How Smarter Funding And Better Science Can Transform Musculoskeletal Care

What if the biggest breakthroughs in joint care are stalled not by science, but by budgets? We sit down with Dr. Josh Jacobs to trace the future of orthopaedic research across funding realities, scientific frontiers, and the mission to keep surgeon scientists in the game. It’s a candid look at how NIH indirect cuts, DOD reductions, and shifting hospital margins collide with the urgent need to tackle periprosthetic joint infection, chronic pain, and the rising burden of osteoarthritis.

Dr. Jacobs explains why NIAMS remains a vital engine for musculoskeletal research, how advocacy can reshape priorities, and why better grant quality—paired with clinically informed study sections—may be the fastest way to win a larger share of federal dollars. 

If you care about the future of joint replacement, surgeon scientist careers, and truly personalized musculoskeletal care, this conversation connects the policy dots with the lab and the OR. Subscribe, share with a colleague who writes grants, and leave a review with your take on where orthopedic research dollars should go next.

Transcript

SPEAKER_00 0:21

Welcome to the AOA Future in Orthopedic Surgery Podcast Series. This AOA podcast series will focus on the future in orthopedic surgery and the impact on leaders in our profession. These podcasts will focus on the vast spectrum of change that will occur as the future reveals itself. We will consider changes as they occur in the domains of culture, employment, technology, scope of practice, compensation, and other areas. My name is Doug Lundy, host for the podcast series. Joining us today is Dr. Josh Jacobs. Dr. Jacobs is professor and chairman of emeritus of the Department of Orthopedic Surgery at Rush University Medical Center. He concentrates his practice on total hip and total knee arroplasty at Rush University Medical Center, and he's specifically interested in the materials used for prosthetic devices and has conducted research and published extensively on this topic. In terms of leadership, he was president of ORS from 2006 to 2007, president of the U.S. Bone and Joint Decade from 2009 to 2010, past president of the American Academy of Orthopaedic Surgeons, and is currently president of OREF. He went to medical school at the University of Illinois residency at Harvard and then did his fellowship at Rush. And when specifically within the AOA, Dr. Jacobs was on the executive committee in 2004 and 5 and served as chairman of the membership committee. Dr. Jacobs, thank you, and welcome to the podcast, sir. Thank you for having me. So Josh and I have been friends for a while, specifically through our role in the American Board of Orthopedic Surgery. I neglected to add that to your list of accolades as a director of the ABOS. And uh you've you've done a substantial amount of research, especially within the field of total joint arthroplasty. So I think you are keenly fit to discuss changes in research as the orthopedic surgery advances into the future. Where do you see orthopedic surgery going in terms of research as the future continues to roll out here?

SPEAKER_01 2:34

Well, this is a very important topic, and I'm so glad that the AOA has had the wisdom to you know feature this in their podcast series. And research going forward in orthopedics will continue to be extremely important for advancing our field. That's one thing that hasn't changed. The primacy of research so that we can better understand the diseases, injuries, developmental processes that we encounter, better understand them so that we can have better therapeutic targets, better preventive strategies, and better ways to prevent disability and restore function to our patients. And if anything, the the prospect for brown baking research going forward, given all the advancements over the last decades in biotechnology, information technology, and nanotechnology, there's more promise than ever in terms of coming up with innovative ways for us to conquer musculoskeletal disease. With that promise, of course, comes a series of challenges that are real and something that the profession and professional organizations like the AOA can have a role in addressing and removing some of the barriers to research that currently exist and may actually be more substantial and formidable barriers in the future.

SPEAKER_00 4:09

Now, I also noticed that you had worked a lot with NIAMS. Clearly, where there is no funding, there's no mission. And I know that you were able to work a lot with that. Can you kind of give us your take on how NIAMS has affected your research and where you see that affecting research as we go ahead?

