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This is Carly Beam with Becker Spine and

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Orthopedics podcast. And joining me today is doctor

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Bradley Lamb, director of Foot and Ankle Deformity

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Center and Fellowship at the Paley Institute.

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Doctor Lamb, thank you so much for joining

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us today.

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Thank you for having me. And so before

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we dive into our questions, I'd love if

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you could just introduce yourself, share more about

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your work and background.

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I am doctor Bradley Lam. I am a

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foot and ankle

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surgeon

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in West Palm Beach. I am the chief

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of foot and ankle surgery at the Saint

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Mary's Medical Center in Palm Beach Children's Hospital.

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I'm also the director of the Foot and

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Ankle Deformity Center and Fellowship at the Paleo

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Orthopedic and Spine Institute.

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I've been practicing for over twenty five years

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and have had

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numerous fellowships in club feet,

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orthopedic trauma, which is called AO trauma,

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limb deformity correction and limb lengthening.

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And

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I am specifically interested in,

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deformity correction when it comes to the foot

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and ankle and have had,

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vast experience

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with,

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very complex cases that require unique solutions.

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Yeah. And you're kind of hooking off of

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that. You recently performed the world's first,

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MedCAD three d printed

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patient specific cut guide procedure for an ankle

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realignment, and it was a very complex case.

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And I was wondering if you could share

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more about that and what you learned from

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it. What are the wins? What will you

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build on for future cases, etcetera?

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Yeah. So MedCAD offers something,

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I think, disruptive

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to orthopedics,

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meaning

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it offers

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my

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unique patients or unique deformity,

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or my patients who have unique deformities,

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a solution which is very

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patient specific.

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This is kind of revolutionary

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in orthopedics where it's not deformity

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specific,

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where it's five degrees of

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rotated or angled,

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bone,

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but it's very patient specific where it's not

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only five degrees, but it's got the lumps

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and bumps and contour of their specific,

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deformity.

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And so

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what MedCAD

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provides

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and what I was able to provide provide

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my patient

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was,

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the first ever in the world patient specific,

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MedCAD,

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medical procedure. So

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that includes,

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patient specific,

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procedure

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where we use cut guides to make sure

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we cut and realign the bones correctly.

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We use specific,

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reduction

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devices that are,

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made for that patient's,

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specific,

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correction of their malaligned bone or ankle in

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this case.

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Also, patient specific plates,

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to fit the contour of that bone,

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and screw sizes that fit the length of

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the bone and the exact contour

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and can,

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be planned so that

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it's in the anatomic right position or correct

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position so that doesn't give them trouble down

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the road and also creates the,

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correction and healing that we need.

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And this is all based off of a

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three d CAT scan that,

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we use to plan this whole procedure.

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So the beauty is the patient can see

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the plan, I can see the plan, I

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can adjust it,

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what I need to adjust it to make

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sure that it is

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gonna work exactly how I plan it to

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work. And in the OR, it's kind of

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becomes just cookie cutter in a sense where,

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this is all,

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following the steps of this patient specific plan.

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So

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it's an awesome,

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way to,

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correct these deformities where we were in the

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past just free handing and,

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also kinda guessing, hey. Is this five degrees

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or is this

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six degrees of a change? And every millimeter

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matters, every degree matters, and this provided my

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patient a,

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superb accurate outcome, which again is gonna,

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create a great functional outcome in the end

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is what we're looking for for these patients.

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I can imagine. And can you talk more

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about just the actual process of getting these

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guys from the image to the product and

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then to to OR? How does it fit

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into the whole

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workflow within this patient episode?

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Yeah. So the workflow,

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with MedCAD is,

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is simple.

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Basically,

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with these complex deformities,

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patients usually get CAT scans,

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preoperatively,

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before the procedure anyway.

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So with this CAT scan that's three-dimensional,

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we can therefore

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then plan the correction,

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whether it's a joint fusion,

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whether it's a realignment osteotomy,

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whether it's a

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combination of some

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bony work and soft tissue work.

