Patient Care and Orthopedic Innovation in the Age of AI: Why Human Skill Still Outweighs Robotics

Welcome to CurveBeam AI connect. I'm your host, Vinti Singh, Vice President of marketing at CurveBeam AI. Today on the podcast, we're joined by Dr. H. Curtis Biggs, founder of the Joint Replacement Institute in Naples, Florida. Dr. Biggs is a board-certified Orthopedic Surgeon who performs more than 900 joint replacement surgeries each year. And is recognized nationally for advancing minimally invasive techniques and personalized implants. Over his career, he has performed more than 6,000 direct anterior hip replacements and recently brought his own innovation-- the Xerxes femoral stem, from concept to FDA approval. Beyond his surgical expertise, Doctor Biggs leads one of Southwest Florida's Premiere Orthopedic Centers, which integrates joint replacement, sports medicine, imaging, and rehabilitation, all under one roof. We're excited to talk with him about where orthopedics is headed, from robotics to AI to patient centered models of care. Welcome, Dr. Biggs, thank you for joining us. Before we dive in, how are things in Naples this time of year? Wonderful. It's actually a little bit slower than normal because our snowbirds are out of town, but it's warm and never unrelenting. That's great to hear. That's great to hear. So you grew up with a surgeon, father. You trained in Ohio. And then built the Joint Replacement Institute in Florida. Looking back, what motivated you to focus so strongly on joint replacement and what sets your approach apart today? I think the exposure for me at a young age to medicine, and my father being a general surgeon, I had access to his friends and colleagues and was able to be through high school involved and watching total joint surgeries, which for me that was it. The light went on and I was happy, thought that was what I wanted to be at the end of my career training. So I had to see that pathway and find out what I needed to do to make that happen. I went to college to be a joint replacement surgeon. I didn't go to be a doctor. It just so happens that I have to be a doctor in order to do this. And so that takes me down that pathway. I think what differentiates myself from some of my colleagues, which we are all doing our own unique and individual way that we treat patients and approach practice. I think for myself, the personalized aspect of this-- treating patients as you'd want to be treated, spending the time putting in the education hours for the patient to make sure they understand what it is that's going to be done, what the expected outcomes are supposed to be, and creating that relationship so that we're on a joined pathway, as opposed to just somebody that meets at an operating room. Well, that's awesome to hear. In your career, you've performed more than 900 joint replacements annually and over, 6,000 anterior hip replacements. How do you see advancements in robotic surgery, personalized implants, and AI-driven diagnostics shaping the next decade of your career? I think, it's going to move slower than we think. I think, the ideas are out there and there's many, but the application of it is where the challenge is going to be. So AI is going to be fantastic on the diagnostic spectrum. It's going to be fantastic on the research side-- to help us go through the data and information, to give us treatment protocols and directions, but the applications of robotics and AI into the operating room has proven to be a challenge. And with that being said, I've done 1,000 robotic knee replacements over the years, and patients are always surprised when I tell them that the robot never touches them. They have this concept that the robot is doing everything. And in the end, the robot's giving us data, which we then apply to our surgery, but the surgeon is still doing the surgery. So there are some programs that are coming out, the autonomous cutting of the bone, but they're still not doing the approach. They're still not doing the injections. They're still not doing the things that are necessary-- the other parts of the surgery. So the robot, also in data, has proven that it's a great tool for the instrumentswise for the surgeon to use, but it's not changing the outcome for the patient, as far as long-term survivability. So there's no benefit to the patient, as far as robotically as of yet, but it's a great set of instruments that the surgeon individually can select to use that gives them what's comfortable for their result. So were on that verge of making the robot more pertinent, I guess, more present in the operating room. But what are we getting at the end of the day is yet to be seen completely. I think that AI is going to replace a lot of the diagnostic challenges, which, thankfully, it'll be there for. It'll also replace a lot of the people that have been doing that for some time. But if we can do it with more accuracy and then still have the presentation of diagnosis and treatment done by the human, I think, it'll allow for a better form of medicine. So AI is helping us improve our processes. But as far as robotics, or Crystal Hall, is still a little bit cloudy. You're not-- It is a little cloudy. There's some of us that we're very-- we have three categories-- there's the people that robots are the greatest thing ever, there's the surgeons that say, the robots are worst thing that was ever created, and then you have the guys in the middle that are like, if you want to use a robot, go ahead or you don't, who cares. It's what your outcome is in the end. What gives you the tools in your hand to give your patient the best outcome? And that's where the robots are now. Now, turning it over to the robot to do the surgery, I don't know if we're going to be in the next 10 years. I don't think we're going to be there for that. But I think they're going to work on that technology, quite honestly, to be there. We might get just one step closer to that. Yeah. Yeap. Yes. Yeah. It'll be exciting to watch? As I tell patients every day, slow and steady wins the race. Yep, yep. Very true. There's financial rush where companies want to get this to market quickly, but the reality is the slower, conservative pace results in better outcome and a better product. Yeah, absolutely. Speaking of some of that conservative care or preventative care, the AAOS has highlighted the role that orthopedic surgeons can be playing in osteoporosis-related fracture prevention. What do you think are the most practical ways surgeons can step into that preventative role? Yeah, that's a role that we've always pushed back a little bit on, because we tend to be more-- I'm going to fix this. Oh, it's broken, I'll fix it. That's more the