Latest / Deep Dive Ortho — Orthopaedic Surgery, AI & Digital Health Podcast. / Now and tomorrow in Orthopaedics

Transcript

Now and tomorrow in Orthopaedics · Deep Dive Ortho — Orthopaedic Surgery, AI & Digital Health Podcast.

0:00
Did you know the American Academy of Orthopedic
0:02
Surgeons? Well, they've just updated key guidelines
0:05
for things like carpal tunnel syndrome, meniscal
0:07
pathology, just this year alone. Staying on top
0:12
of what's new isn't just important. It's fundamental
0:15
in a field that's moving this quickly. Absolutely.
0:19
The pace is remarkable. Welcome to the deep dive.
0:22
I'm your host and today we're taking a really
0:25
focused look at the cutting edge of orthopedics
0:27
We've pulled together a whole range of sources
0:30
recent research clinical guidelines expert interviews
0:32
to to explore the big Advancements and trends
0:35
shaping how care is delivered right now Sounds
0:38
good and guiding us through all this material
0:40
helping us sort of cut through the complexity
0:41
is Prof Mo Imam who brings just a wealth of experience
0:45
in orthopedic research and practice Great to
0:47
have you back. It's always good to be here ready
0:50
to explore these sources. Excellent. OK, so to
0:53
get us oriented, let's do a quick check in with
0:55
the sources on three big questions. First up,
0:58
if we look beyond the actual surgical theater,
1:01
what are the most significant recent insights
1:03
affecting patient recovery and their overall
1:07
outcomes? Well, the sources really emphasize
1:09
preparing the patient before surgery, what we
1:12
call preoperative optimization. Right. managing
1:14
risks beforehand. Exactly, identifying and managing
1:17
those risks. And crucially, there's a massive
1:20
shift towards multimodal pain management, actively
1:23
trying to reduce reliance on opioids. That's
1:25
huge. It is. And increasingly, we're seeing the
1:28
impact of psychosocial factors being properly
1:31
recognized and, importantly, addressed. OK, that
1:34
makes complete sense. Second question, how are
1:36
these rapid advancements in technology, things
1:38
like sophisticated imaging, robotics, how are
1:41
they practically changing how orthopedic procedures
1:43
are actually performed? Well, technology is fundamentally
1:45
changing the precision and also the planning
1:47
of surgery. Robotic assistance, for instance,
1:50
is sort of moving cores, becoming a standard
1:52
tool. Really? Standard tool. Especially for those
1:55
complex maneuvers and really tight spaces. Imaging
1:58
is vital for diagnosis, obviously, but it's equally
2:01
important, maybe even more so for guiding the
2:04
surgical strategy itself. Ah. And AI, artificial
2:08
intelligence, is starting to play a supportive
2:10
role, too, in areas like patient safety. So the
2:13
tech is less about automating the surgeon, maybe,
2:16
and more about empowering them. Precisely. It's
2:18
about augmenting the surgeon's skill and insight.
2:20
It's not about replacing them. Got it. Okay.
2:23
And finally, with this constant stream of new
2:26
research coming out, updated guidelines, interviews
2:29
like the one with Dr. Purshvira, how can orthopedic
2:33
professionals best navigate all this information,
2:36
this wealth of information really, to truly inform
2:38
their day -to -day practice? Yeah, that's a key
2:41
challenge. And this is where evidence -based
2:43
frameworks become absolutely critical, relying
2:45
on rigorously developed resources like clinical
2:48
practice guidelines from the major bodies and
2:50
knowing how to access and apply them. That's
2:52
key. It's about having a structured approach
2:55
really to integrating new knowledge. That gives
2:57
us a fantastic roadmap for this deep dive. Let's
3:01
jump straight into the first major area then.
3:04
The innovations in treatment itself and the technology
3:07
that's driving so much of it. Looking at the
3:10
sources, especially those insights from Dr. Purskura,
3:13
there seems a clear focus on the evolution of
3:15
surgical techniques. Yes, that's right. Dr. Purskura
3:19
specifically highlights the, well, significant
3:22
increase in hip arthroscopy over the last 15
3:25
years or so. It's now performed far more frequently
3:28
than it used to be, though it arguably remains
3:31
the most technically demanding arthroscopic procedure.
3:34
Why is that? Mainly due to the complex anatomy
3:39
and the very limited space compared to, say,
3:42
the knee or the shoulder. It needs very specific,
3:45
often custom -made tools. Right. And his perceptive
3:47
on the core philosophy seems really important
3:49
here too, doesn't it? This whole idea of repairing
3:51
versus replacing. Absolutely. He argues that
3:53
the future of orthopedic surgery, particularly
3:55
with arthroscopy, is increasingly about repairing
3:58
damaged structures rather than just replacing
4:00
them. Trying to preserve what's there. Exactly.
4:04
The goal is to preserve as much of the native
4:06
tissue and function as possible. But, and this
4:09
is the key part, this requires very precise,
4:12
very efficient techniques. You need to identify
4:15
and address lesions quickly. Before it's too
4:17
late. Before they become irreparable, yes. Or
4:20
perhaps require much more complex reconstruction
4:23
down the line. And that's where the technology
4:24
slots in, right? This need for precision seems
4:28
perfectly aligned with what robotics can offer.
4:31
Exactly right. Robotic -assisted surgery is becoming
4:33
a more mainstream tool precisely because it can
4:37
enhance that precision. Especially, as I said,
4:40
in those technically difficult areas like deep
4:42
inside the hip joint. Sources suggest it's helping
4:44
surgeons perform maneuvers with greater control
4:46
in tight spaces. And some even project we could
4:49
become a standard approach in certain procedures.
4:52
Interesting. And beyond robotics, we also see
4:54
AI mentioned as a potential partner in things
4:56
like patient safety, improving precision in surgical
4:59
planning that comes up in sources like the Campbell
5:02
Clinic material. But even before you get anywhere
5:04
near the operating room, diagnostic technology
5:06
is just fundamental, isn't it? It absolutely
5:09
is. The array of imaging modalities got x -rays,
5:12
ultrasound, CT, scintigraphy, PETCT, and especially
5:16
MRI. The gold standard? Well, it's often considered
5:19
the gold standard for detailed soft tissue and
5:21
cartilage evaluation in joints like the hip and
5:24
knee. They're all essential tools. And Dr. Prisgur
5:27
makes a really crucial distinction here, doesn't
5:29
he? Emphasizing that imaging supports the diagnosis.
5:33
but doesn't make it on its own. This is such
5:35
a critical point for practitioners. The diagnosis
5:38
is made by the specialist. It integrates the
5:41
clinical findings, the patient's history, their
5:44
symptoms, the physical examination with the imaging
5:47
results. Right. You're treating a patient, you
5:49
see, not just an image report. The imaging provides
5:51
vital information for the specialist's decision
5:54
making process, but that clinical context is
5:57
paramount. And having access to that detailed
5:59
imaging data isn't just helpful for the surgeon.
6:02
The sources call it vital for surgical planning.
6:05
Why such a strong emphasis on that? Oh, it's
6:07
crucial. Because having direct access to the
6:10
imaging scans themselves, not just the written
6:12
report, allows the surgeon to meticulously plan
6:15
the procedure. They can visualize the specific
6:18
anatomy, identify potential challenges, anticipate
6:21
maybe unexpected lesions, and mentally rehearse
6:25
the steps involved. Digital access streamlines
6:28
all of this. Makes it quicker. Much quicker to
6:30
review. And even to share complex cases for colleague
6:33
consultation. Ultimately, it should lead to more
6:36
predictable and potentially safer surgical outcomes.
