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Industry 5.0 technology capabilities in Trauma and Orthopaedics
, Eindere Zaw Peb, Janaranjan Jallic, Madapura K. Shashidharad, Vijay K. Jaine, Abhishek Vaishf, Raju Vaishyaf
∗Corresponding author: Karthikeyan P. Iyengar. kartikp31@hotmail.com
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Received: ,
Accepted: ,
This article was originally published by Reed Elsevier India Pvt. Ltd. and was migrated to Scientific Scholar after the change of Publisher.
Abstract
Abstract
The fifth industrial revolution, which is also known as Industry 5.0, involves the interaction of human intelligence and cognitive computing to deliver personalised products. Industry 5.0 is an advancement on the inherent pillars of Industry 4.0 revolution with the ‘Personalisation of Automation and Efficiency’.
In this article, we explore the evolution of the Industry 5.0 revolution in the branch of trauma and orthopaedics. We highlight the interface of human intelligence, Robotic technology, and Smart machine systems in the development of personalised care for patients with orthopaedic conditions.
A comprehensive search strategy was conducted using databases of Embase, PubMed, Google Scholar and ResearchGate to discover the suitable literature published till March 2022 on the subject. The keywords used for the search included “Industry 5.0” and “Orthopaedics” to identify the appropriate literature and prepare this narrative review.
Industry 5.0 revolution appears to have made significant expansion on Industry 4.0 enabled technologies. Innovations in computer technology, implant designs, orthopaedic research, increased collaboration between humans, Robots and smart systems have led to multiple inventions. Industry 5.0 has led to the development of patient-specific implants, instruments, and devices in the sub-specialty of trauma and orthopaedics.
Evolution of Industry 5.0 has paved the way to introduce personalised products in the diagnosis, treatment, and management of a spectrum of orthopaedic pathologies. By enabling automation and enhancing labour efficiency, Industry 5.0 has made it possible to engineer patient-specific tools, instruments and implants to improve clinical, functional, and Patient Related Outcome Measures (PROMs).
Keywords
Industry 5.0
Orthopaedics
Artificial intelligence
Internet of things
Robotic surgical procedures
Additive manufacturing
Computers
Smart implant
1 Introduction
Since the inception of the Industrial Revolution 1.0 (1760–1840), further Industrial Transformation and development of the Industry 4.0 have resulted in a paradigm shift in how healthcare is delivered across the world. 1 Industry 4.0 integrated advances in computer technology with the development of Cyber-physical systems, Internet of things (IoT), Cloud computing, and Cognitive computing based on Artificial Intelligence (AI) technological platforms.2,3 Innovations of Industry 4.0 since its introduction in 2011, have transformed patient care at every step including early diagnosis, faster development of innovative treatments, and interconnecting health systems.4,5 However, though Industry 4.0 through Automation and Efficiency could fulfil the need for mass production using smart manufacturing with less human effort, it could not deliver the emerging trend of ‘Personalised care’.6 The concept of Industry 5.0 introduced in 2015 has allowed personalisation of products and greater involvement of human intelligence in the manufacturing process.7 Building on the sophistication of Industry 4.0 technologies, enhanced interaction between human intelligence, Robotic technology, and Smart machine systems is envisaged to develop and deliver personalised care for patients with orthopaedic conditions.8
This narrative review explores the various applications of Industry 5.0 in the sub speciality of Trauma and Orthopaedics (Fig. 1). The evolution of the Industry 5.0 revolution, the need, drivers, and various components contributing to the advances in the personalised care of orthopaedic patients are discussed. Futuristic anticipated developments to strengthen Industry 5.0 revolution is conceptualized with greater collaboration between human intellect, robotic science, and advanced engineering. These will involve incorporating advanced Additive Manufacturing (AM), AI, Robotic Assisted Surgery (RAS), SMART Sensor technology, Extended Reality (Virtual reality/Augmented reality), Holography, and the Internet of Everything.9–15
2 Material and methods
2.1 Search strategy
A comprehensive search strategy was conducted using databases of Embase, PubMed, Google Scholar and ResearchGate to identify the literature published till March 2022. Major research objectives were identified. The keywords used for the search included “Industry 5.0” and “Orthopaedics” to identify the literature for assessment and prepare this narrative review. Published Clinical trials, Randomised control Trials (RCTs), Original articles, Observational studies, systematic reviews, meta-analysis on the subject were reviewed. Only articles printed or online in English literature were included.
