The orthopedic industry is constantly changing. Here is how orthopedic surgeons hope it evolves in 2024.
Four orthopedic surgeons connected with Becker's to answer, "How would you like the orthopedic industry to evolve in 2024?"
Ask Orthopedic Surgeons is a weekly series of questions posed to surgeons around the country about clinical, business and policy issues affecting orthopedic care. We invite all orthopedic surgeon and specialist responses.
Note: Responses have been lightly edited for length and clarity.
Thomas DeBerardino, MD. Sports Medicine Orthopedic Surgeon at UT Health San Antonio: I would like our orthopedic industry to avoid the one-size-fits-all mantra. Key examples are recent market trends involving patient-specific implants and robotics. Patient-specific implants are a breakthrough of biomedical engineering, but clearly not indicated in every case. They are best suited for complex operations to diminish the degree of difficulty of a standard freehand or standard instrument-guided surgery. Robotic assisted surgery (mostly total knee arthroplasty and total hip arthroplasty) are also a needed technology. Early data suggests no improvement in patient reported outcomes or outcomes in general. I think it would be better to focus on the difficult, dysplastic or post-traumatic revision type cases where the technology can legitimately determine the best plane of bony cut or resection to guide optimal implant positioning.
Brandon Haghverdian, MD. Foot and Ankle Surgeon at Hoag Orthopedic Institute (Irvine, Calif.): There has been enormous innovation in orthopedic implants in the last decade, leading to drastic improvements in surgical accuracy, precision and patient outcomes. Nevertheless, there is wide opportunity for growth, particularly in the area of patient-specific instrumentation and implantation. Customized implants and patient-specific cut guides have allowed for a more streamlined and exact approach to total hip, knee, and ankle replacements. In the world of foot and ankle surgery, for instance, custom talus implants and patient-specific ankle replacements are becoming more the norm in the treatment of ankle and hindfoot arthritis. With more innovation in 3D printing and source materials, we can also expect these implants and designs to become accessible to a greater number of surgeons and patients. I have no doubt that in the coming years, more surgery will be done with the patient's unique anatomy and needs in mind.
Nick Jain, MD. Orthopedic Spine Surgeon at DISC Sports & Spine Center (Newport Beach, Calif.): The orthopedic industry evolution I would most be interested in seeing is a renewed focus on integration of care. Orthopedic care today is often so fractured among many subspecialists and practice extenders. With our aging population, there is an increase in overlapping pathology and symptoms. Improved communication between orthopedic disciplines with improved patient care coordination would be beneficial for both patients and physicians. It would also be amazing if payers recognized and appropriately valued this collaboration and care coordination efforts appropriately.
David Kalainov, MD. Clinical Professor of Orthopedic Surgery at Northwestern University Feinberg School of Medicine (Chicago): In the U.S., the prices of orthopedic implants, devices and IT do not really align with value-based care. For example, a physician may request a new total knee replacement implant with sparse clinical outcome data for use at a hospital.
If the request is approved by the hospital's value analysis committee, the price is negotiated with the implant company and the product is adopted. The cost may have either a favorable or unfavorable impact on facility reimbursement per case, depending on the payer source.
In 2024, I would be in favor of including the orthopedic industry in trial value-based care payment models with insurers, clinicians, ambulatory surgery centers and hospitals. Such an approach could be considered by the Center for Medicare and Medicaid Innovation for inclusion in new traditional Medicare payment models and/or by commercial insurance carriers in Medicare Advantage plans. Shared savings and penalties with the orthopedic industry might help temper the ever-increasing costs of healthcare.