# Orthopaedic templating

Orthopedic templating is a process wherein surgeons use either acetate templates or digital templates to estimate the correct size of the prosthesis to be used in surgery. The biggest educator on the subject has been AO/ASIF. In a study published in the Injury journal published in 1998, 94% of consultants and 100% of trainees felt that planning was important but half, respectively, routinely planned fracture treatment.
Since 1999, companies have developed software to computerize the process. In 1999, mediCAD® was the first commercially available software focused mainly on the German market. The orthopedic templating software market began in the United States in 2000 when Medstrat, bootstrapped by Mike Cowden and company, introduced their Workflow Engine (WFE), the industry’s first orthopedic-specific PACS. The market grew in 2003 when UK-based OrthoView was founded by Albany Ventures and the Israeli-based Orthocrat-TraumaCad was bootstrapped by an Orthopedic Surgeon Doron Norman MD and a software entrepreneur Zeev Glozman. Other later work includes that of the orthopedic pediatric surgeon Peter Stevens MD from the University Of Utah.
The main driver of software-based orthopedic templating was the introduction of computed radiography (CR) and digital radiography (DR) systems on a mass scale, which in essence eliminated film from the hospital environment, creating the need for digital templating. Unfortunately, eliminating film creates a major flaw when viewing digital images in a variety of viewing formats. Therefore, a value of known size must be present within the image much like a legend on a map. The first calibration device has been introduced into the market by Zimmer corporation which consisted of an acrylic bar with two embedded steel balls. OrthoMark and J2 Medicals Akucal were the first devices to use a spherical marker on an articulating and adjustable arm attached to a base that could be placed next to or under a patient. Subsequently, several different OrthoMark models became available with a variety of bases. Some companies copied these devices, among them was Orthocrat-TraumaCad (subsequently Voyant Health, then Brainlab) with what they called VoyantMark. Another adaptation was the development by Mr Richard King of the University of Coventry & Warwickshire of a dual marker calibration device dubbed KingMark.
Several PACS (picture archiving and communication system) providers such as Medstrat, Sectra, and Cedara developed templating in-house as part of their PACS solution, making them orthopedic-specific PACS. Many non-orthopedic PACS providers have partnered with Voyant Health (previously Orthocrat-TraumaCad, now Brainlab, purchased in 2012) or OrthoView. While none of the software packages necessarily address the entire aspect of the surgical tactic, instead focusing on pre-operative implant size selection, the tools prove to be quite usable, convenient, and efficient.
The next step of this technology was making it available on mobile devices such as iPad as well as Android platforms. Medstrat introduced its echoes iPad application in January of 2011. BrainLab demonstrated its iPad application for Orthopaedic templating at AAOS 2014.
Medstrat envisioned digital templating helping pre-plan cases as a result of the relationship between a Stryker joint rep and his brother-in-law. Orthocrats TraumaCad was founded as a result of patient-doctor relationship between a young rock climber and an orthopedic surgeon. OrthoView was founded in 2003 by Adrian Dwyer, Peter Quinn, and John Chambers as well as an orthopaedic surgeon Grant Shaw of Southampton. It was acquired by Materialise NV in 2014.
As technology moves forward, Artificial Intelligence (AI) made its way to orthopedic templating. PeekMed launched in 2015 an AI-based system, that speeds and automatizes several time-consuming and cumbersome steps by performing automatic bone segmentation, automatic landmark detection, and the automatic planning of the procedure, using the best surgical practices and quick selection of the correction and implants needed. Furthermore, PeekMed allows the surgeon to edit the planning and to simulate different outcomes of the procedure. One of the features of this ultimate technology, automatic orthopedic templating helps the surgeon by automatically placing the most suitable template in the correct position with extreme accuracy.