2.2 Research Objectives(RO)
The five primary research objectives of this article revolve around the understanding the philosophy behind the “Industry 5.0” evolution, its need and its current applications in the field of Trauma and Orthopaedics.RO1: To study the requirements of Industry5.0 in the field of Trauma and OrthopaedicsRO2: To identify major ‘Driving Components’ of Industry 5.0 for personalised Orthopaedic demand.RO3: To assess current major technological applications of Industry 5.0 in Trauma and OrthopaedicsRO4: To study significant benefits and challenges for Industry 5.0 in Trauma and OrthopaedicsRO5: To analyse future perspectives for Industry 5.0 in Trauma and Orthopaedics
3 Results and discussion
3.1 The need, Driving Components and major technology applications of industry 5.0 in trauma and orthopaedics
3.1.1 Evolution of Industry 5.0 technology and the advancement on industry 4.0
The Fourth Industrial Revolution (Industry 4.0) introduced in 2011 has had a major impact on the development of various industries including healthcare. It was built on Automation and Efficiency to improve production ability and interconnected machine systems which govern themselves. Industry 4.0 is predominantly driven by Digital technologies, AI algorithms, Machine learning, Big Data, IoT, Cloud computing and Cyber-physical systems. This led to a increased efficiency, productivity, better operational performance and digitisation of the manufacturing process. Industry 4.0 technologies became applicable in medical field as well to improve delivery and demand of health care products.
However, the last decade has seen the rise of ‘Personalisation’ of products. The term Industry 5.0 was conceptualized to meet the increasing personal needs of the population at large and patients in healthcare. It has been developed to reinforce the enabled technologies of Industry 4.0 by delivering highly personalised products and services. Industry 5.0 is the revolution in which man and machine reconcile. Greater collaboration between humans and robots to make life easier for humans whilst also enabling automation alongside enhanced labour efficiency are the foremost aims. Industry 5.0 establishes a framework for increasing human resilience and sustainability by safeguarding the global ecology and making the most efficient use of available resources for current and future generations.
The characteristic differences between Industry 4.0 and Industry 5.0 technology are highlighted in Table 1.
| Domains of the Technology | Industry 4.0 technology | Industry 5.0 technology | |
| 1 | Principle Pillars | Automation and Efficiency | Personalisation; human-centric |
| 2 | Objective | Mass Customisation | Mass Personalisation |
| 3 | Emphasis | Efficiency | Emphasises efficiency through craftsmanship & Innovation |
| 4 | Coordination | Better coordination between Machines and Information Technology | Better coordination between Humans, Robots and Machines. |
| 5 | Tasks | Efficient, automated tasks | Creative, Precision tasks |
| 6 | Data Usage | Digital use of data | Intelligent use of data with human cognitive power and analytical capabilities. |
| 7 | Connectivity | focuses on Intelligent and better-connected machines. | gives the freedom to merge cognitive computing with human intelligence |
| 8 | Environment transition | Robots working in a completely virtual environment & Machines govern themselves | Transit back to the real environment by balancing machine-human interaction. |
| 9 | Employment | Machines and Robots may reduce workforce | Re-integration of human touch, talent, increased collaboration between human and machine may increase employment. |
| 10 | Healthcare | Interconnected Healthcare systems | Personalised Healthcare systems |
| 11 | Products | Smart products | Personalised products e.g. Patient specific Implants, tools and Instruments |
| 12 | Sustainability | Focused on Efficiency and Automation | Environmentally friendly systems to prioritise Greener solutions, renewable energy and eliminate waste |
3.1.2 The emergence of industry 5.0 revolution in healthcare
The term Industry 5.0 was introduced in 2015. It refers to enhanced cooperation between Man, Robots and Smart Machines. Industry 5.0 is about Robotic systems working alongside humans to leverage advanced technologies of the Industry 4.0 Revolution such as Internet of things (IoT), AI, Big data etc in the pursuit of ‘Personalised’ delivery of care for patients.16–18
Whilst Robots are more consistent and better at precision, Robotic and Smart Machine systems are incapable of adaptability and critical reasoning that define our Human Intelligence. Industry 5.0 hence brings back human touch to the twin pillars of Industry 4.0 of Automation and Efficiency. These pillars predominantly focussed on improving interconnectivity of machines, systems and processes to improve efficiency and productivity at the expense of human involvement. Industry 5.0 takes the development of Industry at a personalised, customised, patient-oriented level in the Healthcare. The need for personalisation has evolved in all levels of society. Industry 5.0 is aimed at merging Cognitive computing capabilities with Human Intelligence to deliver people centric health care. It is thus designed at synergising and strengthening collaborative interaction between humans and machines. The ultimate goal will be to improve precision with Robotic, Smart machines in conjunction with human oversight to improve patient related outcomes. This concept of delivering patient specific diagnostic and treatment modalities is described as ‘Personalised medicine’. With an ageing, expanding population along with the need to deliver personalised, cost-effective medical care, Industry 5.0 has evolved to provide interconnected with an range of remote, mobile health and integrated applications.
