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ORTHO AI: The Dawn of a New Era: Artificial Intelligence in Orthopaedics

Journal of Clinical Orthopaedics | Vol 8 | Issue 2 |  Jul-Dec 2023 | page: 05-06 | Parag Sancheti, Neeraj Bijlani, Ashok Shyam, Amit Yerudkar, Rohan Lunawat

DOI: https://doi.org/10.13107/jcorth.2023.v08i02.578


Authors: Parag Sancheti [1], Neeraj Bijlani [2], Ashok Shyam [1, 3], Amit Yerudkar [4], Rohan Lunawat [4]

[1] Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra India.

[2] Orthotech Clinic, Chembur, Mumbai, India.

[3] ndian Orthopaedic Research group, Thane, India.

[4] Scriptlanes Pvt Ltd, Pune, India.

Address of Correspondence
Dr. Ashok Shyam, Indian Orthopaedic Research group, Thane, India.

E-mail: drashokshyam@gmail.com


Editorial

OrthoAI is the new buzz word in Orthopaedics. It was launched on 11th Dec 2023 at the hands of Dr Raghunath Mashelkar. It was an amazing event structured around the World’s First AI Focussed on Orthopaedics. Artificial Intelligence revolution began in Nov 2022 with advent of Chat GPT 3.5 on the AI landscape. Since then the advancements in Artificial Intelligence (AI) have started to change the landscape of various industries, and orthopaedics is no exception. Based on our observations and research, we firmly believe AI will redefine the landscape of orthopaedics in the near future specially in fields mentioned below but not restricted to it. With OrthoAI as first step we have created the foundation on which we can build on. We would be working in this field and follow it as it unfolds and present our insights from time to time.

OrthoAI: A Generative AI Revolution in Orthopaedics
As said OrthoAI is the foundation of the AI Revolution in Orthopaedics, and we would like to share some more insights about it. OrthoAI primary is a Generative AI like chat GPT. You can even call it OrthoGPT (Ortho Generative Pre-trained Transformer), a type of artificial intelligence model designed for understanding and generating human-like text. OrthoAI, akin to a specialized version of Chat GPT, or ‘OrthoGPT’, stands on three foundational pillars:
1. The OrthoAI Database: The essence of OrthoAI lies in its meticulously curated vector database, developed over nine months by a team of expert orthopaedic surgeons. This database is the cornerstone of OrthoAI’s reliability and validation.
2. PubMed Access: OrthoAI’s integration with PubMed enriches its evidence base, ensuring that its responses are grounded in the latest orthopaedic literature.
3. OrthoTV Access: With over eleven thousand orthopaedic videos, OrthoTV provides a wealth of expert knowledge and experiences. OrthoAI’s access to this repository allows it to offer comprehensive answers, supplemented with relevant article links and video content
Before we explore the far-reaching applications of OrthoAI, it’s crucial to gain an understanding of what AI is and its main types. At its core, AI involves creating computer systems that mimic human intelligence, enabling them to perform tasks that usually require human intellect.
Before delving into OrthoAI’s applications, it’s vital to understand AI’s core components:

• Machine Learning (ML) is a subset of AI that allows computers to learn and improve from experience without being explicitly programmed. In simpler terms, it’s like teaching a child to identify objects. Over time, the child learns to recognize and distinguish objects on their own, much like ML algorithms learn from data and improve over time. OrthoAI is primed with Machine Learning
• Deep Learning (DL) is a more complex subset of ML that mimics the neural networks of our brain. DL involves feeding a computer system a vast amount of data, which it uses to make decisions. For example, DL can help computers identify diseases by analyzing thousands of radiographs or MRI Scans. This ability to process and analyse a significant amount of data makes DL particularly valuable for OrthoAI.
• Natural Language Processing (NLP) is another critical aspect of AI that focuses on the interaction between computers and humans using natural language. NLP can read and understand human language, enabling it to extract essential information from clinical notes or respond to patient queries in real-time. OrthoAI has NLP built in and will continue to learn from all its interactions.
The rise of NLP and Large language models in last few months has infused new life in the AI arena and has piked the interest in these models.

