Daniel Berry

MD

Associate Professor, University of Minnesota, Mayo Clinic

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David Lewallen

MD

Professor, Mayo Clinic

Hilal Kremers

MD

Associate Professor, Mayo Clinic

Marc Swiontkowski

MD, FAOA

Professor, University of Minnesota

Mohit Bhandari

FRCSC, PhD

Distinguished University Professor, Chair of Surgery, McMaster University

The discussion explores how rapidly expanding administrative datasets and national registries are reshaping orthopaedic research, highlighting both their promise and pitfalls. The experts emphasize that while these large resources enable unprecedented scale, they also invite misinterpretation, particularly when associations are mistaken for causation or when biases inherent to big data go unrecognized. The group reflects on lessons from building a national infrastructure, noting surprises such as gaps in Medicare datasets and challenges in evaluating new technologies through administrative data. They describe emerging opportunities, including embedding clinical trials within registries to reduce cost and improve efficiency, though legal and logistical barriers remain substantial. The upcoming journal supplement synthesizes these insights, offering practical guidance on database strengths, limitations, analytic strategies, and the future role of AI and natural language processing. Ultimately, the conversation underscores a cultural shift: as data volume grows, so must methodological rigor, national collaboration, and support for investigators aiming to translate massive datasets into reliable, clinically meaningful evidence.