Advances and Innovation in Musculoskeletal Health: Lower Extremity
[MUSIC PLAYING] Thank you for joining us for Advances in Innovation in Musculoskeletal Health Series: The Lower Extremity. My name is Claudia Zurlini And I'm a senior coordinator with the Community Education and Outreach Department here at Hospital for Special Surgery. In this webinar this evening, we're going to talk about the newest advancements in lower extremity surgery and care, and how this technology, and other innovations, can impact care, treatment, and your outcomes as a patient.
Our guests this evening are Dr. Cynthia Kahlenberg, a clinical fellow in adult reconstruction and joint replacement; Dr. Jensen Henry, one of our other wonderful clinical fellows in foot and ankle; and Sandra Bossi, the Director of Care Delivery and Innovation.
We're so glad to have you here. Thank you so much for joining. Great. So we're going to move through basically the trajectory of care in a more linear approach this evening. We'll start with non-surgical and pre-surgical advancements.
We'll follow by advancements during surgery. And finally, we'll look at post-surgical innovations. But before we get started into really the depth of it, if you all don't mind, would you briefly introduce yourselves and explain your role at HSS? And we can start with you, Dr. Henry. Thanks so much for the intro, Claudia. Hi to everybody out there. Looking forward to hopefully seeing folks in the real world in person soon.
I'm Jensen Henry. I'm one of the foot and ankle fellows at Hospital for Special Surgery. So what that means is we've already done our residency training. We're doing an extra year of specialized training in an area within orthopedic surgery of interest. And then I'll be starting as an attending surgeon at Hospital for Special Surgery this fall, in September.
And my specialty will be foot and ankle. Great. And Sandra? Nice to beat you all tonight. So I'm Director of Care Delivery Innovation at HSS Innovation Institute.
And in that role, I lead initiatives that leverage new technologies to improve healthcare access and delivery. And these technologies can range from anything from digital health to various applications of machine learning and artificial intelligence in medical diagnosis and process improvement, a lot of data analytics and prediction tools that we develop, as well as motion assessments technologies and variables for remote monitoring and rehab. And I have been for six years with the HSS Innovation Institute.
And it has been really truly exciting time to be creating those new ways of delivering care to people and being able to bring HSS best practices and unique clinical expertise to the community and the rest of the world. So very excited to be here tonight and participating in the conversation. Fantastic, thank you. And Dr. Kahlenberg, so glad to welcome you. Thanks so much, Claudia.
And thanks, everybody, for being here tonight. I'm Dr. Cynthia Kahlenberg. I'm a fellow in adult reconstruction and joint replacement surgery, which is essentially hip and knee replacement surgery here at HSS. And along with Dr. Henry, I completed my residency
here at HSS also previously. And I'll be seeing patients for hip and knee replacement starting in August at HSS at both the main campus and in Stamford, Connecticut at the HSS facilities up there. Fantastic. Thank you all.
So we're going to get into the meat of it now really. And before we dive into the details, in general, overall, how does technology intersect with surgery and patient care? Really how do technological innovation impact the patient care that we are able to deliver and the outcomes that patients are able to have? I think that this is relevant for everyone on this panel. So Sandra, if you'd like to begin, you're more than welcome. Sure. So I see two really important, meaningful ways that we can leverage the technology in healthcare.
One has to do with patient engagement and the communication that can be streamlined between patients and clinical teams. And really in so many ways, in profound ways, it allows for better care delivery and management. So we see a lot of digital tools that allow for a more personalized care and for better engagement. And we have developed some of them here at HSS as well. We will talk about them later.
But technology has also allowed patients to be more active and knowledgeable about their care. And I think that's a really important aspect. And they can participate better in the decision making process. It also allows for that better communication between clinicians and patients. On the other side, by using technologies, we are really able to generate way more data.
And we are also able to use the analytics tools, as well as all machine learning and AI applications to apply it to the data. And those are the environments we necessarily didn't have 10 years ago. And that's the infrastructure that allows for that data management. Why is that important? Because it can allow us to generate new clinical insights and apply them in the treatment and in the diagnosis.