We believe AI will primarily impact in following Five areas of Orthopaedics
OrthoAI & Clinical Decision Making

OrthoAI as discussed above is built on a validated database, along with PubMed and OrthoTV access. This makes the answers most relevant and trustworthy. With a synthesised answer from all sources, it will be source of having a huge thinking knowledge bank at your fingertips. It will act as CO-PILOT or as EBM Assistant to Orthopaedic Surgeons, helping them in tricky situations. The queries can vary from clinical, academic, case based, surgical steps, drug interactions, rehabilitation, complications, and surgical planning too. This is the version 1, and more things would be added in coming versions

AI and Orthopaedic Imaging
One of the most promising applications of AI in orthopaedics is in imaging. We rely heavily on imaging for diagnosis and treatment planning. AI can help streamline this process. ML algorithms, with their ability to identify patterns, can analyse and interpret imaging data from radiographs, MRIs, CT scans, etc. These algorithms can diagnose conditions like fractures, disc herniations and osteoarthritis with a level of accuracy comparable to experienced radiologists, saving significant diagnostic time. We believe radiologist are already using such algorithms and DL models, but it will soon extrapolate into a more common use by orthopaedic surgeons too

AI in Surgical Planning and Execution
The influence of AI will also transform surgical planning and execution. Patient specific planning and preoperative templating can be easily done by AI. AI’s influence isn’t confined to diagnostics—it’s also transforming surgical planning and execution. Additionally, AI can help surgeons place implants accurately during orthopaedic procedures, thus reducing complications and improving patient outcomes. With large data available from the rise of robotic surgeries in last decade, will help in training these models and soon a combination of robotic AI will be available to help us. OrthoAI is currently being worked as a platform for surgical planning too

AI in Prosthetics and Rehabilitation
Customised prosthetic development and suggesting innovative strategies in prosthetics that mimic natural movements will be achieve through advanced machine learning algorithms. Furthermore, AI-based rehabilitation programs will offer personalized therapy plans and monitor patient progress in real-time, ensuring a more efficient recovery process. Customisation & utilisation of smart devices in this area will increase.

AI in Predictive Analytics
Predictive analytics is another area where AI is showing tremendous potential. AI algorithms can analyse vast amounts of patient data to identify risk factors and predict disease progression. This information allows orthopaedic professionals to intervene early, potentially preventing the development of severe conditions and improving patient care. The algorithmic nature of these analysis make it most suitable to be plugged in into OrthoAI. A separate team in working on adding this unique feature to OrthoAI and we are sure that this will come as an update soon.

Ethical Considerations and Challenges
Like any technology even AI has its limitations. The issues of hallucinations of AI and providing wrong information are not uncommonly reported. This is the reason why we started with creating a validated database for OrthoAI and also limit its access to all unnecessary information. The integration of AI into orthopaedics will not be without challenges but we have created a foundation for it. AI will also raise critical ethical considerations concerning data privacy, informed consent, and accountability in the event of AI errors. Additionally, we need to develop a standardized set of regulations for using AI in healthcare to ensure its ethical and safe application.

Conclusion
OrthoAI is launched at the threshold of a new era in orthopaedics, bringing significant improvements in diagnosis, treatment planning, surgical execution, prosthetics, rehabilitation, and predictive analytics. As we start to incorporate AI more comprehensively into our practice, we need to conscientiously navigate the ethical and legal challenges it presents. Our enthusiasm as technologically inclined orthopaedic surgeons drives us to harness OrthoAI’s full potential, ushering in an era of precision, efficiency, and patient-centric care in orthopaedics.

 

How to Cite this article: Sancheti P, Bijlani N, Shyam A, Yerudkar A, Lunawat R. ORTHO AI: The Dawn of a New Era: Artificial Intelligence in Orthopaedics. Journal of Clinical Orthopaedics 2023;8(2):05-06.

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Does inequality prevail in treatment of fairer sex in orthopaedics?

