An early start was required of him just to secure this interview, but his joie de vivre is palpable throughout.
Interestingly, medicine wasn’t Stefano’s first career choice. He had planned to become an international lawyer, originally studying political science at Stanford University in California. However, one significant event led to an epiphany of sorts that altered his career trajectory.
Encouraged by his father to accompany one of his friends – a professor of medicine – on his hospital rounds, Stefano realised that law, a notoriously aggressive and combative career, no longer held its appeal. Instead, he saw medicine and surgery as an opportunity to genuinely assist others. Fainting at the bedside while watching an invasive procedure on this introductory ward round does not seem to have dented his enthusiasm for clinical practice. Surgery, he says, offered him opportunities to take on nature as the primary adversary rather than spending a life combating lawyers as. The responsibility placed upon him as a physician to collaborate with others and strive for the betterment of patients satiated this innate hunger to effect change more positively.
So, why orthopaedics? After exploring various medical fields, Stefano found his niche in surgery, a discipline that values practicality. Within this arena, orthopaedics captured his interest and became his specialty. With a passion for problem solving, he was drawn to its hands-on approach to fixing what was broken. This mindset shaped his future, and he now looks for practical solutions to the challenges facing the modern healthcare system through digital innovation and technology.
Stefano has been working in orthopaedics since 1997, amassing vast experience. He has observed some remarkable advancements in surgical practices, which have ignited his passion for the science behind them.
With the advent of modern anaesthesia, outpatient surgery has undergone a significant transformation, leading to streamlined processes that have impacted his approach to his work. The fields of engineering and metallurgy have also made significant advancements, resulting in the creation of implantable devices that can handle physiologic loads and the ability to perform complex surgical procedures thanks to ever improving implant designs and surgical techniques. And Stefano believes that, without these adjacent innovations, progress within orthopaedics would have been limited.
The integration of new technologies, such as robot-assisted procedures, nanotechnology, genomic medicine, advanced data analytics, artificial intelligence (AI), augmented reality (AR), 3-D printing and virtual reality (VR), continues to move healthcare forward. The fourth industrial revolution and inexorable demographic trends are bringing further significant changes and challenges to clinical environments. Consequently, there is pressure to integrate these technologies and evolve the current health care paradigm.
A prominent trailblazer who boldly advocates for novel technologies and techniques, he has elevated his clinical practice through these innovative approaches – experiences and knowledge he is happy to share with colleagues and peers. And it is no doubt thanks in part to his boundless enthusiasm for innovation that there is huge excitement among physicians about the plethora of benefits these technologies have to offer.
And he speaks with authority (and still perhaps with the slight trace of an Australian accent). With his impressive academic credentials and extensive expertise in orthopaedic surgery, the Professor of Arthritis & Joint Replacement at the University of California San Francisco (UCSF) is a highly regarded academic surgeon and technology advisor who is recognised for his past clinical work and his current research in the use of sensors and AI. Through his research and clinical practice, he has made significant contributions to the field of orthopaedics and is widely considered a leading expert in the discipline.
But it is the digital revolution that is elevating surgical techniques and patient care pathways. Robotic surgery, for example, is heightening a surgeon’s capabilities and enhancing their precision. Robotics, like other digital tools such as patient engagement platforms, has proved to be a remarkable and critical tool expanding Stefano's scope of work, and propelling his interest in technology from what he calls a ‘side gig’ to becoming a large part of his time commitment.
He is fortunate to have been in the right place at the right time and thereby having the opportunity to be instrumental in the reinvention of a healthcare delivery model in the United States. Before joining the faculty at UCSF, Stefano worked in various leadership roles at Kaiser Permanente.
‘I had the opportunity to contribute to the reinvention of a healthcare delivery model that became an example for others to copy. During the time of the Blair government, for example, the NHS underwent significant transformation, and its leaders sent many managers to see and experience what we were doing at Kaiser Permanente.”.
‘One of the most impactful things I did while at Kaiser, however, was to help build the Kaiser Permanent Total Joint Replacement Registry, which quickly became one of the largest registries in the world. Registries are useful for tracking outcomes and improving care by providing evidence for change. As someone in academia, I believe it's important to build the infrastructure necessary to measure the impact of our actions and determine whether the results are helping our patients,’ he says.
His involvement in the American Association of Hip and Knee Surgeons and the American Academy of Orthopaedic Surgeons saw him focus on developing opportunities for the exchange of ideas between American and international surgeons. The experience of helping to lead the International Committees of both societies and his own experience during his fellowship in Italy, showed him the importance of sharing ideas and points of view at a global level. These experiences led him to start a new society with colleagues in France and Canada with a vision to move arthroplasty to the next logical stage with a level of personalisation of the entire perioperative care pathways that allows for variation by geography, culture, gender, and body size. After just one year, the Personalized Arthroplasty Society they has more than 25 countries represented in its membership and over 1600 followers on social media.
