'Continuing the upward trajectory': What total joint replacement will look like in 10 years

Carly Behm -  

Technology will play a major role in advancing total joint replacements over the next decade, four orthopedic surgeons predict.

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: What area of regenerative medicine holds the biggest promise for orthopedics?

Please send responses to Carly Behm at cbehm@beckershealthcare.com by 5 p.m. CDT Wednesday, June 29.

Editor's note: Responses were lightly edited for clarity and length.

Question: How do you see total joint replacements developing over the next 10 years?

Anthony Melillo, MD. Bay Oaks Orthopaedics & Sports Medicine (Houston): I see joint replacement surgery continuing the upward trajectory. This is due to several factors, including childhood and young adult obesity, increased longevity and greater demand for active senior lifestyles.

Tomorrow's total joint replacements will be performed via robotic assistance like today's Stryker Mako robot, which I currently use. This provides less pain, less blood loss, improved component alignment and longer implant integrity.

The reimbursements of these important procedures will be reduced due to governmental and commercial insurance pressures to save money and/or increase corporate profits. The patients will continue to request these life-improving surgeries since exercise and locomotion are keys to a healthier life and longevity.

More and more of these procedures will be performed as an outpatient or "observation" status so that payers can justify lower reimbursements, even though it takes good clinical judgment and advanced surgical skills to improve outcomes and patients' satisfaction.

Scott Sigman, MD. OrthoLazer Orthopedic Laser Centers (Rochester, N.Y.): Robotics and navigation are proliferating within arthroplasty. All major medical device companies have now developed systems with a push to ASCs. The question is: Will patient reported-outcomes and survivorship of prosthesis improve with the use of these systems? The most recent data is pointing in that direction. Augmented reality and advanced technology is finally making its way into the operating room. The increased cost of technology must demonstrate improvement in outcomes to justify the expense.

Jason Weisstein, MD. Cleveland Clinic (Stuart, Fla.): With the rapid pace of today's technological advances, joint replacement will see the introduction of smart implants that will be able to monitor the cellular environment for infection or early signs of loosening. Joint replacement will also continue to evolve with improved pain control and increased utilization of outpatient-centered surgery protocols.

Christopher Baker, MD. Florida Orthopaedic Institute (Tampa): Although more than 90 percent of people who have received a total joint replacement such as a traditional total shoulder replacement or reverse shoulder arthroplasty experience a significant reduction in pain, we continue to strive to re-create normal anatomy and function as well as preserve native bone by continually improving implant designs. Patients with glenohumeral osteoarthritis are also being identified at younger ages and are unwilling to reduce their demanding work and leisure activities after failing conservative interventions. These patients are turning to joint preservation procedures, which re-create the native shape of the joint and remove minimal bone, such as Anika’s OVOMotion with Inlay Glenoid total shoulder arthroplasty system. Over the next 10 years, minimally invasive orthopedic procedures maintaining normal anatomy will continue to grow in popularity among surgeons and patients alike.

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