Introduction

Orthopaedic “innovation” is often described in physical terms: a better implant, a more precise robot, a new biologic, a less invasive exposure, a more effective pain protocol, or a more efficient site of care.  Of course, these advances matter.  They have helped make musculoskeletal care one of the most technically dynamic areas of medicine.

However, the next important frontier of orthopaedic innovation may be less visible but no less important: the system by which clinical evidence is generated, governed, and returned to surgeons and patients.

The Research Participation Gap in Orthopaedics

That frontier matters because meaningful participation in clinical research remains unevenly distributed. Academic medical centers, large integrated health systems, and industry-sponsored clinical trial networks possess the research coordinators, infrastructure, institutional review boards, analytic support, and publication pathways necessary to convert clinical questions into formal evidence.

Yet a substantial share of musculoskeletal care occurs outside of those environments, including private orthopaedic practices, ambulatory surgical centers, community hospitals, and regional multi-specialty groups.

Surgeons in these settings make daily decisions that shape patient recovery, functional improvement, pain control, and product adoption.  They also influence quality, cost, and value.

Their experience is clinically rich, but it is often difficult to translate into research-ready evidence.  The problem is not a lack of clinical insight or expertise.  Rather, the infrastructure for converting routine clinical care into structured, longitudinal, and useful data has not kept pace with where and how musculoskeletal care is actually delivered.  That is the unmet need that MOTIV™ is intended to address.

Introducing MOTIV™

MOTIV™ – Musculoskeletal Outcomes and Tracking Intelligence Vault – is an initiative is designed to help orthopaedic physicians participate more directly in real-world evidence generation across all practice settings. The surgeon contributors define the clinically relevant questions and supply the ground-truth observations from their own care. MOTIV™ connects the initiative to the broader mission of advancing orthopaedic research.

This article was developed through a collaborative initiative between the Orthopaedic Research and Education Foundation (OREF) and RegenMed to advance physician-led, real-world evidence generation in musculoskeletal care. 

Why Traditional Data Sources Are Not Enough

MOTIV™ begins from a premise that is increasingly important in modern healthcare: more data are not necessarily better data.

Electronic medical records, claims databases, and implant registries all have value, but they also have predictable limitations.  They are often incomplete, fragmented, and removed from the original clinical event. In many cases, they cannot capture the nuance required by surgeons and patients or address the specific questions clinicians are trying to answer.

Traditional research studies built around these data sources may answer narrowly defined questions within controlled populations.  However, these approaches alone cannot fully address the need for practical, prospective, physician-engaged evidence generation derived from routine orthopaedic care.

Structuring Evidence Before It Is Collected

MOTIV™ complements traditional approaches by structuring evidence before it is collected.

Participating surgeons work from defined observational protocols.  These clinically designed frameworks specify which patient-reported outcomes, clinician observations, operative variables, recovery milestones, and follow-up measures should be collected for a particular clinical question.

The objective is not to create additional administrative burden.  Instead, MOTIV™ seeks to make high-quality evidence generation a natural byproduct of efficient clinical workflows.

Supporting Value-Based Care and Patient-Reported Outcomes

This structure becomes increasingly important as orthopaedic surgery responds to the expanding role of patient-reported outcomes and value-based care.

The Centers for Medicare & Medicaid Services (CMS) Total Knee Arthroplasty Patient-Reported Outcome Performance Measure has increased focus on functional recovery and patient-reported improvement.  However, a system that captures only the CMS minimum may overlook important clinical insights.  Conversely, a system that attempts to collect excessive data may become impractical.

The ideal middle ground is a prospective framework that is clinically meaningful, feasible at the point of care, and capable of supporting longitudinal analysis.

The First MOTIV™ Circle: Total Knee Arthroplasty

The first data “Circle” within MOTIV™ focuses on Total Knee Arthroplasty (TKA).

TKA serves as an ideal proof-of-concept because it is common, highly successful, technically variable, and clinically rich.  Outcomes can be influenced by numerous factors, including:

• Patient selection
• Comorbidity burden
• Implant choice
• Alignment strategy
• Surgical technique
• Anesthesia selection
• Rehabilitation protocol
• Pain management strategy
• Patient expectations
• Follow-up adherence

These variables interact in ways that are often difficult to understand using current research tools such as code-based registries or isolated institutional experiences.

Development of the MOTIV™ TKA Protocol

The MOTIV™ TKA observational protocol was co-authored by Dr. Andrew Wickline and Dr. John Mercuri and underwent expert review by several respected OREF orthopaedic surgeons.

The protocol builds upon the CMS TKA PRO-PM framework while incorporating additional clinically relevant domains, including:

• Product selection
• Pain management
• Range of motion
• Complications
• Rehabilitation
• Recovery trajectories

The protocol includes:

• Patient pre-operative surveys
• Clinician pre-operative evaluations
• Operative data collection
• Longitudinal patient follow-up through 12 months

Electronic surveys use responsive logic and workflow optimization tools to reduce burden for physicians, staff, and patients.

Early Results and Feasibility Outcomes

The early experience should be viewed as a strong feasibility signal rather than mature outcomes evidence.

