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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. One 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 Adrian Dwyer, Peter Quinn and John Chambers, and after seed-funding, funded by a consortium of investors led 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 was by Dr by Dr Grant Shaw of OrthoView, and later the Zimmer corporation, the latter 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. which is licensed by major PACS vendors including GE Healthcare, Fujifilm, Philips and Agfa Healthcare, with a library of over 220,000 intelligent templates from orthopaedic companies including DePuy Synthese, Striker, Smith & Nephew and Zimmer Biomet. 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 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 1999 by Adrian Dwyer, Peter Quinn, and John Chambers as well as an orthopaedic surgeon Dr Grant Shaw of Southampton. It was acquired by Materialise NV in 2014.