NIAMS, NIH, And Shifting Budgets

Indirect Costs And Institutional Impact

DOD Cuts And Advocacy On The Hill

Aligning Funding With Disease Burden

Strengthening Grant Quality And Review

SPEAKER_01 4:27

Sure. And IAMS are the National Institute of Arthritis and Musculoskull and Skin Disease, is one of the 27 institutes and centers that comprise the National Institutes of Health, which really is a gem in terms of governmental support for research. I think worldwide, there are few, if any, countries that could match the investment in basic and translational research that the NIH provides for its citizens and for its research workforce. We've enjoyed for the last few years very strong bipartisan support in Congress for the NIH budget, and that has really helped to contribute to the health of a lot of our research programs. However, that's a moving target, and I don't think the funding situation is as good this year, and maybe going forward, it's potentially even more challenging. There's actually a bill that's floating that people are talking about, and I don't know all the details that would combine and reduce some of the NIH institutes into larger entities. And I think NIAMS is one of the institutes that's being discussed as being on the table for combining with others. And depending exactly on the finances, that could be a net loss or it could be a net gain. And so that's something that we need to keep a very close eye on. And the advocacy arms of our organization need to be quite involved with the NIH and with the Congress to make sure that the research funding is enhanced for musculoskelet disease and not contracted. I yes, I've had a lot to do with NIAMs over my career. I've served on their advisory council for a number of years. And before and after that service, I've been on various study sections and external advisory committees and still have a number of interactions with the NIAM staff. It's staffed by very good people who are very committed to research and advancing research in the musculoskeletal field. Although, as I mentioned, there historically, at least over the last eight to ten years, has been strong support on both sides of the aisle for NIH funding. With the new administration in DC and the new leadership of Department of Health and Human Services, there has been a specific focus on the NIH, specifically the focus on cutting NIH indirect costs, limiting the budget. I think we should just discuss briefly. The administration proposed across the board cut in NIH indirect funds to 15%. And currently that number is typically in excess of 50%. That is something that, if it went through, would be really harmful to musculoskeletal research and all our academic medical centers. And not only musculoskeletal research, but research in general. And for those that don't know the difference between direct and indirect funds, the direct funds that come from NIH pay salaries, they pay for reagents, experimental animals, personnel required to do the procedure. It's really the direct cost simply of that particular research project. However, to do the research project, there are other costs involved that the direct funds don't account for. And those include all the individuals behind the scenes that do research regulation, for example, are the IRB personnel, individuals that deal with animal care, the legal portions of our universities, and make sure that we're compliant with all our all the laws governing human subjects research. And that is really part and parcel of all the expenses involved in research that the indirects cover. So, contrary to what is being portrayed, it's not a windfall for academic medical centers. In fact, those funds, which are absolutely essential, don't cover, still don't cover all the costs of research. So cutting indirects to that extent would really be harmful to research. What it would mean is that less research is done, less researchers are trained, less individuals in the pipeline, less graduate students, et cetera. So that's something that we need to counter, if at all possible. The AAOS, with many other organizations, has sent in a letter opposing these the transition to 15% indirect rates. And that currently is tied up with a legal injunction. I know there was a hearing recently where that was brought up. So it's unclear whether or not that's ever going to be imposed, but it certainly does point to the fact that we cannot count in the future on our NIH indirect spenses being what they've been all along. And then another threat was also to cut the NIH budget by 40%, which was the White House's initial budget. Now, the White House just proposes a budget. It's actually Congress that enacts a budget. The Senate and the House versions were far less cuts than that. In fact, the last House version I saw proposed a 10% cut. The Senate version was flat. But you should understand that even a flat budget is effectively a cut in research because of the inflationary costs of doing research. Salaries go up, uh all the equipment goes up. So the combination of cuts of indirect costs and also an overall NIH budget cuts has really imperiled federal research in a way that's very threatening. That's the NIH. The other is the Department of Defense. And for years, they have been supporting medical research. In fact, congressionally directed medical research programs, CDMRP, for many years has had a peer-reviewed orthopedic research program that has provided$30 million in funding for musculoskeletal research. That budget of the CDMRP was cut 57%. And within that budget, they totally cut out the peer-reviewed orthopedic research program. It went down to zero. So that's a$30 million cut in federal funding of research. And that's a substantial percentage of what we get from the federal government. Maybe 20 to 25% of all federal research funding comes through the DOD. So that's something that we recently advocated for reversing when we were on the Hill with the American Academy of Orthopedic Surgeons National Orthopedic Leadership Conference. And it does not make sense to totally cut out DOD funding of musculoskeletal research, since, as we know, many of the battlefield injuries now, because of improved armor and that not only injuries, but the post-injury recovery is hampered by musculoskeletal issues. And so that investment and research for our active soldiers and our veterans is absolutely essential. And I think we have a great case to make with Congress. So as a profession, we are facing deep federal cuts in orthopedic research. It's something that we need to be very well aware of. We need to advocate to mitigate those cuts, and we need to potentially look at alternative sources of funding. The percentage of funding of NIH for muscular disease or for NIAMS in particular is estimated to be two to four percent. And so there is this discordance of the percentage of funding with the actual burden of disease that has been a bit of a frustration for orthopedic surgical researchers for a number of years. And given the very important prevalence of our diseases, such as back pain, osteoarthritis, degenerative disc disease, tendinopathy, and the list goes on, given the prevalence and the morbidity associated with them, we think that a much more substantial investment in musculoskeletal research is called on, really proportionate to the burden of disease that it's responsible for in our society. We, as an or as a profession, I think we do have a lot of interactions with NIAMS, which are very important. And I guess I would one admonishment I would give to people who might be listening to this, orthopedic surgeons in particular, who are active in research, is the more you participate in the grant review process, the better our grant reviews will be. It's very important to have someone at the table during those study section meetings that understands the clinical import of the studies being proposed. Having sat on a number of study sections over the years, I found that sometimes orthopaedic clinical knowledge is underrepresented around the table. And that doesn't bode well for the real understanding of the importance of the research that we're doing. So while you know it's it's a labor of love doing grant reviews and participating in study sections, it's not an activity that is highly compensated, to say the least. So NIAMS has been a very good partner for our profession. And I think there's ways in which that partnership can be enhanced, and we can, as a as a group of clinicians and clinician scientists, can participate more with the programs and the grant review process at NIAMS.

