As the 21st century comes of age and the global burden of disease shifts increasingly towards musculoskeletal conditions, orthopaedic surgeons will be called upon to rise to the challenge.
Orthopaedic surgery is on a path towards less invasive and more precise operations, with a greater proportion of outpatient and overnight procedures1. This trajectory is likely to continue and will be further facilitated by new technologies, making surgery more selective and the orthopaedic surgeon an increasingly proactive specialist in the management of injuries and conditions. As the saying goes: “Predictions are difficult, especially about the future.” It would be remiss to presume too much about how orthopaedic surgery will look tomorrow, but there are a few key trends that are becoming apparent. This is occurring against a backdrop of increasing demand for orthopaedic services worldwide and the rising threat of antibiotic resistance2,3,4. Clinical expertise and experience will be needed to inform appropriate responses.
Technology is reshaping the world and, with it, orthopaedic surgery. Whilst many recent advances have occurred inside the operating theatre, much of what is set to change will take place outside of the hospital, beyond the clinic room, in the time before and after surgery.
Measuring quality: Tomorrow’s questions
As new tools and techniques enter orthopaedic practice, accurate and comparable approaches to assess quality of care and outcomes will be paramount. The future success of orthopaedic surgery will be assessed using digitally enhanced Patient-Reported Outcome Measures (PROMs). By applying Item Response Theory and Computer Adaptive Testing (CAT), which shapes remaining survey questions based on those already answered, patients can be asked more relevant questions whilst giving fewer responses.
CAT can make patients’ survey responses more efficient, of higher quality and more easily comparable. Cambridge University’s open-source adaptive testing platform Concerto (concertoplatform.com) and the Patient-Reported Outcomes Measurement Information System (PROMIS) (www.healthmeasures. net) are leading exponents of this approach, with the latter comprising the world’s largest item bank of CAT measures currently being translated, implemented and validated across the word. PROMIS surveys measure generic, commonly relevant outcomes such as pain and physical function that can be used and correlated across and within different patient populations. Increasingly, orthopaedic patients have more than one condition and combining generic scores with disease or procedure-specific measures provides opportunities for more comprehensive assessments with relevance across different groups5. PROMIS CAT surveys can also avoid the ceiling effects seen with other musculoskeletal function scores6.
Beyond surveys: Smartphones and sensors
As existing models of measuring pre-intervention function, treatment progress and outcomes are being refined, smartphones, wearables and sensors are adding new layers of objective, real-world data, informing a deeper and more nuanced understanding of musculoskeletal treatments and results. Specialised sensors able to provide continuous, real-time information will increasingly enhance decision-making before, during and after surgery.
Smartphones are rapidly becoming ubiquitous across the world and, with their in-built recording of steps and activity, offer a convenient and scalable means of measuring the physical activity of both individuals and large populations7. Automatically collected patient-specific data will reveal new insights into recovery patterns and enhance pre- and post-intervention planning.
Image Credit: Emerging Implant Technologies