6:39
It sounds absolutely vital for orthopedic surgeons
6:42
to have that direct digital access to the detailed
6:45
imaging. It goes way beyond diagnosis, doesn't
6:48
it? It's the cornerstone of precise surgical
6:50
planning, helping anticipate complications, tailor
6:53
approaches, better results in the operating room.
6:55
That preparation phase, which is deeply informed
6:57
by imaging, is simply indispensable for complex
7:00
modern orthopedic surgery. It really is. We also
7:03
saw mentions of technology extending out into
7:05
the rehabilitation phase as well. Yes, that's
7:07
right. Sources like the Campbell Clinic Interview
7:10
discuss integrating tools like wearables, for
7:12
example, for monitoring patient progress or using
7:16
modalities like shockwave therapy and physical
7:18
therapy to help aid recovery. So it's not just
7:21
pre -op and intra -op. No, technology's role
7:24
doesn't stop at the operating theater door. And
7:26
speaking of evaluation, the JAMA sources really
7:29
highlight how research is constantly evaluating
7:32
different treatment approaches, doesn't it? Often
7:34
comparing new methods or technologies against
7:37
the established ones? Precisely. You see studies
7:40
comparing outcomes for things like casting versus
7:42
surgical intervention for pediatric fractures,
7:44
for instance, or operative versus non -operative
7:47
management for conditions like adult lumbar scoliosis
7:50
or humeral shaft fractures. Right. This research
7:53
is constantly refining our understanding of when
7:55
to intervene surgically, and perhaps when alternative
7:58
approaches may be more appropriate. And this
8:00
evidence feeds directly back into practice. That
8:02
transition is smooth, actually, because it brings
8:05
us very nicely to the second major area we wanted
8:08
to cover, the frameworks that guide practice
8:10
and those broader factors influencing patient
8:12
outcomes. So if research tells us what might
8:16
work, how do practitioners navigate all that?
8:19
How do they determine the best approach for a
8:21
specific patient? I suppose that's where clinical
8:23
practice guidelines come in. Exactly. Organizations
8:25
like the AAOS play a absolutely crucial role
8:28
here. They develop these evidence -based clinical
8:31
practice guidelines or CPGs. Right. They essentially
8:33
distill the best available research into actionable
8:36
recommendations for diagnosis, for treatment,
8:39
for post -operative care across a vast range
8:42
of orthopedic conditions. And looking at the
8:44
source material, these guidelines seem to cover
8:46
a huge spectrum. From common upper extremity
8:48
issues like carpal tunnel, rotator cuff injuries,
8:51
to lower extremity problems like ACL tears and
8:54
osteoarthritis, specific pediatric conditions
8:57
like hip dysplasia, critical areas like managing
8:59
infections or pain after trauma, it's broad.
9:02
The breadth is really significant. And as you
9:05
noted right at the start, these weren't static
9:07
documents. They're constantly evolving. Yeah,
9:09
the 2024 updates. Exactly. The fact that key
9:13
guidelines were updated just this year really
9:15
underscores the dynamic nature of the field.
9:18
And resources like the OrthoGuidelines app make
9:20
accessing this vital, up -to -date information
9:23
readily available to practitioners, often right
9:26
at the point of care. And they also produce other
9:28
tools, don't they? Like appropriate use criteria
9:31
and performance measures. What are those about?
9:33
Yes, those derivative tools help apply the evidence
9:36
-based recommendations to specific clinical scenarios.
9:40
And they also help evaluate how well care actually
9:43
aligns with best practices. For quality improvement.
9:46
Precisely. It's also worth noting the AOS endorses
9:49
guidelines from other specialty societies, too,
9:51
after a pretty rigorous review process. Yeah.
9:53
So that expands the pool of trusted resources
9:55
available. Okay. Shifting focus a bit now from
9:58
the guidelines themselves to the patient. The
10:00
sources place a lot of emphasis on factors beyond
10:02
the operating room that impact outcomes. What
10:04
really stands out there? Well, preoperative optimization
10:07
is a recurring theme as we mentioned earlier.
