Orthopedic reconstruction has been built around a practical compromise. Surgeons study the patient’s anatomy, assess the deformity or damage and then choose the best available implant from a standardized set of options. For many patients, that model still works well. Selene Parekh, MD, believes the next era of orthopedics will be defined by the patients for whom it does not.
Dr. Parekh, an orthopedic surgeon at Philadelphia-based Rothman Orthopaedics, has spent years working with 3D printing, custom implants and AI-enabled modeling to treat some of the most complex lower extremity cases in orthopedics. His view of the field has changed dramatically. “The real challenge becomes who needs a custom solution,” Dr. Parekh told Becker’s. “Can we figure that out versus who can just work with an off-the-shelf solution?”
That question may become one of the most important in orthopedic reconstruction. Not every patient needs a custom implant. But for the right patient, customization can mean the difference between accepting a limited reconstruction and preserving motion, function or even a limb.
From last resort to strategic option
When Dr. Parekh first began working in patient-specific orthopedics, the technology was often reserved for the most desperate situations. Many patients were near the end of the treatment line. They had failed prior surgeries. They had severe deformity. They had bone loss, infection, soft-tissue problems or a complex anatomy that did not fit traditional implants.
“When we first started customization, it was really on those patients who were at their last step or even at the doorstep of an amputation,” Dr. Parekh said. That remains a critical use case. But the indications have expanded. Customization may now make sense for patients with metal allergies who need specific alloys, patients with unusual anatomy, patients with failed ankle replacements or patients whose deformity cannot be solved well with standard implants.
The shift is not from standardized implants to custom implants for everyone. It is from customization as a rescue tool to customization as a more deliberate option for patients whose anatomy or pathology demands it. Cost and time remain barriers.
“I still think that we are far from being able to offer everyone a customized solution,” Dr. Parekh said. “Primarily because of cost and time.” Still, he expects that equation to change. As adoption increases, manufacturing improves and AI shortens design timelines, what is rare today may become far more routine within the next five to 10 years.
The advantage of building for one patient
The power of 3D printing is not simply that it creates custom shapes. It allows surgeons and engineers to design implants around biological problems that traditional manufacturing struggles to solve. In limb salvage cases, that can mean designing around bone loss, deformity, infection history or adjacent joint disease.
“The limitation is just your imagination,” Dr. Parekh said. An implant can include polished surfaces in one region and ingrowth surfaces just millimeters away. It can incorporate fixation points, anchors and geometry designed for one patient’s exact defect. It can address an ankle deformity that looks nothing like the next patient’s ankle deformity.
That matters because two patients may share the same diagnosis but need entirely different reconstructions.
“Patient A who has a varus ankle deformity may be very different than patient B,” Dr. Parekh said. “The solutions might be very different.”
For surgeons, that represents a fundamental change in mindset. The question is no longer simply which implant best matches the patient. It is whether the implant can be designed around the patient from the beginning.
AI’s first real role
AI is often discussed in orthopedics as a future force. Dr. Parekh sees it already beginning to matter in a practical way: planning and design. Many companies developing patient-specific implants have years of prior cases, designs and outcomes data. AI can use those databases to suggest early solutions for new patients before surgeons and engineers begin refining the plan.
That does not remove the human role. It accelerates the first iteration. “We are just scratching the surface of it,” Dr. Parekh said. The near-term value is speed. AI may shorten development time by weeks or months, especially in complicated reconstructions where multiple design iterations would otherwise be required.
Over time, the more transformative opportunity is learning. As outcomes from patient-specific implants are fed back into the system, AI may begin identifying design patterns surgeons and engineers did not initially consider.
Dr. Parekh does not believe the field is there yet. But he sees the direction clearly: AI will increasingly produce a near-final design that still must be reviewed and certified by a surgeon and engineer. In other words, AI may not replace expertise. It may change where expertise enters the process.
The operational challenge hospitals cannot ignore
Patient-specific orthopedics also changes the hospital workflow. These implants are not sitting on a shelf. They are manufactured for one person, one operation and one surgical plan. That makes every step of the process more important.