SPEAKER_00 14:05

Let's stick with total joint arthroplasty because clearly you're an expert in that. You know, the value paradigm of total joint replacement for people in terms of the national economy, in terms of getting people back to work and back to a more functional life, in addition to increasing longevity and activity in individuals is unquestioned, at least in my mind and what I've read in the literature. How can y'all, or have you been able to use that in a way to leverage Niams or anybody, any of the other funders saying, look, you know, total joint replacement specifically is critical to the outcome of our country? To your point, it was in the double digits in terms of the effect on the U.S. bone and joint deck, and I think that's where you were going with that. How can y'all use the power of that argument to try to increase funding within the research space?

Protecting Time For Surgeon Scientists

SPEAKER_01 15:02

You know, it's it's a very compelling argument, as you mentioned. And when I during my time in the presidential line in the American Academy of Orthopedic Surgeons, you may recall that John Tung led an initiative during his presidency where we actually quantified the value of things like knee replacement and ACL repair, and I believe some more of the more common spinal surgery. And the value of these procedures in terms of what they provide to society, it's overwhelming. Very valuable procedures. And I think that's a compelling argument to make on a number of levels, not only with research funding organizations, but also with third-party payers. And how investment in these procedures, at least from the research side, can yield tremendous return on investment in terms of improving public health. What's an argument we continue to make in our research advocacy efforts with the Congress and with NIH. And while we think it's a compelling argument, it's hard to move the needle on NIH funding. Where in the 20 plus years I've been involved in research advocacy for NIH, we really haven't moved the needle much in terms of the percentage of funding that comes to Muscle Skeletal Research. I think what's going to move the needle the most is higher quality grant applications. As I mentioned before, more active participation of orthopedic clinician scientists on study sections. Because the better the grants are that we write, and the better the reviews are, the the bigger the slice of the pie our researchers will get. And so what that means for our profession, our organization, is we have to be very intentional on how we educate our current and next generation of clinician scientists on how to write effective federal grants. And that's that's one of the things that I think that we could do better as a profession. And quite frankly, we do a fair amount. There are organizations such as the U.S. Boy and U.S. Bone and Joint Decade, which now is this the program they had for grant writing has been taken over by the Orthopedic Research Society, the ORS. I know the Academy in partnership with the OREF and ORS have had very successful grant writing workshops. But there's probably more that we can do to not only nurture the those among us that want to have a career as a clinician scientist, to give them the necessary and protected time and invest in them so they can become successful grant writers. Grant writing is a very challenging enterprise. Uh and having done it for my entire professional career, it's it can be very frustrating. It's a lot of time commitment with an uncertain outcome, an uncertain ROI. You can spend hours and hours and hours and days writing grants and not get funded, but that's just the nature of the beast, and you just have to keep at it. And the better you get at it, the more you do it, the more successful you will be. That's a challenge, particularly for orthopedic surgeons, clinicians who also have a practice and also may not have the kind of institutional support they need for the protected time that is required to write successful grants. That's what we can do as leaders, that's what AOA can do as a leadership organization, is to really try to develop ways and to prod our leaders to help nurture our emerging orthopedic clinician scientists. It's an area where the OEF is quite active. As you mentioned, I'm the current president of the Orthopedic Research and Education Foundation, where you know our sweet spot is to try to cultivate and nurture the young surgeon scientists to help them get their first grants in the form of OEF grants, to give them the preliminary data they need and to make them more and more competitive to achieve federal funding, which after all is the most robust funding because not only does it provide salary support and hundreds of thousands of dollars typically for the to support the research, but it also provides indirects to the institution that are critical to them for sustaining and maintaining their research enterprises.

