Arthroplasty at the crossroads: The technologically enabled arthroplasty surgeon

We take pride in introducing to you the first issue of the Indian Journal of Hip and Knee Arthroplasty, the official publication of the Indian Society of Hip and Knee Surgeons (ISHKS). The ISHKS has already embedded education and research as core values in its charter, and it is only fitting that this publication also embodies those very same values. As we embark on this journey together, we aim to bring cutting-edge research to the table as well as deep, engaging discussions and knowledge gained from experience. Striking that sweet spot between experience, knowledge, wisdom, and evidence will be a daunting task, but we hope to reach there soon. We welcome reviewers and authors to be part of our journey and walk hand in hand with us to a successful future. We would like to take a brief look into the future as the science of arthroplasty stands today at the crossroads of overwhelming influx of technology and rising volumes with yet uncertain patient outcomes from these very same technologies, as balanced against the predictable outcomes of traditional methods. What better way to mark this inaugural issue than by contemplating the future of our field and the forces shaping arthroplasty as we head into the next decade? The journey of ISHKS has always been about fostering surgical excellence, elevating patient care, and promoting academic growth. With this first issue, we don’t just celebrate a publication–we ignite conversations about where we are going as a specialty. Few questions are more timely, or more provocative, than this: By 2035, will arthroplasty be defined by evolution, revolution, or the extinction of the surgeon’s hand as we know it? Take the case of personalization of joint replacement spurred by the 10%–20% dissatisfaction rates among hip and knee replacements that have befuddled surgeons through decades. Multiple factors from implant design to surgical approaches have been studied as possible causes, as has been mental health and comorbidities, with no really satisfactory resolution. Even minor outliers to standard implant positions were not predictive of major changes in patient-related outcomes and could not justify major changes in surgical technique. With the advent of finer polyethylene, the threat of polyethylene wear-induced osteolysis has largely been eliminated. Additive manufacturing of implants and instruments is a silent revolution in the background for many years. Navigation added a level of finesse that was previously not available and also a new tool, data. Therein started the slow influx of technology to refine the alignment of the artificial knee and its balance, both of which we learned, we had very little reliable real-time quantitative data. Over the years, the axes of knee motion were redefined, the understanding of constitutional alignment evolved to a space beyond rigid mechanical alignment. From analog to digital, the switch was twice as fast, and robotics entered the space with a bang. The exponential growth of robotics in joint replacement, considering a relatively narrow application area, has been exponential and explosive, to say the least. From mechanical alignment to kinematic personalization, from standard instruments to robotic precision, our field has thrived on incremental refinements. By 2035, evolution will have quietly continued its course, implants will probably last longer, surgeries will become less invasive, hospital stays will shrink, and patient outcomes will be more predictably excellent. Lower costs of health care would be a most desirable parallel outcome, as would accessibility to uniform standards of care across geographies and income groups. We will see real-time data analytics integrated into operating rooms, sensor-embedded implants routinely used to monitor function, and surgical decisions increasingly supported by artificial intelligence (AI)-driven predictive models. Standardization will reign supreme. RISE OF THE MACHINES AND THE HUMAN-MACHINE COLLABORATION AI is not just a guide; it is becoming an active partner in surgical execution. Robotics has transitioned from assistance to autonomy in defined surgical steps. Regenerative therapies, including biologically engineered cartilage and bone constructs, are moving from research labs to real-world applications. Day-care joint replacements are becoming commonplace, and virtual reality-based global training platforms have democratized education like never before. The boundaries of orthopedic practice are expanding, with surgeons collaborating with data scientists, bioengineers, and AI specialists. The revolution is not just in devices, it is in the way we think, plan, and deliver care. It is in the way we use machines to make our care simpler, safer, and more efficient. This comes with the obvious fear of redundancy, will autonomy in machine-orchestrated care pathways make us redundant? I think we can keep that fear well aside. We develop machine intelligence for healthcare and surgery, firmly keeping the human in the loop intact and irrevocable. The surgeon or physician has a greater role to play than ever before in ensuring the correct and safe application of tools for patient outcomes. It is we, s surgeons, who have the final say as to what works or does not work in our hands, and in doing so, to define a future where human and machine work in tandem and not in isolation, with the controls in the hand of the surgeon. This existential redefinition of the care pathway that is in evolution today is likely to see results in the next decade or so. We cannot ignore the changes, but we need to train ourselves to adapt and implement the necessary tools we need in patient care. A degree of pessimism is always helpful, balanced with healthy optimism, to find the right balance. In other words, we can see a decade of re-defining ourselves for the future of Integrated care and digital orthopaedics. The age of the technologically sophisticated and enabled arthroplasty surgeon has arrived, and we will be defined in how well we embrace it. At the same time, we will always be defined by human touch, by empathy and understanding, compassion and presence, qualities a machine will probably never emulate in our lifetimes. “The scalpel may evolve, the robot may rise, but the soul of surgery will always be human–provided we choose to keep it that way.”