And so we don't necessarily have the data that resides in silos, but really can be used in a way more effective way to inform about the outcomes and the processes. Dr. Kahlenberg or Dr. Henry, anything to add at that, especially important considerations when we're thinking about technology in healthcare, especially that orthopedic care of the lower extremity? Sure, I can jump in. I think Sandra really hit the nail on the head in terms of the broad areas of how technology is being applied in the joint replacement arena. It's being applied on both the clinical side, so how we give care to patients, and on the research side and how we think about broad trends and what we can do to improve care in joint replacement.
And we're lucky at HSS that we do thousands upon thousands of joint replacements here every year. And by using technology, we've been able to take a lot of data that we've learned from those joint replacements and use it to make preoperative care, operative care, meaning what we do in the operating room, and post-operative care better from everything that we've learned and we're continuing to learn at a faster and faster pace as we learn how to use the large data that we're able to collect. And on the clinical side, we'll get into more specifics as we go on, but we've really seen a lot of technological advances in those three areas as well on the clinical side, preoperative, how we actually do joint replacement surgery, and in the post-operative arena. I couldn't agree more. I think really technology in the foot and ankle world allows us to capture data and allows us to capture data more precisely and more accurately than we ever have before. So I think now, prior to surgery, we have so much more information.
And we have the capacity to get so much more information from whether it's a technically advanced imaging study, whether it's from a gait analysis study, whether it's from computer modeling based on imaging. So I think by the time we actually get to the surgery process, if that's the right decision for the patient, we're able to really identify what the problems are and almost rehearse our intraoperative plan ahead of time, which only allows us to be, I think, more precise, more accurate, like I was saying, and just better prepared, which hopefully guarantees or at least provides more security for a somewhat more predictable outcome. Yeah, and that's certainly a word that we hear a lot when we're thinking about advances and innovation is that it will be more predictable, that we can better predict how a patient is going to-- what their outcome is going to be. And so we're going to dive into some of these specific innovations.
But before we do, Sandra, would you mind laying the groundwork of how all of these state of the art concepts and inventions really come to fruition? Can you discuss the innovation process and how HSS partners with others? Absolutely. So just to mention first that at the Innovation Institute we have three verticals. And the processes may slightly vary. But overall, it's a similar process. So there are three verticals, life sciences, medical devices, and the care delivery that I lead. So we have a very robust evaluation process, because we see a myriad of technologies on a regular basis.
And first of all, we are looking at the projects that align with our mission, and core values, and that really have a potential to truly transform and improve healthcare value. Also, our processes can be both inside out and outside in. And what that means is when we work inside out, it means that we help bring the innovative ideas and concepts that are developed internally at HSS to markets.
And HSS has a really long history of innovation. We are over 150 years old institution that has solely specialized on orthopedics. And you can imagine the expertise that has been accumulated and the unique knowledge that has been accumulated. So we leverage that. And we are really blessed to have all these resources.
And we work with our researchers, surgeons, all clinicians, motion analysis and biomechanical experts, rehab teams, and data science teams as well to develop those internal ideas. And to bring them to fruition, we often need to partner with outside companies, because they have that ability to scale and commercialize those ideas. The other model is outside in. What that means is that we look for outside technologies that can be applied in medical field. And we partner with those companies, so that we can infuse our own best practices and standards of care and help those companies develop the products that can really make a difference in healthcare.
And as I said, the process is very robust. We have enormous resources at HSS to test and validate those products and really apply them in a real clinical setting, which is extremely valuable to those companies. Because that's how they can develop, and reiterate, and create the products that really are successful.
There are lots of technologies out there. And it's very important to know when to say no and when to identify the ones that really solve real problems. Because you can very easily be distracted with all the coolness around it.
So our due diligence process is very robust. One thing I would like to mention is that when you are truly innovating, you're likely to fail. And I don't think we acknowledge that enough. And I think that is really, really important.
