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The integration of digital ecosystems into orthopedic care is transforming how surgery is performed with navigation systems, preoperative planning platforms and surgical robots. By leveraging vast amounts of data, these technologies enable surgeons to evaluate the risks and benefits of different treatment options and personalize surgeries to meet the needs of individual patients.
For joint replacement surgeons, digital ecosystems and predictive models facilitate personalized implant selection and alignment based on each patient’s clinical profile and functional goals. Spine surgeons benefit from 3D-planning software that identifies optimal locations to place pedicle screws and implants.
Digital platforms are also connecting orthopedic patients with care providers before and after surgery, leading to improved adherence to treatment plans. As these tools evolve into the standard of care, there’s a growing sense that orthopedic and spine companies that don’t develop digital tools and ecosystems will fall behind the competition.
It’s all part of orthopedic surgery’s continuing evolution that promises to make optimal patient outcomes more predictable and possible.
More Than Navigation
Proprio develops immersive, intelligent technologies to help surgeons practice, perform and perfect spine surgeries. The company’s Paradigm navigation system utilizes “Volumetric Intelligence” to enhance surgical performance by providing a 3D view of anatomy and the surgical space without exposing patients to harmful radiation. Paradigm can collect a high volume of data with approximately 250GB of information captured per hour.
According to Neeraj Mainkar, Ph.D., Vice President of Software Engineering and Advanced Technology at Proprio, artificial intelligence (AI) and machine learning (ML) are central to analyzing real-world data to segment vertebrae during spine surgery.
“We provide surgeons with the ability to separately track and register each vertebra,” Dr. Mainkar said. “Our devices, which are essentially 3D imaging cameras with RGB depth, operate without ionizing radiation, meaning they can remain on during the entire surgery.”
While Paradigm assists spine surgeons in real time, the technology’s data-collection capabilities serve a dual purpose. “The platform records the entire surgery, resulting in invaluable surgical video data that we’re cataloging,” Dr. Mainkar explained. “We’re developing applications for surgical guidance and decision support during surgery, as well as for predictive analytics.”
Predictive analytics applied to preoperative planning for spinal surgery can transform a patient’s unique anatomical and demographic data into accurate and actionable outcome predictions. According to Dr. Mainkar, the biggest challenge in further developing AI and ML technologies for this application is the lack of access to sufficient clinical data. While some types of medical information are relatively inexpensive and straightforward to collect, capturing intraoperative data is costly and complex.
“Deep learning requires massive amounts of training data,” Dr. Mainkar said. “One of our key challenges is figuring out how to multiply the number of surgical videos we have or how to take a six-hour video and convert it into multiple instances of data to extract more insights from a limited dataset.”
Keeping Patients Informed and Engaged
Force Therapeutics is focused on transforming patient data into useful surgical insights. Bronwyn Spira, the company’s CEO, co-founded the company in 2010 to help accelerate patient recovery through digital connectivity.
The company’s digital health platform offers personalized care plans that include instructional and educational video content, outcomes data collection and remote patient monitoring. The goal is to improve patient engagement and workflow optimization for episode-based orthopedic care.
“Our platform enables care teams to utilize evidence-based care pathways for any orthopedic procedure, guiding patients through each step of the pre-op, post-op and rehab journey,” Spira said. “The platform automates routine touchpoints to gather actionable patient data, enabling providers to monitor and interact with their patients.”
By engaging patients in their care early on, providers can better understand patients’ goals and adapt care plans accordingly, Spira explained.
She added that shared decision-making between providers and patients is a critical step in setting appropriate preoperative expectations and driving better clinical outcomes.
About 800,000 patients have undergone surgery or rehab using the Force platform. Spira estimates that the program collects “billions” of data points from surgical procedures and rehabilitation activities, which are translated into evidence-based best practices and shared with the orthopedic community.
“Our machine learning algorithms have been rigorously tested and refined over the past decade, enabling us to guide providers in optimizing patient care based on a patient’s social determinants of health, clinical presentation and medical history,” Spira said.
As payors push providers and health systems to achieve better outcomes with fewer resources, innovating every aspect of a surgical episode is becoming increasingly crucial. For elective procedures, this begins with optimizing the patient preoperatively so they are prepared for surgery and their discharge plan before the procedure takes place.
“Surgery centers and hospitals need to consider the efficient use of operating rooms and the costs of implants and robotics,” Spira said. “However, the post-acute phase of care might be the most challenging to manage, as navigating the patient journey outside brick-and-mortar locations and controlling the associated costs become increasingly complex. Creating scalable operational infrastructure to manage post-op care requires digital solutions that can reach and monitor patients wherever they are.”
Spira noted the importance of keeping patients connected with care experts to ensure they are adequately prepared for surgery and safe discharge as more orthopedic patients seek services outside traditional hospital settings.
“Prescriptive, customizable technology offers patients the education, information and resources they need to prepare for surgery and recover safely,” she said. “For instance, 95% of patients using Force have reported feeling prepared for surgery. As a result, we’ve seen a more than 25% reduction in cancellations and a 20% decrease in post-op length of stay.”
Spira explained that patients undergoing joint replacement procedures are now prepared to go home within hours of surgery. “It has become critical to maintain a digital connection with patients and their loved ones as they navigate their recovery journey at home,” Spira said.
She identified a key obstacle to the wider adoption of digital healthcare platforms: misconceptions about which patients are best suited to use the technology successfully. She noted that many orthopedic providers still believe that older patients will not engage with digital technology, a misnomer that creates a barrier to the use of effective solutions.
