The Birth of Orthopedics 4.0

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

Very few savvy device companies are working in this area. There will be a ton of opportunity for those who “get it” and can capitalize on the Predictive wave.  Surgeons will want to tap into these new Predictive tools, Healthcare Providers will want to leverage it, and Insurance Providers will want to purchase access to it.

The Orthopedics 3.0 shift was all about automation and personalization, and we are well into it now. [more here].

A few years ago, I predicted that software was starting to eat orthopedics.  Well its happening. New orthopedic products contain some sort of a software component. 

We are about to enter Orthopedics 4.0.

Today 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.  Too many people are still thinking “implant” and “relationship”. However, the good news is that we have the opportunity to learn from the other industries that have embraced “predictive”. These industries have moved well into the predictive adoption curve.

Examples of predictive adoption 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 at most 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 tools?

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. The entire episode of care will use a Predictive Ecosystem.

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?
  • Should there be backup implants delivered for the case?
  • Which surgeon is the best for this surgical procedure and this patient?
  • Is a rep needed for the case?
  • What should the surgeon do right now? Real-time guidance with the surgeon during the procedure, based on thousands of like surgeries.
  • 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?

An example sharing by Dr Steve Badylak.

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

Smart systems will leverage big data to 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.

Which companies are developing predictive ecosystems today?

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

Proprio Vision is a smart AI/ML company creating predictive real-time surgery feedback ecosystem that turns a mediocre surgeon into a world-class surgeon. Faster surgery, less errors, better outcomes for ALL surgeons using the ecosystem.

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

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.  Look for meaningful advances by 2025.

Drop me a note when you catch a Predictive sighting –