Redefining Innovation in Orthopaedics For Seamless Patient Care and Improved Operational Efficiency

Sureshan Sivananthan, Consultant Orthopaedic and Sports Surgeon, ALTY Orthopaedic Hospital

With new technology being introduced to the market ever so often, the future of orthopaedics care in the region has never looked more promising.

Digital transformation has presented incredible opportunities for change, especially within the field of healthcare. Technologies such as big data, artificial intelligence (AI), machine-learning (ML) and analytics have gained popularity in recent years and promise greater business impact and industry disruption.

Big data provides the raw material (data sets) for AI and ML to make better data analysis such as personalised risk prediction, improved decision-making process, detecting implant specifics from imaging that will assist to monitor patient movement and recovery process.

Some possible innovations in orthopaedic surgery predicted by experts also include the use of robotics and augmented reality (AR) for greater precision1 in the operating room. This makes remote procedures and minimally invasive surgeries a reality, further minimising patient recovery timelines.

With these technological and innovative approaches in place, we can foresee the orthopaedics industry moving to a spectrum of providing minimally invasive treatments with maximum results.

This is more so needed in emerging markets within the Asian region where healthcare models are already fragmented. A seamless and more efficient approach to healthcare delivery can also improve operational efficiency and patient experience for electives such as cardiovascular conditions, orthopaedics, oncology etc.

Let us take orthopaedics into consideration. Chronic pain is one of the most critical healthcare problems in the Asia-Pacific region2, and twenty per cent of chronic pain worldwide3 is related to osteoarthritis (OA). In fact, a recent study showed that in some countries like Malaysia, one in three people over the age of 55 suffer pain from OA. Apart from OA, musculoskeletal discomfort (MSD) typically related to our shoulders, neck and lower back region has also increased in recent years.

A study published by the International Journal of Health Sciences and Research reported that 70.5 per cent4 of participants between 18-65 years who were working from home  reported discomfort and pain, especially in the lower back and neck region. With a growing ageing population and a sedentary lifestyle, the burden of orthopaedic conditions in this region is only expected to rise.

In order to effectively manage the surge in orthopaedic related conditions and to offer patients the highest level of care and efficiency, industry leaders need to start developing approaches that are efficient across all levels — from diagnosis, treatments, post-operative care and follow ups.

A shift to remote patient care via telemedicine

The pandemic has accelerated digital adoption in the healthcare industry, and one such prominent example is telemedicine. Although telemedicine has been available pre-pandemic, the urgency to digitalise increased during the pandemic.

Telemedicine in orthopaedics allowed healthcare professionals to connect with their patients remotely when movement was restricted. This shift to remote patient care has made consultations and post-surgery followups more convenient, cost-effective and well-received5 especially by younger patients who are early adopters of technology.

The use of telemedicine in an orthopaedic setting further allows surgeons to consult and tailor best treatment options to their patients via secure video conferencing platform. Though remote care for conditions such as fracture may seem unconventional, healthcare professionals who are quick to embrace technologies have found ways to do much of it virtually6.

For example, by delivering X-ray imaging to doctors for diagnosis virtually, they may be able to perform preliminary examinations without the hassle of walk-in appointments. Telemedicine may also facilitate with post-operative care such as follow-ups, consultation on diet and lifestyle habits, movement observations post-surgery, and rehabilitation. Patients who require more advanced care can stay connected to their consultants remotely while seeking for home care and therapy, making the overall journey for patients more seamless, convenient and costeffective.

Improving operational efficiency via ERAS

Enhanced Recovery after Surgery (ERAS) is all about improving patient outcomes and speeding up recovery after a surgery. An enhanced recovery pathway focuses on optimising every aspect of a patient’s journey and promoting the patient as an active participant in their recovery process and rehabilitation. Successful pathways aim to optimise every step of a patient’s journey in order to accelerate  post-operative recovery, reduce complications and general morbidity. For instance, an ERAS Pathway could potentially be as follows:

PREOPERATIVE: Minimise fasting to reduce anxiety and pain perception, and improve diet recovery

INTRA-OPERATIVE: Optimise anaesthesia and pain relief protocols and promotion of normal blood circulation, temperature and oxygenation during surgery

POST-OPERATIVE: Patient assessment, early physiotherapy, promotion of a wellness model of care and team approach to perioperative management, utilising medical hospitalist and cardiologist to optimise medical care during early recovery

DISCHARGE: Patients improve faster and are therefore discharged home earlier and have clear instructions on how to progress with their rehabilitation at home and have home visits from the physiotherapist to ensure that they are progressing well.

