Table 2.

Major advancements of Industry 4.0 in orthopaedics.

S No	Advancements	Description	References
1	Customised treatment	•This revolution is popular as it provides customization, by which individual requirements of patients can be assessed & fulfilled in lesser time •In orthopaedics, there is an essential requirement of customised patient-specific implants which now are quickly manufactured by using AM/3D printing technology •Perform customised patient treatment with advanced and digital technologies •Improves treatment quality with the proper management of medical devices •Used to address various symptoms, the discomfort of the legs and feet •Customised treatment of foot deformities and other bone injuries	Chen et al., 201278; Mok et al., 201679; Javaid and Haleem, 201880; Padilla-Castañeda et al., 201881
2	Real-time information and its management	•All data and information are stored digitally, which reduces the paperwork •24 × 7 access to information for better treatment •There is a reduction in inventory and inventory holding cost, as patient-specific implants and devices are printed only at the time of requirement •Provides proper information about bone fracture which helps to improve the surgical procedure and better recovery of the patient •Study and management of the injury during any sports activities •Proper navigation, tracking and management of data for better analysis	Çetinkaya et al., 201782; Qudsi et al., 201883; Lübbeke, 201884; Lindsey et al., 201885
3	Digitisation/Intelligence in manufacturing	•Industry 4.0 converts the information of non-digital format to digital formats •In orthopaedics, it helps to intelligently create innovation in the manufacturing of the required part in lesser time and cost •Intelligently provides the opportunity of auto-check and adopt the better problem-solving technique •Sensors provide proper feedback of manufacturing and other maintenance requirements •Ability to increase the efficiency of treatment with the proper communication system •Fulfil the challenges automatically during any design changes of product/orthopaedics part	Vavken et al., 201586; Assaf et al., 201687; Jennings et al., 201688; Kubicek et al., 201989
4	Planning and decision making	•Industry 4.0 uses various innovative technologies for planning and decision making during the complex orthopaedics cases •These technologies provide fundamental changes to increase the capabilities of researchers, doctors and surgeons •Create a flexible network using a cyber-physical system to increase self-optimising performance •There is a massive exchange of real-time data for the decision making and proper management of ongoing situations •Innovative information technologies used in this revolution reduces the errors of planning and decision-making process	Land et al., 201790; Khan and Muehlschlegel, 201891; Boland et al., 201992; Ierano et al., 201993
5	Transparency	•Advance information technologies are used to provide transparency during the treatment •Useful for advanced health monitoring system with proper treatment •Create transparency to make a proper decision of surgery with lesser risk •Opens a truthful communication between doctors, patient and family	Karam et al., 201294; Duymus et al., 201795; Sener et al., 201996; Sobel et al., 201997
6	Health monitoring	•A microcontroller is used to track and access data for proper monitoring of health parameters •Proper monitoring of body temperature, blood pressure and heart rate using advanced sensors •Used to suggest the actions on patient conditions based on the integrated algorithms •Notifies specialists during emergency cases •Develop a useful tool for a health monitoring system to save human lives •Provides actionable intelligence during the complicated cases	Naslund et al., 201798; Ten Haken et al., 201899; Weiss, 2019100; Hall et al., 2019101; Krick et al., 2019102
7	Risk management	•New innovative technologies can identify the diseases at an early stage, which helps to reduce the risk of patient •Due to the higher capacity of digital data storage, there is better management of risk at many stages of treatment •Better selection of a strategy for patient safety and other financial losses •Analyses the dangerous side effect during the specific medical condition of the patient •Keep accurate patient background information of the disease to reduce risk during treatment	Morris et al., 2003103; Etges et al., 2018104; Chen, 2018105; Jafari et al., 2018106
8	Intricate designing of orthopaedics tools	•In orthopaedics, there is an essential requirement of intricate design to make high-quality products •Various software, 3D scanners are used to improve the design of tools and devices as being used in this field •New technologies provide a positive impact on the development and innovation of the product •Due to its ability, the surgeon can perform bone surgery precisely in lesser cost and time •With the applications of various designing software and scanning technology, it can design and develop complex and intricate designs	Gallo et al., 2014107; Dorozhkin et al., 2015108; Groen et al., 2017109; Martinez-Marquez et al., 2018110
9	Patient-specific implants	•Designing and printing of patient-specific implants is the primary challenge in the orthopaedics field and undertakes this challenge by the applications of Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) and 3D printing technology •Scanning technologies are used to capture data of the patient and 3D printing easily print this data in lesser time and cost •Provide an innovative solution with the help of medical devices and service •These technologies are also applicable for custom fit prosthetic to create comfort to the patient	MacBarb et al., 2017111; Haleem and Javaid, 2018112; Mangano et al., 2020113; Memari et al., 2020114
10	Increase the performance of the surgeon	•The surgeon can make a brief idea of the surgery before even performing •These technologies are used to perform mock surgery on the patient-specific bone model to increase surgical performance •During surgery, sensors are used to measure surgeon movement to make it successful •Suggests necessary procedure to increase the quality of treatment	Liu et al., 2014115; Barrett et al., 2019116; Apramian et al., 2018117; Dalager et al., 2019118
11	Rapid development	•This revolution uses advance manufacturing technology which can easily create rapid development in orthopaedics tools and devices •All information’s and processes are digitally controlled to create advancement rapidly •Helpful to execute post-trauma surgeries using patient-specific implants •Uses 3D printing to create a prototype which creates rapid development in the field of orthopaedics •Research and development of product become more accessible with the use of advanced manufacturing and information technologies	Munshi et al., 2012119; Fayaz et al., 2013120; Hoang et al., 2016121; Zhou, 2017122
12	Daily patient routine	•Industry 4.0 provides innovative opportunities to follow a daily routine to stay fit •Helps patients to follow up proper exercise in day to day life •Suggest proper food, nutrition service and proper menu to the patient •Predicts motion of the fractured bone and helps treatment at home with proper exercise •The patient can learn better activities and follow up on the daily routine and daily medication	Al Shahraniet al., 2018123; Gershengorn et al., 2018124; Van der Willik et al., 2019125; Kirk et al., 2019126