3.1.3 The need for Industry 5.0 technology in Trauma & Orthopaedics
The field of orthopaedics is growing day by day. As with different components of healthcare, there has been an emphasis on development of newer, innovative techniques that can be utilised in the early diagnosis, enhanced management and rehabilitation of orthopaedic conditions.
Industry 5.0 applications are able to provide patient-centered orthopaedic care to deliver better clinical and functional outcomes, eventually to a better quality of life. Industry 5.0 revolution with its ‘Delivering technologies’ have capabilities to manufacture patient specific implants, tools and devices. Newer implant designs are envisaged to increase longevity of implants leading to lower revision rates and better patient outcomes.
Custom-made implants are used to fit patient's anatomical size, shape, and needs. The future of customized orthopaedic implant market is likely to be driven by new technological developments and demand for patient-specific implants. These may allow better osteo-integration of implants and survival rates. AI, Robotic assisted surgery, SMART sensor technology can provide intra-operative and perioperative guidance for ideal placement of implants such as soft tissue and ligament balancing in Total knee replacement surgery.12 Advances in Additive manufacturing with titanium alloy and newer materials will ensure better implant osseous integration, stability following massive bone defect or revision joint replacement surgery.10
As the field of Trauma & Orthopaedics grows along with complexity of revision surgery or even primary replacement surgery such as in orthopaedic oncology, the role of Custom-made implants, Robotic precision surgery under the supervision of Human Intelligence and other components of Industry 5.0 will have a significant role.
3.1.4 ‘Driving Components’ of industry 5.0 for personalised orthopaedic demand
The Driving Components of Industry 5.0 to allow greater interaction between Human Intelligence and Machine systems are depicted in Fig. 2. Essentially it is an emergent technology building on the Cyber-physical systems, Internet of things (IoT), Cloud computing and Cognitive computing technological platforms of Industry 4.0 with further refinement to fulfil the personalised or customized requirements of orthopaedic patients.
3.1.5 Major technology applications of industry 5.0 for Trauma and Orthopaedics
3.1.5.1 Artificial Intelligence, machine learning and deep learning
Artificial Intelligence (AI) is a branch of computer science that involves incorporating human behaviour and intelligence into machines or systems. Though AI represents a key component of the Industry 4.0 generation, increasing interaction with Human reasoning has extended its capability in the Industry 5.0 generation in health care.19 Over the last few decades, AI have been able to make a foothold in the branch of orthopaedic surgery such as fracture prediction, radiographic analysis, Robotic Assisted Surgery, oncology to name a few.20
AI in healthcare is an umbrella term with various subfields including Machine learning (ML) and Deep Learning (DL) algorithms. Integration with other Drivers of Industry 5.0 has extended its ability to extended applications in Orthopaedic imaging, fracture detection, aseptic loosening of implant arthroplasty and grading of chondral lesions or osteoarthritis.21
ML and its subset DL with extensions of Convolutional neural network (CNN) have found roles in prediction. risk stratification, risk assessment, due to the ability to learn experience in planning orthopaedic conditions such as Anterior Cruciate Ligament and sports injury management.22
AI, ML and DL algorithms have the potential to improve prediction, accuracy, plan patient journey, length of in-hospital stay, mortality through adaptive learning, logic regression analysis and problem solving in the field of orthopaedics.23
Reinforcing the basic concept of Industry 5.0, AI-derived applications will be key in greater collaboration between Human intelligence (Clinical experience), Robots (Precision) and Machines (Prediction, Efficiency) rather than the concern of computers replacing surgeons. 24
3.1.5.2 Robotic Assisted Surgery