Journal of Clinical Orthopaedics | Vol 8 | Issue 2 |  Jul-Dec 2023 | page: 01 | Nicholas A Antao

DOI: https://doi.org/10.13107/jcorth.2023.v08i02.572


Authors: Nicholas A Antao [1]

[1] Department of Orthopaedics, Holy Spirit Hospital, Mumbai, India.

Address of Correspondence
Dr. Nicholas A Antao,

Department of Orthopaedics, Holy Spirit Hospital, Mumbai, India.
Chief Editor Journal of Clinical Orthopaedics
Managing Trustee of FIAMC BioMedical Ethics Centre
Past President of Bombay Orthopaedic Society
Past President Of Indian Arthroscopy Society
Past Editor of Indian Journal of Orthopaedics
E-mail: narantao@gmail.com


Editorial

From times immemorial, women has had the difficult road to travel, may be their values in societal position, their active participation and understanding and realisation of their voice in matters of legislation, not to say the least in day to day contribution still needs to be appreciated despite working full time24/7.
When I was a resident in the seventies, I often used to wonder, why the Opd’s were full of womenfolk as compared to men in chronic ailments of musculoskeletal pains carrying a with them , a thick pad of opd papers with only written legible prescription was ctall (continue all). On the other hand, the numbers were higher for male gender in trauma and sports injuries. To attend the OPDs, probably was an outing for them, getting away from daily chores of unrecognised and unappreciated, housebound work of 24/7.
The most research subjects were males than females and the surprising feature was absent of consent when it came to consent for surgery, as if their presence does not matter and their place needs to be at home alone. It was accepted that they are not the bread winners but only the homemakers and medical expenditure on them was not very fruitful. It was after the 1993 the National Institute of Health made a declaration to deliver equal high quality of care and effective management to all and not to make gender biased discrimination.
As we crossed the twentieth century and went into the 21st century, a forward progressive thinking brought about sea of change, when women started working in offices, took up to education, excelled more than men in education and in financial matters , thereby becoming independent and therefore demanded equality of status. There are now ever increasing number of women not only doing Orthopaedics but also superspecialising in sub specialist and attracting female patients and thus competing with their male counterparts. So you no longer see the world” destined for men only “ operating today, because of the need felt to give equal opportunity to all without any bias and discrimination of social status and circumstances to attain their full potential.
Nowadays you see more women readily agree to consent for surgery, since more and more educated young men and women tend to accompany their mother for being operated because they insure their parents for medical treatment and feel satisfied emotionally and morally as they are giving back to them to reciprocate their loved and care. But still in some developing and underdeveloped countries for want of insurance agencies and abilities, there opportunities of facilities of care are lacking and therefore the male counterpart still is preferred for surgery over female patient. The female patient has more ailments of osteoporosis, osteoarthrosis and musculoskeletal problems than the male counterparts and the need to be promptly treated, to keep the pillar and backbone of the family healthy and not disabled.
In developed countries, many joint replacement registries show, increasing number of female patients getting operated for joint replacement surgery and even for sports related injuries, implying that the ratio is changing to the prevailing order earlier.
This reversing trend is better for society as the female patient becomes multitasked and well respected needs to be equally cared for and given the importance.

 

Dr. Nicholas A Antao
M.S; D.N.B; F.C.P.S.
Professor and Head of Department of Orthopaedics, Holy Spirit Hospital
Chief Editor Journal of Clinical Orthopaedics
Managing Trustee of FIAMC BioMedical Ethics Centre
Past President of Bombay Orthopaedic Society
Past President Of Indian Arthroscopy Society
Past Editor of Indian Journal of Orthopaedics
E-mail: narantao@gmail.com

How to Cite this article: Antao NA. Does inequality prevail in treatment of fairer sex in orthopaedics? Journal of Clinical Orthopaedics 2023;8(2)01.