Because a failure is an integral part of innovation. And it's not because something doesn't work at first, or even after several iterations that it won't become inevitable to use in the future. So it is really about how quickly you learn and about your ability to apply lesson learned in your future iterations and endeavors that is truly a part of innovation. And the other thing what I think is really exciting about the work that we do at the Innovation Institute is that we put experts from various teams to work together. And by combining those expertise and having people with very, very different points of view and work together, it is necessary to innovation. Very exciting process.
And I'm excited to dive into a bit more of some of the specifics. And so thank you, Sandra. As we get into care and care delivery, let's talk about the pre-surgical process or more non-invasive treatment options.
And something that we hear about a lot is this idea of predictive analytics. So what is that? And what is its role in surgery? And how is it really changing the clinical outcomes of our patients? Yeah, I can get started on that if you want. So I think predictive analytics is a broad term.
But it's basically a research and clinical tool that we use to take our experiences from the past and data from past patients and use that to predict how if we see a patient with x, y, and z factors or characteristics, we can integrate those together and say, how did a similar patient to this do in the past based on our algorithms? And in joint replacement and in all of the different surgeries that we do at HSS, we have a lot of algorithms that help us determine certain risk factors that might make surgery more risky, certain positive factors that might make us think that surgery is a very good option and that certain types of patients will do very well. But essentially, at the end of the day, it's using our past experiences and many, many data points that have been collected over many, many years and many patients to determine on an individual patient level for an individual patient with certain characteristics what we think will be the best path forward. And that's been very helpful in the area of joint replacement, where we have just, for example, certain decisions to make, such as, will the patient do well with going home or going to rehab? And a lot of our patients, most of our patients now, do great with going home, and certain other types of things, like what kind of medications we need to give the patient to do well after surgery, if their current functional level, how much better that is going to get after surgery.
So those are some of the things that we think about with predictive analytics on the joint replacement side. That's great. And I know, Dr. Henry, you're going to take us through some of the other exciting advances. But is there anything that you would like to add about predictive analytics in ankle? I think everything that Dr. Kahlenberg said is really applicable to multiple areas of surgery.
I think the other interesting aspect about that is that predictive analytics often helps us try to figure out, some folks are almost too good early on for surgery, where you always trying to think of the balance of, is surgery going to make someone better? And how much better are they going to get? And so I think one thing that I've really learned in the last few years from the predictive analysis side is trying to figure out, who is really going to have the most benefit from surgery? And really trying to identify that sweet spot of, who's going to be incredibly happy and satisfied that they went through? Again, just going back to that idea of trying to achieve a more predictable outcome and really identifying who is going to be in that target zone. Great. And so this just gets me thinking. Is this something that patients would have access to? Or rather it's a conversation always with their physician, their surgeon? For me, it's always a conversation. I think that certain centers across the country and I'm sure down the road we might start to see it incorporated more in healthcare is where as an individual you fall in the metric of how we're trying to really map? Are you going to go home? Are you going to go to a rehabilitation facility? Are you going to be on x or y medication to help your pain after surgery? And I think ultimately, that would be a fantastic way to innovate, right? The second that you meet with your surgeon, you have your x-rays done.
You fill out your preoperative intake forms. You're able to see that barometer. But at the end of the day, patients are-- we're still treating people at the end of the day. We're not treating algorithms, or numbers, or x-rays.
And so I think at the end of the day, it's still a conversation. And that's what really will always separate medicine from just something that a computer could exclusively do. Great. Yes.
And I would just like to add I absolutely agree with this comment. And I think a lot of variability goes into each and every patient. And that's why those predictive models will always be to a certain extent a challenge.
And we'll need that in person communication, that explanation. But there are more and more tools that are being developed from the innovations perspective that we review and evaluate. And the reason why those tools are today possible is because there is more and more data that's being available.
And to be able to predict those who really need long term trends, you need to collect data over multiple years, if not decades, to really generate meaningful insights and to be able to predict outcomes. But obviously, that's something patients would always really want to know. What are their odds if they go down that path? To be able to make more informed decisions. So the technologies today allow us to collect that data.
