Repairing and replacing, not removing, is the future of orthopedics: Dr. Kevin Stone

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Although there are several new technologies and techniques improving outcomes for sports medicine and orthopedic patients, many surgeons are not incentivized to use them, according to Kevin Stone, MD.

Dr. Stone is an orthopedic surgeon leading the Stone Clinic in San Francisco. He specializes in robotic-assisted surgeries and the use of biologics for joint preservation, holding more than 40 U.S. patents and lecturing worldwide on cartilage and meniscal treatments. 

He recently spoke with Becker's about innovations shaping patient care and the roadblocks keeping providers from onboarding new technology and techniques. 

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

Question: What are the biggest challenges facing the industry right now?

Dr. Kevin Stone: The industry that I work in is in sports medicine and arthritis. So I see athletes of all ages, and I see people who are developing arthritis or developed arthritis and want to stay active and keep doing the sports they love to do. In my space of the world, it's really educating people that taking tissues out, such as the meniscus cartilage, or shaving the cartilage, the particular cartilage away, or leaving people with unstable knees leads them to arthritis. And we have developed the techniques now for replacing the meniscus, for regrowing the cartilage, for rebuilding the ligaments accurately so that if people and doctors knew that it's not a good idea to take someone's meniscus cartilage out — for example, it's much better if it's damaged to repair it, to regrow it or to replace it — then we would save tens of millions of people the arthritis they would later develop.

The biggest challenge is educating doctors and patients to repair and replace tissues, not to take them out. The second biggest part in the industry is the old thinking that artificial joint placement means patients can't return to sports or should stay home and rest their knee, or only do limited activities. That's simply not true anymore. In the age of robotics, what's happened is that robotics have permitted us to become much more precise as partial and total knee replacement surgeons. And when we do a total knee replacement now, we don't need to use cement anymore. So we don't need to limit the patient's activities because they're not going to knock the implant loose, and educating patients and doctors about that has been much harder than we ever thought, because so many patients are being told they can't be active and so many doctors are still doing procedures with old technology.

Q: What technologies and techniques are improving efficiency and quality of care?

KS: This is the era of growth factors and lubrication. So the injection therapy has gotten so good now that many people who once were being brought to surgery for certain types of injuries are being treated successfully with injections, and this is the abandoning of cortisone and then moving toward anabolic injections, growth factors and lubrication.

Q: How do you expect the industry to evolve in the next three to five years?

KS: We will start to get birth tissues approved, which will be much more potent anabolic therapies both with growth factors and anti-inflammatories and cellular recruitment factors, so that the injection therapies will become even more effective. Number two, robotics will expand and patients will demand they be treated with more modern techniques, and that will permit people to be returned to sports, and be much more active than they have been in the past. So I think those two things are probably the biggest changes.

Q: If you could change one thing about the industry, what would it be?

KS: I would improve the incentives for innovation, because right now doctors are not incented to innovate, and that inhibits a lot of the development of the technology and techniques that we would like to use and develop. 

[This is partially due to] cost, because robotics are more expensive at first — although they're cheaper in the long run — and in part, health programs, insurance programs that do not encourage innovation. And because most people only stay with their healthcare plan for two or three years, the insurance companies and healthcare plans don't really care about the long-term outcomes for patients, because those people will not be their patients in the long term. So the incentive is all wrong.

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