Did you know the American Academy of Orthopedic
Surgeons? Well, they've just updated key guidelines
for things like carpal tunnel syndrome, meniscal
pathology, just this year alone. Staying on top
of what's new isn't just important. It's fundamental
in a field that's moving this quickly. Absolutely.
The pace is remarkable. Welcome to the deep dive.
I'm your host and today we're taking a really
focused look at the cutting edge of orthopedics
We've pulled together a whole range of sources
recent research clinical guidelines expert interviews
to to explore the big Advancements and trends
shaping how care is delivered right now Sounds
good and guiding us through all this material
helping us sort of cut through the complexity
is Prof Mo Imam who brings just a wealth of experience
in orthopedic research and practice Great to
have you back. It's always good to be here ready
to explore these sources. Excellent. OK, so to
get us oriented, let's do a quick check in with
the sources on three big questions. First up,
if we look beyond the actual surgical theater,
what are the most significant recent insights
affecting patient recovery and their overall
outcomes? Well, the sources really emphasize
preparing the patient before surgery, what we
call preoperative optimization. Right. managing
risks beforehand. Exactly, identifying and managing
those risks. And crucially, there's a massive
shift towards multimodal pain management, actively
trying to reduce reliance on opioids. That's
huge. It is. And increasingly, we're seeing the
impact of psychosocial factors being properly
recognized and, importantly, addressed. OK, that
makes complete sense. Second question, how are
these rapid advancements in technology, things
like sophisticated imaging, robotics, how are
they practically changing how orthopedic procedures
are actually performed? Well, technology is fundamentally
changing the precision and also the planning
of surgery. Robotic assistance, for instance,
is sort of moving cores, becoming a standard
tool. Really? Standard tool. Especially for those
complex maneuvers and really tight spaces. Imaging
is vital for diagnosis, obviously, but it's equally
important, maybe even more so for guiding the
surgical strategy itself. Ah. And AI, artificial
intelligence, is starting to play a supportive
role, too, in areas like patient safety. So the
tech is less about automating the surgeon, maybe,
and more about empowering them. Precisely. It's
about augmenting the surgeon's skill and insight.
It's not about replacing them. Got it. Okay.
And finally, with this constant stream of new
research coming out, updated guidelines, interviews
like the one with Dr. Purshvira, how can orthopedic
professionals best navigate all this information,
this wealth of information really, to truly inform
their day -to -day practice? Yeah, that's a key
challenge. And this is where evidence -based
frameworks become absolutely critical, relying
on rigorously developed resources like clinical
practice guidelines from the major bodies and
knowing how to access and apply them. That's
key. It's about having a structured approach
really to integrating new knowledge. That gives
us a fantastic roadmap for this deep dive. Let's
jump straight into the first major area then.
The innovations in treatment itself and the technology
that's driving so much of it. Looking at the
sources, especially those insights from Dr. Purskura,
there seems a clear focus on the evolution of
surgical techniques. Yes, that's right. Dr. Purskura
specifically highlights the, well, significant
increase in hip arthroscopy over the last 15
years or so. It's now performed far more frequently
than it used to be, though it arguably remains
the most technically demanding arthroscopic procedure.
Why is that? Mainly due to the complex anatomy
and the very limited space compared to, say,
the knee or the shoulder. It needs very specific,
often custom -made tools. Right. And his perceptive
on the core philosophy seems really important
here too, doesn't it? This whole idea of repairing
versus replacing. Absolutely. He argues that
the future of orthopedic surgery, particularly
with arthroscopy, is increasingly about repairing
damaged structures rather than just replacing
them. Trying to preserve what's there. Exactly.
The goal is to preserve as much of the native
tissue and function as possible. But, and this
is the key part, this requires very precise,
very efficient techniques. You need to identify
and address lesions quickly. Before it's too
late. Before they become irreparable, yes. Or
perhaps require much more complex reconstruction
down the line. And that's where the technology
slots in, right? This need for precision seems
perfectly aligned with what robotics can offer.
Exactly right. Robotic -assisted surgery is becoming
a more mainstream tool precisely because it can
enhance that precision. Especially, as I said,
in those technically difficult areas like deep
inside the hip joint. Sources suggest it's helping
surgeons perform maneuvers with greater control
in tight spaces. And some even project we could
become a standard approach in certain procedures.
Interesting. And beyond robotics, we also see
AI mentioned as a potential partner in things
like patient safety, improving precision in surgical
planning that comes up in sources like the Campbell
Clinic material. But even before you get anywhere
near the operating room, diagnostic technology
is just fundamental, isn't it? It absolutely
is. The array of imaging modalities got x -rays,
ultrasound, CT, scintigraphy, PETCT, and especially
MRI. The gold standard? Well, it's often considered
the gold standard for detailed soft tissue and
cartilage evaluation in joints like the hip and
knee. They're all essential tools. And Dr. Prisgur
makes a really crucial distinction here, doesn't
he? Emphasizing that imaging supports the diagnosis.
but doesn't make it on its own. This is such
a critical point for practitioners. The diagnosis
is made by the specialist. It integrates the
clinical findings, the patient's history, their
symptoms, the physical examination with the imaging
results. Right. You're treating a patient, you
see, not just an image report. The imaging provides
vital information for the specialist's decision
making process, but that clinical context is
paramount. And having access to that detailed
imaging data isn't just helpful for the surgeon.