And in the future, I think we will see more and more predictive analytics being applied and having its place in a healthcare environment. Yeah. And I think kind of jumping off of that, Sandra, is it really is a conversation starter. It's never this algorithm churned out this value.
Well, stamp yes surgery or stamp no surgery. It's really a means to generate a higher level discussion to help facilitate that informed decision making, so that we all understand what the process will entail and that we feel like we're coming at it with all the information. I think it's a great tool. And one of those tools that we'd like to highlight that is helping is my understanding to improve patient outcomes and deciding who is a candidate for surgery or other treatments is computed tomography. And so Dr. Henry, can you discuss
the weight bearing computed tomography and how this has improved the treatment of foot and ankle conditions? And I know we have some images here that I will pull up. Yes, that's fantastic. This is a major absolute passion of mine. And so when we get x-rays, they are a workhorse in orthopedics.
Whether you're going to see someone for your hip, or your foot, or your shoulder, We. Always get x-rays. And they provide a wonderful view and alignment of the bones.
And we try to, at least in the foot and ankle world and I think also for the hip and knee replacement world, we often get those x-rays with a patient standing. Because if you can imagine, if you get them when you're lying down, you're not looking at your joint in a functional position at all. So here's a couple of images of just a regular standing x-ray on someone doesn't have significant foot and ankle pathology.
And it's nice. Because you can see the bones. You can see the alignment. But the foot and ankle, it's got 26 pounds, 33 joints.
And so trying to appreciate the nuances of all of that in this two-dimensional modality is challenging. So if you go to the next slide, one of the ways that we try to conquer that is with CAT scans or computed tomography. And traditionally, even though we got more 3D information about these, they were always done in the non-weight bearing position. So if anybody has ever had a CAT scan out there, you know that you typically lie on a bed. And you go into the tube. And if you go to the next image, I think it'll hopefully see exactly-- the image on the left, you're in a nonfunctional position.
Most people don't have orthopedic pain when they're lying down. It's often when you're trying to do activities, or negotiate stairs, or walk on the beach, or something like that. And so in the last several years, one of the amazing advents that HSS has been behind is the inclusion of a weight bearing CAT scan, or a weight bearing CT, where you actually can stand in the CAT scanner. And we get the three-dimensional information about your foot and ankle, but in a functional position, which has been an absolute game changer for how we identify, and diagnose, and manage, and follow our patients, especially when they have these complex deformities or complex problems of the foot and ankle. So if you go to the next slide, I think this will hopefully illustrate it. This is a patient who had both non-weight bearing and weight bearing CAT scans of their ankle.
And I'll admit, on the left, you can see a front view. And on the right is a side view. And yes, the differences are somewhat subtle. But I took the liberty of measuring one of the key angles that we look at when we're trying to look at angle deformity. And on the left, when the patient was not standing in the CT scanner, their deformity was six degrees.
And if normal is zero, that's not that far off. But once the patient gets in the functional position, once they're in the CT and they're actually standing, that abnormality at the ankle joint goes up to 18 degrees. And similarly, you can see similar parameters on that side view. And so weight bearing CT is allowing us to better understand our patient's deformity and their problems. And so the surgical decisions that we might make for a six degree deformity can be very different than the ones that we would make for an 18 degree deformity. And that's just one of the examples of where technology has really improved and changed the way that we do things.
I mean, this is the standard of care now at HSS for any patient with ankle arthritis, for many of our bunion or our flat foot patients. And it's just helping us understand the deformity better, so that we can treat our patients better. That's amazing. And you would never realize that such a small factor or degree of difference could make such a huge difference. And so as we continue, are there any other advancements that have really improved the preoperative process? Or any advancements that have been used in lieu of surgery? And I think that you all could have extremely valuable contributions to this question. Yeah, I think in terms of hip and knee replacement, it really gets back to what we were speaking about before in terms of the predictive analytics.
So I think now we as surgeons and also our medical colleagues, the medical doctors who think about patients health risks before surgery and help us assess that, we all have better tools that can help us determine which patients are going to benefit the most from surgery. So as Dr. Henry said, sometimes patients come in and we look at their functional scores. And they're doing quite well.
