The field of orthopedics is rapidly changing with the advent of several new procedures, especially those tailored for the outpatient setting.
Here is what to know about four new orthopedic procedures that could revolutionize the industry:
BEAR implants
Daniel Romanelli, MD, an orthopedic sports medicine surgeon based in Texas, recently became the fifth surgeon to surpass 100 bridge-enhanced ACL restoration, or BEAR, implant procedures.
The BEAR implant first earned FDA de novo approval in December 2020. It is a collagen-based implant used to facilitate healing of a torn ACL. Using the patient’s blood, the implant enables the body to heal the torn ends of the ACL back together while maintaining the ACL’s original attachments to the femur and tibia. As the ACL heals, the BEAR implant is resorbed by the body.
The BEAR implant allows patient’s bodies to heal on their own, preventing lengthy surgeries. In March, the FDA expanded its usage of the implant, approving it for patients of any age, including children and teens.
In 2023, 11 major practices added the BEAR implant, and that number continues to grow.
“I’ve always been a big believer in biologics for orthopedics,” Sean McMillan, DO, chief of orthopedics and director of orthopedic sports medicine at Virtua Medical Center in Burlington, N.J., and a BEAR specialist, told Becker’s. “Long before there were surgeons, the body had the ability to heal itself. Back in the 1700s, we just broke bones and they healed. I did some work in medical school looking at biologics to heal ligaments and tendons. Now, 20 years later, that technology is the foundation, in part, for what we’re seeing now with a lot of the new biologic agents for rotator cuffs and ACLs.”
“It inherently made sense that we could get the body to heal if we figured out the right sort of algorithm for dealing with it. The ACL is the only ligament in the entire body that we never sewed back together. Everything else that you tear, we sew back together. We don’t replace it. As we started learning about it and doing our homework and research on it, a lot of the science made sense, and I had a patient population that was young and active and that would benefit from BEAR.”
Bikini incisions
In 2020, six surgeons worked together to develop a new approach to total hip replacement in which a surgeon makes a small, “bikini-type” incision within the skinfold of the hip, and performs the surgery from the front.
Bikini inches are just three to four inches, and in line with the actual natural lines of healing of the skin, leading to faster recovery and more cosmetically appealing post-surgical scars.
Brett Shore, MD, an orthopedic surgeon at DISC Sports and Spine Center in Marina del Rey, Calif., has spent his time as a hip specialist perfecting the minimally invasive incision approach that he learned during his time in training.
“The main difference, or the main thing I’m doing, is basically the skin incision. The actual surgical approach is basically the same for anterior total hip, but the difference is that while I was in Switzerland, I worked with a surgeon who did all of his total hips through bikini incision instead of longitudinal,” Dr. Shore told Becker’s. “By spending a lot of time with him … he showed me how to use it properly and what the benefits were. Benefits from his perspective … were more predictability and better healing. The tension lines of the skin run in an oblique orientation, and the bikini incision follows the lines of the skin. When you make an incision that follows those lines, it heals more narrowly, it doesn’t scar, you don’t get as much scarring. The second benefit is that the upper portion, the most proximal portion of the standard incision, goes across a flection crease, which puts the incision under stress. This incision is slightly lower, further down the leg, and it doesn’t see the inflection crease. As a secondary benefit, it looks pretty. It’s a more cosmetic incision. There are still times when it’s appropriate to do longitudinal, but for the majority, and 98% of hip replacements, I use bikini style.”
3D-printed devices
3D printing is growing rapidly across spine and orthopedics.
“3D printing has been around for decades. However, it is recent that the application of this technology started impacting everyday patient care. From patient-specific implants to well-fitting orthotics and prosthetics, 3D-printed devices are starting to become standard practice. Personalized medicine, including innovations like 3D printing, offers significant advantages for hand and upper extremity surgeons, both in the operating room and in post-operative care,” Michael Rivlin, MD, co-founder and president of Dimension Ortho and hand surgeon at Philadelphia-based Rothman Orthopaedics, told Becker’s.
“In the operating room, 3D printing enables the creation of patient-specific surgical guides making some challenging procedures more precise, implants that are better fit for complex anatomy and anatomical models for better surgical planning. In the postoperative period and during rehabilitation 3D printing allows for the fabrication of custom-fit orthotic devices (braces, splints and casts) that provide superior comfort, functionality and aesthetic appeal. This level of personalization promotes better patient compliance, faster recovery and improved overall outcomes, revolutionizing the standard of care in hand and upper extremity surgery.”
In 2024, VySpine earned FDA clearance for its LumiVy OsteoVy PEKK lumbar interbody fusion device. That same year, Oliver Tannous, MD, of MedStar Washington Hospital Center, became the first to use a 3D-printed replica of a patient’s spine to assist in surgery and Lisa Lattanza, MD, performed Yale School of Medicine’s first fully in-house orthopedic 3D surgical case.
In 2025, the FDA has approved 3D devices for Eminent Spine, Curiteva and Genesys Spine.
“The future is trending toward personalized surgical care. Using these implants is just like using any other implant a spine surgeon typically would but the enhanced emphasis on surgical planning does give globally more reproducible outcomes,” Theresa Pazionis, MD, assistant professor of orthopedic surgery and sports medicine at the Lewis Katz School of Medicine at Temple University in Philadelphia, told Becker’s.
“Whether or not we are using personalized or off the shelf implants, planning using predictive analytics and robotics platforms allows us to give the patient the best surgery for their anatomy and physiology. Companies like Carlsmed are producing patient-specific cages and implants tailored to individual anatomies. These allow for better load distribution across the endplate as opposed to point loading, more precise correction and reduced revision rates. With systems like Medtronic’s UNiD patient specific rods, we now leverage predictive analytics and digital twins to simulate outcomes, ensuring the best surgical strategy. This not only benefits the patient with improved quality of life but also reduces costs for healthcare systems by minimizing reoperations.”
Tornier pyrocarbon shoulder replacements
Stryker’s Tornier pyrocarbon humeral head offers several advantages for patients, including durability, which allows younger patients to undergo more invasive shoulder replacement procedures.
The device was recently cleared by the FDA and benefits younger patients seeking a return to active lifestyles who do not want to undergo total shoulder replacement.
Stryker’s Tornier pyrocarbon humeral head is the only pyrocarbon implant cleared for shoulder hemiarthroplasty in the U.S.
In April, E. Scott Paxton, MD, an orthopedic surgeon at East Providence, R.I.-based University Orthopedics, became the first surgeon in the state to perform a partial shoulder replacement using the technology.
“For many years, we’ve had joint replacement surgeries and shoulder replacement surgeries, but to date they have been done with metal in the shoulder. At the current time, the gold standard for shoulder replacement is replacing the ball and socket with metal and plastic, similar to knee or hip replacements. But in the shoulder, we have a problem with loosening of the socket component over time. Because the shoulder has so much motion, it relies a lot on soft tissue and has a lot of different ways that the ball and socket move together,” Dr. Paxton told Becker’s.
“More stress can get put on that socket piece and so it can loosen,” he said. “We have studies showing at 15 years we have considerable amounts of loosening seen on X-rays. This procedure, while the actual technology, incision and instruments are similar to previous shoulder replacements, the material we are using is different. We are just replacing the ball with pyrocarbon and the socket we are leaving alone or preparing it to accept the new ball. There are benefits to patients, including immediate benefits and later benefits. The most immediate benefit is pain relief, which is a benefit of all joint replacements.”
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