Hospital for Special Surgery

Joshua S. Dines

Orthopedics is a vast field of medicine that has evolved dramatically over the last few decades. There have been new innovations and advances that have greatly improved patient care. In my view, there are three main trends in the field right now which are as follows.

Injury prevention and sports performance: While at first glance, this may not seem connected to orthopedic surgery, it is the same patient base of athletes who look to prevent injuries and perfect their performance to stay at the top of their game. When we talk about injury prevention, that’s where technology comes into play. Wearable are a big orthopedics trend right now that can do everything –from helping track stresses at the elbow in baseball pitchers to how patients may be sleeping at night.

Non-surgical treatments in the office: Even as surgeons, most patients that we see can be treated non-surgically. There are a wide variety of first-line-defense treatment plans that we offer such as anti-inflammatories, physical therapy, injections and biologics. It is all about creating a personalized treatment plan for patients based on their goals. Biologics include things like PRP injections, stem cells and other regenerative medicines that’s aimed to either delay or prevent surgery or improve surgical outcomes in patients when deemed appropriate. ‘Stem cells’ continues to be a popular buzz word in medicine (not only in orthopedics) so there’s been a lot of interest from both physicians and patients on the possibilities as a treatment method.

Improving surgical outcomes in the operating room: In the OR, surgery has gotten much more minimally invasive which entails using smaller cameras and probes to see inside joints (could be shoulders, knees, hips, spine, and others.), instead of making large incisions. When we combine minimally invasive techniques with advanced imaging capabilities and patient-specific implants (sometimes using 3D printing), we’ve really started to revolutionize the orthopedic space.

"I’m personally working on two exciting projects that will help move some of these ideas forward."

While these innovations affect most of orthopedics, one of my specialties is the shoulder. It’s currently possible for me to do a shoulder replacement on a computer model before even touching the patient. I’ve been using tailor-made implants for my patients when appropriate, based on their unique anatomy, since implants are not ‘one size fits all’.

All new technologies come with a learning curve on how to use them best. We’ve seen great potential for things like biologics and wearable, but as an industry, we are still determining the safest, best and most effective way to make these available to all patients. In the case of wearable, we are collecting a huge amount of data that we need to determine how best to interpret.

I’m personally working on two exciting projects that will help move some of these ideas forward. The first involves a wearable device that tracks stresses in a baseball pitchers’ elbow. We’re developing protocols and determining what to do with all the data. We’re working with big data experts to help identify modifiable risk factors that can help us pinpoint things that we can adjust as physicians who treat these types of athletes. We’re also in the very early stages of developing an app for young athletes, parents, and coaches to guide injury recovery after Tommy John surgery. The idea is to provide exercises to prevent shoulder and elbow injuries in an engaging way for these youth athletes.

All in all, the most exciting trends I’m seeing in orthopedics are wearable devices and patient-specific implants coupled with machine learning. If we can continue to perfect that and take away the human bias of doctors, we’re advancing in the field.