What's next for AI, augmented reality in orthopedics?


Six orthopedic surgeons connected with Becker's to discuss what is next for artificial intelligence and augmented reality in the orthopedic industry.

Ask Orthopedic Surgeons is a weekly series of questions posed to surgeons around the country about clinical, business and policy issues affecting orthopedic care. We invite all orthopedic surgeon and specialist responses.

Next question: Inflation hit a record 9.1% last year, which has chipped into physician compensation as well as independent practices' bottom lines. What initiatives has your practice found successful in offsetting the effects of inflation and rising costs?

Please send responses to Riz Hatton at rhatton@beckershealthcare.com by 5 p.m. CDT Thursday, May 18.

Note: Responses have been lightly edited for length and clarity.

Asheesh Bedi, MD. Director of Comprehensive Sports Medicine and Joint Preservation at NorthShore Orthopaedic & Spine Institute (Glenview, Lincolnshire and Skokie, Ill.): The intersection of medical data with artificial intelligence will have a transformative impact on orthopedic care delivery in the years to come. Preoperative risk factors, individual anatomy, intraoperative techniques, and structural and patient reported outcomes will all be brought together as data streams to inform every phase of patient care. AI will help to create data-driven algorithms that will notify our decision-making as clinicians to select the most cost effective intervention with the most reliable and predictable outcome. While we will always have the art of medicine, it will be domain-specific expertise superimposed on a much more enlightened and data-driven approach.

Ehsan Jazini, MD. Spine Surgeon at the Virginia Spine Institute (Reston): As a distinguished spine surgeon with extensive expertise in both innovation and the cutting-edge applications of augmented reality in spine surgery, it is with great pleasure that I present the remarkable strides we have already taken in this field. Our advancements have allowed us to gain precise insights into patients' range of motion, enabling us to enhance motion preservation techniques and employ noninvasive reconstructive surgery for stabilization, thus optimizing patient outcomes. The integration of artificial intelligence has played a pivotal role in achieving safer, faster, and more precise surgical interventions, thereby facilitating accelerated patient recovery.

Looking ahead, a myriad of exciting developments are on the horizon, with one particularly vital area of progress being the utilization of AI in decompressing nerves and protecting the spinal cord — the very foundations of patients' functionality. Through tremendous technological advancements, AI has acquired an impressive capacity to comprehend these delicate soft tissue structures. I am thrilled to share that in our pre-clinical research endeavors, we have made tremendous strides, laying a solid groundwork for further improvements.

By harnessing the potential of augmented reality and embracing the advancements made possible by AI, we are poised to revolutionize spine surgery and significantly enhance patient care.

Philip Louie, MD. Spine Surgeon at Virginia Mason Franciscan Health (Seattle): Improve accessibility and demonstrate outcomes of current applications.

Artificial intelligence and augmented reality have rapidly expanded from a buzzword to an explosion of various applications. Specifically, in the spine world, AI now plays a large role in gathering large amounts of perioperative data and outcomes in hopes of developing patient specific models of care. AR has been a bit slower to enter the field, given the large costs and potential new workflow learning curve associated with this technology. Both have promised incredible abilities to improve the care that we provide to our patients. In fact, some companies utilize AI to gather large amounts of data to provide information that can be fed into AR platforms as surgeons plan for and perform the actual surgery.

Ultimately, like all technologies — we need to start diving into the transparent outcomes and barriers of these technologies. In a cost-constrained healthcare landscape, how do these technologies fall into a value-based algorithm? What are the pitfalls and various complications associated with these technologies? I am certainly a believer in what AI and AR can provide along the perioperative continuum. But, I also recognize that the grass always appears greener on the other side of technology when you don't currently utilize it. In a field full of predictions and ideals, we need to start critically evaluating the outcomes of the early applications of these technologies on patient care and the cost/safety/efficacy of this care.

Nader Nassif, MD. Division Chief of Joint Replacement Surgery at Hoag Orthopedic Institute (Newport Beach, Calif.): As we continue to accumulate more data, artificial intelligence will become much more "intelligent" and will provide significant insights for surgeons. I see a lot of promise in its usage as a decision-support system. In knee replacement, for instance, I can envision a future in which AI may suggest optimal component position and releases that will result in a best outcome, or kinematics for a specific patient. 

I can imagine that augmented reality may be a much more accessible technology that will likely have a larger penetration in the ASC setting. Hopefully, with a reduced cost compared to traditional navigation or robotic systems currently available, and virtually no footprint, AR will be another enabling technology that may help surgeons achieve results that may not currently be achievable with our standard analog instrumentation, for example, using data from AI to place a knee implant.

Arjun Saxena, MD. Adult Hip and Knee Reconstruction Surgeon at Rothman Orthopaedic Institute (Philadelphia): Artificial intelligence is a buzzword in every field right now. I see a future in which we use artificial intelligence to better serve our patients. Advanced triage using artificial intelligence has potential to expedite care and appropriate diagnostic testing and diagnosis for patients. For surgical patients, AI has the potential to select risk and site of surgery based on patient comorbidities and even insurance to provide the lowest cost to the patient. Predictive capabilities may enable accurate implant selection and implant position, decreasing supply chain constraints and improving outcomes. All of these potential functions of AI have the promise to reduce costs and improve outcomes faster. As a field, we need to embrace AI and leverage it for the benefit of our patients.

Augmented reality in surgery may be closer than we think. Utilization of robotic surgery has increased significantly in recent years. Augmented reality is the next step. As hip and knee replacement surgery shifts to ambulatory surgery centers, we will see the number of facilities where these procedures are performed increase exponentially. For each facility to purchase and maintain one or more robotic systems is not feasible from a production or cost standpoint. Augmented reality could allow surgeons to utilize the software for the robotic platforms without having physical equipment in the operating room. Imagine wearing glasses that connect to a centralized robotic platform and then a sensor on your reamer can show you exactly what you are doing for your acetabular component in real time.

Scott Sigman, MD. Founder and Chief Medical Officer of OrthoLazer Orthopedic Laser Centers (Chelmsford, Mass.): AI and AR will have a profound effect on orthopedic education and surgical technique. For example, two weeks ago, Danny Goel was in Vancouver, Canada, Shariff Bishai was in Detroit, and I was in Boston. We met in the metaverse to go through a Conmed rotator cuff module literally in the same virtual operating room while in three different physical locations. The options for surgical education and training are endless. 

I also see AI providing guidance in the operating room. Technology will allow us to combine thousands of surgical videos from orthopedic surgeons to generate standards within an AI platform. With this information, the platform will be able to predict anatomy and improve implant positioning while incorporating imaging such as MRI and generating operative notes of the procedure. 

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