The study below represents four years of work and the starting point for much more. I consider the emergence - and convergence - of both triplanar CT imaging with unsupervised AI as nothing short of serendipity.
The purpose of the work was to three-dimensionally phenotype the broad variation of arthritic knee anatomy to establish a foundational language for longitudinal comparison along the episode of care for total knee replacement. Quite frankly, we had no idea how many phenotypes would exist when you’re simultaneously evaluating 27 variables in three planes across 1,352 knees. We were shocked to find just a total of four clusters exist, with two groups embodying clear outliers. These outlier phenotypes, Type 1 (18.5%) and Type 3 (7.5%), represent a unique cohort of preoperative patients that preoperatively start off distinct from the pack and encompass a whopping 26% of patients. Variables from all three planes matter.
Future work necessitates contextualizing the preoperative Type to implant selection, alignment technique, and applied technology. Perhaps this foundation may lead to pathways that allow for better balancing, more rapid recovery, and greater satisfaction after TKA with a more “personalized” approach that takes into account the uniqueness of each knee.
Shout out to my amazing team @joshua_w00@alpertmedicalschool@sayyidahasan@rushumedicalcollege@nawabid@hss.sports@corycalendinemd@antoniachen9876@utswortho@commonsclinic
👀Don't forget to check your blindspot!
Preoperative planning for TKA is often centered on distal anatomy. However, this study in Arthroplasty Today suggests that rotational variability in arthritic knee morphometry may predominantly originate from the hip.
This reframes an important concept:
👉 The knee may reflect upstream rotational alignment rather than define it
👉 Variability we attribute to the knee may actually be driven proximally
👉 A limb-wide perspective may improve surgical planning and consistency
💡 Takeaway:
The hip might be a rotational blind spot. To better understand knee rotation, we may need to look beyond the knee itself
/action/showPdf?pii=S2352-3441%2826%2900016-6 #TKA #Orthopedics #SurgicalPlanning #PrecisionMedicine
#Arthroplasty
Special patient shout out to Tom who is back to surfing 3 months after knee replacement. Happy to play a small part in his amazing journey back to his life.
Technique. subvastus, MAKO, cementless TKA with unrestricted kinematic alignment
Love getting great people back to great things!
#kneereplacement #kneesurgery #knee #kneepain
Special patient shout out to @linkomaromi who returned to skiing ~ 90 days after hip arthroscopy… followed by the Vegas @hyroxworld race just ~ 120 days after hip arthroscopy.
Her dedication and resilience to her craft is amazing! @isha_hip_pres_society
Pain with sitting, pain with long car rides or flights, pain with squatting, and pain with lunging are often all treatable. Hip pain can be in the low back, front of the knees, the groin, or through the waist.
We love getting great people back to doing great things
Never would I have ever thought eight years ago when we first started this foray into artificial intelligence and orthopedics would it have led to one of our most significant academic milestones - while in private practice. Technology is a powerful equalizer that proves you don’t need to live in an ivory tower to contribute meaningful, original academic research. Worthy ideas come from surrounding yourself with brilliant minds, namely my co-authors Andrew Yang and Joshua Woo, not familiar brand names institutions. Publishing in the Nature Portfolio is a small but relevant external barometer of this truth. Looking forward to continue learning and building with the right people.
/articles/s44387-025-00070-2
Commons Clinic (and what it stands for) may just be what orthopaedic specialists have been clamoring for all along. We have unprecedented opportunity to regain control of our craft and combat the downward pressures of a faceless, siloed system that continuously prioritizes quantity over quality, speed over service, revenue over relationship, and everything else over expertise and experience. Now out in @the_jbjs
Extreme sports generate extreme injuries.
Honored to be invited back to the X Games to provide sideline orthopaedic sports medicine support as a small part of the greater, amazing medical team.
Thank you to those who included me, thank you to the Winter X Games Aspen team, and thank you to the elite athletes for constantly redefining the boundaries of athletic achievement.
Special shout-out to @hiroto_ogiwara for reminding me 2340° means 6.5 spins on a snowboard in 0° weather off a 75-foot tall ramp.
🤛🏽 @commonsclinic