orthopedic mindset. And for decades, it's all been left to the primary care and the endocrinologist to control this. But were part of the point of the spear with them, as far as seeing patients coming in for bone pain, recognizing an X-ray and a patient that's at risk for osteopenia, osteoporosis and then putting them on the correct pathway for treatment. I think that's important because we are affected down the road of somebody who has an osteoporotic-related fracture. Maybe we could have prevented that. So it's like that idea of, see something, do something. That's where this lies. It's not see something, send them away, which it's been for many years send them to the primary. You have a chance to make a difference there. And that's the part, I think, it would be best way to put it is see something, do something when you see the osteoporosis coming in, it'll make a difference for sure. Yeap. And what could some of those do's be, from your point of view? As far as exercise programs, vitamin, and supplement regime, medications, as far as the bone support that are prescription medications and then their biannual DXA scan that can be monitored and followed. Yep, yep. Great. Moving on to your practice, the Joint Replacement Institute. So it has grown into a comprehensive center with imaging, physical therapy, pain management, all on site. From your perspective, what's the biggest advantage for patients when you offer all of those services under a single roof? I know it's a cliche saying, but one stop shop really means a lot for patients in comfortability because they know what number to dial when they need anything done. And we've grown from a one doctor, one-employee practice in 2008 to a 7 doctors, 7 PA, 4 physical therapists, and 48 employees as of 2024. So it coincides with the growth that's been happening here in Southwest Florida. For us, within the practice, it allows us to practice within a subspecialty training that we prefer. So for me to be able to not do feet. That's great. That makes my day. It makes me getting out of bed and going to work easier, because I don't like to do feet, pants, shoulders, back. And I have somebody who feels equally passionate about what they do that's right here in the building. We have some very well-qualified guys, all fellowship trained, that really enjoy what their lane is. And so you get an opportunity to stay in your lane. And so it's like going on an Expressway as opposed to trying to muddle through Downtown traffic. It's much more efficient. The practice works easier. And if we can keep things as simple and easy for patients as possible, the better. That's great. And we are an imaging company that specializes in orthopedic imaging. So I've got to ask some questions around imaging. So I know that your institute, it does offer imaging inhouse with MRI. And there's been a lot of progress recently in advanced modalities, like MRI and what [INAUDIBLE] may offer is weight-bearing CT, which can show joints under their natural load. From your perspective, how important is it for imaging technology to evolve alongside the surgical technique? Without a doubt, it's necessary, especially in orthopedics, where many of our surgical technologies are going to be based off of that imaging. So to have access to it in the office, both MRI and for us we have a C-Arm, we have a Mini C-Arm, we have multiple ultrasounds. So we have used those modalities in many ways. And for us our next direction will be towards a CAT scan, because a lot of the robotic data and information is gathered through that. And so if a spine surgeon on board, our shoulder surgeon uses personalized images and cutting blocks, these are all things that are necessary. Then the other aspect that nobody likes to talk about as the financial side-- is that ancillary income is important for private practice. I saw a stat the other day that there's only 17% all orthopedic practices in South Carolina, which I'm not in, but only 17% of practices in South Carolina are private. So we're seeing the consolidation of services where private practice, because of overhead and reducing reimbursements are just losing ground. And they have to find other ways in which they can collect so that they can stay relevant, patients are happy, and that we, as physicians, can stay autonomous and have decision-making. And building on that a little bit, what advice would you have-- since you've successfully implemented so many different imaging modalities-- what advice would you have for other orthopedic groups that are looking to add advanced imaging ancillary services that may not already have it? From your own hindsight, what advice would you give about a successful integration? I think, some of the big are the basics. Some of the big ideas are the basic ones. Count your numbers. I mean, it doesn't take much. You can just watch patients for about a month and see who's going where and for what. And that data can be very revealing as to whether your investment is going to have a return. And you don't go on maybes and we'll, you go on what you have in front of you. Because if you plan on it getting you more, you're going to be a very unhappy and that you may not be able to cover that expense and not cover the cost that goes with the device. And take a deep dive into the imaging device itself, in the sense that, OK, there's a price for the device, what's the price to keep this thing running? All of them have preventative maintenance contracts. They all have technicians that cost and they cost beyond just their salary. They also have a benefit packages and things that they all bring to the table. So you have to see if you have the numbers that make it work. We do find that the patients prefer to be here. So if we say, hey, where do you live? And they live 7-, 10-miles away. Oh, we'll send you to a different imaging center. They prefer not. They prefer to come here because they're familiar. They know it's easy. It's a lot easier coming in and out of a private practice than it is from a large facility or a hospital. So there are definite benefits and it makes you communicate or makes a connection with the community that is different. And you don't think about that when you're buying an MRI, or you're purchasing your second digital X-ray machine, it's the convenience connects you to the community, and they recognize that, and they don't see you as just some other business. They have loyalty. That's important. That's a great point. And building that trust with the patient, you've been involved in investigational studies in multicenter trials, was having imaging on site beneficial in your participation in any of those? Absolutely, because they all required for us when we