And they may not think they're doing quite well. But compared to what we would expect the outcome of the surgery to be, we can tell them you only may get a slight benefit from this surgery. Whereas, other patients, their functional scores are a lot lower. And we can tell them, we really think you're going to have huge gains from this surgery. So it really gets back to what Dr. Henry was saying
before about better predictions of how patients are going to do after surgery. And also, on the medical side, their medical risks, how the different medical problems that they have might factor in, what chances they have of having some sort of medical complication after the surgery, all of that has really improved with the tools that we have of predictive analytics, and the data algorithms that we have been able to put into place and improve in recent years. And I would just like to add a couple of projects that at innovation we have been looking at that also concern a pre-surgical planning. Those are AI and machine learning technologies that apply to the [INAUDIBLE] prediction.
So based on the radiology images, x-rays or CT scans, which is better because provides 3D vision, we have developed the algorithms that can with more accuracy predict the implant size that is going to be needed and hopefully, improve the outcomes as well. So there are different types of those technologies that we are looking at. But the ones that use CT scans not only hopefully predict the size, but also the orientation of the implant. So it adds another value to the surgical process afterwards. Thank you all.
And speaking of the orientation, I recently read about how important and effective robotic-assisted surgery can be in securing the orientation of joints and in replacements. And so I'd like to kind of move into advances during surgery and during the operative process. And so something we hear about a lot is robotic-assisted surgery. Can you discuss what this is, what it means? Is it a robot replacing my knee? And how it affects the patient experience overall? And I know we have some images here as well, which I can pull up. I can get started with that. So the use of robots and computer technology has really, I would say, exploded recently.
In hip and knee replacements specifically, I would say hip and knee replacement are really two of the surgeries that are leading the way in terms of robots and computer navigation, which are sort of two different areas of advancement in technology and surgery. Robotic surgery is broadly defined as when the surgeon uses a tool, a robotic tool, that helps theoretically increase the precision or accuracy of where the implant is placed, what bones are cut during the surgery, how the bone cuts are made, and where the implant ultimately ends up. And then computer navigation is similar in that it helps the surgeon determine where the implants should end up. But the surgeon generally uses manual tools to get there and then uses the computer navigation to help with the alignment or placement and help determine also things like sizing or thickness of the implants.
So I think it's very important to know that while these are really new and exciting technologies, there's no one robot or one piece of computer navigation technology that has taken over at this point that we can say this one is better or this one is better, or even that computer navigation and robotic technology is necessarily better than the manual technology that we have. And that's because all of these advancements are very new. So the most important thing I think when you're looking at surgery and choosing a surgeon is finding a surgeon that's very experienced in hip or knee replacement.
And we're really fortunate at HSS to have many surgeons who focus their entire career solely on joint replacement surgery. So I think trying to find a surgeon just based on one specific type of technology that they use may not be as advisable as trying to find a surgeon who you feel comfortable with, who you trust, and who is focused on hip and knee replacement surgery. But having said that, for surgeons who are experienced with these technologies, both the robotic side and the computer navigation side, are helping surgeons be more accurate and precise in where they place their implants. I think it's very exciting. When I started my residency almost seven years ago now, very few surgeons were using any type of robotic technology or computer navigation in their surgeries.
And now, a very large proportion of surgeons here at HSS are using these. So it's become much, much more common in recent times. And it's really exciting on a broad scale, because the data that is collected with each surgery that uses one of these technological advances is able to contribute to future learning for future patients of where we can go in terms of making joint replacement more successful. And I think all of these technologies have already been through a few iterations and are continuing every year to have new versions come out, new iterations that are more precise, more accurate, and give us more useful information during the surgery.
To get back to your initial question though, is a robot doing the surgery? The answer to that is no. So in all of the technologies that are currently in use, at least here at HSS, a surgeon is in control of the surgical equipment. And whether it be the robotic saw, or the robotic reamer, the robotic burr, arm, any piece of equipment, the surgeon is in control of it the entire time, as well as any of the computer navigation devices. But the robot or the computer navigation device can be giving the surgeon extra information in real time that helps them complete the surgery. Feels similar to an airplane pilot, right? In the air, the pilot will always be in the plane.