The sources call it vital for surgical planning.
Why such a strong emphasis on that? Oh, it's
crucial. Because having direct access to the
imaging scans themselves, not just the written
report, allows the surgeon to meticulously plan
the procedure. They can visualize the specific
anatomy, identify potential challenges, anticipate
maybe unexpected lesions, and mentally rehearse
the steps involved. Digital access streamlines
all of this. Makes it quicker. Much quicker to
review. And even to share complex cases for colleague
consultation. Ultimately, it should lead to more
predictable and potentially safer surgical outcomes.
It sounds absolutely vital for orthopedic surgeons
to have that direct digital access to the detailed
imaging. It goes way beyond diagnosis, doesn't
it? It's the cornerstone of precise surgical
planning, helping anticipate complications, tailor
approaches, better results in the operating room.
That preparation phase, which is deeply informed
by imaging, is simply indispensable for complex
modern orthopedic surgery. It really is. We also
saw mentions of technology extending out into
the rehabilitation phase as well. Yes, that's
right. Sources like the Campbell Clinic Interview
discuss integrating tools like wearables, for
example, for monitoring patient progress or using
modalities like shockwave therapy and physical
therapy to help aid recovery. So it's not just
pre -op and intra -op. No, technology's role
doesn't stop at the operating theater door. And
speaking of evaluation, the JAMA sources really
highlight how research is constantly evaluating
different treatment approaches, doesn't it? Often
comparing new methods or technologies against
the established ones? Precisely. You see studies
comparing outcomes for things like casting versus
surgical intervention for pediatric fractures,
for instance, or operative versus non -operative
management for conditions like adult lumbar scoliosis
or humeral shaft fractures. Right. This research
is constantly refining our understanding of when
to intervene surgically, and perhaps when alternative
approaches may be more appropriate. And this
evidence feeds directly back into practice. That
transition is smooth, actually, because it brings
us very nicely to the second major area we wanted
to cover, the frameworks that guide practice
and those broader factors influencing patient
outcomes. So if research tells us what might
work, how do practitioners navigate all that?
How do they determine the best approach for a
specific patient? I suppose that's where clinical
practice guidelines come in. Exactly. Organizations
like the AAOS play a absolutely crucial role
here. They develop these evidence -based clinical
practice guidelines or CPGs. Right. They essentially
distill the best available research into actionable
recommendations for diagnosis, for treatment,
for post -operative care across a vast range
of orthopedic conditions. And looking at the
source material, these guidelines seem to cover
a huge spectrum. From common upper extremity
issues like carpal tunnel, rotator cuff injuries,
to lower extremity problems like ACL tears and
osteoarthritis, specific pediatric conditions
like hip dysplasia, critical areas like managing
infections or pain after trauma, it's broad.
The breadth is really significant. And as you
noted right at the start, these weren't static
documents. They're constantly evolving. Yeah,
the 2024 updates. Exactly. The fact that key
guidelines were updated just this year really
underscores the dynamic nature of the field.
And resources like the OrthoGuidelines app make
accessing this vital, up -to -date information
readily available to practitioners, often right
at the point of care. And they also produce other
tools, don't they? Like appropriate use criteria
and performance measures. What are those about?
Yes, those derivative tools help apply the evidence
-based recommendations to specific clinical scenarios.
And they also help evaluate how well care actually
aligns with best practices. For quality improvement.
Precisely. It's also worth noting the AOS endorses
guidelines from other specialty societies, too,
after a pretty rigorous review process. Yeah.
So that expands the pool of trusted resources
available. Okay. Shifting focus a bit now from
the guidelines themselves to the patient. The
sources place a lot of emphasis on factors beyond
the operating room that impact outcomes. What
really stands out there? Well, preoperative optimization
is a recurring theme as we mentioned earlier.
Ensuring patients are in the best possible health
before surgery. That's key to minimize risks
and improve recovery. So managing comorbidities,
nutrition? Yes, all of that. Managing comorbidities,
nutritional status, and importantly, addressing
psychosocial factors. Things like anxiety, depression,
or maybe a lack of social support. They can make
a difference. Oh, they can significantly influence
pain perception, adherence to rehab programs,
and overall satisfaction after surgery. This
is highlighted in some of the trauma -related
guidelines particularly. And alongside that preparation
piece is pain management. Especially, I suppose,
given the broader context of the opioid crisis.