do knees and our hip exams and they come in for their quarterly, then they're half year and then they're yearly exams over the course of five Years to have that accessibility. And then to have everything on one site when it comes to go review those, because that continued review happens even further down the road. So it becomes a 5-year study, becomes a 10-year study, becomes a 15-year, like, where's all your stuff? Well, it's right here. That's a lot better than like, well, we have to collect it from that place. And over there it does make it simpler and easier. Being part of those research plans are helpful in many ways. Again, it connects you to the community because people hear about it, they tell their friends and neighbors, they think, that's wow, they're doing something to move this forward. That's where I want to be because they're on the cutting edge. And so having the imaging, having being on that front line of what's changing and what's new and what's now, those are all part of that puzzle that makes a practice that's accessible and accepted. And in general, what value do you see for private practices participating in clinical research? That's a great question, because you have to be set up in order to do it. Because we don't have residents and fellows. We don't have a clinical department that sits with a data person who's just collecting information and answering questions. So it has to be selected very carefully, determining how many visits there required, what are the forms that are going to be bringing in, whether you're going to have enough patients to do that. Because if you've got somebody not doing enough cases on a yearly basis to contribute viable patients into that study, then they shouldn't be involved. It just does not pushing things forward. It's actually slowing down the process because you're not contributing enough people to the party. It's a tough decision also, it slows you down and in private practice, why? Because of our confinements of financially, you have to really watch your bottom line because slowing things down to be part of a study can very well take your business into a bad direction. Sure. So you have to have safeguards in place to ensure that the research, which is very important, is not impacting operations to a point where it's costing you more to do the study-- Correct. You're paying to be in the study. Yep, yep. You don't want to pay to be in a study. Yeah. It's just not it. You want to be net neutral, or you want to be seeing patients and generating as a result. And can you talk about one of the studies that you are proudest to have been involved in. Well, United Orthopedic Company brought a stem to market. We were able to contribute. We were able to follow. We're now just past the 10-year follow-up on it for one of their hip stems. And for us, that was our first one that we were able to participate in. I thought that was very educating. And being able to see it through for so many years. It's been nice to see patients back because they have to come back for their follow-up. We've had 100% retention of all our patients, which is fantastic. And nobody's been a no show that's also nice about being in a community size. It's not giant. They're not traveling 300 miles away to go to some big tertiary center. They're all within a couple counties, and they look forward to coming in and being part of that process. That's wonderful. And then for any patients who may be listening to the podcast today, what advice do you have for them if they're facing a joint replacement? One takeaway that you'd give them, maybe it's some reassurance, what would you say directly to a patient who's looking at a joint replacement procedure coming up? Well, the important thing. Well, I'll hit a couple of them. Because one is-- be able to communicate with your surgeon is a very important part. Now, you may have a guy that's awesome, has all these great five stars, but you sit in the room and you can't speak to them. That's a problem. Because if there's a problem, you need to be able to talk to that guy. And so it's important to interview someone because we're interviewing them as doctors. Because some patients, this is dating when we first meet. Because you're deciding whether you want to date me, I'm deciding I want to date you, and whether we want to get married. And both of us can say no. So I got to think that you're engaged, and you're part of this process, and you want the best outcome. And then the patient has to say, I trust him, her, and I can communicate with him, especially if there's something wrong. So those are things-- is go in with a good open mind for communicating. Look for somebody that's sitting down in the room to talk to you that you feel like you can have a conversation. Also very important thing for the patient is be engaged in the process. This is not a passive process. You are actively part of your own recovery. And make sure you understand. And it's our job to make sure the patient understands what we're expecting of them so that everybody's on the same page and nobody's panicking. So that's been a big emphasis here for the last year for us is trying to get people to get off the idea that, I'm going to have my knee replaced the next week, I'm going to be back playing pickleball. It's just absurd how we've gotten to this point where people think that this surgery is like having a mole removal. So that's a part of the education and expectations that have to be set up front. And Dr. Biggs, just to close this conversation, we have AAHKS coming up in just a couple of months here. Will you be there? And will you be bringing anything significant to show the hip and knee community? Yes, I am excited about AAHKS coming up this year. It gives me an opportunity to present one of my passion projects. I have an implant that I started from concept through design through 510(k) approval to manufacturing and then implanting. It's coming to market this year through signature orthopedics, and I'll be looking forward to that opportunity to show off the stem what it can do and get some surgeons interested in restoring anatomy back to its normal. Well, this was a fantastic conversation. Are there any other thoughts that you would like to leave us with before we close? No, I appreciate the opportunity. I think, there's a lot of up and up things for this area of medicine for sure. Absolutely. Thank you so much. And if folks are interested in following you or learning more about you, are you on X, Are you on Instagram, how can folks reach out to you? On Instagram, @drcurtisbiggs, and also on Facebook, is the same. Wonderful. Well, have a great day. And it was wonderful chatting with you. Great. Thank you.