But I definitely prefer to probably be on the plane with the computer assist. And Sandra, did you have anything additionally to talk about robotic-assisted surgery? No. So the only thing is like what Cynthia already mentioned is that apart from the accuracy that robotic surgery can allow, what's really important is that data collection that we previously didn't have while we did more traditional way. And through that data collection, we really hope to gain also, additional insights into the clinical surgical processes and the potential how they can be correlated with the outcomes.
So that is very exciting. The other thing that I would like to mention is that we also, the robotic surgery also can be correlated with smart implants. And we were the hospital that did the first knee joint replacement with a smart implant that is FDA approved.
And the data is being collected over a 10 year period. And so you can imagine how the healthcare really will be connected by understanding more like what happens during surgery? What happens post surgery? By being able to track all these things that we normally can to see how patient is really doing and to have an impact at the very early stages in the post recovery, if we notice that something is not going right that the clinicians can be alerted and that they can act upon it. So I think it's the whole technology there, the whole ecosystem, is really connected and will be really transformed in the years to come. Amazing. And Sandra, you mentioned smart implants. Dr. Kahlenberg, I know you were recently
involved in a few cases with smart implants. Could you describe what they are and their implications for patients? Yeah, absolutely. So smart implants are very new to the market, newly approved by the FDA. There's currently just one knee replacement that I'm aware of that is FDA approved as a smart implant. And that implant is unique in that it has a chip in it that's able to provide data from the knee implant to the surgeon that can help to guide the patient's recovery.
We're definitely in very early stages of this, with a small number of these implants having been implanted at HSS and a small number elsewhere around the country. But we're very excited to see the data that can come out of this to help guide the recovery for the individual patient, as well as on a broader scale and a research scale, help us understand more about knee replacement recovery in the future. So I think it's really very exciting time in smart implants.
It's very much in the infancy, very early on in that area, but hopefully much more to come in the future in terms of smart implants. And just to speak a little bit more to it, the surgery itself, to implant one of these devices, is actually pretty much identical to a regular knee replacement surgery. The only difference is that the implant itself has embedded in it this chip that, as I mentioned, is able to provide real time data to the surgeon.
But the process of the surgery is the tried and true process that we've been doing for a long time. And we're just very excited to see where we can go forward with these smart implants. Amazing. I imagine eventually you might be able to hook it up to your Fitbit or something. We didn't get to touch on robotic-assisted surgery in total ankle replacements and foot.
But Dr. Henry, would do you mind? Do you see robotic assistants in the future of foot and ankle surgery? And why might it not be included now? I think it's definitely where the field is going. We just don't have it yet. And honestly, it's just due to mere, I think, numbers and proportions.
Dr. Kahlenberg can correct me if I'm wrong. But I want to say there's close to maybe 800,000 to a million total knees done in the United States every year. And comparatively, there's only 8,000 to 10,000 ankles done, ankle replacements done in the United States every year. And so one of the benefits, like we've been talking all evening about data, is in order to generate this and to really make decisions on this, you just need data.
You need numbers. And so I think going forward we'll get it, especially as the current generation of ankle replacements evolve. We just don't have that technology yet.
I think we just need more patients and a greater number of historical patients to do so. But it will be, I think, really fascinating to see where that goes. Because one of the reasons why I love total ankle replacement is because after you do the total ankle replacement in surgery, you then have to understand what's going on in the foot underneath the ankle. And so having that technology, so that once we do the ankle replacement making sure that the rest of the foot, all those other joints of the foot are balanced underneath the ankle is one of the biggest and most exciting challenges that I think we have in surgery.
And so using, again, technology and data to help us plan our surgeries and be more precise and accurate will be incredibly fruitful. Amazing. And speaking of precision, let's talk a little bit about 3D printing.
