If you are a parent, you may find each stage begets longing for the next. “It will be so much easier when he is potty trained!” quickly becomes, “She can finally drive herself to school!” We want our children to launch as adults, but that means arguably our greatest success as parents is to become irrelevant.

Professionally, being deemed unnecessary has less appeal. As artificial intelligence (AI) rolls into the medical sphere, orthopaedic surgeons watching its impact on radiology, dermatology, pathology, and other fields might feel a little smug, reflecting, “Machine learning may be coming for the image readers, but not for my knife!” But while the threat from AI may feel remote, advances in this and other fields will pressure our profession.

GLP-1 RAs reshape arthritis care
This issue of AAOS Now includes articles exploring the impact of obesity and its treatment on orthopaedic surgery. As the use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) exploded, so, too, did rumbling about the possible impact on surgical volumes for total joint arthroplasty (TJA). Patients struggling with obesity and an arthritic knee joint found that losing 40 pounds also meant losing chronic knee pain.

A 2024 New England Journal of Medicine article comparing semaglutide use to placebo in patients with moderate knee arthritis demonstrated that the medication led to reductions in both body weight and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scores. A JAMA study suggested the use of these medications could be considered a strategy to lower TJA revision rates. A retrospective cohort study demonstrated such an effect, reporting that three-year exposure to semaglutide or tirzepatide resulted in an absolute risk difference for undergoing total knee arthroplasty (TKA) of -4.71% points at eight years.

Biologics move arthritis treatment upstream
Early in my foot and ankle career, rheumatoid foot deformities were common. Even before the shoes came off, I could anticipate severe hallux valgus and lesser toe deformities by observing the ulnar drift of a patient’s fingers. In less than one generation, the wide use of biologic disease-modifying antirheumatic drugs and Janus kinase inhibitors has moved the treatment of inflammatory arthritides upstream of the surgeon.

In this month’s Final Cut commentary, Jocelyn Wittstein, MD, FAAOS, notes that while she can repair the mechanics of an ACL rupture, the surgery fails to address the impact of an inflammatory cascade. Despite ACL reconstruction, the index injury will likely tee the patient up for TKA 15 years down the road. She calls for improved understanding and intervention in the complex biochemical cascade of post-traumatic arthritis.

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Related Content

• Troubling trends: Childhood obesity influences fracture risk and recovery patterns (AAOS Now)
• GLP-1 RA medications are changing the TJR landscape (AAOS Now)
• New studies link GLP-1 receptor agonist medications to tendon rupture risk and changes in bone metabolism (AAOS Now)

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One answer to that call comes from creative approaches in arthritis research: The multicenter collaborative effort Novel Innovations for Tissue Regeneration in Osteoarthritis (NITRO) offers a glimpse into emerging therapeutics that could halt or slow arthritis long before the operating room. Well ahead of peer-reviewed papers, press releases from three institutions in April 2026 heralded early-stage research that could someday alter surgical treatment of osteoarthritis (OA).

Duke University researchers described injectable, time-released, combination drug formulations that stimulate bone and articular cartilage regeneration in joints impacted by OA. A University of Colorado Boulder team revealed results of animal studies on novel proteins and a particle delivery system that produced focused cartilage regeneration. Columbia University described a potential future competitor for the metal TKA: a 3D-printed human knee built on a biodegradable scaffold populated with stem cells either from the patient’s own body or inducible pluripotent stem cells. Implanted in the human, the cells would regenerate both cartilage and bone. The press releases from the NITRO consortium indicate that commercial companies will be moving these technologies forward.

Technology accelerates professional change
Physicians bring deep knowledge and experience to diagnosing and treating illness and injury. That advantage may soon belong to the computer: Over just three years, large language models have progressed from functioning at a postgraduate year 1 level to surpassing most PGY-5s on the Orthopaedic In-Training Exam.

In our clinical practice, ambient scribes likely outperform the average surgeon at capturing every detail of an encounter. Last month, AAOS Now interviewed experts who noted the rapid, broad uptake of the technology, with its power to pull information from the exam room as well as the medical record to even produce an assessment and plan.

Granted, the robots are not yet coming for your knife, but technology in the operating room is becoming more pervasive. Robotic assistance is expanding in both frequency of use and case breadth and is now commonplace for TKA and increasing for hip and shoulder arthroplasty. A recent proof-of-concept cholecystectomy performed in a non-primate animal by two humanoid robots demonstrates that “not yet” does not mean “never.”

A laudable goal for every medical specialty would be to create health so pervasive that the field becomes obsolete. To be sure, history has demonstrated that for every medical treatment triumph, another challenge lurks. Over the past 100 years, the antibiotic era emerged but, regrettably, so did HIV and COVID-19. I do not recall operating on a rheumatoid forefoot deformity in the last 10 years, but e-bike and pickleball injuries have created new orthopaedic opportunities.

It is unlikely that orthopaedic surgeons will become obsolete in this century, but the profession will evolve. We should also recognize that some musculoskeletal conditions central to our practices today may be resolved well upstream of the operating room in coming decades.

Even with progress, there is value in retaining fundamental techniques. Thirty years later, as a grandmother, I find myself revisiting those diaper-changing skills.

Alexandra E. Page, MD, FAAOS, is a foot and ankle specialist in private practice in San Diego, California, and the editor-in-chief of AAOS Now.

References

1. Bliddal H, Bays H, Czernichow S, et al. Once-weekly semaglutide in persons with obesity and knee osteoarthritis. N Engl J Med. 2024;391(17):1573-1583. doi:10.1056/NEJMoa2403664.
2. Xie D, Englund M, Lane NE, et al. Postoperative weight loss after antiobesity medications and revision risk after joint replacement. JAMA Netw Open. 2025;8(2):e2461200. doi:10.1001/jamanetworkopen.2024.61200.
3. Kolata G. Federal agency unveils three potential osteoarthritis treatments. New York Times. Published April 6, 2026. Accessed July 16, 2026. https://www.nytimes.com/2026/04/06/health/arpa-h-osteoarthritis-bone-cartilage.html
4. Advanced Research Projects Agency for Health. ARPA-H fast-tracks historic regenerative breakthroughs to transform osteoarthritis care. Published April 6, 2026. Accessed June 28, 2026. https://arpa-h.gov/news-and-events/arpa-h-fast-tracks-regenerative-breakthroughs-transform-osteoarthritis-care
5. Marshall L. A simple shot shows promise to reverse osteoarthritis within weeks. CU Boulder Today. Published April 6, 2026. Accessed July 1, 2026. https://www.colorado.edu/today/2026/04/06/simple-shot-shows-promise-reverse-osteoarthritis-within-weeks
6. Patringenaru I. Surgeons use teleoperated humanoid robots to perform live surgery: a world first. UC San Diego Today. Published July 8, 2026. Accessed July 12, 2026. https://today.ucsd.edu/story/surgeons-use-teleoperated-humanoid-robots-to-perform-live-surgery-a-world-first
7. Shah A, Vediya N, Wolfstadt J, et al. Large language models outperform PGY-5 residents on the Orthopaedic In-Training Examination: a comparative analysis of six cutting-edge large language models. J Am Acad Orthop Surg. 2026;34(13):e1771-e1780. doi:10.5435/JAAOS-D-25-01242.
8. Carter V, Desverreaux E, Amin I, et al. Glucagon-like peptide 1 receptor agonist use and risk of arthroplasty for knee osteoarthritis: retrospective database analysis. Reg Anesth Pain Med. Published online June 2, 2026. doi:10.1136/rapm-2026-107658.