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

➢ Multicenter studies remain rare in orthopaedics (9.9% of recent publications) due to regulatory complexity, restrictive data-sharing policies, and administrative delays, despite their proven value in generating robust, generalizable evidence. ➢ Federated computing (FC) brings analytic code to each institution's data and returns only encrypted, aggregated results. This preserves patient privacy, maintains institutional control, and streamlines compliance by reducing or eliminating the need for complex data-use agreements. ➢ Extensive applications in other medical fields show that FC can match or exceed the performance of centralized analyses across diverse data types (imaging, electronic health records, genomics, and surgical video) without centralizing sensitive information. ➢ For orthopaedics, FC enables scalable, privacy-preserving collaboration on rare events, low-frequency outcomes, and practice variation across subspecialties. Broad adoption could expand research scope, improve evidence quality, and accelerate translation of findings into clinical care. ➢ FC enables secure, privacy-preserving multicenter collaboration in orthopaedics, overcoming long-standing barriers to data-sharing and expanding the scope of clinically impactful research.