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Joint replacement has seen a flurry of activity, from new implants to new robotic and navigation technology to new partnerships. Much of the implants, instrumentation and technology have been developed to drive higher precision and more personalized approaches to surgery.
In anticipation of talking points at AAOS, we recap recent announcements for the 10 largest players in the joint replacement space. Of note, we cover product announcements and strategic updates daily at ORTHOWORLD. We guide you there for continuous company coverage from AAOS.
Zimmer Biomet Focuses on Data Capture
Much of Zimmer Biomet’s knee and hip replacement efforts have focused on components for ZBEdge, the company’s suite of connected digital and robotic technologies, including ROSA, mymobility and the new Persona IQ knee.
In 2021, Zimmer Biomet gained FDA 510(k) clearance of the ROSA Hip System for robotically-assisted anterior total hip replacement, adding to the company’s ROSA Robotics portfolio that includes the ROSA Knee System for total and partial knee replacement. FDA also granted Zimmer Biomet and Canary Medical a De Novo classification to market their Persona IQ, reportedly the first and only smart knee cleared by FDA for total knee replacement. Persona IQ combines Zimmer Biomet’s Persona The Personalized Knee with Canary Medical’s implantable canturio te tibial extension sensor technology that measures and determines a patient’s range of motion, step count, walking speed and other gait metrics.
Data from these ZBEdge technologies are incorporated into Zimmer Biomet’s intelligence platform, OrthoIntel, and then provided to surgeons to inform patient care decisions.
Stryker Expands Knee and Shoulder Portfolios
Back in 2019, Stryker and Conformis entered an agreement in which Conformis would develop, sell and license aspects of its patient-specific instrumentation (PSI) to Stryker for use in knee implants. In 2021, Conformis received FDA 510(k) clearance for PSI designed to be used with Stryker’s Triathlon Total Knee. The clearance further solidifies the partnership and differentiates Stryker’s knee portfolio from its competitors.
Stryker has also ramped up their shoulder replacement activity after acquiring Wright Medical/Tornier in late 2020. Stryker launched the Tornier Perform Humeral Stem and Perform Patient-Matched Primary Reversed Glenoid, both leveraging Blueprint planning software capabilities.
To generate the Patient-Matched Glenoid, the surgeon uses Blueprint Software to virtually position and execute the creation of a patient-matched implant. Once completed in Blueprint, an order is generated to manufacture the glenoid baseplate and patient-specific instrumentation. The surgeon will receive the sterile devices and execute the implantation of the baseplate using a ream-free, bone-preserving technique.
DePuy Synthes Reaches Robotics Market with VELYS
DePuy Synthes gained FDA 510(k) clearance to market the VELYS Robotic-Assisted Solution for use with the ATTUNE Total Knee back in early 2021. The VELYS system provides surgeons with data that assists with real-time decision-making during a total knee replacement.
At the ast AAOS meeting, DePuy Synthes announced their vision to advance the VELYS Digital Surgery Platform and extend into adjacent surgical fields, including hip replacement. Meanwhile, innovations including VELYS Insights — an integrated clinical support solution connecting care teams with real-time patient-specific data — and a new image guidance capability for VELYS Hip Navigation are growing DePuy Synthes’ digital surgery capabilities across joint reconstruction and replacement.
Smith+Nephew Expands Robotics Portfolio
Smith+Nephew’s latest iteration in robotics is CORI, an advanced handheld system. CORI, reportedly much more compact than competitors’ systems, is fully mobile and requires minimal setup time. The solution incorporates 3D intra-operative imaging with an advanced robotic sculpting tool.
In 2021, the company announced CORI’s compatibility with both total and partial knee replacement. This year, the company expanded the surgical system into total hip replacement with RI.HIP NAVIGATION. Software installations for hip replacement started in January for a limited number of hospitals and ASCs in the U.S., with broad commercial availability expected later in 2022.
Smith+Nephew also acquired Engage Surgical, developer of the only cementless unicompartmental knee system commercially available in the U.S. The Engage Surgical Partial Knee is optimized for robotics and will have a future application with CORI, deepening Smith+Nephew’s implant and robotics portfolio.
Aesculap Partners on Antimicrobial-Coated Implants
Aesculap’s notable joint replacement activity includes its international cooperation agreement with Bio-Gate for the antimicrobial coating of revision implants for knee and hip systems. The deal, which took place in mid-2020, also included an option to use HyProtect™ coating technology in other applications.
In recent years, the companies have successfully worked together on several studies, including an osseointegration study in which they investigated the healing process of human bone ingrowth in implants. Throughout the study, HyProtect coating demonstrated good bone ingrowth performance. Furthermore, the coating showed high antimicrobial effectiveness in human cases.
DJO Enhances Portfolio with Acquisitions and Partnerships
DJO has said that it is building toward a $1 billion joint replacement business through new partnerships and technology.
DJO previously invested in strategic innovations, including those from Insight Medical Systems, developer of ARVIS (Augmented Reality Visual and Information System). ARVIS combines tracking cameras with a 3D display and hands-free interface in an integrated eyepiece for total joint replacement DJO’s EMPOWR Partial, Primary and Complex Primary Knee and Hip systems are compatible with ARVIS.