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We can basically preplan this out,

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with the engineers at MedCAD.

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Of course, they have great knowledge and plan

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most of the case out and share with

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me their results, and then we,

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work together to fine tune it to the

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patient's specific needs. And then, also,

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you can design specific implants, whether it's a

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screw, a plate, a pin, as,

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a rod. That way, it goes exactly where

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you want it for the correction that you

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want. And, you know, preoperatively, I can talk

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to the patients and show them exactly the

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plan,

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correction

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through these beautiful printouts or on the computer,

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and this gives patients confidence in me. It

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gives me confidence that I know we can

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get this accurately,

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corrected.

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And then in surgery,

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it it makes it real easy that, I

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can kind of follow the steps one by

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one.

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Got it.

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And, you know, how do you see this

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type of technology, you know, both MedCAD and

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just patient specific technology, North Peaks overall,

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converging with other big things like robotics,

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outpatient care, value based care?

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Yeah. So I think this fits nicely into

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the,

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ever changing,

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advancing

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technology

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that,

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surgeons are provided to help their patients. So,

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this would, you know, lessen,

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implant,

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you know, misuse

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or lessen the,

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chances of,

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negative outcomes because having a a better plan

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leads to a better result. So,

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I think it fits nicely into all this,

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it is patient specific and I know patients

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demand

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the best of the best

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health care in The States, and so this

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MedCAD,

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patient specific

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treatment option

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is right on that same track.

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And

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what what's your what are your predictions for

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this technology in the next five years? What

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do you think, you know, MedCAD two point

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o, for instance, would look like?

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Yeah. So I think, at the moment, I'm

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using these,

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specialty,

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cut guides,

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reduction guides, and implants,

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for for complex cases. But I think it's

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something that is going to

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be,

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demanded of even the more simplistic,

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everyday,

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cases that we do. So that way patients

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can

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have,

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you know, the the best possible outcome and

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the best possible,

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implants,

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and position

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of their, you know, foot and ankle,

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and,

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again, that I feel can lead to the

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best,

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possible functional outcome.

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Got it. And, you know, last question for

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you, doctor Lam, is what are three top

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health care trends that you're following today?

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Yeah. So I think

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the ever changing

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medical field or ever evolving

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medical field is,

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you know, hard to keep up with because

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there are so many new

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advancing technologies.

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But I think this,

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patient specific,

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repair of deformities and malalignments,

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is definitely in that

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spectrum of

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disruptive technology where it's gonna change what we

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do, where we can make it specific

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each surgery for each patient.

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I think also

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technology where there's,

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you know, all calcium implants which become incorporated

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into the body is kind of the next,

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the next frontier.

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Having,

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you know,

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surgeries that heal quicker than, say, the average

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where we have,

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medical technology to help in advance,

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healing of the surgeries that we do. I

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know we do

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more minimally invasive surgeries, which is, along that

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same line, but also having technology that will

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advance, repair of our our surgeries or,

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injury repair so that patients can get back

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to their feet, back to their activities,

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their sports, and work as as fast as

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possible.

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Thank you. And a quick follow-up. I'm curious

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to just kind of pick your brain on

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biologics in orthopedics. I'm wondering what your predictions

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are just in the short and long term

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in that area.

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These days, biologics

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play a huge role in our surgical

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procedures,

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to try to advance the healing, whether it's,

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you know, stem cells, whether it's, bone grafting,

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whether it's,

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PRP,

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peptides, you name it. There are many forms

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of

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advanced healing

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techniques that are,

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promising to be regenerative, and I think that's

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going to be,

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now and also in the future, a huge

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part of

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orthopedics and,

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helping the patients get back to their feet

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and,

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do their activities quicker.

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Alright. Well, doctor Lam, thank you so much

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for your time hopping on the podcast. It's

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been a great conversation, and I look forward

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to connecting the future.

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Yep. Thank you very much for your time

286
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too. Have a great day.