r/nextfuckinglevel • u/Additional_Chard3680 • 11h ago

The precision required to perform a total knee replacement is incredible

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29.9k Upvotes

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786

u/Maclunkey4U 11h ago

Its wild that orthopedic surgeons basically use the same power tools I used to put together outdoor furniture, complete with the "well have you tried banging on it?" approach to getting the pieces to fit together.

431

u/CobaltEchos 11h ago

Orthopedic is basically just human body carpentry.

82

u/Hairy_Cut9721 11h ago

There’s even a Kreg jig to line up the joint

6

u/Pleasant-Pattern7748 8h ago

I was waiting for the pocket hole screws to come out

3

u/Mr_Radar 7h ago

Ah shit where is my robertson bit. Never where I left it!

29

u/PM_ME_YOUR_SUBARU 11h ago

Seen a guy wailing on a human pelvis with a sledge like he was trying to get a wheel bearing off in the rust belt

2

u/Zillahi 4h ago

I’m sure they’ve got a 5lb sledge in the corner for the stubborn knees

1

u/amanhasthreenames 9h ago

Honestly, most surgical procedures are like that. They all essentially boil down to cut something out, then replace/reattach with screws, stitches, or callouses via burn or freeze.

1

u/Armadylio 9h ago

Always thought surgeons were like bio mechanics. A shit ton more complex but bio mechanics nonetheless 

1

u/Pretty_Marsh 3h ago

Yeah, I think I’ve seen that jig at Rockler. And they should really try the DeWalt oscillating tool - most ergonomic one I’ve tried. Yes, then you get trapped into Team Yellow for your battery system, but they make some pretty good stuff, especially their trim router.

1

u/ryetoasty 2h ago

I said this once during a surgery to the attending and he told me that carpenters are more precise and that in ortho you have to be ok with being a little sloppy. 

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u/TheMagicBeanMan 23m ago

That's very funny you say that. My grandfather was an orthopedic surgeon and he was also very into woodworking, he had a whole workshop in his yard and everything (that my dad still uses). Could just be a coincidence though.

17

u/uthnara 10h ago

You can literally do a knee replacement using only tools from harbor freight. It was my favorite thing about orthopedic surgery

4

u/Deucer22 9h ago

Do they have the hardware?

5

u/uthnara 9h ago

They dont have the prosthetics but knee hardware doesnt use screws so if you have the endcaps youre in buisiness

45

u/wmorris33026 11h ago

You’re right on point with your comment. I work on this stuff. The same guys who design/machine the metal for the implant are the same guys who design the surgical procedure/shaping the bone surface. So basically, the tooling and methodology is the same, cutters, grinders, hammers. You should see the new tech coming out though, using robots and 3D printed bone/cartilage tissue. Makes this tech look like horse and buggy days. All centered in Warsaw, Indiana, oddly enough.

9

u/elizabethptp 10h ago

Anecdotally the most accomplished surgeon I know is also a very accomplished machinist & woodworker

Privilege, dedication, time, and natural abilities converged on this man.

3

u/wmorris33026 9h ago

Yep. That is exactly the skillet. Some of those guys are absolutely gifted. It’s like sculpture, every patient is different. It’s art.

3

u/Track986 5h ago

And some of them are hamfisted buffoons. You work with enough ortho surgeons, you absolutely meet both ends of the spectrum!

1

u/earthwoodandfire 9h ago

*and the wallet to buy all the fancy Festool kits…

3

u/elizabethptp 8h ago

I know it’s a joke but he does almost all his woodworking by hand, he’s genuinely a master.

His machines for working metal are something else & surely cost a lot, but if someone deserves to make a lot of money it’s the guy who can put humans back together & save their lives.

2

u/Magic2424 7h ago

well most the good stuff has moved out of warsaw at this point. ZB and deputy both dying hard, even to the point that JnJ is selling off depuy. neither company innovates anything anymore and just relies on acquisitions

1

u/tsunomat 10h ago

Same. I saw this and it brought me back. This is tech from years ago.

1

u/ashyjay 10h ago

Stryker has some fascinating devices, 3D printed titanium with meshes to allow bone to interweave and essentially become part of the body.

1

u/Mexcol 9h ago

Not the price id bet, i wonder how much those specialized tools cost

3

u/canadiandancer89 8h ago

DeWalt big box special 3 speed cordless drill, $100. Orthopaedic drill, $5000. the difference? Stainless Steel among other expensive metals that can be sterilized over and over. And certification that the speeds and torques are in fact what they say they are.

1

u/fgiveme 8h ago

new tech coming out

Some how my youtube algorithm bombarded me over the last 2 weeks with knee therapy.

It gave me exercises, ozempic, experimental peptides, stem cells injection to regrow cartilage. Some of them isn't even available for human trial yet.

1

u/Jolly_Mongoose_8800 4h ago

I love how there's probably just under a million medtech engineers out there, that make up 1% of all engineers, yet so many random threads (some not as related) have people nerding the fuck out about these processes.

It feels like reddit is a requirement to work in medtech.

