In my last Editor’s Letter of 2016 (my first full year with ODT), I shared my views of the industry after attending the NASS annual meeting. Specifically, I said the spine industry would transform dramatically from the current spinal fusion technology that permeated so much of the show to more natural, biologics-based treatments. At the time, I suggested a relatively small window of time for how long it could take before the event of 2016 looked radically different in 2025.

Call it hopeful naivety or maybe forgetfulness about just how slowly the healthcare industry moves toward new, innovative technology. Here in 2023, it’s easy to see that timeframe has no hope of becoming reality. However, I think the ultimate outcome will be the new look for the industry at some point. And not just spine either; all of orthopedics will embrace technologies that promote a more natural healing protocol. It’s most certainly in the best interest of the end customer—patients.

I recently spent time with my in-laws. Unfortunately, my father-in-law fell in a store and ended up fracturing his hip. He had two screws inserted to help secure the area while it heals. This got me thinking about the current situation within orthopedics.

My father-in-law’s gait was adversely affected many years ago, which may have contributed to this fall. He was in an accident and required work on his knee. I don’t know the exact details of what was done or what follow-up procedures occurred, but ultimately, he was left with a hole in his knee as an implant used to treat it (perhaps a screw) was removed. To me, it sounds like the knee never healed completely or perhaps the ultimate result was the “best case scenario” given the trauma experienced by the joint in the accident. Again, the details I’ve gotten are several decades old, aspects could have been omitted, and the facts as I’m presented them could be getting delivered like a game of telephone (i.e., details change and/or are left out).

Fast-forward a couple decades, add an ankle injury on the same leg to the equation (perhaps a side effect of the knee damage), and he’s probably a candidate for a total knee replacement. Unfortunately, before that could happen, his gait and a poorly maintained shelving unit led to the trauma to his hip.

How much better would his situation be if, back when he had work done on his knee, a treatment protocol could have leveraged his body’s natural healing mechanism? Sure, there may have been a need to immobilize the leg with either a cast or perhaps anchors/screws of some sort. But what if those were resorbed into the body as healing occurred, eliminating any need for a follow-up procedure to remove them? Further, if biologic technologies were employed on top of the resorbable implant, growth could have been stimulated to ensure virtually no sign of the original injury remained.

I’m thrilled to see aspects of the industry heading in this direction. One need look no further than in this very issue for an anecdote of what it could mean for patients. In Michael Barbella’s additive manufacturing feature (starting on page 36), he shares the story of a young patient who, due to circumstances he explains more completely in the article, required removal of a significant portion of bone. A 3D-printed technology was used along with a bioresorbable material to help bone regrow in place of the eliminated section.

In another example, we shared a news item just this week involving a partnership between Evonik (a materials supplier) and BellaSeno (a developer of 3D-printed absorbable scaffolds) to commercialize 3D-printed scaffolds for bone regeneration. The scaffolds address the limitations of today’s solution of using tissue autographs (i.e., they sometimes lack stability and cannot be packed in a controlled manner). Meanwhile, the material utilized features a degradation profile that enables the implant to be absorbed at the same rate of new bone formation. The current target applications are for large and complex bone defects, but I would imagine the use cases could grow from there.

These examples represent just two of the many applications happening within orthopedics that will ultimately reflect more of the standard—rather than the exception—for restoring the body following trauma. Sure, we have a long way to go (I don’t think anyone has come close to presenting a natural alternative to joint replacement; if you’re working on it, I’d love to hear about it). But it’s exciting to see advances like these as the early steps in the right direction.

So as I move about the AAOS 2023 annual meeting expo floor this week, I’ll see a number of impressive innovations, from robotic surgical solutions to smart implants. What I’ll really be keeping an eye out for, however, will be the biologics offerings and technologies that restore the body to a more natural state. 

Sean Fenske, Editor-in-Chief
sfenske@rodmanmedia.com