10:10
Ensuring patients are in the best possible health
10:12
before surgery. That's key to minimize risks
10:15
and improve recovery. So managing comorbidities,
10:19
nutrition? Yes, all of that. Managing comorbidities,
10:22
nutritional status, and importantly, addressing
10:24
psychosocial factors. Things like anxiety, depression,
10:28
or maybe a lack of social support. They can make
10:30
a difference. Oh, they can significantly influence
10:32
pain perception, adherence to rehab programs,
10:35
and overall satisfaction after surgery. This
10:38
is highlighted in some of the trauma -related
10:40
guidelines particularly. And alongside that preparation
10:43
piece is pain management. Especially, I suppose,
10:46
given the broader context of the opioid crisis.
10:49
This is a really critical area of evolution right
10:52
now. The trend is strongly towards multimodal
10:55
pain management strategies. Meaning using lots
10:57
of different things. Yes, using a combination
10:59
of approaches. Regional nerve blocks, non -opioid
11:02
analgesics like NSAIDs or paracetamol, other
11:05
adjunctive medications, often all packaged within
11:08
enhanced recovery after surgery protocols or
11:10
ERS protocols. Right, ERS. The goal is to effectively
11:13
manage pain. while drastically reducing, or ideally,
11:17
even eliminating the need for opioids, which
11:21
aligns perfectly with concerns highlighted by
11:23
sources like the NAO material referencing CDC
11:26
data on opioid overdoses. We also saw some insights
11:29
into more systemic issues that impact orthopedic
11:32
care access and delivery. Yes, the comparison
11:34
mentioned regarding hip and knee replacement
11:37
volumes and particularly waiting times for free
11:39
prostheses between different countries. Romania
11:42
and Sweden were mentioned. There were examples
11:44
cited. Yes, it vividly illustrates how factors
11:47
like healthcare funding models, public trust
11:49
in the system, how they can create significant
11:52
disparities in patient access to necessary, often
11:55
life -changing procedures. And this links, I
11:58
suppose, to the point made about patient reluctance
12:00
towards surgery sometimes. Indeed it does. Part
12:03
of the professional's role, informed by these
12:05
broader insights, is effective patient education.
12:08
helping individuals understand the potential
12:10
benefits of procedures like joint replacement
12:12
for improving their quality of life, addressing
12:14
fears, addressing misconceptions, building trust
12:17
in the process, basically overcoming reluctance
12:20
that might be driven by fear or perhaps just
12:24
a lack of information. And finally, the sources
12:26
also touch on the evolving roles within orthopedics
12:29
itself and the crucial issue of health disparities.
12:32
Yes, health disparities particularly racial and
12:35
socioeconomic disparities, in access to care
12:38
and outcomes for procedures like joint replacement.
12:42
They're increasingly being scrutinized. You see
12:44
research published in journals like JANA discussed
12:46
the neon sources, there's a growing recognition
12:49
of the impact of what we call social determinants
12:52
of health, things like education level, income,
12:55
geographic location, cultural factors, how they
12:57
impact musculoskeletal health, and access to
13:00
timely, effective care. And we're seeing expanded
13:02
roles for other members of the orthopedic care
13:04
team too. Absolutely. The roles of orthopedic
13:07
nurses and nurse practitioners, for example,
13:08
are expanding significantly. Sources point to
13:11
their increasing involvement in areas like outpatient
13:13
sports medicine clinics, primary care settings,
13:16
managing musculoskeletal issues. Patient navigation
13:18
too. And crucial roles in patient navigation
13:21
throughout the entire surgical journey, yes.
