The field of orthopaedic surgery convened in San Francisco from March 12 to 16, 2024, for the AAOS Annual Meeting, featuring exciting research, innovation, and opportunities for collaboration. Several prevailing themes emerged this year, illuminating the future direction of the field.
Patient-centered care took center stage in the joint replacement sessions at the conference. As health care transitions toward a more value-focused system, patient-reported outcome measures (PROMs) have become crucial in demonstrating the real-world effectiveness of interventions like total hip and knee arthroplasty. The impending CMS mandatory PROMs collection for total joint arthroplasty by 2027 underscored the significance of this topic, as evidenced by the ICL on using PROMs to guide decision-making in TKA. Incorporating PROMs data into risk calculators and care pathways can help set appropriate expectations and identify patients likely to have suboptimal outcomes, as discussed in the ICL. For instance, Orr et al. recently defined preoperative PROMs phenotypes combining scores on pain, function, and mental health measures. Patients with multiple low domain scores (KOOS Pain < 41.7, KOOS Physical Function < 51.5, VR-12 Mental Health < 52.8) had over twice the odds of dissatisfaction at one year after TKA. Tracking phenotypes longitudinally could also identify patients on suboptimal trajectories who may benefit from targeted interventions. As mandatory PROMs collection approaches, practices should consider how to best collect and utilize preoperative PROMs phenotypes to optimize surgical decision-making, whether by setting appropriate preoperative expectations based on likely outcomes or intervening to address modifiable risk factors in higher-risk phenotypes.
In line with this, a crucial question arises: What is the ideal duration of PROMs follow-up to balance meaningful data collection versus efficiency? An informative study, "Challenging the Status Quo: Debunking the Necessity of 5-Year to 10-Year Patient-Reported Outcome Measures in Total Hip and Knee Arthroplasties," analyzed this issue in depth. The findings showed that the proportion of patients achieving clinically meaningful PROMs improvements plateaued at one year postoperatively for both hip and knee arthroplasty. Yet the clinical relevance ratio accounting for attrition decreased over longer-term follow-up. Ultimately, the results call into question the necessity of five to 10-year PROMs assessment as currently mandated by some regulatory bodies. To enable a more patient-centered, value-driven system, research and regulatory efforts should focus on streamlined PROMs analysis up to one year postsurgery when stability is reached. Rethinking conventions by scrutinizing their evidentiary support is key to balancing outcomes measurement and efficiency.
Another predominant conference theme was the potential applications and limitations of artificial intelligence (AI) in orthopaedics. Multiple studies analyzed large language models like ChatGPT and their ability to provide accurate clinical information to patients. The findings showed promise but also significant inconsistencies depending on the complexity of queries. As presenters emphasized, orthopaedic surgeons remain the most reliable sources for musculoskeletal health information. However, with refinement, these AI chatbots could someday provide a valuable adjunct for patient education and virtual visits. For example, they may be able to respond to common preoperative questions about expectations or recovery. However, the technology is not ready for complex decision-making or replacement of face-to-face consultations. As presenters made clear, surgeons must lead development of these tools to ensure patient safety and ethical application. Beyond patient education, AI also holds great promise for areas like radiographic analysis, surgical planning, personalized implants, and risk stratification. However, key limitations around data quality and real-world validation remain. Orthopedic AI is an important area for future development but still in its nascent stages. Surgeons will need to engage closely with computer scientists and ethicists to realize the potential of AI while maintaining standards of care.
Beyond the advancements in data analytics and AI, several sessions tackled innovations in robotic assistance, wearables and digital technology. For robotics, while autonomous surgery remains theoretical, multiple robotic platforms for hip and knee arthroplasty aim to augment the surgeon’s technique and were presented. Though clinical data is still maturing, early findings suggest potential for improving component alignment over manual methods.
On the wearables front, digitally enabled shoes, braces, and motion sensors may someday transform musculoskeletal care from one-off office visits to continuous monitoring. Developers are exploring wearables integrated with machine learning algorithms to predict injury, track postoperative progress, and provide real-time feedback on gait. However, clinical integration remains highly complex.
As with other digital health technologies, surgeons emphasized that wearables must seamlessly integrate into workflow while demonstrating tangible improvements in patient care. Though robots may someday transform orthopaedic surgery practice, most technologies still have maturing to do. Nevertheless, the conversations at AAOS highlighted the building momentum in surgical robotics, wearables, and digital health — and surgeons will play a key role in responsibly guiding development.
In terms of format, the hybrid approach blending virtual presentations with in-person gatherings was well received. This method captured the convenience of remote talks combined with the critical face-to-face networking unavailable in pure virtual settings. For those unable to attend particular sessions, the academy offered an extensive 2024 Annual Meeting OnDemand, allowing attendees to revisit or catch up on content across all orthopaedic subspecialties. With more than 350 hours of material accessible online, this virtual library enabled participants to sync recordings across devices, download handouts, and even earn up to 100.5 CME credits. As all conferences continue to balance hybrid factors in a post-COVID world, the AAOS model provided a strong blueprint. Resources like the OnDemand library will help extend the meeting's educational impact for months to come.
With so much insight around both clinical advances and innovations in knowledge sharing, the 2024 conference demonstrated the continued vibrancy of the orthopaedic field. Attendees are already anticipating the unveiling of next year's meeting.
Dr. Piuzzi specializes in hip and knee reconstructive surgery and serves as the Cleveland Clinic Adult Reconstruction & Research Director.
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