is easy to use, and it fits every operating table and into every surgical system. At the same time, it allows me as surgeon to have full control alone. After all, I am responsible for the patient and have to decide how much force to apply to the bone. There is always a risk of fractures, and injury to the muscles or nerves may occur. It is good to have everything in your own hands. And that is what ADAPTABLE makes possible.


Are there any limitations with ADAPTABLE?

Prof. Thaler: I do not see any limitations for clinical routine and standard surgeries such as a total hip replacement.


Prof. Nogler, Prof. Thaler, thank you for this interview!


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