Robotic technology has been integrated into several industries including healthcare. The robotic platform offers many benefits to patients and surgeons; with the ability to achieve precision, increased productivity, and efficiency that would not be possible with humans alone.25 The Industry 5.0 application has taken this a step forward. With increased collaboration between Human intelligence and Robotic-Assisted Surgery (RAS), this combination provides the precision from the Robotic platform with the critical thinking abilities of a surgeon. Following its initial use in Neurosurgical biopsies, general surgical procedures, Robotic platforms, and RAS applications have evolved in leaps and bounds in the branch of orthopaedic surgery.26,27 Patient demand, patient expectations, and public demand has led to a statistically significant increase in the use of robotics in arthroplasty worldwide.28 RAS in orthopaedics has been utilised to improve precision, and efficiency, restore limb alignment, and joint kinematics building on the principles of Industry 5.0. RAS in trauma and orthopaedics has enabled better soft-tissue handling, faster post-operative rehabilitation, and reduced in-hospital length of stay over conventional operative techniques. Industry 5.0 technologies allow active/passive/semi-active, image-based/imageless, or Closed/open Robotic platforms with the option of haptic feedback and data capture possibilities. RAS has been compared with traditional surgical techniques in all sub-specialty regions of orthopaedics. Increasing reports of RAS in joint arthroplasty of the knee, hip, ankle, etc have been published including its application in Trauma and Spinal conditions.29–31
However, though RAS provides an avenue for improved technical performance and added clinical advantages, the technology is in the process of universal validation with long-term outcome data, steep learning curve, and cost.32
3.1.5.3 Enhanced additive manufacturing in orthopaedics
Additive manufacturing (AM) is a set of technologies that provides an innovative way to build complex structures including custom-made implants and scaffolds leading to its applicability in the field of Orthopaedics. AM has one of the key pillars of Industry 4.0, specifically with 3-D printing technology in which replacement parts are created layer by layer addition of materials with the help of Computer Aided Design (CAD).33 However, with the integration of Industry 5.0 technologies, AM has taken a step further in the field of orthopaedics with new materials, alloys, polymers such as Polyaryletherketone (PAEK).34 Advances in AM with 4-D printing by adding the fourth dimension of Time and Laser powder bed fusion (L-PBF), AM have found applications in the manufacturing of custom-made implants, prostheses, and surgical planning of bone tumours.35
Industry 5.0 supported Enhanced AM provides significant advances in the development of engineering patient-specific orthopaedic implants, bio-compatible, sustainable implants, allow osteointegration, enhances tissue engineering to replace traditional tumour prosthesis or allografts. 5-D printing is a new branch of additive manufacturing in which the print head & the printable object have five degrees of freedom.36
3.1.5.4 Internet of Everything |Digital Ecosystem | Multiagent systems
Internet of Things (IoT) has been an integral component of Industry 4.0 revolution with increased automation and efficiency. It essentially represents different devices and machines connected through the Internet. With the Industry 5.0 principle, Internet of Everything (IoE) integrates people. The Internet of Everything (IoE) with four pillars: people, process, data, and things builds on top of the IoT with expected applications in healthcare and Orthopaedics.37
The crucial pillar of IoE is data. Data collection, integration and analysis with human interaction can provide a guided course of action in managing orthopaedic patients especially in tracking implanted devices and remote monitoring. Multiagent systems and Digital Ecosystem create an environment to connect multiple devices to allow mobile health monitoring such post-operative follow-up of orthopaedic patients. It can provide seamless communication between patients, clinicians and healthcare providers for an enhance patient experience.
3.1.5.5 SMART implants, sensor technology and smart materials
SMART (Self- Monitoring Analysis and Reporting Technology) implants are implantable devices which have a capability of reacting to physical, chemical or biomechanical changes in their surrounding environment. Sensor technology provides a way for these signals/changes to be measured. SMART implants and Sensor technology combination have thus been developed to provide diagnostic, therapeutic and monitoring applications in the field of orthopaedic surgery.38 There applications have been identified in Total knee arthroplasty (TKA), total hip arthroplasty, fracture healing and evaluation of orthopaedic infection.12,13 (Figs. 3 and 4).
