Publication of March-April 2020

Our health care system is not sustainable anymore. A new ecosystem is absolutely mandatory. The key elements of this new system are as follows: Internet of Things (IoT), big data, artificial intelligence, as well cloud and blockchain. In such a system, patients become connected “objects” within the IoT and, hence, produce a real continuous tsunami of data. To transform this enormous amount of data in useful information, we need artificial intelligence. This will allow for the evolution towards refined and personalized diagnostics and treatment decisions.

Worldwide demographics are at the origin of the shift towards connected health care and “offshoring”, both for primary and specialized care. The connection of patient results within a continuous data flux characterized by big volumes, variability and velocity. In order not to bias artificial intelligence, we must ensure data veracity. Automation becomes mandatory in all sectors of human activity, inclusive health care. This will likely be a perfect opportunity to come back to the real values in health care: communication, teamwork, and human empathy.

The year 2019 has provided us three major themes: the contribution of 3D imaging in the planning of shoulder replacements, joint reconstruction of the elbow by mirrored osteoarticular graft, and finally scoliosis surgery by modulation of growth, without vertebral fusion. Shoulder disease is one of the most common conditions involving the musculoskeletal system, affecting about half of the patients with musculoskeletal complaints. Gleno-humeral osteoarthritis, whatever its etiology, may justify prosthetic replacement. However, the fate of these implants does not attain the survival rates of prosthetic hip and knee implants. The severity of bone loss, particularly within the scapula, and the difficulty of precisely orientating implants both account for a large part of common and too early failures. Planning surgery using planning software from 3D reconstruction scans can anticipate these problems and enable us to establish an appropriate surgical strategy.

The fate of elbow replacements remains limited over time, especially in the young and active subject. Using osteochondral reconstruction allows us to postpone arthroplasty for several years. The need for perfect joint congruence is currently made possible via mirror planning from the healthy joint and selection of the most appropriate allograft based on scanner imaging. Surgery is made possible by the surgeon's provision of cutting guides for the injured joint and allograft, ensuring accurate correction, in accordance with preoperative planning.

Scoliosis mainly affects a young population, tending to worsen with growth. Until now, surgery has been aimed at restoring the spine’s sagittal balance by fusion of the bony segments to prevent further deformation. This strategy has implemented constraints on the spine segments left free of instrumentation and bone fusion with potentially secondary discoradicular pathologies at these levels. The concept of using residual spine growth to correct deformation has recently been introduced. Rather than permanently fusing the column, the material is positioned to slow the growth on the curvature’s convex side and let the concave side continue to grow and correct the deformation. This is growth modulation. In this configuration, the column is no longer blocked and retains its flexibility.