SPEAKER_00 19:30

So I was not aware of the clinician scientist track when I was coming up and through. I think that's probably more prevalent now, and at least more visible at least, and it could partially be because of the some substantial interconnectedness that all of us have these days. Any thoughts on how that might proceed in the future? Because obviously these folks give up a fair amount of clinical time, which let's call it the way it is. That's how people make money. And if they're giving up that clinical time to focus all On research. How do you see that in the future in terms of us enabling these people to be successful and competitive with their colleagues who are purely clinical?

The Business Case For Arthroplasty Value

SPEAKER_01 20:10

Yeah, it's a great question. It's one of the biggest barriers that I see going forward to having a robust and successful musculoskeletal research enterprise. You have probably seen, or many of our listeners have probably seen, a variety of publications talking about the near extinction of the clinician scientists, the surgeon scientists. I've seen papers dating back to the 80s and 90s on this topic. As everybody is aware who's listening, hospital margins are increasingly diminishing and are challenged in most healthcare systems. Many healthcare systems are actually underwater. And it might even be most healthcare systems, in terms of at least academic medical centers, are very challenged with more and more constrained margins, which really has eliminated one of the best sources we had for helping to fund the upcoming surgeon scientist. And I know in my own institution, I've seen the change since when I started in the late 80s, uh, the tremendous change in hospital margins that are available for us to invest in the research enterprise. And as chair for 16 years, I've seen how those have been progressively diminished by a combination of Medicare payment policy and the change in our profession and the surgical practice from being mostly inpatient to outpatient. That's certainly happened in adult reconstructive orthopedic surgery. It's it's happening in spine surgery and other areas of surgery where a lot of this is outpatient, which is great for patient recovery. It's great for patients. It's not great for Academic Medical Center's margins necessarily. So we have to come up with more innovative ways to fund this critical pathway of developing orthopedic surgery surgeon scientists and be very intentional about it and understand it as an important investment. And that's where the importance of leadership comes with our various orthopedic departments within academic medical centers and the academic medical centers themselves, for them having the understanding and the vision to invest in orthopedic surgeon scientists, understanding the critical role they can play in advancing the field. There's many organizations that get it, there's others that don't. And it's it's very important that we sit with our leaders and make them understand the critical importance of this role. But it is a challenge, and you're simply not going to make as much revenue spending your time doing research, writing grants, writing papers, massaging data. You will never make as much money doing that as you would do generating revenue from surgical services. And so that's something that good leadership can figure out ways in order to how to nurture those individuals and to make sure that we do have the next cadre of orthopedic surgeons and scientists.