In TKA, Smart sensor technology can be applied at the intra-operative, post-operative, and rehabilitation stages of TKA pathway. It allows intra-operative reliability of achieving ideal soft tissue and ligament balancing supporting the classical principle of Industry 5.0 i.e. collaboration of surgeons and innovative technology.39 Future applications would allow earlier detection, self-management of implant related infections and local release of antibiotics.40 Sensor based technology thus is projected to improve patient satisfaction and clinical outcomes.41
3.1.5.6 Holography techniques for Trauma and Orthopaedics
Holography is a method of generating three-dimensional images whereby 3-D objects are recorded using a laser and then restored as precisely as possible to match the originally recorded object. It incorporates multiple technologies simultaneously of advanced imaging, 3-D reconstruction, computer designs and allows a 3-D assessment of a structure.42
This image processing tool has an extensive application in various medical fields and expanded in the field of orthopaedics.15 It can provide high resolution 3-D imaging of bone, tissue, vascular anatomy, cranial nerves and pelvic anatomy in details. It can allow multi-dimensional view to aid surgical planning. It can thus assist a surgeon in patient management and improving outcomes. Industry 5.0 enabled robotic technology and human interaction can cooperate in analysing orthopaedics conditions, use holography to produce 3-D images of bones with sizable focal depth calculation, provide better information about bone, tissue, osteochondral and chondral defects. Holography can also be utilised to design artificial bone to explore ways to manage different osseous conditions. Holography is an efficient technology for decision-making, solving a complicated problem and can pave way for future innovative orthopaedics.
3.1.5.7 Virtual reality augmented reality/Extended reality (XR) technology in orthopaedics surgery
Virtual reality (VE), Augmented reality(AR), formally known as mixed reality (MR) and the emerging extended reality (XR) technology are digital enabled technologies. These are able to create an environment where real world visualization and virtual world objects are combined to provide a simulated experience.43
These technologies have been increasingly applied in all branches of surgery including orthopaedics. The simulated environment allows digital transformation with integration of 3-D medical images, Sensor technology, AI and Human interaction.14
There applications in the field of orthopaedics include teaching, training, minimally invasive surgery, spine surgery, trauma and orthopaedic surgery.44,45
AR system has been evaluated to measure pelvic position and acetabular implant alignment with a hip navigation system (HipNav®) during total hip replacement. This has been predicted to allow better intra-operative placement of acetabular implants and reflect better outcomes.46 Similarly AR is being tried in intra-medullary nailing procedures to facilitate placement of distal locking screw.47
3.1.5.8 Advanced imaging in orthopaedic radiology utilising industry 5.0 applications
Four-dimensional computed tomography (4-D-CT) and Four-dimensional Magnetic Resonance Imaging (4-D-MRI) are emerging technologies with evolving applications in the field of orthopaedic radiology to improve quality of imaging especially of moving anatomical structures.48
4-D CT is crucial for evaluation of moving structure like lung lesion where the dynamic volume data set is obtained by imaging the region of interest over time. This has traditionally been used in radiation therapy.49
4-D MRI is being used to assess the blood flow. Volume acquisition of the region of interest is obtained and blood flow patterns within this can be evaluated. Various techniques have been used to aid this including cardiac gating and respiration control (StAR VIBE) as well quick data acquisition technique. These techniques help to negate the motion artefacts encountered in the chest and abdomen imaging. 4-D MRI has applications in vascular imaging in polytrauma situations, flap reconstruction as well for evaluation of fracture of ribs in particular.50
The physiological forces experienced during ambulation are different to those in supine position. This enables identification of certain pathologies in ambulation or upright position that might have been concealed if scanned in supine position.51 Upright MRI enables to image in standing, sitting, flexion, extension or any other position where the pathology is most likely to be deciphered. Standing CT is akin to standing MRI which has been used in foot and ankle imaging for assessment of alignment during weight bearing that can be vital in management of such conditions.52 Combination of Advanced Imaging techniques of 4D-CT, 4D-MRI and 4D-printing is being planned to manufacture SMART orthopaedic implants with its extended uses.35
3.2 Significant benefits and challenges of Industry 5.0 for Trauma and Orthopaedics
Industry 5.0 with the above-described applications thus are to provide high-quality, personalised, patient-specific implants, tools, instruments, devices, and enhanced surgical techniques in Trauma & Orthopaedics sub-specialty.
