Orthopedic Advances to Watch

Sensor-based technology, robotic platform accessibility and promising new techniques for cartilage repair are transforming the surgical landscape.

It’s an exciting time to be in the orthopedics industry. When you combine innovations in sensor-based wearable technologies, smart implants and more accessible (i.e., affordable) robotic platforms with the growing adoption of new surgical techniques that can preserve and restore damaged anatomy, patients are reaping the benefits of life-changing care.

And savvy surgical leaders are looking for ways to bring these cutting-edge advances to their facilities.

Emerging technologies

Seth A. Jerabek, MD, an orthopedic surgeon at Hospital for Special Surgery in New York City, has kept himself abreast of the emerging technologies in his field and is most encouraged by the following categories.

• Sensor-based technology. Wearables that provide a variety of useful patient metrics are an extremely promising technology — generally in the recovery phase of care. For instance, accelerometer-based activity sensors, which are attached directly to the patient on a location like their thigh, allow providers to remotely monitor data such as steps taken, range of motion and how often the patient gets up. If these numbers trigger any concerns, providers can intervene. “If the activity isn’t where it needs to be, it could point to a problem with pain control that needs to be addressed, or it might be as simple as encouraging the patient to step up and be more proactive in their recovery,” says Dr. Jerabek, who adds that adoption of the tech is lagging a little behind what was initially expected by industry insiders. The issues, he says, lie on the reimbursement and administrative side of things. Specifically, current codes are geared toward the monitoring of diabetic and bariatric patients, and there’s a general lack of understanding on just how to bill for this in the orthopedic capacity. Plus, the technology isn’t integrated with the major EMR vendors, an issue tech companies are actively trying to remedy. “The current technology has created an administrative burden to document and bill for it, but there are companies working with one of the major electronic record vendors to integrate the tech into the EMRs,” says Dr. Jerabek.

• Smart implants. One downside to sensor-based wearable tech, of course, is the fact that you need to get patients to use it. That’s not an issue with smart implants that come embedded with sensors in the small stem of the tibial component, capturing much of the same data as accelerometers — step count, distance traveled, etc. — and sending that information to providers via a cloud-based dashboard. “The real issue right now with these implants is that they don’t collect continuous data, and providers don’t know how to best use the data yet,” says Dr. Jerabek.

New technology offers ‘off-the-shelf’ transplant capabilities where you don’t need to wait for a donor.
Brian Walczak, DO, PhD, FAAOS

• Robotic platform growth. While the original orthopedic robotic platform has exploded in use throughout the last decade, with more than 1,000 systems installed worldwide and robots in every U.S. state, the market itself has also grown. Today, every major player in the ortho space has a robotic system to offer, and that competition has made this technology more accessible than ever — particularly for small ASCs that wouldn’t have dreamed of investing in robotics until recently. Even with the creative pricing arrangements vendors are willing to offer, robotic platforms are still a major expense. But Dr. Jerabek points out that there are certain efficiencies inherent in robotics that busy facilities shouldn’t overlook. “You can save money by reducing the trays you use,” he says. “If you don’t need to open as much instrumentation, if you don’t need to open Sizes 1 through 8, there’s a lot more efficiency, and that adds up.”

Cartilage repair

Total joint replacement surgery is a game-changing procedure for most patients, with more 2.8 million hip and knee procedures being performed in 2022 alone, according to the American Joint Replacement Registry Annual Report.

But cutting-edge techniques in cartilage repair offer an alternative to replacement and show a lot of promise in helping young and at-risk patients to restore the function of their joint before they reach end-stage arthritis. For instance, biological resurfacing with transplantable cartilage can often restore the joint’s function while also preserving the patient’s joint surface. Brian Walczak, DO, PhD, FAAOS, an orthopedic surgery specialist at Rush Health in Chicago, has performed hundreds of cartilage repair cases involving transplants over the past five years — in addition to the very impressive and award-winning research he’s conducted in this area involving stem cells.

He sees cartilage repair as a paradigm shift in orthopedics. “It used to be all about preserving the joint, now’s it’s all about preserving and restoring the anatomy,” says Dr. Walczak, who has seen a wide variety of patients — from adolescents to collegiate and professional athletes and even individuals in their 50s — benefit tremendously from cartilage repair procedures. “The activity remains the same for patients post-procedure,” he says, adding that he believes advances in the transplant technology will help make this option more generally available over the next five years. “New technology offers ‘off-the-shelf’ transplant capabilities where you don’t need to wait for a donor,” says Dr. Walczak. “You can personalize at the time of surgery and customize to fit defects.” OSM