5 trends changing the orthopedic landscape

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Ten years from now, the orthopedic surgery landscape could look very different. 

Gregory Kolovich, MD, orthopedic surgeon and co-founder and chief medical officer of OXOS Medical, connected with Becker's to discuss what the orthopedic surgery landscape will look like in 10 years.

Note: This response has been lightly edited for length and clarity.

Dr. Gregory Kolovich: In my 15 years of experience (including orthopedic schooling, training and out in private practice), I have witnessed these trends which are rapidly changing the orthopedic landscape:

1. Patients seek their own satisfaction: Patients are demanding more intimate access, attention and information from surgeons, largely due to the internet and social media. Local reputation and referrals matter less and less as patients increasingly select a surgeon based on online reputation and reviews. These digital rankings, through platforms like Google and Healthgrades, have largely become gospel among certain patient demographics, like younger generations or those with higher levels of education. I have seen more second opinions and takeover care referrals than ever before as patients "doctor shop" more than ever. I expect the internet, social media and online reputation to play a bigger role in securing patient volume. Like or hate it, budding surgeons should get on board with this reality and participate actively. 

2. Efficiency is everything: Outpatient surgery has become the overwhelming standard. I remember not long ago when patients stayed three to five days after a total hip or total knee replacement. Now, it is rare to find these patients staying more than 23 hours for observation in my own ASC or hospital. Hospitals that once relied on inpatient services must now rely on accommodating the fast-paced, outpatient surgery trend, which means administrators need to supply flip rooms, equipment and staff to accommodate surgeons who can rapidly churn outpatient cases. No longer can a hospital survive doing two to three total knee arthroplasties in one operating room. Hospitals must learn to run fast-paced private practice ASCs, which benefit from lofty, high-volume facility fees. 

3. Minimally invasive takeover: As technology and techniques rapidly advance, surgeries are getting smaller, more efficient and more accurate. Computer navigation, robotic-assisted, and percutaneous skeletal fixation are all great examples of this takeover. For example, my wrist, elbow and shoulder arthroplasties rely on preoperative templating and computer navigation to ensure proper placement. This, in turn, has made my job easier, more accurate and more precise. The same goes for my hip/knee, sports and spine partners. I now percutaneously fix scaphoid, phalanx, metacarpal and wrist fractures and some distal humerus fractures wherein the recent past open reduction with internal screw or plate fixation was the standard of care. This is largely due to technological advancements in headless screws, which allow for these minimally invasive or percutaneous fixations. As such, patients have less pain and swelling with faster recovery of motion and quicker return to activity or sport.

I have personally taken care of collegiate and professional athletes in this manner and have seen return-to-sport times cut by more than half. The same goes for ACL reconstructions and UCL (Tommy John) reconstructions, which are rapidly returning players to sport. 

4. The rise of WALANT: As physician reimbursement and facility reimbursement continue to decline every year, hand surgeons such as myself look for ways to efficiently operate on patients without the cost, need and risk for anesthesia. "Wide awake local anesthesia no tourniquet" (WALANT) is emerging as a great way to treat patients same day with little to no risk, and very little overhead (no need for anesthesiologist, anesthesia machines, large drapes, RNs, ORs, etc.). Procedures such as carpal tunnel releases, finger fracture pinnings, trigger finger releases, tendon repairs or tenolysis, and fracture reductions, can be done in a procedure room under local anesthesia without large overhead. This is a trend that is exploding in my field. 

5. At-home diagnosis and telemedicine: In terms of total revenue, orthopedics ranks third behind diagnostics and cardiology. In spite of the rise in MRI and CT scan, simple X-rays still reign supreme as the most important image modality in orthopedics. It is the first diagnostic test I order at the start of the treatment algorithm (wrist X-ray to diagnose wrist fracture for example) and the last test I order before the end of the treatment algorithm (final X-ray at three to six months to ensure full healing and release the patient back to full duty). It is also the simplest and cheapest diagnostic test for me to order. 

I probably order 80 to 100 X-rays before I order one MRI or CT scan. With the rise of portable imaging and home healthcare providers, I expect to see diagnostic portable imaging explode in the next 10 years for injuries on the field, at the work site or at home. Imagine a patient falls and hurts themselves at home and is concerned about a simple, closed, non- limb- or life-threatening wrist fracture. Rather than go to an urgent care or emergency room and spend thousands of insurance dollars and half of your day, patients now have access to order via their smartphone an urgent home health visitation by a mobile provider (Dispatch Health, Sprinter Health, Get Labs, etc.). Each service will carry mobile image capability devices that can obtain rapid diagnostic X-rays at home while accessing an instantly available radiologist and orthopedic surgeon via the telemedicine platform to triage the injury and provide appropriate care and follow-up. In the era of ordering personalized groceries and meals to your doorstep, accessing care and diagnostics — for certain types of injuries and illnesses — will soon be no different. 

This trend is primed to take off in a post-COVID world, where people prefer to avoid crowded, costly emergency rooms and urgent care, but also want instant access to care.

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