Federated Computing in Orthopaedic Surgery: A Paradigm Shift in Collaborative Multicenter Research.

Area of Science:

• Orthopaedic research
• Medical informatics
• Data privacy

Background:

• Multicenter studies in orthopaedics are rare (9.9% of publications) due to regulatory hurdles, data-sharing restrictions, and administrative delays.
• Despite these challenges, multicenter studies are crucial for generating robust and generalizable evidence in orthopaedics.

Purpose of the Study:

• To introduce federated computing (FC) as a solution to overcome barriers in multicenter orthopaedic research.
• To highlight FC's potential for privacy-preserving, scalable collaboration in orthopaedics.

Main Methods:

• Federated computing (FC) involves bringing analytical code to each institution's data, returning only encrypted, aggregated results.
• This method preserves patient privacy and institutional control, reducing the need for complex data-use agreements.
• FC has demonstrated success in other medical fields across various data types (imaging, EHR, genomics, surgical video).

Main Results:

• FC enables scalable, privacy-preserving collaboration on rare events, low-frequency outcomes, and practice variations in orthopaedics.
• The approach matches or exceeds the performance of centralized analyses without data centralization.
• FC facilitates secure collaboration, overcoming long-standing data-sharing barriers.

Conclusions:

• Federated computing offers a secure and privacy-preserving framework for multicenter collaboration in orthopaedics.
• Widespread adoption of FC can expand the scope of orthopaedic research and accelerate the translation of findings into clinical practice.
• FC enhances evidence quality and supports research on rare conditions and practice variations.