The initial MOTIV™ TKA Circle launched in February 2026.  At the time of writing, the program included:

• More than 15 orthopaedic surgeons
• More than 225 longitudinal patient cases
• 87% physician survey completion
• 93% patient survey completion

The long-term objective is to expand participation to dozens of surgeons and at least 2,000 TKA patients with complete longitudinal follow-up.  If sustained, this scale will support investigation of clinically important questions related to:

• Range of motion
• Opioid exposure
• Pain trajectories
• Forgotten Joint Score
• Surgeon-level practice variation

Advancing Real-World Research in Pain Management

Non-opioid pain management represents one of the most important areas where contemporary orthopaedic practice requires stronger real-world evidence.

The field continues to evolve through innovative rehabilitation protocols and new therapies such as suzetrigine.  The key question is not whether one protocol is superior to another.  Rather, it is whether physician-led observational infrastructure can help determine how emerging pain-management strategies influence:

• Opioid exposure
• Pain scores
• Functional recovery
• Patient experience

These are precisely the types of questions that require greater detail and flexibility than traditional studies often provide.

Beyond TKA: Expanding the MOTIV™ Model

The value of MOTIV™ extends far beyond total knee arthroplasty.  The same evidence-generation framework can be applied to:

• Hip arthroplasty
• Spine surgery
• Sports medicine
• Orthopaedic biologics
• Fracture care
• Pediatric musculoskeletal conditions
• Rehabilitation
• Pain management

The model also provides surgeons from academic, private-practice, community, and hybrid settings with opportunities to participate in protocol development, research collaboration, quality improvement initiatives, authorship, and evidence stewardship.

Empowering Surgeons Through Evidence Stewardship

For surgeons, the central promise of MOTIV™ is professional agency.

Physicians should not function merely as data sources for institutions, payers, vendors, or registries removed from the point of care.  Instead, they should play a central role in defining questions, generating evidence, interpreting findings, and applying knowledge back to patient care.

Improving Patient-Centered Care

For patients, the value is equally significant.

Better real-world evidence enables surgeons to provide more specific guidance regarding:

• Recovery expectations
• Pain trajectories
• Functional milestones
• Medication requirements

Patients do not experience “average” orthopaedics.  They experience a specific diagnosis, a specific procedure, a specific surgeon, a specific care pathway, and a personalized recovery journey.  Clinical evidence should increasingly reflect this reality.

Building a More Inclusive Research Ecosystem

The opportunity for orthopaedics is larger still.

Musculoskeletal care requires faster, more practical, and more inclusive evidence generation.  Not every important question requires a randomized controlled trial, and not every valuable dataset should be developed solely within academic institutions or organizations removed from patient care.

A healthier research ecosystem should integrate physician-led, real-world evidence networks and pragmatic clinical studies alongside traditional research methodologies.

The OREF/RegenMed MOTIV™ program seeks to create that missing layer by transforming everyday clinical care into structured, clinically useful, real-world evidence.

Conclusion: The Future of Orthopaedic Innovation

If this model succeeds, its significance will not be that it created another database.

Its true impact will be in expanding participation in orthopaedic research, accelerating the investigation of clinically relevant questions, and strengthening the connection between evidence generation and patient care.

Orthopaedic innovation is not limited to what enters and exits the operating room.  It also encompasses the evidence systems that enable the profession to learn from patient experiences, improve outcomes, and continually advance musculoskeletal care.

Executive Summary

MOTIV™ (Musculoskeletal Outcomes and Tracking Intelligence Vault) represents a new approach to orthopaedic innovation by focusing not on implants or surgical techniques, but on the way clinical evidence is generated and applied in everyday practice.  The initiative was created to address a longstanding gap in musculoskeletal research: while a large portion of orthopaedic care occurs in private practices, ambulatory surgery centers, and community hospitals, meaningful participation in clinical research has traditionally been concentrated within academic institutions and large healthcare systems.

Developed through a collaboration between the Orthopaedic Research and Education Fund (OREF) and RegenMed, MOTIV™ enables surgeons across diverse practice settings to contribute directly to real-world evidence generation.  The platform uses structured observational protocols that define what clinical, operative, and patient-reported data should be collected before evidence generation begins.  This approach aims to transform routine clinical care into standardized, longitudinal, and clinically meaningful data while minimizing administrative burden.

The first MOTIV™ "Circle" focuses on Total Knee Arthroplasty (TKA), serving as a proof-of-concept for physician-led evidence generation.  Early participation has been encouraging, with more than 15 orthopaedic surgeons contributing data from over 225 patients and achieving high survey completion rates from both physicians and patients.  The TKA protocol expands on existing CMS patient-reported outcome measures by incorporating additional variables such as implant selection, pain management, rehabilitation, range of motion, complications, and recovery trajectories.

Beyond TKA, the MOTIV™ model has the potential to support research across hip arthroplasty, spine surgery, sports medicine, biologics, fracture care, rehabilitation, and pain management.  By empowering physicians to define research questions, generate data, and interpret findings, the platform seeks to create a more inclusive, practical, and responsive evidence ecosystem.

Ultimately, MOTIV™ is not simply a new database.  Its broader goal is to expand participation in orthopaedic research, accelerate the generation of real-world evidence, and strengthen the connection between clinical knowledge and patient care.  If successful, MOTIV™ could help redefine how orthopaedics learns from everyday practice and translates those insights into better outcomes for patients.

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