The Imperfect Journey of Medical Advancements: Lapiplasty®
In an ideal world, we like to envision medicine and surgery in terms of perfection, constantly advancing with groundbreaking discoveries each year. However, the reality often paints a different picture.
Many medical procedures, despite being practiced for years, are still in their infancy regarding effectiveness and efficiency. This was notably the case with bunion surgery. For years, this common yet troublesome condition remained a challenge, with conventional surgical methods offering limited success. The development of Lapiplasty® by Dr. Santrock and his colleagues at Treace Medical eventually marked a significant milestone, but the start of the journey was an unlikely one marked by reluctant surgeons.
The Parable of the Blind Men and the Elephant: A Metaphor for Pre-Lapiplasty Bunion Surgery
To understand the state of bunion surgery before the advent of Lapiplasty®, consider the ancient parable of the blind men and an elephant.
The Parable of the Blind Men and the Elephant
In a small village, there lived six blind men who had never encountered an elephant. One day, an elephant was brought to the village, and the men, curious about what an elephant was like, decided to find out for themselves.
Each man approached the elephant and touched a different part of its body.
The first man, whose hand landed on the elephant’s trunk, said, “Ah, an elephant is like a thick snake.”
The second man, feeling the elephant’s ear, disagreed, saying, “No, it is like a large fan.”
The third man, grasping the elephant’s leg, retorted, “You are both wrong. An elephant is like a tree trunk.”
The fourth man, who had laid his hands on the elephant’s side, declared, “An elephant is like a wall.”
The fifth man, who touched the elephant’s tail, argued, “It is like a rope.”
Lastly, the sixth man, feeling the elephant’s tusk, exclaimed, “You are all mistaken. An elephant is hard and smooth like a spear.”
Each man insisted he was right, based on his own experience. Their argument grew heated, and they could not agree.
A wise man passing by heard the commotion and asked what was the matter. After listening to the blind men’s experiences and arguments, he smiled and said, “Each of you is right, and each of you is wrong. The elephant is indeed like a snake, a fan, a tree trunk, a wall, a rope, and a spear, but in different parts. You are each describing only a part of the elephant. The elephant is a combination of all these parts.”
The blind men were astonished. The wise man continued, “Your experience is true, but it is only a part of the truth. Just like the elephant, truth can be a complex thing, with many aspects and perspectives. To truly understand, one must consider all perspectives, not just one’s own.”
Moral of the Story
Similarly, before Lapiplasty®, bunion surgery was fragmented, with different surgeons using varying techniques and theories, none of which fully addressed the complexity of the condition. This disjointed approach often led to inconsistent outcomes, leaving both patients and surgeons in search of a more comprehensive solution.
Dr. Santrock & Treace Medical’s Elephant, Bunion Surgery
To appreciate the magnitude of Treace Medical, Dr. Santrock, and his colleagues’ vision to try and revolutionize bunion surgery, it’s essential to look back at the transformation of joint replacement surgeries in the early 2000s and how surgeons were beginning to recognize their elephants.
Dr. Santrock was fortunate to be in residency and fellowship during this revolution and worked alongside pioneers in medical engineering like David Blaha, Tom Lee, Greg Berlet, and Jim Nunley. He was part of a time when there were major advancements in Orthopedic surgery.
Material Innovation: The early 2000s saw the introduction of new materials like highly cross-linked polyethylene, which significantly improved the wear characteristics and longevity of joint implants. This development addressed one of the most pressing issues in joint replacement: the wear and degradation of implant materials over time.
Surgical Techniques: Minimally invasive surgical techniques were developed, reducing the trauma of surgery, which led to quicker recovery times and less postoperative pain. This approach marked a departure from the traditional, more invasive methods.
Computer-Assisted Surgery: The integration of computer and robotic technology in joint replacement surgeries improved the precision and accuracy of implant placement. This technology enabled surgeons to achieve better alignment and fit, which are crucial for the longevity and performance of the implants.
Patient-Specific Implants: Advances in imaging and manufacturing technologies allowed for the creation of custom implants tailored to the individual anatomy of patients. This personalized approach enhanced the comfort and functionality of the implants.
John Treace knew the technology was ready. Dr. Santrock and his colleagues knew the advancements were possible. The process of discovery just needed to be applied to bunion surgery by the best orthopedic surgeons and podiatrists in the country.