Overall, ERAS is a paradigm shift in perioperative care. The use of enhanced recovery pathways within elective orthopaedic surgery can help reduce patient discomfort and pain, allow early mobilisation and improve patient outcomes. This multidisciplinary approach has improved outcomes in nearly all surgical specialties, including shortening length of stay (LOS) by 30 per cent to 50 per cent7, making it more cost effective.

Adapting technological advancements in imaging and diagnosis

In the past, orthopaedic practices addressed musculoskeletal deformities through exercise and splints. Moving into the 19th century, doctors practicing orthopaedic techniques and treatments used intramedullary rods to help with broken femur and tibia bones8. Today, effective and non-invasive health screenings and procedures are widely available as multi and single specialty hospitals have been investing in stateof-the-art technologies operated by experienced healthcare professionals to provide seamless patients and quality healthcare.

This boom in imaging technology can provide a new dimension for Asia’s healthcare framework, especially combined with the rise of super specialty hospitals in the region that focus on niche areas.

For example, at ALTY Orthopaedic Hospital we are focused on managing orthopaedics and related musculoskeletal conditions. ALTY Orthopaedics Hospital is equipped with facilities that aid in the functional recovery of patients with advanced imaging technologies that help transform patient’s journey to wellness.

The hospital recently acquired the first ever EOS imaging system in Malaysia, an advanced 2D/3D imaging system dedicated to adult and paediatric patients with orthopaedic and osteoarticular pathologies.

As compared to conventional X-ray systems, EOS imaging offers 50 per cent9 to 85 per cent10 less radiation and up to 95 per cent11 less dose than basic computed tomography (CT) scans, in accordance with the ALARA (As Low As Reasonably Achievable) principle for minimising a patient’s exposure to radiation. As such, reducing radiation dose is particularly beneficial for children requiring frequent imaging, such as children with spinal deformities like scoliosis.

In addition, the hospital also invested in Malaysia’s first-ever weightbearing Magnetic Resonance Imaging (MRI), also known as the tilting MRI. The machine allows a patient to be positioned in a supine (lying down) or weight-bearing (standing up) position, as the device can rotate a patient from 0 to almost 90 degrees.

This enables doctors to study all joints and the spine with more precision and produce more detailed diagnosis. For example, when a patient is suffering from joint pain, a traditional MRI imaging (usually when a patient lay downs) could not detect the pressure on the joints as is significantly decreased in that position. However, when a patient is in a natural stand-up position, the compression and pressure cause by the force of the body weight reveals the symptoms and disorders more clearly.

Not only do advanced imaging provide visual aid that aid the consultant’s accurate diagnosis but also improves the overall patient experience via a safer delivery method.

As healthcare evolves with an increased focus on patient care, investing in advanced imaging technologies will not only develop a reputation for providing niche care, but also further strengthen access to quality care for patients. Advancements in imaging will provide great potential for shorter reporting times, fulfilling urgent patient needs and improving overall healthcare outcomes.

References:

1 https://www.alcimed.com/en/alcim-articles/3-applications-oftechnological-innovations-in-orthopedics-and-orthopedic-surgery/
2 https://www.masp.org.my/index.cfm?menuid=14
3 https://apsoc.org.au/PDF/GYAP/2016_GYAP/Fact_Sheet_13_Osteoarthritis_Pain.pdf
4 https://www.ijhsr.org/IJHSR_Vol.11_Issue.2_Feb2021/IJHSR05.pdf
5 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7594965/#:~:text=Telemedicine%20for%20orthopedics%20has%20safely,outpatient%-20basis%20in%20many%20countries
6 https://www.verywellhealth.com/telehealth-for-fractures-5115438
7 https://ortoday.com/the-2-25-million-financial-impactof-an-enhanced-recovery-after-surgery-program-andpriceless-improvements-in-patient-safety/
8 https://aica.com/the-history-of-orthopedics/
9 Diagnostic imaging of spinal deformities: reducing patient’s radiation dose with a new slot-scanning x-ray imager. Deschenes S et al. Spine. 2010
10 Comparison of radiation dose, patient comfort and financial break-even of standard digital radiography and a novel biplanar low-dose x-ray system for upright full-length lower limb and whole spine radiography. Dietrich TJ et al. Skeletal Radiol. 2013
11 Ionizing radiation doses during lower limb torsion and anteversion measurements by EOS stereoradiography and computed tomography. Delin C, et al. Eur J Radiol. 2013

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Author Bio

Sureshan Sivananthan

Sureshan Sivananthan is a Consultant Orthopaedic, Arthritis & Sports Surgeon at ALTY Orthopaedic Hospital. He is Board Certified by the UK General Medical Council and is on the National Specialist Register. For the past 15 years, he has performed over 5,000 procedures on the hip, knee and shoulder joints.

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