How has this been applied to orthopedic care of the hip, knee, foot, and ankle? I can jump in on the hip and knee side. So currently, in terms of 3D printed implants, this is especially being used in revision surgery. So if something doesn't go right with a hip or knee replacement and it needs to be redone, certain times, there's bone loss and very complex problems that occur.
And we're really lucky here at HSS to have partners both on-site and off-site, but even on-site, that are able to design special custom implants that are 3D printed to help us in the revision surgery setting. And these can be really powerful tools for patients who have major problems with hip and knee replacement. In terms of on a broader scale, for the majority of patients who have their first hip or knee replacement surgery, 3D printing is used for some of the implants to provide the coating on the back of the implant.
It's not on a custom basis. It's how it's done for every implant that's made. But the really exciting area here at HSS is how we're able to, in some extreme cases, actually 3D print custom implants to solve some of the most complex challenges that we're seeing come through. Amazing. And I think I have an image here that you likely prepared. Yeah, and then, Sandra, I know you also have some exciting information about 3D implants as well.
So this is my slide. It's in partnership with an Italian company, Lima Corporate. At Innovation Institute, we have worked to create the really first provider-based 3D printing center at HSS enabling us to print those customized implants for patients who, as Cynthia mentioned, are either revision or a very complex joint reconstruction. And so that's a testimony of HSS's commitment to really patient centric care and the precision. We talked previously about the AI tools that are being designed to predict the ideal or the most optimal implant size. But this is really patient centric.
And so we were excited when last year we opened that center. And just to chip in, this has been a huge area for foot and ankle surgery as well. Again, it's not typically for that first time patient.
But in the revision setting, in a patient who had an ankle replacement who maybe they had it 20 years ago and it worked wonderfully, but over time, they started to have loss of bone or wearing out, we can actually-- the bones of the foot are not very big. So you don't have that much room left. So we can actually 3D print entire bones. And I'm actually in my office right now.
So here is an example of one of the 3D printed total [INAUDIBLE]. The company usually makes three. And when you're in the surgery, the one that is not for the patient, you keep for showing the next patient. So it's been truly remarkable.
And it's allowed us to save our patient's range of motion and function rather than commit them to a surgery that might be a little bit more outdated, because we didn't have those capabilities. Amazing. That part is really beautiful. It looks like a piece of jewelry or something. It's so nice.
Great. So I think that, obviously, there are so many implications for the operative process, the preoperative process, the operative process. Now I'd like to kind of move into what happens after surgery if a patient does require surgery? And so just being mindful of our time here, how has technology impacted the surgical recovery timeline? And what can patients expect post-surgery based on current advances in innovation that we're seeing here at HSS and beyond? I would be happy to jump in here and mention one of the projects that we developed in partnership with Zimmer Biomet, a global leader in the manufacture of the implant devices. And they have developed the digital remote care platform that can be used in conjunction with Apple Watch.
And that's a digital platform that can facilitate better communications between clinicians and allow for remote monitoring both before surgery and after surgery. So Claudia, you asked about the post-surgery. So how does that help? Well, through their cell phones, iPhones or Androids, patient can download the app.
And it guides them. They have the whole full surgical episode of care with the educational content that's provided there, as well as exercise levels, exercises that they need to complete. And the tool also monitors their adherence to that content and the completion levels, which is very useful for clinicians to understand how well patients are recovering. The fact that they also have a watch, so we piloted the MyMobility platform at HSS. And with the patients who were also using Apple Watch, we were able to collect additional data around steps and gait and see how they were doing post-surgery. So why is that important? It's important to stay connected in many ways afterwards, post-surgery, to be able to see how patients are doing.
And it can be done in certainly a passive way. In other words, through those dashboards, where clinicians can see how well patients are doing for their pain levels and they can see their physical activity. Now, I would just mention, it was a small rollout. It was more experimental for us to see. But the patient feedback was extremely positive. And we had even one patient who had knee surgery at HSS three years prior.