13:24
Their continuous professional development and
13:26
certification are highlighted as really key factors
13:29
in driving quality improvement and enhancing
13:31
the overall patient experience. It feels like
13:34
optimal outcomes in orthopedics are clearly so
13:38
multifaceted. It depends heavily on practitioners
13:40
leveraging evidence -based guidelines like those
13:43
AAOS CPGs, implementing effective multimodal
13:46
pain management, and, crucially, actively addressing
13:50
patient -specific factors, psychosocial needs,
13:53
and the impact of health disparities and social
13:55
determinants of health. It's a much more holistic
13:58
view of patient care, isn't it? Recognizing that
14:00
the best surgery is really only one piece of
14:03
a very complex puzzle. That gives us a really
14:05
comprehensive picture. Let's do a quick lightning
14:07
round now, drawing from the sources we've discussed.
14:10
What's one quick win for improving the patient
14:12
experience, either pre or post surgery? That
14:14
came through clearly. Preoperative patient optimization,
14:17
definitely. And effective multimodal pain management
14:19
using those ERAS protocols. They're probably
14:21
the fastest, most impactful interventions. Okay.
14:24
A surprising finding from recent ortho - research
14:27
that was mentioned. Well, the exploration into
14:29
how weight loss medications might influence revision
14:31
risk after joint replacement, that's certainly
14:34
a novel area of research highlighted. And studies
14:37
on implicit bias in care delivery are also revealing
14:40
some important insights. Right. One non -surgical
14:43
factor that's increasingly crucial for orthopedic
14:46
recovery. Psychosocial readiness, I'd say, and
14:49
robust, consistent physical therapy. They're
14:52
absolutely vital non -surgical components for
14:54
success. And a key digital resource mentioned
14:57
for orthopedic professionals. The AAOS OrthoGuidelines
15:01
app. It provides direct, portable access to those
15:04
evidence -based guidelines. Quick and insightful.
15:06
Right, let's wrap up by distilling this deep
15:08
dive into just a few key takeaways for you, the
15:11
listener. OK. First, modern orthopedic practice
15:14
is increasingly intertwined with technology.
15:17
Robotic assistance enhances surgical precision,
15:19
advanced imaging is vital for planning, and AI
15:22
is beginning to support aspects of care, particularly
15:24
around patient safety. Second, staying current
15:27
with evidence -based resources is really non
15:29
-negotiable. Clinical practice guidelines from
15:32
organizations like the AAOS are essential tools
15:35
for navigating treatment decisions across diverse
15:37
conditions. And resources like the OrthoGuidelines
15:40
app make them accessible. Third, achieving the
15:43
best possible outcomes involves a focus that
15:46
extends well beyond the procedure itself. Preoperative
15:49
patient optimization comprehensive multimodal
15:53
pain management strategies, dedicated physical
15:56
therapy, and addressing psychosocial factors
15:58
and social determinants of health. They're all
16:01
critical components. Fourth, the field is continuously
16:04
evolving, driven by research published in journals
16:07
like JAMA and ORS, exploring everything from
16:10
managing complications and refining recovery
16:12
techniques to evaluating treatment effectiveness
16:14
and actively working to understand and reduce
16:17
health disparities. And finally, the roles of
16:20
orthopedic nurses and allied health professionals
16:22
are expanding significantly. They're contributing
16:24
expertise in areas from outpatient care and patient
16:27
navigation right through to driving quality improvement
16:30
initiatives alongside surgeons. That paints a
16:32
really clear picture of a dynamic and forward
16:35
-thinking field. If you found this deep dive
16:37
valuable, please do consider rating and sharing
16:39
the show. It really helps other professionals
16:41
discover us. Ultimately, I think the sources
16:43
reveal an orthopedic landscape that's just relentlessly
16:47
pursuing better ways to restore mobility, alleviate
16:50
pain, and enhance lives. It's a field that's
16:53
constantly learning, integrating new technologies
16:56
and insights, and expanding its understanding
16:58
of what truly contributes to a patient's successful
17:00
outcome. Given all we've discussed today, what
17:03
specific area of orthopedics do you think is
17:06
poised for the most significant transformation
17:08
in the coming years? That's definitely a question
17:10
worth pondering. Thank you for joining us for
17:12
this deep dive into the cutting edge of orthopedics.