The biggest challenge in orthopedics is also its best opportunity: key thoughts from Dr. Michael Gerhardt


Michael B. Gerhardt, MD, is a sports medicine specialist and orthopedic surgeon at Cedars-Sinai Kerlan-Jobe Institute in Los Angeles and team physician for the LA Galaxy and U.S. Soccer Men's National Team.

Here, Dr. Gerhardt discusses key challenges and areas for growth in the coming year.

Question: What are the top challenges you're facing heading into 2019?

Dr. Michael Gerhardt: Orthobiologic modalities such as stem cell therapy stand out as one of the most exciting prospects in the entire field of orthopedic surgery heading into 2019. While at the same time, it also remains one of the biggest challenges in our field. In the last several years, we have gained a better understanding of how to use the healing power of stem cells and growth factors to assist in orthopedic healing. For example, using what we learned in the laboratory, we can apply to certain clinical situations to enhance healing. An example of this is in the area of bone growth. By adding growth factors and stem cells to certain bones in the body we can effectively accelerate bone healing. However, the fact remains we still have much to learn about translating this basic science knowledge to meaningful real life situations in other parts of the body such as cartilage, tendons and ligaments.

For example, recent studies have shown stem cells inciting cartilage regrowth in the laboratory and even in very small cartilage defects in humans. We have yet to incite significant cartilage regrowth in joints globally depleted of cartilage.

Currently, patients who have significant global cartilage loss in their knee or hip joints, or arthritis, are still better served by joint replacement surgery rather than stem cell injections. The hunt is on for the biologic agent that will direct the stem cells to morph into cartilage cells which could effectively reverse the arthritic changes in a joint. When this is discovered, it will truly change the field of orthopedic surgery as we know it. Unfortunately, we have yet to crack this code, but perhaps 2019 will be our year to do this.

Q: What technology are you most excited about in the future?

MG: Navigation in orthopedic surgery is arguably the most exciting aspect of our field in the immediate future. Navigation is defined as a means to enhance the surgeon's accuracy in performing a surgical procedure. This can be accomplished either through enhanced imaging guidance platforms or through robotic technology. Navigation is quickly becoming the gold standard in a multitude of surgical procedures, but currently joint replacement appears to be poised to benefit from this technology the most. Multiple studies have shown outcomes can be improved by using cutting edge navigation techniques such as robotic assisted joint replacement. Improving the surgeon's ability to more accurately place prosthetic implants through navigation is becoming the gold standard in joint replacement surgery, and is being applied to other orthopedic procedures throughout the body.

Q: What is your best opportunity for growth?

MG: Advancement and growth in orthopedics is most dependent on two things — technology and surgeon education. The more we can apply technology to surgical challenges in our field, the faster we can improve our ability to solve problems and impact patient outcomes. Additionally, our field has always relied on surgical education: ongoing surgeon training remains the cornerstone of all surgical fields. The combination of technology and education will clearly enhance orthopedic surgery as a whole.

A prime example of this is in the introduction of surgical simulators in surgeon education. Life-like surgical simulators including virtual reality platforms will allow both young surgeons and older surgeons to gain invaluable experience in a variety of surgical techniques in an efficient and cost-effective manner. Early validation studies suggest that reductions in technical errors and improvement in surgeon efficiency is correlated to increased time with the simulators. This emerging technology has already become a part of many orthopedic residency and fellowship programs. Eventually, it will be introduced as an option for continuing medical education, and perhaps even a part of the recertification pathway. Overall, this advancing technology will hopefully enhance the surgeon's experience as they continue to gain access to these simulators and VR platforms.

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For a deeper dive into the future of orthopedics, attend the Becker's 17th Annual Future of Spine + Spine, Orthopedic & Pain Management-Driven ASC in Chicago, June 13-5, 2019. Click here to learn more and register.

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