Orthopedics is full of exciting technologies and innovations.
Five orthopedic surgeons connected with Becker's to answer, "What orthopedic innovation are you most excited about?"
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.
Next question: What is your biggest concern as an orthopedic surgeon?
Please send responses to Riz Hatton at rhatton@beckershealthcare.com by 5 p.m. CDT Thursday, May 16.
Note: These responses have been lightly edited for length and clarity.
Joel Fechisin, MD. Orthopedic Surgeon at Seaview Orthopedics (Ocean Township, N.J.) and Monmouth Medical Center (Long Branch, N.J.): One recent orthopedic innovation that I am excited about is smart knee technology with built-in sensors. As the smart knee moniker implies, these sensors track a patient's gait activity after surgery, including steps taken, walking speed, range of motion and other indicators of knee function after total knee replacement surgery. This allows doctors to remotely monitor progress and potentially adjust physical therapy plans quicker, aiming for better patient recovery and post-operative mobility outcomes. The smart knee technology has a 10-year battery life, meaning data can be accessed for years after surgery.
Amir Jamali, MD. Orthopedic Surgeon at DISC Sports & Spine Center (Walnut Creek, Calif.): The orthopedic innovations that I am most excited about are those related to the distraction of arthritic joints. In many joints, we know that unloading can have remarkable effects in decreasing pain. We can achieve this to some degree with weight loss.
I am most excited about two relatively unknown approaches towards the unloading of the knee joint to alleviate pain. The two categories are: 1) an implantable shock absorber device that has been cleared by the FDA, (MISHA, Moximed, Fremont, CA) and 2) the use of knee distraction treatment using dedicated external fixators.
The MISHA device is inserted through a surgical incision under the skin but on the outside of the knee capsule. It is currently in a limited release and I personally have not implanted any of these devices. In a cohort study, it performed better than high tibial osteotomy for treating isolated medial knee osteoarthritis with a follow-up of at least 24 months.
The second category pertains to knee distraction using external fixators, as popularized in the Netherlands. In this technique, two external fixators are used to achieve a 5mm joint distraction across the knee. A number of studies have shown that six to seven weeks of distraction of the knee can have similar improvement in patient reported outcomes to total knee replacement, partial knee replacement and tibial osteotomy out to one to two year follow-up. This is a remarkable finding in light of the avoidance of a permanent implant. I look forward to further work on the ideal candidates for this distraction treatment and its wider use and adoption in the United States.
Philip Louie, MD. Spine Surgeon at Virginia Mason Franciscan Health (Tacoma, Wash.): I think that wearable and smart implants will generate some new meaningful data that we have not previously captured.
Recovery after orthopedic and spine surgery is often multifactorial and incredibly variable depending on the patients' comorbidities, preoperative functional status, duration of symptoms and psycho-social factors. Traditionally, patient-based reported outcome measures of symptoms and function have been used to gauge the success and extent of recovery. However, these patient reported surveys often fail to track outcomes, specifically physical function, in a continuous and objective manner outside of the clinic. Wearable technology and smart implants will enable us to capture objective patient activity continuously. Thus providing us with a lot more data in the realm of recovery kinetics — helping us better guide patients during the recovery process.
Keith Michael Nord, MD. Orthopedic Surgeon at Sports Orthopedic & Spine (Jackson, Tenn.): The greatest innovation I see currently in my orthopedic hand practice is an artificial intelligence-driven ambient listening solution I'm using called NextGen Ambient Assist. It drastically reduces my documentation burden, giving me time to see more patients and spend more time with my family.
The technology interprets patient-provider conversations in real time, summarizes appointments and delivers SOAP notes directly into the EHR. With one tap, the platform generates an accurate medical note in about 30 seconds. I've already used it for more than 500 encounters.
For me, the innovation that AI brings has truly revolutionized my practice. My patients like the shorter wait times and additional time spent talking over typing. I can see at least five more patients a day, and my family likes the extra time with me.
John Scolaro, MD. Chief of Orthopaedic Trauma at UCI Health (Orange, Calif.): Over the last decade, three-dimensional printing technology has undergone rapid evolution. The increased availability and improved technology along with the decreased cost and production time has impacted almost every industry, especially medicine. In orthopedic surgery, three-dimensional printing has improved the ability to educate and plan for surgical procedures with polymer models of osseous structures. Additive manufacturing of metallic implants has increased the utilization of custom metallic implants for complex orthopedic pathology.
The use of custom metallic implants in orthopedics is not in and of itself new. Complex reconstructive cases, especially in joint arthroplasty and oncology, often require unique implants to address large areas of bone loss in the pelvis and extremities. Recently, increasing attention has been directed to how custom metallic implants can be rapidly designed specifically for critical sized bone defects and challenging loss of articular cartilage. This technique is now a part of the reconstructive armamentarium for the orthopedic surgeon.
In orthopedic trauma, bone loss due to trauma or infection is commonly addressed with distraction osteogenesis or staged bone grafting into an induced membrane (Masquelet technique). These techniques are biologic reconstructions but have limitations, especially in periarticular locations or poor hosts. In such cases, amputation or joint arthrodesis were considered. In select patients with complex defects who desire limb salvage, custom patient specific metallic implants will have an increasing role in the treatment algorithm and is an area of rapidly growing innovation.