Not one to rest on his laurels, Stefano now focuses his research on digital medicine, particularly in the areas of improving knee replacements through the use of robotic surgery and sensors to track recovery. He is a strong advocate for the use of AR and VR technologies in upskilling healthcare professionals – not only for experienced surgeons, but also for the next generation. He foresees immense opportunities for better training and skills development, leading to improved patient outcomes and broader access to surgical care.
our ability to measure clinical outcomes are currently limited, he says. This he views as an obstacle in the pathway of any development, as our current tools have “ceiling effects”, meaning that they cannot measure improvement above a relatively low level. It’s a bit like having a speedometer that maxes out at 60 mph and putting it on a car that goes twice as fast: it will not be able to record the additional speed. As our procedures exceed our ability to measure their impact, the time is ripe rethink the ways we collect data and measure outcomes. The answer, he believes, may lie in digital sensors coupled to cutting edge AI algorithms. His recent collaboration with Google has seen him take raw data streams from wearable sensors to create algorithms that replicate the way the knee moves in space during gait.
‘With these tools, it is possible to create a “digital twin” of the knee and compare it to a normal knee, taking into account factors such as height, gender, size, and lifestyle. By doing so, it is possible to improve the way we measure outcomes across the spectrum of human experience,’ he says.
For AR and VR to reach their full potential, we will need to see advancements in computing and screen technology, or “adjacent technologies” as Stefano refers to them. Other adjacencies that will catapult the power of “XR” will be the advent of rapid data transfer to access cloud-based data quickly, and truly immersive experiences that encourage participation, he suggests.
VR offers a significant advantage by enabling precise control of the environment the viewer is immersed in and creating personalised experiences with immense potential to transform healthcare and education, especially in regions of the world where access to training is limited and the conventional educational infrastructure is insufficient to meet future needs. Stefano also believes the use of AR is gaining momentum as a tool to help medical practitioners deliver better care. AR technology enables surgeons to continue surgery without being distracted by having relevant information shown in their field of view and eliminating the need for additional screes. AI on the other hand can scan the medical record and provide real-time and accurate feedback loops based on a patient's vital signs, thus creating a safer delivery. The introduction of large language models in recent months has further clarified the potential and transformative power of AI in healthcare.
However, while this technology presents exciting prospects for the healthcare industry, it does pose some challenges. For example, many of these technologies aren't widely accessible, as not everyone has access to expensive VR simulations and headsets. Additionally, there is the ongoing and exciting challenge of deciphering data stored across multiple systems and in different formats and appropriately train machine learning algorithms and avoid issues related to data bias. But as these technologies become more accessible we will see their broader integration into the fabric of health care. – Stefano maintains that we can expect to see significant growth in their usage to the benefit of everyone involved. Eventually, as with all technology, we will one day wonder how we ever lived without it.
A pioneer in digital health, Stefano is a visionary who is generous with his time – and there’s not a lot of it to spare. An early start was required of him just to secure this interview, but his joie de vivre was palpable throughout.
Despite a massively busy schedule, he is looking relaxed. So, what does he do in his downtime? He loves cycling, which ‘keeps him on an even keel’. ‘It’s very meditative,’ he says, ‘especially if I find a good climb’. And he is currently teaching himself to play the guitar (another opportunity to problem-solve, no doubt). But even when discussing downtime, he has one eye on his work-life – ‘it’s not work if you like it, so I feel I get to play every day'. And he cannot speak highly enough of the experiences he has enjoyed and all the innovative people around him in Silicon Valley who give him that ‘charge’ he takes with him every day. Quite simply, he says, ‘I love what I do’.
With a sabbatical in the pipeline, travelling around the world visiting centres of digital excellent to learn the latest technological innovations in surgical care while promoting the idea of Mobility as a Vital Sign internationally, he continues to push the envelope in orthopaedic care.
Helping others adopt new systems that create exciting opportunities in orthopaedics and beyond is seemingly part of his DNA, as he pushes hard to drive exciting innovations forward to the betterment of healthcare in general.
So, looking to the future, what is his key piece of advice to young surgeons starting on their career journeys?
He often tells his students that everything he is about to teach them will be proven to be at least partially incorrect, if not completely false within a decade. He adds: ‘If you start with that idea, then you start to question assumptions. It is limiting to assume that just because we have done something for the last 50 years that this is the way we should continue to do it. Today we can do things that 50 years ago were considered Science Fiction.
Clinical practice should have an unwavering commitment to change based on new discoveries. The second thing I speak about is Adjacencies: it is such a powerful concept. Sometimes new ideas are only possible when an adjacent and enabling technology becomes accessible. It is important, in my view, to seek education to understand new developments and keep challenging what you do and come up with better solutions.’
