Where orthopedics needs more innovation

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Image interpretation within the orthopedic surgery field could use more innovation, according to David Kieras, MD.

Dr. Kieras is an orthopedic surgeon at Virginia Mason Medical Center in Seattle. He recently spoke with Becker's about the areas in orthopedics that need more innovation.

Editor's note: This response was lightly edited for clarity and length.

Question: What areas of spine or orthopedic surgery need more innovation?

Dr. David Kieras: Though slowly starting, definitive innovation in image interpretation and subsequent application to clinical care is needed.  

Examples: Knee MRI with initial interpretation of "meniscus tear" without further description of the nature of the tear (degenerative, flap, size, location, etc.), or a description of "arthrosis" without concise description of size, depth, location, cartilage quality, surface characteristics, local bony edema, etc. are not particularly helpful to the primary care provider, mid-level provider and patient. This "low quality" information along with information obtained online can be quite distracting. An initial visit with the orthopedist becomes an effort at debunking prior misconceptions on the results of imaging rather than an educational effort about findings and best treatment options.

Similarly, with respect to shoulder MRI, rather than "tendinosis," "arthrosis, "labral lesion," "rotator cuff tear," etc., a more precise description [is needed], including degree of tendon, labral, cartilage or capsular damage or thickness, degeneration or signal quality distortion, precise area and depth of involvement, association with other findings such as narrowing of the subacromial space, deflection of the rotator cuff (assessed in three rather than two dimensions), estimated degree of atrophy, local edema, etc., is wanting.

Along with precise imaging algorithms and data collection on outcomes, recommended care will eventually incorporate specific accepted clinical algorithmic recommendations, [such as] medical/physical therapy, arthroscopy, arthroplasty, etc.

Eventually, these advancements will result in streamlined care and should properly result in less questioning of clinical care by third parties, including insurance representatives. Initial evolution of this process will begin with improved MRI algorithms and subsequently be augmented via applied artificial intelligence.

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