PJI: The Stubborn Frontier

SPEAKER_00 23:42

You and I were in a meeting maybe not too long ago where Dr. Berry and his colleagues at Mayo gave a presentation. And I think Dan said that the last frontier, specifically within total joint arthroplasty, was PJI. And it was very compelling how he called out that a substantial amount of frontiers have been not necessarily conquered, but substantially overcome, with the exception of PJI. We're pretty much in, and I'm putting words in your mouth since you're a joint surgeon, that it's essentially not moved the needle at all or at all materially within the last several decades. Where do you see? Let's just use that as an example since you're certainly an expert on total joints. Where do you see, for instance, the future research going in terms of advances within PJI? You may want to touch on nanotechnology or anything else that you might want to say on how the future may enable us to at least make hedgeway on that.

Nanotech, Biofilms, And New Coatings

SPEAKER_01 24:39

Yeah, Dan, the Barry is correct. We've made tremendous headways in arthroplasty with understanding wear and preventing wear. Uh, ultra-high molecular weight, uh highly cross-linked ultra-hymolecular polyethylene is a great example of that. It's transformed a lot of our practices. When I initially came out in the 80s and 90s, we were dealing with massive prevalence of peripostatic osteolysis, primarily due to polyethylene wear debris, to some extent due to debris from corrosion of head-neck junction. And, you know, we've really had tremendous advancements in the materials, in our diagnostic capabilities that has really not eliminated that as a problem, but certainly mitigated it, so that we have much more reliably have long survivorships of both total knee and total hip replacements. Those are the procedures I'm most familiar with clinically. We've also had tremendous advancements in implant fixation during my professional career. And that was another major problem. Aseptic loosening was another major problem that I think we have a number of excellent solutions to make that much and much less and less prevalence. On the other hand, the percentage of failures due to periprosthetic joint infection remains at a stubborn one to three percent, depending on what database you're looking at. And even though that sounds like a small percentage, since over, it's probably now a million and a half hip and knee replacements are done every year in the U.S. alone, that's a lot of patients. And that's a big burden on our society, not only in terms of cost, but also in terms of patient morbidity. It's a very problematic outcome from what otherwise is a transformative procedure in terms of the patient's well-being and health. So it's an area full of opportunity where we can, as you mentioned, we can leverage nanotechnology. At the during the same meeting, you probably heard a presentation from our lab on using, for example, titanium nanotubes and deposition of antibiotics, you know, using electrodeposition technology. That's one of a number of solutions, nanotechnology solutions of that involve coating of implants. There are innovative ways to have non-antibiotic solutions to periposthetic joint infection where we manipulate the immune system. Other promising ways to potentially impact the PJI incidents is to come up with novel barriers for the biofilm that develops on inert materials after implantation, including joint placement components, because it's the biofilm that makes bacteria impenetrable to antibiotic treatment. And there are innovative ways that this can be dealt with. I know that the REF has funded through a number of mentorship campaigns, George Galante mentorship being one, innovative ways to treat periprosthetic joint infection with some of these new technologies. So there are a lot of things coming down the pike using nanotechnology, advances in biotechnology to try to solve this conundrum of periprosthetic joint infection. But it will take a lot of investment, it will take time, and it will take us, again, nurturing and developing the orthopedic surgeon scientist to be a very active member of this research team. Well, you know, PGI is certainly an active area of infection. PGI is certainly an active area of research and very important. I don't think we should be complacent on other aspects of arthroplasty because in order to achieve our ultimate goal of a 35, 40, 45-year total hip, total knee, we still can benefit from improvements in the materials that we use. Understanding better the host response to debris generating from these materials, inevitably there's a certain amount of wear debris. And even though it could be quite low, with time, it can eventually lead to periposthetic bone loss, aseptic loosening. So we shouldn't take our foot off the gas looking at ways of improving the functionality of joint replacements and reducing the morbidity of the surgery, improving the outcomes with other modalities. There's a long way we can go to further perfect total hip and knee replacement. PGI is a big frontier, but there are other areas within arthroplasty that advancements can really be implemented to improve outcomes and survivorship.

