The Birth of Orthopedics 3.0

COVID has accelerated change everywhere. Some sectors are being turned upside down – retail shops, restaurants, tourism, travel, leisure, casinos, live entertainment, sporting events, etc. Ultimately, fifty million Americans will find new ways to earn a living.

Fortunately for the orthopedics device community, orthopedic care is in demand. Elective surgeries are being resumed this spring.

However, the Orthopedics Industry is going through a metamorphosis.  I call this new phase Orthopedics 3.0.

First let me walk you through some quick history of orthopedics 1.0 and 2.0.

Orthopedic care has been around a long time.  Fracture repair began in the middle ages including the use of casts and crutches. I would suggest the beginning of modern orthopedics was in 1960 with the advent of OA treatment and the the first protheses. 

Orthopedics 1.0

Orthopedics 1.0 was conceived with a focus on PAIN RELEIF.  

In 1960, Sir John Charley ushered in “low friction arthroplasty” with stainless steel and teflon (later changed to polyethylene).  Charley implanted the first stainless steel monoblock hip stems with PMMA and polyethylene cups in the 1960s. The Charley Hip was available in one size.  

Dr. Marmor brought the first total knees to the world in the 1970s with three sizes. Marmor implanted side by side unis to create the first total knee.

Very few materials were available. Few sizes were available. No rights or lefts. The surgeon had to make the implant fit the patient.  Sounds barbaric, but that’s the way it was.

During Orthopedics 1.0 device companies concentrated on improved materials, kinematics and bone conservation. The FDA started regulating orthopedic devices in 1976. 

Orthopedics 2.0

Orthopedics 2.0 was born with a focus on SURGICAL OPTIONALITY.  This started aronud 1980 with the surgeon’s insatiable need for more choice – more anatomic sizes, lefts/rights, technology, constraints, surgical approaches, MIS, etc. Device companies like Biomet started making customs for each surgeon that visited the plant in the 1980s.  

The more implant choices the better. Choice became addictive. The surgeon demanded every possible implant and instrumentation option in surgery to provide the best treatment for the patient.  

New practicing surgeons were trained on optionality and became hooked on optionality. Device companies were happy to deliver more choices.

The result of the 2.0 focus was increased procedure complexity and driven up costs.  

Orthopedics 3.0

Today, we are entering Orthopedics 3.0. The new focus is AUTOMATION. This is driven by the need for less human touch, greater efficiencies and less burden on hospitals. Ortho 3.0 is focused on all processes that touch the healthcare system; whereas, Ortho 2.0 was primarily focused on the surgical event. From the device company point-of-view, this new metamorphosis effects R&D, testing, marketing, surgical training, Med Ed, clinical studies, finance, operations, selling, marketing, service, inventory, and logistics. 

The goal or Ortho 3.0 is seamless integration of all touch points in orthopedic care with less of human touch.  The automation revolution is driven by data, not humans. The cost of automation is decreasing each year. Speed and flexibility will win the day.

Change in the Orthopedics 3.0 era

Orthopedic diagnoses will become more AI driven. (see an AI wrist diagnosis)

Patient consultations will be done more through Telehealth. On-call orthopedic consults will provide immediate triage and support.

Implants will become patient specific. Each patient will receive a unique implant based on their boney anatomy, kinematics, and genome. (see Bodycad)

Inventory/logistics/shipping/delivery will become more automated.

Pre-operative surgical planning will become more automated.  (see GEO)

Sales support will become less human touch. (see Avail)

Most surgical training will become more VR-based. (see PrecisionOS)

Medical education will become both more virtual and more on demand. 

Medical conferences will become more virtual (CCJR going virtual).

Physical therapy will become more coached by avatars at home and less coached by PT professionals in a rehab facility. (see virtual PT

The work done by employees of device companies will become more remote and more distributed.

Hiring will become faster and more virtual. Device companies will have access to exceptional talent once they look outside their usual building locations.

Clinical trials will derive more data seamlessly from wearables and less from nurse/doctor followups.