After acquiring Mathys, a Switzerland-based joint replacement company, in June 2021, DJO expanded its joint replacement channels outside the U.S. The deal has the potential to nearly double DJO’s international revenue, with an expanded global market for the AltiVate Reverse shoulder replacement, EMPOWR Hip and Knee Systems and foot and ankle products. Among the products that Mathys brings to the partnership is the RM Pressfit vitamys Monobloc acetabular cup.
PeekMed and DJO Surgical recently developed a new technological strategic partnership at the end of 2021. The partnership leverages the respective strengths of DJO’s surgical business and PeekMed’s dedicated focus and expertise as an innovative technological player for orthopedic surgeons.
Medacta Expands Planning Platforms
Medacta received regulatory approvals for its NextAR Augmented Reality (AR) surgical platform for knee, shoulder and spine applications, with the first Reverse Shoulder Arthroplasty using NextAR Shoulder successfully taking place in July 2021.
NextAR’s smart delivery tools include the single-use NextAR TS tracking system and NextAR Augmented Reality Smart Glasses, and is the first platform to offer augmented reality solutions for joint replacement and spine. Prior to surgery, the surgeon uses a 3D virtual model of the patient’s joint to choose the best implant and position to restore the patient’s anatomy. NextAR is part of the MySolutions ecosystem of implants and surgical techniques.
In late 2021, Medacta launched MyKnee R, a patient-specific set of 3D-printed blocks that can be directly positioned on the failed primary implant in situ, in order to easily proceed with its replacement. Starting from a CT scan, MySolutions engineers create a 3D reconstruction of the patient’s joint where a failed primary implant has been positioned. This reconstruction is then used to accurately plan the positioning of a new prosthesis, chosen from Medacta’s portfolio of total knee replacement solutions.
Exactech Harnesses Intelligence Tools
In mid-2021, Exactech launched an integrated bundle of updates to its Active Intelligence technologies designed to help surgeons plan and execute shoulder replacement surgery and better predict patient outcomes. The ExactechGPS Shoulder updates incorporate a direct connection to Predict+ machine learning-based software as well as user experience enhancements and new intra-operative software features.
The ExactechGPS Shoulder can be used with the Equinoxe Planning App version 2.0, which earned FDA 510(k) clearance in February 2022. The latest update to the Planning App includes the ability to pre-operatively plan humeral implant options to model the best fit for each patient’s anatomy, the ability to assess shoulder range of motion and impingement, and visual enhancements.
Recent innovation at Exactech isn’t limited to the shoulder. The company’s Truliant Total Knee System expanded in August 2021 to include a porous-coated implant option, supporting surgeons who are interested in a non-cemented approach to total knee replacement. It integrates with the system’s ergonomically designed mechanical instrumentation and the ExactechGPS TKA Pro application for a guided, personalized experience.
Also in the sphere of knee replacement, Exactech announced the first surgeries using its Newton technology, which combines dynamic ligament balancing and real-time guidance for a personalized intraoperative solution. By capturing active balance data through the entire arc of motion with the patella in place, Newton integrates with ExactechGPS’s connected platform to allow surgeons to visualize a predictive plan through operative insights, without the need for external soft tissue tensioners.
LimaCorporate Innovates in the Knee and Shoulder Space
LimaCorporate has experienced a slew of activity in the last year with entrance into the cementless knee market and launches of shoulder technologies.
LimaCorporate’s introduced its Smart SPACE 3D Virtual Planner and the Shoulder Cubit Guidance digital platform. The digital platform is powered by artificial intelligence algorithms developed by TechMah Medical and allows surgeons to develop a complete preoperative plan and execute the plan using a combination of patient-specific 3D Positioners and the Cubit Guidance System’s sensor technology. It provides real-time feedback regarding instrument and implant positioning while maintaining surgeons’ desired O.R. and patient set up.
LimaCorporate’s focus on shoulder replacement extends to their Investigational Device Exemption study for the SMR Stemless Reverse Shoulder, which began nearly a year ago. The implant is approved in Europe, Mexico and some APAC countries. There are currently no stemless reverse implants cleared for use by U.S. FDA.
On the total knee front, LimaCorporate entered the cementless knee market with their Physica system Trabecular Titanium (TT) Tibial Plate. Designed in collaboration with Hospital for Special Surgery, the TT Tibial Plate provides a more bone-preserving implant with long-term biological fixation compared to standard cemented designs.
Corin Expands Robotics and Pre-op Planning Platforms
Corin announced the first clinical cases of OMNIBotics 2.7, upgrading the robotic-assisted platform for use in hip replacement. The updated system allows surgeons to review operative planning and reports against their patient profiles and patient-reported outcome measures, as well as benchmark data from similar patient cohorts.
OMNIBotics 2.7 supports seamless data transfer to the proprietary CorinConnect registry and analytical ecosystem. By integrating OMNIBotics with the CorinConnect dashboard, surgeons can access analytical insight to make more informed decisions to improve patient outcomes in both hip and knee replacements.
The U.K.-based company also commenced the global launch of OPSInsight preoperative planning software for total hip replacement, the next generation of the company’s Optimized Positioning System (OPS).
Looking Forward
These 10 companies play a significant role in the $19 billion total joint replacement market due to their size and product tone. Based on the product clearances and launches from the last 12 months, we expect companies of all sizes will continue to find ways to integrate robotic and digital technologies into their portfolios, as well as next-generation implants.