Spira also pointed to the immense importance of collecting high-quality clinical data in the development of digital platforms that drive surgical decision-making.
“Data remains heavily siloed across healthcare, and orthopedics is no exception,” she said. “Differing workflows and data structures across health systems make analyzing global trends increasingly challenging without complex and often fragile data cleansing, transformation and normalization.”
Zimmer Biomet’s ROSA robotic systems capture intraoperative data that could help to inform the future of orthopedic care.
Identifying Important Clinical Trends
Nitin Goyal, M.D., Chief Science, Technology and Innovation Officer at Zimmer Biomet, said the growing orthopedic digital toolbox is most effective if clinical data is fed into a single system.
“By seamlessly integrating data from preoperative monitoring and planning tools, intraoperative robotic systems and postoperative monitoring devices, a more cohesive and informed patient care journey can be created,” he said. “By having data at every stage of the care journey, surgeons can better plan procedures, monitor progress and adjust treatment as needed.”
Clinical data has been used to understand and improve the ways surgeries are performed, but Dr. Goyal said this information has often been limited to subjective patient-reported outcomes with low capture rates or limited in-office clinical variables.
“These data have proven valuable but are not able to provide a holistic view,” Dr. Goyal said. “The integration of clinical data capture using smart technologies collects real-world, free-living information.”
He also said that the intraoperative data that’s being collected through robotic systems can further the understanding of the effect of surgeon decision making has on postoperative outcomes.
Zimmer Biomet has created digital solutions that enable surgeons to use pre-, intra- and postoperative data to guide patient care and gain insights into the patient’s surgical journey. The company’s mymobility Care Management Platform sends procedure-specific and surgeon-driven education and exercise instructions to patients’ personal devices before and after surgery.
The company’s Persona IQ Smart Knee implant provides objective kinematic metrics from inside the patient. Patient-specific data like joint range of motion, qualified step count, walking speed and stride length are pulled into a “recovery curve” that compares that patient against a benchmark of similar cases in Zimmer Biomet’s Care Management platform.
“Enhanced patient engagement through mobile applications and wearables allows patients to track their progress and provide feedback, which can be used by surgeons to tailor treatment plans that align with the patient’s preferences and comfort,” Dr. Goyal said.
Zimmer Biomet has partnered with Surgical Planning Associates on an exclusive agreement to co-market the HipInsight System. This augmented reality platform allows surgeons to visualize anatomy, instruments and implants inside the patient’s body in real time to improve acetabular component placement and alignment during hip replacement surgery.
“During surgery, intraoperative data provide surgeons with crucial information, offering precise guidance on implant balancing,” Dr. Goyal said. “The integration of this information helps surgeons make immediate adjustments.”
According to Dr. Goyal, the increased adoption and understanding of AI and ML are expected to drive several innovations in data integration that could significantly transform orthopedic care.
Additionally, Dr. Goyal believes integrating advanced imaging and 3D modeling technologies with AI could allow for more precise surgical planning and execution. “Surgeons may be able to create detailed, patient-specific models that guide them through complex procedures to improve accuracy and outcomes,” he said.
Data analytics have always played a critical role in the evolution of orthopedic devices, according to Dr. Goyal, who said designing the next generation of smart implants with enhanced long-term data integration will be an important step in tracking how a patient is recovering long after a procedure is completed.
“Advanced data analytics and machine learning algorithms can process vast amounts of patient-specific data from smart technologies, which can help inform the design or functionality of subsequent generations of implants,” he said. “Continuous data collection and analysis that create feedback loops should continue to improve future designs, ensuring that each generation of smart implants is better than the previous one.”
Dr. Goyal also pointed out that data analysis could identify patterns and trends that predict potential complications related to implant designs in association with patient characteristics, morphology and activity levels. He said implant designers could modify implants to mitigate these risks, which could lead to safer, more reliable devices and more personalized care options.
Overcoming the Obstacles
Integrating data from various digital platforms in orthopedic care presents numerous challenges arising from the diversity of data sources, the need for regulatory compliance and the complexity of healthcare data.
“Data interoperability can be a significant barrier, as different platforms and devices often use varied formats, standards and protocols,” Dr. Goyal said. “This inconsistency can prevent the smooth integration of data. Addressing this challenge requires the adoption of standardized data formats and protocols across all platforms.”
Data privacy and security is another critical challenge, Dr. Goyal noted. “With the increasing amount of sensitive patient data being collected and shared across platforms, ensuring data protection is paramount,” he said.
Dr. Goyal recommends implementing advanced encryption methods and ensuring compliance with regulatory requirements through Business Associates Agreements (BAA) and Data Protection Agreements (DPA). He also said robust access controls and continuous monitoring for potential security breaches are essential to maintain data integrity and patient trust.
Data complexity is another challenge orthopedic companies face. “The integration of vast amounts of data from various sources requires sophisticated analytics and machine learning tools to derive actionable insights,” Dr. Goyal said. “It’s essential to invest in data scientists and software engineers who can design and manage advanced analytics platforms to handle large datasets and provide real-time decision support. Continuous training and support for healthcare professionals in using these tools are also crucial to maximize the benefits of integrated data systems.”
Dr. Goyal believes that overcoming these challenges will allow orthopedic teams to leverage data to enhance their understanding of individual patients through more informed and personalized decision making. “Successfully tackling these hurdles will enable a more efficient, secure and holistic approach to patient care,” he said.