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Surgical Site Infections in Orthopaedics: The Role of Antibiotics

Journal of Clinical Orthopaedics | Vol 4 | Issue 2 |  July-Dec 2019 | page:26-32 | Dr. Mala V. Kaneria, Dr. Gautam Zaveri


Author: Dr. Mala V. Kaneria [1,2,3], Dr. Gautam Zaveri [4,5,6]

[1] Department of Medicine, T.N.Medical College and B.Y.L.Nair Ch. Hospital
[2] Kasturba Hospital for Infectious Diseases
[3] Consultant in Infectious Diseases and Tropical Medicine, Jaslok Hospital and Research Centre
[4] Department of Orthopaedics, Rajawadi Municipal Hospital, Mumbai
[5] Department of Spine Surgery, Jaslok Hospital & Research Centre
[6] Consultant Spine Surgeon,Reliance HN, Fortis, Zen Hospital, Mumbai

Address of Correspondence
Dr. Gautam Zaveri
Jaslok Hospital & Research Centre, Mumbai
E-mail: gautamzaveri1969@gmail.com


Abstract

Inspite of advancements of surgical techniques and operating room technologies, surgical site infections still remain a major problem. Bacteria have also evolved specially in nosocomial settings and both prophylactic and therapeutic use of antibiotics has to be rationally decided based on individual cases.
Keywords: Surgical site infections, orthopaedics, antibiotics, prophylaxis.


References

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2. Onyekwelu I, Yakkanti R, Protzer L, et al. Surgical Wound Classification and Surgical Site Infections in the Orthopaedic Patient.J of AAOS Glob Res Rev. 2017 Jun; 1(3): e022
3. Anderson DJ and Sexton DJ. Antimicrobial prophylaxis for prevention of surgical site infection in adults. Up To Date (2015): 1-31
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17. Bull AL, Worth LJ, Richards MJ. Impact of vancomycin surgical antibiotic prophylaxis on the development of methicillin-sensitive staphylococcus aureus surgical site infections: report from Australian Surveillance Data (VICNISS). Ann Surg 2012; 256:1089
18. Patzakis MJ, Wilkins J. Factors influencing infection rate in open fracture wounds. CORR 1989;243:36-40
19. Templeman DC, Gulli B, Tsukayama DT, Gustilo RB.Update on the management of open fractures of the tibial shaft. CORR 1998;350:18-25
20. Patzakis MJ, Wilkins J,Moore TM. Considerations in reducing the infection rate in open tibial fractures.CORR 1983; 178: 36- 41
21. PatzakisMJ, Wilkins J,Moore TM. Use of antibiotics in open tibial fractures. CORR 1983;178:31-35
22. Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: Retrospective and prospective analyses. J Bone Joint Surg Am. 1976; 58:453–8
23. Gustilo RB, Gruninger RP, Davis T. Classification of type III (severe) open fractures relative to treatment and results. Orthopedics. 1987; 10:1781–8
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How to Cite this article: Kaneria M V, Zaveri G. Surgical Site Infections in Orthopaedics: The Role of Antibiotics. Journal of Clinical Orthopaedics July-Dec 2019;4(2):26-32.

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Surgical Management of Surgical Site Infections in Orthopaedics

Journal of Clinical Orthopaedics | Vol 4 | Issue 2 |  July-Dec 2019 | page:17-25 | Dr. Sitaram Prasad, Dr. Gautam Zaveri


Author: Dr. Sitaram Prasad [1], Dr. Gautam Zaveri [2]

[1] Department of Plastic Surgery, Fortis & Zen Hospitals, Mumbai.
[2] Department of Spine Surgery, Jaslok, Fortis & Zen Hospitals, Mumbai.

Address of Correspondence
Dr. Gautam Zaveri
Department of Plastic Surgery, Fortis & Zen Hospitals, Mumbai
Email: gautamzaveri1969@gmail.com


Abstract

Surgical site infections are a source of great misery to both patients and surgeons. The management requires a multipronged approach specially in orthopaedics. The current chapter outlines the various methods of source control when dealing with musculoskeletal infections.
Keywords: Surgical site infections, orthopaedics, management


References

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How to Cite this article: Prasad S, Zaveri G. Surgical Management of Surgical Site Infections in Orthopaedics. Journal of Clinical Orthopaedics July-Dec 2019;4(2):17-25.

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