This is a really critical area of evolution right
now. The trend is strongly towards multimodal
pain management strategies. Meaning using lots
of different things. Yes, using a combination
of approaches. Regional nerve blocks, non -opioid
analgesics like NSAIDs or paracetamol, other
adjunctive medications, often all packaged within
enhanced recovery after surgery protocols or
ERS protocols. Right, ERS. The goal is to effectively
manage pain. while drastically reducing, or ideally,
even eliminating the need for opioids, which
aligns perfectly with concerns highlighted by
sources like the NAO material referencing CDC
data on opioid overdoses. We also saw some insights
into more systemic issues that impact orthopedic
care access and delivery. Yes, the comparison
mentioned regarding hip and knee replacement
volumes and particularly waiting times for free
prostheses between different countries. Romania
and Sweden were mentioned. There were examples
cited. Yes, it vividly illustrates how factors
like healthcare funding models, public trust
in the system, how they can create significant
disparities in patient access to necessary, often
life -changing procedures. And this links, I
suppose, to the point made about patient reluctance
towards surgery sometimes. Indeed it does. Part
of the professional's role, informed by these
broader insights, is effective patient education.
helping individuals understand the potential
benefits of procedures like joint replacement
for improving their quality of life, addressing
fears, addressing misconceptions, building trust
in the process, basically overcoming reluctance
that might be driven by fear or perhaps just
a lack of information. And finally, the sources
also touch on the evolving roles within orthopedics
itself and the crucial issue of health disparities.
Yes, health disparities particularly racial and
socioeconomic disparities, in access to care
and outcomes for procedures like joint replacement.
They're increasingly being scrutinized. You see
research published in journals like JANA discussed
the neon sources, there's a growing recognition
of the impact of what we call social determinants
of health, things like education level, income,
geographic location, cultural factors, how they
impact musculoskeletal health, and access to
timely, effective care. And we're seeing expanded
roles for other members of the orthopedic care
team too. Absolutely. The roles of orthopedic
nurses and nurse practitioners, for example,
are expanding significantly. Sources point to
their increasing involvement in areas like outpatient
sports medicine clinics, primary care settings,
managing musculoskeletal issues. Patient navigation
too. And crucial roles in patient navigation
throughout the entire surgical journey, yes.
Their continuous professional development and
certification are highlighted as really key factors
in driving quality improvement and enhancing
the overall patient experience. It feels like
optimal outcomes in orthopedics are clearly so
multifaceted. It depends heavily on practitioners
leveraging evidence -based guidelines like those
AAOS CPGs, implementing effective multimodal
pain management, and, crucially, actively addressing
patient -specific factors, psychosocial needs,
and the impact of health disparities and social
determinants of health. It's a much more holistic
view of patient care, isn't it? Recognizing that
the best surgery is really only one piece of
a very complex puzzle. That gives us a really
comprehensive picture. Let's do a quick lightning
round now, drawing from the sources we've discussed.
What's one quick win for improving the patient
experience, either pre or post surgery? That
came through clearly. Preoperative patient optimization,
definitely. And effective multimodal pain management
using those ERAS protocols. They're probably
the fastest, most impactful interventions. Okay.
A surprising finding from recent ortho - research
that was mentioned. Well, the exploration into
how weight loss medications might influence revision
risk after joint replacement, that's certainly
a novel area of research highlighted. And studies
on implicit bias in care delivery are also revealing
some important insights. Right. One non -surgical
factor that's increasingly crucial for orthopedic
recovery. Psychosocial readiness, I'd say, and
robust, consistent physical therapy. They're
absolutely vital non -surgical components for
success. And a key digital resource mentioned
for orthopedic professionals. The AAOS OrthoGuidelines
app. It provides direct, portable access to those
evidence -based guidelines. Quick and insightful.
Right, let's wrap up by distilling this deep
dive into just a few key takeaways for you, the
listener. OK. First, modern orthopedic practice
is increasingly intertwined with technology.
Robotic assistance enhances surgical precision,
advanced imaging is vital for planning, and AI
is beginning to support aspects of care, particularly
around patient safety. Second, staying current
with evidence -based resources is really non
-negotiable. Clinical practice guidelines from
organizations like the AAOS are essential tools
for navigating treatment decisions across diverse
conditions. And resources like the OrthoGuidelines
app make them accessible. Third, achieving the
best possible outcomes involves a focus that
extends well beyond the procedure itself. Preoperative
patient optimization comprehensive multimodal
pain management strategies, dedicated physical
therapy, and addressing psychosocial factors
and social determinants of health. They're all
critical components. Fourth, the field is continuously
evolving, driven by research published in journals
like JAMA and ORS, exploring everything from
managing complications and refining recovery
techniques to evaluating treatment effectiveness
and actively working to understand and reduce
health disparities. And finally, the roles of
orthopedic nurses and allied health professionals
are expanding significantly. They're contributing
expertise in areas from outpatient care and patient
navigation right through to driving quality improvement
initiatives alongside surgeons. That paints a
really clear picture of a dynamic and forward
-thinking field. If you found this deep dive
valuable, please do consider rating and sharing
the show. It really helps other professionals
discover us. Ultimately, I think the sources
reveal an orthopedic landscape that's just relentlessly
pursuing better ways to restore mobility, alleviate
pain, and enhance lives. It's a field that's
constantly learning, integrating new technologies
and insights, and expanding its understanding
of what truly contributes to a patient's successful
outcome. Given all we've discussed today, what
specific area of orthopedics do you think is
poised for the most significant transformation
in the coming years? That's definitely a question
worth pondering. Thank you for joining us for
this deep dive into the cutting edge of orthopedics.