Beyond Infection: Materials And Longevity

SPEAKER_00 29:06

And I'm sorry, my business background keeps pushing this in the front of my head because I mean you're familiar with orphan drugs that are very expensive research to develop orphan drugs that really only help a finite amount of the population. And so, from a cost-benefit standpoint, it doesn't really aid the drug companies very much to invest money in that, were it not for incentives that the government may give the drug companies in order to chase that. So how do we get ahead? Because there's some very, very important things that we need to do research and factors that we need to do research and develops developments we need to make. However, if there's not a cost-benefit realization by the manufacturers, is it in vain? And would they pick it up and then market this and develop this and make this available to us if there's no money in it for them? You see where I'm going?

Orphan Devices And Market Incentives

SPEAKER_01 30:04

Oh, yeah. And yeah, you're right. It's it is it's one of those barriers I was referring to. That there's a lot of wonderful ideas out there. There's a lot of innovative ways that we can, and it's not only for rare diseases, it could also be, you know, innovations in joint replacement to treat osteoarthritis. But if the industry sector does not see positive margins from it, these innovations will not necessarily see the light of day. I don't know that I have the secret formula for how to solve that problem, but I think as you mentioned, there are various agencies in government that I think do recognize the importance of these so-called orphan drugs. And I guess by extension and application, you can talk about orphan devices. And many folks in industry do get it that not every device they produce has to be profitable, and that it is important to have certain devices available to have, for example, treating massive bone defects, they do need to have the ability to provide custom implants and you know, so-called one-offs. But I think this is where our government can be helpful partners in, you know, providing the appropriate incentives so that uh essentially no one is left behind. That if there are orphan drugs or orphan devices that would uh benefit many of our patients, that there are pathways whereby there can be some incentives to to make these available. But this is a this is gonna be a an ongoing challenge, and there are patient advocacy groups that do this and do this very effectively and how to make these drugs available. And and we've managed to make some headway in that area, but it's gonna be an ongoing effort that's gonna be required. And a final area for the uh future of muscoskeletal research has to do with pain. This is an initiative which really was supported uh quite extensively by the previous director of NIH, Francis Collins, when he set up the Helping End Addiction Long Term or HEAL program, which funds a variety of aspects of opioid use disorder, addiction, and also pain, the origins of pain, the neuropathology, neurophysiology of pain. In the future, I think we as orthopedic surgeons are going to understand pain in a much more in-depth way. There are components that involve brain function, peripheral nerve function, neuroanatomy, plasticity of neuroanatomy in the joint itself. That's something that's being studied by Heel Grant called Rejoin, which is mapping the joint nerve interactome. And also there are important psychological components to how individuals experience pain. So I think going forward, there are wonderful opportunities for orthopedic surgeons to get involved in pain research. After all, that is the primary symptom most of our patients present with, other than acute trauma. And it's people generally have chronic problems leading to pain, muscoskeletal pain that bring them into our offices. Wouldn't it be wonderful in the future if we understood pain in a much more in-depth way, that we can we understood new targets, new non-opioid treatments, new ways to prevent or mitigate pain following our procedures? This is a very active area of investigation, and I'm quite pleased that the NIH through the heal initiative is supporting it so well.

SPEAKER_00 33:45

So you're actively involved in clinical education at Rush. Y'all have medical students and residents coming through there. So I'm going to ask you toward the end of your current class of residents' career, so 25, 30 years from now, based on the trajectory that you see, and just in an optimistic, Pollyannish kind of view, where do you see the world for our current residents 25, 30 years from now? And you can pick it in either total joint arthoplasty or arthroscopic surgery or just the management of arthritis from a biochemical level or whatever you'd like. Where do you see us, you know, just a very Pollyanish, optimistic view? Where do you think we'll be?

