Preoperative Planning for Total Hip Arthroplasty in ASCs

Preoperative Planning for Total Hip Arthroplasty in ASCs:
Improving Accuracy, Efficiency, and Patient Satisfaction

Ambulatory Surgery Centers (ASCs) are changing the face of orthopedic procedures. THA surgeries in an ASC setting have been successful with low reoperation rates, readmission rates, infection rates, and patient satisfaction scores as high as 99%. For now, slightly more than 500 ASCs in the United States offer total joint replacement surgeries as outpatient procedures. But that number is rapidly increasing.  

Options for patients are on the rise, a patient who is anticipating total hip replacement surgery has a growing list of ASC options. ASCs are looking to technology to help streamline the surgical planning process. In particular, ASCs can improve preoperative planning for total hip arthroplasties and total knee arthroplasties to keep up with demand. 

Technologies like Artificial Intelligence (AI), 3D-printed implants and instruments, and Augmented Reality (AR) can help ASCs maintain good patient outcomes and a high level of patient satisfaction cost-effectively. 

I. Artificial Intelligence-based intelligent surgical workflow

AI is helping hospitals and surgeons radically improve their preoperative planning. 

AI can: 

1. Improve preop clinical decision making for post-op care

The Hospital for Special Surgery (HSS) in NYC used AI to help surgeons preoperatively determine which individuals will get the most benefit from surgery. 

2. Increase efficiency in Computer-Assisted (CAS) and Robot-Assisted surgeries

AI can help generate accurate preop plans - and get them right the first time.

Due to patient demand and potential for greater intraoperative accuracy, many hospitals are beginning to invest in Computer-Assisted surgeries (CAS) and Robot-Assisted surgeries. 

However, while they bring many benefits to the intraoperative and postoperative surgical process, they can extend preop planning time. Manufacturers offer their preop plans, which may often need revisions – this can add several minutes to each case. Even ten minutes extra per case in an ASC setting adds up and prevents one or more cases from being scheduled each day. 

3. Optimize 3D modeling and templating for patient-specific implants and instruments

AI can provide intelligent sizing by segmenting medical imaging scans automatically and generating 3D anatomic models with a higher level of accuracy, much faster than an individual can. 

Patient-specific solutions can help improve clinical accuracy of bone cuts, intraoperative surgical time and lower overall inventory and sterilization costs. But this process adds time to preoperative planning. Once a patient gets their total hip replacement Xray, CT, or MRI, manufacturers hire skilled labor to manually create 3D anatomic models of each patient’s anatomy. Implants and related instruments are then sized based on these models. 

This preoperative plan is sent to the surgical team that reviews the plans and often makes revisions. Once the manufacturer makes the revisions, they send the plan back for approval. This back-and-forth can add days, and even weeks, to the preoperative process. AI-driven intelligent sizing can help reduce intraoperative inventory by as much as 75%. 

4. Streamline end-to-end inventory management 

There is greater pressure in an ASC setting to reduce inefficiencies in inventory management. 

ASCs spend the same amount for inventory management, instrument sterilization, implant costs as a hospital setting but with a lower ceiling. 

The average ASC can spend $1.5 Million per year in operating expenses. As more orthopedic surgeries move to an ASC setting, staying on top of overall logistics and costs is crucial. After all, the actual procedure for a THA is the same, whether in a hospital setting or an ASC, with the same implants, instrument kit management, and surgical procedure. Mainly, post-op protocols vary since THAs in ASCs are outpatient procedures. 

But reimbursements in an ASC setting are lower, making it more important to keep an eye on rising costs and process inefficiencies.  

Using the power of machine learning and predictive analytics, device manufacturers can also realize greater cost-efficiencies and optimize their inventory management processes. 

II. 3D-printed implants and instruments 

AI, together with 3D printing technology, is changing the landscape of orthopedic surgery. By combining machine learning and machine vision, 3D printers can create robust and intricate designs tailored to each patient’s anatomy and disease requirements. The AI component is what makes it efficient and more accurate. Without it, device manufacturers would have to manually model and program the 3D printer for each patient’s case.  

AI predictive analytics can automatically figure out the right design and implant fit for patients based on their scans and print it out. 

Hospitals and ASCs are even partnering with device manufacturers to design and print implants on-site to save time and improve efficiency. 

Many orthopedic surgeons envision that with AI-powered 3D printing technology, even complex THA, TKA, and spine procedures can be moved to an ASC setting. 

III. Augmented Reality for Orthopedics

Orthopedic surgeons at New England Baptist Hospital (NEBH) performed the first THA using Augmented Reality on March 31^st, 2021. This AR technology received FDA clearance this year. This means the floodgates for using AR in orthopedics are flung open. 

More hospitals and ASCs will embrace this technology for its benefits. For a THA, surgeons use X-Rays for preoperative planning and, in surgery, have a small window of visual access into a patient’s hip. But with AR, surgeons were able to bring their preoperative planning to life intraoperatively. 

With minimally invasive surgeries, ASCs can improve patient outcomes and satisfaction scores and enable THAs as outpatient procedures. But the smaller incisions make it harder for surgical teams to get a good view inside the surgical exposure. 

AR goggles project a patient-specific hologram that incorporates preoperative planning onto each patient’s anatomy. AR can also guide accurate acetabular cup placement in surgery. Another benefit is that surgeons can focus solely on the patient and do not have to look at a monitor to estimate their next steps during surgery. 

Artificial Intelligence is the disruption Orthopedics Needs Today. Learn why: