On any given day, April Armstrong, MD, might move from teaching surgical residents to mapping gene variants to talking with patients in their 90s about their goals for life after a fracture.
It’s that blend of science, systems and empathy that she believes will define the next era of orthopedic care.
Dr. Armstrong is the C. McCollister Evarts professor and chair of orthopaedics and rehabilitation at Hershey, Pa.-based Penn State Health and Penn State College of Medicine. She also serves as chief of the shoulder and elbow service.
“We really have to think about how we’re developing our workforce — really changing our curriculums and investing in the education and training of individuals who are structured to focus on the special considerations for that aging population,” Dr. Armstrong told Becker’s. “Working with specialists in geriatric medicine is actually a newer field and something that we’re still trying to understand and develop. They bring a lot to the table in terms of how best to care for these patients.”
Rethinking orthopedic care for older adults
Dr. Armstrong said hospitals are seeing more patients in their later years — often with multiple injuries and chronic conditions that complicate recovery.
“What we’re starting to see are many patients in their later years — in their 90s — who are having hip fractures, but they don’t always come in with just that injury,” she said. “They may also have rib fractures or other conditions that put them at much higher risk. So how do we optimize our care pathways for hip fracture care when we’re also managing someone in their 90s with multiple comorbidities? It becomes very complex.”
She added prevention and collaboration are key.
“It’s hard for orthopedic surgeons to champion all of that care on their own — we need collaborators and partners in that work,” she said.
Programs like the American Orthopaedic Association’s “Own the Bone” initiative have helped institutions standardize care and reduce the incidence of fragility fractures. A CMS value-based care mandate for hip fractures is accelerating that work and encouraging more multidisciplinary alignment.
Preparing for a surge in complex cases
While orthopedics has seen a migration to outpatient care, Dr. Armstrong said hospitals must still be ready for rising inpatient volumes tied to complex revisions and fracture cases.
“The national data is showing that the incidence of hip and knee revision care is increasing,” she said. “Our hospitals need to be prepared for this, because these are typically inpatient care patients.”
Social factors, she added, are increasingly inseparable from clinical outcomes.
“People have social situations, economic factors, housing, transportation, nutrition — all of those things, I believe, will influence their outcomes,” she said. “That’s why I think a multidisciplinary approach is going to be extremely important.”
Turning data into insight
AI is already starting to reshape how Dr. Armstrong’s team approaches shoulder reconstruction — not through automation, but analytics.
“I do think AI will truly move the needle,” she said. “We’ve been trying to do predictive analytics long before AI became the force it is in our world today.”
Her team is using AI to analyze two decades of shoulder replacement data to identify the risk factors for glenoid component loosening — a complication seen in roughly half of cases.
“If we truly have a better idea, we can really look at big data and delve into what those true risk factors are,” she said.
She added 3D surgical planning and patient-specific implants are already redefining what’s possible in complex revisions. Robotics and navigation are still “a little bit behind” in shoulder and elbow surgery, but she believes that will change quickly.
Exploring the genetics of healing
Dr. Armstrong is also studying genetic variations linked to rotator cuff tears in collaboration with researchers at the University of Utah in Salt Lake City.
“The idea is — and again, we’re really early in this — the possibility of genetic engineering approaches,” she said. “Can we improve tendon regeneration and healing? I think that’s something that’s still evolving, but it’s gaining some traction.”
She noted that one of the biggest challenges, and opportunities, lies in how genes change over time. “Some things can change as you age as well,” she said. “So this may be a moving target.”
Keeping care human
Even as technology accelerates, Dr. Armstrong said its greatest value may be freeing clinicians to do what drew them to medicine in the first place: connecting with patients.
“From an operational standpoint, there’s a lot of opportunity for AI to really decrease the burden on the healthcare providers so that they can spend more face time with the patients,” she said.
She’s watching as wearable technology and “smart implants” make their way into orthopedic use.
“If you have a smart implant, meaning that you’ve got monitors directly in the implant and really get that real feedback, that can also optimize surgical approaches, techniques, designs,” she said. “That’s really exciting.”
Training tomorrow’s orthopedic leaders
Dr. Armstrong’s academic mission centers on developing clinicians who see orthopedics as more than a technical specialty — as a system of teamwork, leadership and calling.
“Physicians really need to understand how to work well within their systems,” she said. “They really need to understand what it takes to care for patients, and it’s really a team effort.”
Her team runs a structured, lean-based quality program that teaches collaboration and systems problem-solving.
“Leadership development is really important as well, because we’re all leaders in some way,” she said. “This is really a calling, and not a job.”