And then he had another knee surgery by using MyMobility. And his feedback to us was that his recovery was much faster the second time, which was really great to hear. So there are definitely a lot of digital technologies out there that can allow for that monitoring. But I would just say that technology is being used in the clinical setting. They really need to be validated. And they need to provide meaningful clinical insights that clinicians know what to do with them.
So the requirements around the use of them are within the healthcare environment are rigorous. And so it's important that as we adopt them that we ensure that those technologies are both technically and clinically validated before they are used on patients. Great. So exciting to hear about the patient who had such improved outcomes as a result of MyMobility. Dr. Henry, Dr. Kahlenberg, anything else
in terms of how technology has impacted recovery for patients? Yeah, I mean, I think a huge area for us is physical therapy. And for patients who require physical therapy after hip and knee surgery, there's been a lot of advances with HSS at home, HSS physical therapy that can be done virtually and remotely and especially for patients who may be post-surgical, may have a difficult time getting to the hospital, may live far away. They, in many cases, can have access to the highest quality physical therapy from the comfort of their home through new technology platforms that have rolled out in the recent years. So that's been a huge advancement, absolutely.
Great. And then finally, you all are so passionate and such wonderful experienced experts in your field. So I'm excited to hear the answer to this question. How do you expect technology to intersect with orthopedics in the coming years? Is there any work or research that you're particularly excited about, or really anything else that you'd like to share? And Sandra, we can start with you, because I know you have an answer for this one.
And I'll go ahead and share. So I would like to share one project that we are currently developing, an innovation. It's a next generation full bodysuit that combines really enormous amount of technologies both biometry, motion capture, VR, and haptic feedback. And we evaluate a lot of technologies that can assess motion, that can evaluate motion, motion assessment.
But this one is really specific. Because it provides that VR experience and also haptic feedback. So that once the data is processed and collects all this data about your movement, it also has that [INAUDIBLE] stimulation with 89 channels that go through the bodysuit that can provide haptic feedback to your body and train you on how to move and all kinds of sensations, so that patients, for instance, through their recovery can be guided on how to move. This could have potentially applications in muscle atrophy or anything where we need to retrain our muscles and our body on how to move. So we are working with this London-based company.
And here at HSS we are working on validating technically and clinically this technology, so that it could be used in a clinical setting. So it's a really exciting project here. You have just the images of it and how it looks like. It surely looks exciting. Dr. Henry, Dr. Kahlenberg, anything that you
are particularly excited about? I think on the joint replacement side, the hip and knee replacement side, as this technology evolves, it's really going to become an era of more personalized joint replacement. What I mean by that is in the past, surgeons had similar targets for most patients for how they wanted to align a hip or a knee and what they were shooting for in terms of what they wanted the x-ray to look like after surgery, what they wanted the need to feel like, and all of those sorts of factors. And I think now with what's evolving on the research side and with the clinical tools that we have, it's really going to become an era of specific targets for each individualized patient and making joint replacement more of an individualized approach to optimize patients' outcomes to the fullest. Yeah, I don't know if I can top that [INAUDIBLE],, Sandra. But very similar to what Dr. Kahlenberg said,
I think really the future for us, especially in the foot and ankle world, is using imaging to better individualize care. I think that I'm obviously very passionate about weight bearing CAT scan. And I think it's going to unlock a lot about how we make our preoperative plans, how we ultimately size and place our implants, and then what decisions we make about the rest of the foot, and how we follow up our patients to say, you've done the first phase of therapy. Now I'm going to clear you to get back in the gym or get back with physical therapy and ramp up your activity. Again, I think using that, for us, it's imaging and technology to really help progress that individualized care.
That is really all of the time that we have this evening. And thank you, again, for tuning in. These are certainly many exciting advances from weight bearing CAT scan to the tesla suit. And it's been absolutely illuminating to learn how this data and technology-driven stage of advancement in orthopedics is really increasing the success and positive outcomes for our patients, making the journey more predictable and really better each time. So thank you all for the work that you do for the lives of our patients. Thank you for joining me this evening.
And I hope that you all have a great evening. Thanks, everybody. Thank you so much. Thanks to everyone for joining.