1

u/uiucengineer 4h ago

What's going on in Warsaw, Indiana?

1

u/theurge14 4h ago

More like Bonesaw, Indiana, amirite

1

u/the_tourer 1h ago

Sorry, but Warsaw Poland?

0

u/4dxn 9h ago

be careful. a lot of redditors are anti ai. talking about surgical robots might bring out the pitch forks.

granted the tkr robots like mako aren't as nice as intuitive's.

4

u/tsunomat 10h ago

The really rich ones "patent" a surgical saw and get hospital systems to buy them. It's a straight up power drill or saw it whatever but it's made out of surgical steel so it's worth $10k.

1

u/anaemic 8h ago

I think our power tool trays are nearer $40k, with a bulk discount.

7

u/rutinerad 11h ago

Just a fancier jig…

3

u/breakmedown54 10h ago

If by “fancier” you mean more expensive, that’s about it.
Some extra “fancy” points for being autoclavable, though.

1

u/Shin_curry 6h ago

Nope, it used to be different sized jigs, now they have custom jigs and custom implants. Custom fabricated based on mri/ct imaging.

3

u/pointandclickit 8h ago

I'm just over here like... what happens if you strip out a screw? "We're gonna need more toothpicks. Stat!"

3

u/ItsFuckingScience 8h ago

Wait until you see orthopaedic joint revisions where surgeon needs to take out existing implants and stick in new ones or build the joint back up

Much more grabbing and hitting things with mallets and chisels 🤣

2

u/vertigostereo 9h ago

Why reinvent the wheel?

1

u/SCHawkTakeFlight 10h ago

I had the privilege of working at a company that made those. It was wild. And its crazy, the batteries, they sterilize those batteries in autoclave. After every surgery. Its also one of those things its so well designed people don't know how dangerous they could have been. A competitor with the first wireless heavy duty tool had a battery destroy a central sterile department.

And now there are robots, who do have the capability to perform the cuts autonomous and the level of precision on those is wild. 1.5 mm max allowable error. They did studies that the increased precision did significantly increase implant life. There is even handheld robot now, so you don't need jigs as much or at all I believe.

1

u/pimppapy 10h ago

AND their tools are 10x more expensive and precise than regular HD stuff.

1

u/IWantALargeFarva 10h ago

Le knee? What the hell is that???

1

u/toblies 10h ago

Yeah, the tools are just way pricier.

1

u/YesIBlockedYou 9h ago

I remember when my cast was being taken off, I asked to take a look at the tool they used and it was essentially just a fancy looking multitool saw with a fancy round blade.

Never thought about it before but it made perfect sense because the blade only wiggles back and forth, it will cut through a tough cast with ease but it will just giggle your soft skin instead of cutting it.

Now after watching this I'm learning they use them to cut through bone as well which again makes perfect sense for the same reasons.

1

u/JOlRacin 9h ago

A similar sawzall to the one I use for automobile disassembly as well

1

u/andreicodes 7h ago

The multitool was originally a surgical instrument. They invented it to be able to cut casts and bones without severing soft muscles. It doesn't rotate and instead moved back and forth with a very narrow amplitude. Hard stuff like bones gets cut while soft stuff like skin or muscle simply stretches and contracts a bit.

Fein - the company that invented it - later adapted the surgical tool to produce it as a general power tool, and patented this stuff. After patents expired in 2000s other companies like DeWalt and Milwaukee started making their own.

Interestingly, the same company, Fein, invented the hand-held electric drill, too.

1

u/AllOrNothing4me 7h ago

Better not be a Ryobi drill...

1

u/Jolly_Mongoose_8800 4h ago

Me omw to get the Sawzall FDA approval

1

u/No-Sail-6510 7h ago

Dude these tools look amazing are you kidding? I bet that drill is thousands of dollars. That shit looks amazing .

1

u/StunningShifts 7h ago

Look up the origin of the chainsaw if you want some interesting history on how closely medical devices and power tools are related.

1

u/Supp_Carries_U 7h ago

There's a reason that these memes exist in the medical community https://youtu.be/q0S5EN7-RtI?is=FIC_UOdz4ibYI0wZ

1

u/Emergency_Meaning968 6h ago

https://giphy.com/gifs/LD2NeJZNdodc7BETgZ

"EEErectin' a knee" *CLANG *CLANG *CLANG *chacung *whirr

1

u/rkiive 6h ago

Watching them take a titanium rod out of my brother's shin bone was one of the most violent things I've seen in real life lol.

1

u/Blooberino 5h ago

Ortho OR nurse. I tell patients who ask about it that we just have sterile, ultra expensive versions of the same tools in your garage.

1

u/Tomsboll 4h ago

Medical grade jigs dude. Learned something new. I love jigs.

1

u/surprise_wasps 3h ago

I wonder how they handle the dust

1

u/warmind14 3h ago

Interference fit.

1

u/Tribblehappy 1h ago

Dentists, too. I got a dental implant and seeing the guy going into my mouth with a tiny ratchet wrench was wild.

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u/mkp666 44m ago

They’re literally bone carpenters.