Treace Medical’s Collaboration: Uniting Expertise for a Breakthrough in Lapiplasty® Bunion Surgery
John Treace pulled together, a collective of top orthopedic surgeons and podiatrists to tackle the challenge of bunion surgery. Phone call after phone call John was met with the same sentiment: traditional bunion surgery was inadequate. Each expert, like the blind men in the elephant parable, had recognized a piece of the puzzle, but it wasn’t until they shared their findings that a complete picture began to form.
1. The Traditional Approach Was Flawed
All of the surgeons agreed, the traditional algorithm for bunion surgery primarily focused on cosmetic correction, addressing the protruding bump on the side of the foot. This approach often involved procedures like bunionectomy, which simply removed the bump, or osteotomy, where the bone was cut and realigned.
However, this method failed to address the underlying structural issues causing the bunion. The root cause of bunions often lies in the unstable tarsometatarsal joint and misaligned bones in the foot, which were largely ignored in conventional treatments. By not treating these foundational problems, the traditional approach only offered a temporary fix, leading to high recurrence rates.
2. Skill-Based Limitations
Dr. Santrock pointed out that while some traditional techniques showed promise, they were heavily dependent on the surgeon’s skill and experience. This reliance meant that the results could vary significantly from one surgeon to another, lacking consistency and predictability. The outcomes of these procedures were often as much an art as a science, reminiscent of a time before the widespread use of X-rays, when surgeons had to rely solely on their anatomical knowledge and manual skills. This variability in outcomes made it difficult to standardize the surgery and ensure reliable results across different patients and surgeons.
He noted how in the 1930s Paul W. Lapidus did successfully perform bunion surgery at the tarsometatarsal joint without a keen understanding of the 3-dimensional positioning. Unfortunately, other surgeons were not able to perform the surgery with repeatable results. Lapidus’s surgery while successful was more of an art form than a systematic scientific process.
3. Multiple Location Issues
Bunions are not just localized issues at the site of the visible bump; they involve complex deformities affecting various locations in the foot. These include the alignment of the metatarsal bone, the condition of the tendons and ligaments around the joint, and the overall mechanics of the foot. Traditional surgery often failed to address these multi-faceted aspects, focusing too narrowly on the bump itself. This oversight meant that even after the cosmetic appearance of the bunion was improved, the underlying biomechanical imbalances remained uncorrected.
4. Rotational Problems
A critical aspect overlooked in traditional bunion surgery was the rotational deformity often associated with bunions. In many cases, the first metatarsal bone is not only misaligned but also rotated. This rotation contributes to the overall deformity and, if uncorrected, can lead to a recurrence of the bunion. Traditional procedures did not adequately address this rotational component, which is essential for a comprehensive and lasting correction of the bunion.
5. Need for Immediate Weight Bearing
The recovery process following traditional bunion surgery was typically lengthy and restrictive. Patients were often required to limit weight bearing on the affected foot for several weeks, significantly impacting their daily lives. This prolonged recovery was particularly challenging for active individuals, working professionals, and especially for women and mothers who needed to return to their daily responsibilities. The need for a quicker recovery process with immediate or early weight bearing became a crucial consideration in the development of new surgical techniques like Lapiplasty®.
The surgical team was in agreement. The current treatment methods were flawed. So, anyone who would take on such a project would be doomed to failure.
The Engineer’s Insight: A Shift in Perspective about Bunion Surgery
The consensus among the surgeons was unanimous. They believed these challenges were insurmountable. However, an engineer present in the discussions viewed the situation differently.
Excitedly, he pointed out that they had, in fact, “figured it out.” By understanding what didn’t work and why traditional methods failed, they had laid the groundwork for a revolutionary approach.
They had identified their elephant.
This shift in perspective, from viewing these findings as obstacles to seeing them as valuable insights, was the turning point in developing Lapiplasty.
What happened next was truly inspirational. More importantly, it has helped 10s of 1000s of bunion sufferers find relief.
GO TO PART 2 – Roots of Resilience
Introducing Our Series on the History of Lapiplasty® and Dr. Santrock
We are excited to announce a monthly series delving into the history of Lapiplasty® and the pivotal role played by Dr. Santrock and his team. Each installment will uncover more about this groundbreaking journey, exploring how a blend of medical expertise, engineering innovation, and a willingness to challenge the status quo led to a transformative solution for bunion sufferers.
If you’re intrigued by the intersection of medical innovation and collaboration, make sure to sign up for our blog to be a part of this fascinating journey through the evolution of Lapiplasty®. Join us as we unfold the story behind this remarkable advancement in foot surgery.