The Birth of Orthopedics 4.0 |

The Birth of Orthopedics 4.0

Get ready for the next shift in Orthopedics – the “Predictive” wave. 

A few savvy device companies will get ahead of this trend. There will be a ton of opportunity for those that “get it” and can capitalize on the Predictive wave.  Surgeons will want to tap into these new Predictive tools, healthcare will want to leverage it, and insurance providers will want to monetize it.

A few years ago, I predicted that software was starting to eat orthopedics.  Well its happening. The software change is here.  Recently launched orthopedic products contain some sort of a software component. This was the Orthopedics 3.0 shift  [read more here].

Now the shift is moving to “Predictive”.

I’ll drop a pin in the year 2025 for the acceleration of the Predictive wave.

Learning from other industries.

As usual, Orthopedics lags behind other industries.  You know that the thinking in our industry is still “implant-centric” and “relationship-based”. However, the good news is that we have the opportunity to learn from the other industries that have embraced “predictive”. These industry are much earlier in the predictive adoption curve.

Examples of predictive tools in other industries:

  • The agriculture industry is uses predictive software to choose when to plant, nurture and harvest.
  • The mining and oil industry is uses predictive technology to determine where and when to drill or mine.
  • The weather industry uses predictive technology to tell us what weather is coming.
  • Universities use predictive to proactively determine which students are most at risk of dropping out, and what can we do to prevent it.
  • Banks are use predictive to proactively determine unhappy customers based on their transaction behavior.
  • You are using predictive technology on driving trips in real-time to guide you to your destination as efficiently as possible around construction and accidents.

Focusing back on Ortho.

So, how can the Orthopedics industry use predictive technology?

The focus in Orthopedics will move from data collection to data analysis in predictive tools.  In other words, the focus will shift from a rear view mirror perspective to looking at the road ahead. 

Today Orthopedics is asking “what happened?”.
Tomorrow Orthopedics will ask “what should happen?”.

In the next few years, Predictive software provided by savvy device companies will guide healthcare in all steps in patient care, including – early treatment, the operative procedure and followup.

Examples of areas for predictive tools:

  • Where is the fracture and does it need to be treated?
  • Where is the cartilage defect today and what is the best treatment for longevity?
  • What age is the best time to implant a hip or knee replacement in a specific patient?
  • Which implant materials will be best received for the patient based on their genome?
  • What is the quality of bone in the patient and how will this effect the procedure?
  • What implant is best to prevent dislocation in this specific patient?
  • What implant will have the best outcome for the specific surgical application?
  • Which surgeon is the best for this surgical procedure and this patient?
  • What personalized physical therapy regimen will result in the best outcomes for this specific patient?
  • When should the patient return to work or decrease pain medication usage?
  • When should the patient remove the brace?  jog? or play golf?
  • How do we monitor the patient remotely, without burden on the healthcare system?
  • How can Clinical Trials use predictive analytics to identify candidates for a quicker, cheaper study?

In the future, AI will provide patient-specific ligament balancing for a total knee patient.

IBM will leverage Watson to scan data and create outcome predictive analytics for orthopedic surgery.

Genomics workups will diagnose scoliosis at birth so better treatment options will be available to the family.

In the trauma world, Dr. Steve Badylak walks us through real-time decision making in fracture treatment with predictive tools in the future. Dr. Badylak, say that AI may be able to identify whether tissues that are healing from a traumatic injury will have a good or bad outcome based on certain biomarkers.“ For example, the more scar tissue and adhesions you get, the worse the clinical outcome is going to be,” Badylak said. “If we knew early on that certain things were starting to go down the wrong pathway, we could intervene either surgically or in other ways that could change the direction of wound healing,” he said. Once the healing biomarkers are identified, Badylak noted AI, in the form of smart bandages, can be developed that, when used on wounds following a traditional repair procedure, can indicate in which direction the wound is healing and provide guidance on how surgeons can intervene, and when. Currently, Badylak and his colleagues are using AI to develop methods “that will decrease the time to functional healing of injured musculoskeletal tissue by 50%.”“In other words, someone comes in with a traumatic injury, they have a fractured femur and they lost 50% of their quadriceps muscle. That is a pretty serious injury. Right now the expectation is we are going to do the best we can to salvage this and we are going to get to a point where we have scar tissue with a lot of morbidity and limited function. Well, the AI tells us that does not have to be the case. We can not only restore most of the functional tissue that was gone, but we could do it in half of the time if we only knew when to intervene and how to intervene both surgically and medically.

Real companies playing with predictive tools today.

Enhatch is a pure play software company deploying AI modules to streamline preoperative planning, logistics and the future of surgery.

Proprio Vision is a smart vision AI/ML company creating predictive tools based on individual surgeon performance.

ExplORer Surgical designs customizable digital platforms that can help accurately predict operational costs, clinical team performance, and increase adoption.

Zimmer Biomet created mymobility with the Apple Watch and iPhone to provide patients with support and guidance at the direction of their clinician when preparing for and recovering from orthopedic procedures while in their own home.

Canary Medical has created the first smart implant that will predict the health of the total knee patient and the total knee implant in real time for 20 years.

TracPatch Health is working on predicting fall risk and other early post op problems.

A final thought on the Predictive shift.

Just a word of caution to manage your expectations. You will barely notice the new predictive Ortho 4.0 trend as it forms. Predictive is nascent today. As most trends go, we tend to overestimate the short-term implications and underestimate the longer term implications. 

Drop me a note when you catch a Predictive sighting –