Understanding Pain: HEAL And New Targets

A 25-Year Outlook For Joints

SPEAKER_01 34:26

Yeah, I would be doing a disservice to our sports medicine colleagues if I started to talk about arthroscopy. So I'll stick with something I know of, or trauma for that matter. So I'll stick with something I know about, and that's uh hip and knee replacement. You know, I think in 25 years, I think we will have a D-mode, a disease-modifying osteoarthritis drugs drug. All of us in arthroplasty that have been in it for a few decades have seen the impact of D-MARDs, disease-modifying rheumatic drugs. That so much so that I remember in my early practice, a very common indication for a knee replacement and a hip replacement for that matter was rheumatoid arthritis or other inflammatory arthritides. That's a rarity these days. I mean, they're out there, but it's it's far rarer because of the advent of the new DMARDs. And there's a number of classes of them, and that's a tremendous advancement. Imagine if we had that for osteoarthritis, a D-mode. And I think it's achievable. I think there will be that advancement. So 25 years from now, we'll figure out ways to diagnose arthritis quite early and intervene with a medication, a biologic, or something other than metal and plastic. On the other hand, I don't think that total joint replacement is going to go away in my lifetime or even in the lifetime of my trainee. I still think there's going to be end-stage degenerative joint disease from a variety of causes that we're not going to cure, either osteoarthritis that's not amenable to D modes or post-traumatic osteoarthritis from an intraarticular fracture, developmental dysplasia. So there's still going to be the need for arthroplasty, but hopefully we can get a better handle and reduce the prevalence of the osteoarthritis and the need for joint replacement for osteoarthritis. So that's one thing that I think our current trainees toward the end of their career are going to see. In addition, I think we're going to have available to us an array of biomarkers that's going to allow us to predict disease in a way that we're just starting to scratch the surface now. And these may be genetic biomarkers, certain genetic polymorphisms that we already know that there are certain genotypes or genetic polymorphisms that patients may have that may predispose them to periprosthetic joint infection or periprosthetic osteolysis. And we may be able to use that information going forward to coming up with not only better therapeutic targets, but also identifying those at risk so that we know who to target as we follow them after their orthopedic injury or their orthopedic intervention. I know that, for example, in our laboratory, we've identified some biomarkers that can predict periposthetic osteolysis as much as six years in advance of it being radiographically apparent. These include interleukin, blood interleukin markers, interleukin 6 specifically, and collagen telopeptide degradation products of type 1 collagen. But things like this, we're going to have more and more tools to have biomarkers or biosignatures of individuals that may be in a pre-clinical state, not manifesting their failure yet in terms of radiographic signs or clinical symptoms, but they're actually have the earliest of the early pathophysiology associated with failure. We'll be able to diagnose that earlier. And maybe even choose implants and materials and interventions, know who's going to benefit most from our surgery by looking at some of these biomarkers, which again can be proteomic, metabolomic, genomic, radiographic, or radiomic. So the explosion in biotechnology, and I'd probably have to say information technology that has occurred and is continuing to occur, has the promise of really transforming what we do. We haven't really talked yet about AI, which I think is going to transform every aspect of orthopedics. I think it already is beginning to do so. And while there are some dangers and limitations of AI, as we learn how to harness its incredible power to treat, to diagnose and treat and prevent musculoskull disease, I think that's going to yield tremendous advancements in how we really personalize our care for our patients. So I think the future is incredibly bright in terms of having better treatments and better opportunities and better outcomes of our surgical interventions. But as I mentioned, there are some clouds on the horizon. There are a number of barriers, not the least of which is the economic barriers, the research funding barriers that we need to be very aware of and very intentional about overcoming.

Closing Thanks And Meeting Details

SPEAKER_00 39:12

You know, this podcast is extremely timely because at the AOA annual leadership meeting next year in Albuquerque, we're actually going to have a symposium on research. So Dr. Leah Gatan, who's an AOA member, is moderating the symposium called Not Just Passion but Profession, Making Research Sustainable in Orthopedics. Another thing that y'all need to recognize is that the whole AOA annual meeting is moved up earlier this year. It's going to be May 11th to 15th in Albuquerque, New Mexico. So y'all come out, come to the annual meeting, and make sure you stay around and enjoy Dodger Katan's symposium on research, not just passion but profession, making research sustainable in orthopedics. It has been an absolute pleasure discussing the future. Of Orthopedic Surgery in terms of research with Dr. Josh Jacobs, who's clearly an expert in this field, especially now. And remember that he is president of OREF, and remember that in your giving and your interest as well. So, Dr. Jacobs, thank you very much for being on the podcast, sir.

SPEAKER_01 40:17

It's been a true pleasure. Thanks so much, Doug.

SPEAKER_00 40:19

So good to see you again, Josh. And y'all stay tuned for future orthopedic podcasts on this channel. Thank you.