Contracts need to be negotiated in advance so health systems are not reinventing the financial arrangement for every case. Implants need to arrive on time. Sterilization teams need to track them carefully. Operating room staff need to verify the implant matches the patient, case and procedure. “You can’t afford to lose these implants, because it’s not like you can just take one off the shelf and replace it,” Dr. Parekh said. For hospitals, that means custom implants are not simply a surgical innovation. They are a systems challenge.
The opportunity, however, is significant. Dr. Parekh believes patient-specific orthopedics can become a distinct service line for complex cases that patients may struggle to solve elsewhere.
“To me, this is an opportunity for a whole new business line,” he said. That business line will require more than surgeons. It will require contracting teams, supply chain leaders, sterile processing, perioperative leadership, manufacturers and clinical teams working from the same playbook.
The implant may be custom. The system around it has to be reliable.
The value question
The economics of custom implants can be difficult to evaluate in traditional terms. A custom reconstruction may cost more upfront than a standard approach. It may require longer planning. It may involve more coordination. But Dr. Parekh argues the value proposition changes when the alternative is a larger fusion, multiple surgeries, loss of motion or amputation.
That is especially true in cases where patient-specific reconstruction preserves movement and function.
“If you ask these patients, the value proposition is not even measurable, because it’s transformative to their life,” he said. A patient who avoids a major fusion may preserve mobility. A patient who maintains motion may maintain independence. A patient who avoids repeated surgeries may remain employed. Those outcomes do not always fit cleanly into a narrow episode-of-care calculation, but they matter deeply to patients and, increasingly, to value-based care.
Dr. Parekh believes the field still needs stronger data to prove those long-term gains. But he sees the effect in clinic.
“Having worked in this space for a long time, I see and hear the impact from patients every day,” he said.
What will look outdated in 10 years
Asked what today’s residents may one day find outdated about orthopedic reconstruction, Dr. Parekh did not point to a single procedure. He pointed to the entire toolkit. The materials are changing. Orthopedics has long relied on stainless steel, cobalt chromium and titanium. In the next decade, he expects the field to explore a much broader range of metal alloys, ceramics, polymers, gels and other biomaterials.
“We’re going to have a whole arena full of materials that we don’t even have right now,” he said. The techniques are changing too. Patient-specific implants often come with patient-specific guides, allowing surgeons to perform operations more efficiently and with more precision.
Then comes the layer he finds especially exciting: augmented reality. Dr. Parekh imagines a future where reconstructive surgeons routinely wear smart goggles that overlay patient-specific instrumentation, surgical cut guides or implant positioning information directly into the operative field.
That future will not be limited to foot and ankle surgery. He sees applications across shoulder, elbow, hip, knee and other reconstructive specialties.
If that happens, the operating room may begin to look less like a place where surgeons adapt tools to patients and more like a place where tools arrive already adapted to them.
Why trainees may have the greatest advantage
For all of Dr. Parekh’s work in surgical innovation, one of his most striking observations is about the next generation. He describes himself as a midcareer surgeon, yet he sometimes wishes he were starting now.
“I wish I was an early career surgeon or a resident right now,” he said. “The pace at which technology is transforming what we can do is incredible.”
The reason is not simply that young surgeons will have access to better tools. It is that the tools for changing care are now more accessible than ever. A resident with an idea can use digital modeling, AI, 3D printing and global collaboration to test a solution faster than previous generations could have imagined.
That could change the hierarchy of innovation. The next breakthrough may not come only from a senior surgeon, a large company or a major academic center. It may come from a trainee who understands the technology well enough to ask a different question.
“The ability to affect change has never been easier than it is today,” Dr. Parekh said. “Even a trainee or a medical student can realize the power they have to affect patient care at an individual, system or even global level. Once you realize that, you get really excited about what you can do in the future.”
The next orthopedic era
Orthopedics has spent decades improving standardized implants and techniques. That work is not going away. For many patients, off-the-shelf options will remain effective, affordable and appropriate. But Dr. Parekh believes the field is moving toward something more individualized.
The challenge is not whether surgeons can customize care. It is determining when they should. The future of reconstruction may depend on knowing which patients need standard solutions, which need custom implants and which need a level of design the field has not yet imagined.
That is the promise of patient-specific orthopedics. Not technology for its own sake. Not customization for everyone. But a more precise match between the patient, the problem and the reconstruction designed to restore their life.
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