3.3 SMART implant technology coupled with AI & robotic-assisted surgery allows precision surgery improving patient experience
Collaboration between Robots, Machines, and Human Intelligence delivers complex surgery in an efficient manner which was not possible previously. Advances in Additive Manufacturing including 4-D printing and SMART manufacturing allows the development of patient-specific implant, bio models, scaffolds, and prosthetics to improve osteointegration including massive bone defect or soft-tissue replacement.
However, the Industry 5.0 applications have several challenges. The cost of technology is a major limiting factor for its applicability for widespread, Global use especially in Low- and Middle-Income Countries (LMIC's). Training and Education in the applied Industry 5.0 technologies can have a long learning curve and few centres to provide them. As with any technology, there is a possibility of ‘Network Collapse’ since the Industry 5.0 revolution depends on Cybersystems interconnectivity and Human Interaction. Finally, regular use of this technology will depend on the ease of availability, validation of results, patient-centered satisfaction surveys, and Data security.
3.4 Future perspectives for Industry 5.0 in Trauma and Orthopaedics
A)Development of Sustainable Systems: Environment friendly systems working on Renewable energy will be the goal to support the Global initiative to limit Green House gas emissions and Elimination of Waste.B)Improving Cost-effectiveness: Mobile technology, Time and Universal applicabilityC)User friendly systems: Development of user-friendly systems to allow ease of training and learning curve for operating theatre staff.D)Validation of systems for higher precision and accuracy to avert outliers.E)Efficient designs for maximum use of technology.F)Complex problem solving: Mechanisms for patients with complex conditions, multi-planar deformity and surgical planning.
4 Conclusion
The fifth industrial revolution (Industry 5.0) involves the interaction of human intelligence and cognitive computing to deliver personalised products. Industry 5.0 offers the ‘Personalisation of Automation and efficiency’ leading to an intrinsic enhanced collaboration between Humans and Robotic systems. It has paved the way to introduce personalised products in the diagnosis, treatment, and monitoring of diseases in healthcare. This concept has been applied to the sub-speciality of Trauma and Orthopaedics in a range of situations. . By enabling automation and enhancing labour efficiency, Industry 5.0 has made it possible to engineer patient-specific tools, instruments and implants to improve clinical, functional, and Patient Related Outcome Measures (PROMs) in orthopaedic conditions. The evolution of Industry 5.0 technology has taken a step towards the personalised designs of implants for primary and revision orthopaedic surgeries. In patients with orthopaedic trauma, Industry 5.0 technology enhances diagnostic accuracy of fractures, surgical precision, operating time, and patient reported outcome metrics.
Personalised care is the way forward for the future in orthopaedics and trauma. Consequently, technological advancement is the key. There is an immense prospective for Industry 5.0 technology to grow further. However, for a better orthopaedic future, robots, machines, and human intelligence must have enhanced partnership to continually improve patient care.
This framework should support human resilience and sustainability by safeguarding the global ecology, making the most efficient use of finite available resources for current and future generations.
Funding
We certify that we have received no funding for the creation of this work and have no disclosure of other sources of funding that would conflict with the published work.
Ethical approval
The submitted work does not contain human subjects research and is composed of review of the available literature. There is no ethical conflict.
Informed consent (Patient/Guardian), mandatory only for case reports/clinical images
Nonapplicable.
Institutional ethical committee approval (for all human studies)
None required. Not a human study.
CRediT authorship contribution statement
Karthikeyan P. Iyengar: Conceptualization, initial draft, Editing. Eindere Zaw Pe: Conceptualization, initial draft, Editing. Janaranjan Jalli: Conceptualization, initial draft, Editing. Madapura K. Shashidhara: literature search, Editing. Vijay K. Jain: literature search, Editing. Abhishek Vaish: literature search, Editing. Raju Vaishya: literature search, Editing, All authors have read and agreed to the final draft submitted.
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