Knee replacement surgery is one of the fastest-growing procedures in recent years. While total knee surgery is successful and quite common, nearly 20% of patients are dissatisfied with their results after total knee surgery.
In the past few years, there have been incredible advancements in the field of orthopedics aimed at improving:
- clinical outcomes
- patient satisfaction and engagement levels
- surgical planning, and
- efficiencies in knee arthroplasty
Here's our roundup of the latest technologies transforming knee surgery:
1. Intelligent AI-Powered Preoperative Planning
"Make time for planning. Wars are won in the general's tent." – Stephen Covey
Preoperative planning is one of the most significant steps impacting total knee surgery. This is especially true now due to the trend towards outpatient and Ambulatory Surgical Center (ASC) TKA[CB1] .
With artificial intelligence (AI), surgeons can drive efficiencies in the patient selection and templating process and help improve post-TKA patient satisfaction.
AI for Patient Selection
Identifying the right patients for TKA surgery can make planning for orthopedic surgery more efficient. But preop patient evaluations also help the healthcare team identify and address comorbidities and any other issues that might impact how a patient may feel post-surgery.
For instance, people with lower back pain before surgery may experience greater challenges post-TKA. Individuals with mild osteoarthritis (OA) who undergo TKA surgery have different expectations and recovery levels post-TKA. Preoperative depression and anxiety are risk factors for severe postoperative pain. Patients with a mental disability may also have other comorbidities resulting in social isolation – which significantly impacts their satisfaction levels post-surgery.
With detailed pre-TKA patient data, surgeons and surgical teams can counsel patients about their expectations. Post-TKA rehab and support can be personalized based on their needs when appropriate. For example, if someone has back pain before their TKA, this can be factored into their rehab and physiotherapy.
AI can generate comprehensive preop surgical plans automatically for surgeons to review and approve. AI algorithms also iteratively learn and will keep a surgeon's preferences and preferred techniques in mind.
This type of technology can save surgical teams a lot of time and effort spent gathering and putting together reports, scans, and notes for each patient. As orthopedic preoperative planning AI gets more sophisticated in the future, it can also predict and recommend personalized post-surgical rehab and post-surgical protocols that may help patient recovery from surgery.
AI for Templating and Intelligent sizing
An orthopedics industry veteran, Chris Harber, states, "Today, tools are available to create 3D virtual models of the patient's anatomy. This allows for a clear picture of what is actually occurring with the patient's anatomy."
With a comprehensive preop planning software solution, orthopedic surgeons and medical device companies can auto-generate 3D anatomic models from 2D scans. These AI-generated 3D anatomic models can offer great insight into patients' joint anatomies that surgeons and medical device companies did not have before. Surgeons can plan more accurately and efficiently for each of their cases without adding unnecessary time to the process.
2. Patient-Specific and 3D-Printed Implants
Patient-specific instruments and 3D-printed custom implants have changed the landscape of preoperative planning for orthopedic surgery:
- Patients get personalized implants made for their specific joint anatomy
- Surgeons get more effective instrumentation and intraoperative guidance for implant placement and positioning
- Medical device companies can improve their service levels and lower costs related to kitting, sterilization, and logistics for orthopedic implants and instrumentation.
But the patient-specific and 3D-printing processes add time to the entire planning process due to multiple back-and-forth communication between surgical teams and medical device companies to adjust implant sizing and positioning.
AI can generate anatomic models faster and automatically size and position implants in 3D. The approval process will be more efficient, and manufacturers can produce and deliver the right implants and instruments cost-effectively while improving their quality of service. An added advantage of intelligent AI-based sizing is that the algorithm learns on the job. With each case, the AI gets better at predicting a surgical team's preferences and auto-adjusts.
3. Robot-Assisted and Computer-Assisted Surgery
The robot-assisted knee reconstruction surgery market is booming and is expected to hit 700,000 procedures globally by 2030 (GlobalData Analysis, June 2021).
Robot-assisted total knee arthroplasty (RA-TKA) can offer greater precision in implant positioning and placement – both significant factors affecting clinical outcomes. As with all emerging technologies, studies are currently short-term, but the technology shows great potential. For example:
- Agarwal et al. discovered that RA-TKA could result in more accurate postoperative implant alignment.
- A meta-analysis of 18 studies by Onggo et al. reported that robot-assisted TKA led to more precise implant placement with significantly fewer outliers. They found that RA-TKA also had a lower mean blood loss than conventional TKA.
But since robot-assisted surgery is in its relative infancy, there are still challenges to overcome. These include longer intraoperative surgical time due to a higher learning curve. Introducing robots into surgery disrupts existing surgical workflows. The robots will also have to be integrated with other existing software and technology. Many implant manufacturers also offer their robots licensed to work with their brand of implants. A hospital or ASC introducing a robot into surgery may have to factor in the learning curve for their surgical teams to get comfortable with new sets of instruments and implants. Also, short-term data demonstrates that today's robots do not significantly improve patient outcomes, so some hospitals and ASCs hesitate before investing in them.
But as new-generation surgical robots enter the market, these challenges will be overcome. Soon, robots that seamlessly integrate into the entire surgical process will be in demand. These robots will be smaller, faster, lighter, more dexterous, and more importantly – intelligent. These robots will harness the power of AI and automatically import and "understand" AI-generated surgical plans for each case. This type of integrated intelligent surgical robot will be the most beneficial for surgeons to gain greater access to the surgical site and intraoperative precision.
4. Augmented Reality (AR) for Knee Surgery
Augmented Reality (AR) has entered the world of orthopedics. Using AR, surgeons can intraoperatively superimpose patient scans and preoperative planning on the surgical site. With effective AI, surgeons will no longer have to spend half their time in surgery looking at a navigational console and adapting it to their bone cuts. The rest of the OR team can see exactly what the orthopedic surgeon sees in real-time and prepare for the next few steps ahead of time.
AR can help surgeons balance a patient's ligaments more accurately and reduce intraoperative time – particularly for a TKA procedure. Using AR, instructors can leverage high-resolution simulation training to enhance training for surgical residents and experienced surgeons.
5. Digital Wearables and Smartphone-based Post-operative Care
Recently, a 2021 Mark Coventry Award-winning article published in the Bone & Joint Journal demonstrated that smartwatches could enhance postoperative patient care. The study showed that smartwatch and smartphone-based care management after primary total knee arthroplasty offers similar clinical outcomes as the traditional process but with added benefits. The patients studied needed significantly less postoperative physiotherapy, and there were fewer visits to an emergency room. The authors state that a smartphone-based care platform can decrease postoperative costs and improve patient engagement.
Digital wearables are any technology that can be easily worn by patients or incorporated into their clothing. In orthopedics, care teams can use smartwatches and fitness trackers to monitor high-risk patients. Additionally, rehabilitation facilities can use them to send reminders, motivate, and improve adherence to post-surgical rehab guidelines. This technology is now in its nascent stage, and its use post-surgery is still being debated and refined.
While a ton of data is being generated, how do surgical teams use it to improve patient outcomes and satisfaction? How can postoperative data from digital health wearables help us refine preoperative and intraoperative processes?
Smartwatches, health tracker apps and sensors, and wearable technology are getting more sophisticated and accurate over time. With each advancement, they may help improve surgeon and patient satisfaction.