Table 1.

Major supportive technologies of Industry 4.0 for orthopaedics.

SNo	Technologies	Description	References
1	Big data	•Big data store large and complex data by the applications of IoT devices •Provide the best service in the orthopaedics field for providing an excellent health information system •A large amount of stored data for personalized and predictive medical treatment •Helps to store heterogeneous data of patients which may be unstructured, structured and semi-structured •Easily store large and complex data, which was not manageable by the previous various data storage techniques •Helpful to identify a wrong medicine, treatment, dose thus, to reduce the errors	Nishimura et al., 201620; Dimitrov et al., 201621; Ehrenstein et al., 201722; Fisher et al., 201823; Cahan et al., 201924
2	Machine learning	•It uses a robust computational algorithm for massive data set processing •Undertakes an advanced scientific study of the statistical and algorithmic model using the computer system to perform specific tasks •Applied for the drug discovery process at an early stage and assess its helpfulness in precise treatment in orthopaedics •To play an essential role for billing, medical record and patient care •Make the orthopaedics field smart by minimizing administrative and supply costs •The significant applications of this technology would be the identification of disease, diagnosis, drug delivery, clinical trial, research and development and commercialization	Cabitza et al., 201825; Mohanty et al., 201826; Kuo et al., 201827; Gunaratne et al., 201928
3	Cloud computing	•Stored data is processed at remote servers using computer sources •Customized applications of internet access to use the information stored in the cloud •Hospital and clinician can store the medical data to help patients and researchers •Deploys access and networked pieces of information and resources by offering on-demand computing using cloudases, this helps effective sharing of patient inform •In emergency cation with the doctor/surgeon at different locations •Easy connect of healthcare centres through the use of electronic documents and quickly providing support to physician enquiry, pharmacy order and patient management system	Whaiduzzaman et al., 201429; Khan et al., 201430; Griebel et al., 201531; Gao et al., 201832
4	Advance robotics	•These are used to create innovation in the industry and many other fields, especially to perform a delicate and challenging task accurately •Robots can perform repetitive and dangerous tasks in difficult environmental conditions •Surgical robots and rehabilitation robots to be used to perform a variety of tasks in healthcare for human treatments •These robots help physicians at rural or remote locations to examine and give treatment to a patient •Useful to reliably supply meals, medications and other essential items to patients and the staff •A Robotic-assisted surgical system allows the surgeon to make precise, delicate motions while controlling the machine •It helps a surgeon to achieve some of the delicate surgeries in hard-to-reach places	Santello et al., 201633; Gifari et al., 201934; Bing et al., 201835; Zhang et al., 201836
5	Internet of Things	•Here all devices used to perform the required tasks are connected to the internet which conveys the information appropriately •IoT helps to perform the world-class treatment and surgical procedure •Provide a guided course of action to improve the overall performance in the digitally controlled management system •Assist in efficient performing of successful bone, knee, hip and other treatment in lesser time •Track status of various diseases like heart failure, diabetes, blood pressure etc. during treatment •With the help of internet facilities, it maintains all clinical record, and in an emergency, it helps doctors and surgeon	Dimitrov et al., 201621; Silva et al., 201937; Lysogor et al., 201938; Homaei et al., 201939
6	Cyber-Physical Systems	•This provides development to physical processes using proper monitoring of network and computer technology and involves the integration of networking, computation and physical processes •Doctors and researcher can better understand the problem and solve various challenges •Health practitioners can now coordinate better among all medical devices to ensure the safety of their interaction •Used for the research & development of highly reliable smart devices and tools •Improves patient safety with the help of networked physical devices	Bradley and Atkins, 201540; Lee, 201541; Dawson and Thomson, 201842; Burns et al., 201843; Labrado et al., 201944
7	Artificial Intelligence	•Artificial Intelligence provides human-like intelligence to the devices with the help of available data by using algorithms and specialized software •Provides exceptional ability to improve physician accuracy and help him/her to focus on specific treatment of the patient •AI is integrated with other technologies (AR/VR/MR) to provides enhanced virtual support between doctors and patients •Increase the service quality in healthcare by improving task performance •Uses computer-based technique to suggest better alternatives for advance treatment, diagnosis and prediction •Useful for proper decision making during complicated cases	Olczak et al., 201745; Elkin et al., 201846; Gan et al., 201947; Han and Tian, 201948; Weng et al., 201949; Haleem et al., 202050
8	Video streaming	•This is live streaming of video for improving the communications among the various stakeholders •Helps orthopaedics consultant to provide better supervision of surgeries in remote places •Video conferencing in local health service provides telemedicine, online consultation and virtual training supports as it is cost-effective •Helpful for remote locations in providing regular access to a medical specialist for treatment and surgery •Helps to track patient history for proper medical support	Kwon et al., 201651; Nguyen et al., 201852; Abenza et al., 201853; Wang et al., 201954
9	Cybersecurity	•This technology provides security to software, hardware and any other electronics data/service from any theft using computer systems and networks •Connect internet, hospital network and other medical tools and devices to treat patients •Protects health care network databases to achieve promising results •Prevents electronic health information from any other unauthorized access and theft and reduces the risk factor •Provides a new network for the medical field for dealing with the security of sensitive healthcare information	Kramer et al., 201255; Papoutsi et al., 201556; Cobb et al., 201857; Veksler et al., 201858
10	3D printing	•It is a layer by layer addition of material to create parts from the input of computer-aided design (CAD) data •Useful for the manufacturing of customised implants, bone, prosthetics and pharmaceuticals •Used for the printing of stems cells, organs and tissues •Used for developing technology for skin printing •In orthopaedics, this technology is now available for bone tissue engineering •Useful to identify the proper bone defect and recreation the missing part of the patient body •Useful for surgical planning and intervention in complex cases	Vaishya et al., 201859; Lal and Patralekh, 201860; Javaid and Haleem, 201861; Fang et al., 201962; Wang et al., 202063
11	Wireless brain sensors	•Wireless brain sensors are used to check brain-related disease, sleep disorder, dementia, traumatic brain injury and other brain-related conditions •Parkinson’s disease can check effectively •Helpful to improve cognitive functionalities and proper monitoring of neurological fluctuations •Used to monitor brain temperature, intracranial pressure and record signalling of the brain using brain waves •Easy checking of intracranial pressure of the brain and inside the skull •Helpful to identify the risk of infection through the skin/organs	Klosterhoff et al., 201764; Cui, 201765; Han et al., 201866; Park et al., 201967
12	Nanomedicine	•Nanomedicine applies the knowledge of nanotechnology for the treatment and prevention of disease •Uses nanoscale material having biocompatible nanoparticles for a living organism •Helpful for diagnosis, delivery and sense regarding the medical treatment of the patient •Successfully applied for the treatment of cancer and another clinical research •Used for tissue engineering to repair/reshape the damaged tissue •Suitable for enhancing the process of manufacturing of scaffold and used as a growth factor •Used for the development of analytical tools, drug delivery, diagnostic devices and physical therapy applications	Armstead and Li, 201168; Mazaheri et al., 201569; Sweeney, 201570; Smith et al., 201871