Copy to clipboard 
Hip replacements are being transformed and improved through new, exciting technologies. Surgical navigation, robotics, augmented reality and artificial intelligence (AI) promise to enhance outcomes by providing surgeons with preoperative planning capabilities, customized implant placement and improved decision-making during surgery.
The industry experts we spoke to shared insights on how the hip replacement market is evolving and discussed what’s next in the space as enabling technology and digital solutions advance and progress pushes more cases to outpatient facilities.
Personalized Care
James Paiva, Vice President of Marketing at Conformis, said that surgeons are increasingly interested in performing personalized hip replacements, and orthopedic companies are taking notice.
“Increasing numbers of surgeons who perform hip replacements utilize preoperative planning tools to review the patient’s native hip anatomy and determine optimal implant positioning,” he explained.
Three-dimensional computer navigation software enables surgeons to make more informed decisions and plan procedures before surgery. It’s a technological advancement that resonates with today’s younger surgeons and savvy patients, said Paiva.
Before surgery, surgeons use computer navigation software to map out procedures based on an individual patient’s anatomy. In the O.R., the software guides surgeons along the predetermined surgical path, allowing them to perform procedures more effectively and efficiently — and potentially with fewer complications.
Conformis uses 3D models of hip joints created by software before surgery to design personalized instrumentation based on a patient’s specific anatomy. The customized instruments and cutting guides ensure surgeons make accurate bone cuts and place implants more exactly.
“Patients with unique anatomies, previous joint trauma or pre-existing hardware benefit from having surgeons work with fully customized instrument sets designed specifically for them,” Paiva said.
Multiple solutions — intra-operative surgical navigation, single-use cutting guides and personalized implants for outlier anatomies or specific patient needs — are available during surgery to help surgeons position implants exactly where they intend.
“As we have seen in the knee space, a personalized approach to surgery greatly improves a surgeon’s ability to recreate the joint’s native biomechanical movement and function,” Paiva said. “The personalization of instruments and implants enables surgeons to achieve accurate implant positioning and restore each patient’s unique anatomy. It also increases overall efficiency in the surgical process.”
Spurring the Outpatient Migration
Preoperative planning and computer navigation reduce the number of surgical steps needed to trial implants and find the right fit. This benefit allows surgical facilities to manage smaller implant inventories and work with fewer instrument trays that need sterilizing — factors that are helping push more cases to the outpatient arena.
The pandemic and technological advancements have accelerated the shift of minimally invasive total hip replacements to ambulatory surgery centers (ASCs), which operate more efficiently and cost-effectively with streamlined supplies of instruments and implants.
Paiva predicted that the efficient and accurate execution of preoperative planning and intra-operative computer navigation will increase hip replacement’s site-of-care shift to ASCs. “The technologies have the potential to improve patients’ recoveries,” he said. “The industry needs to look at these solutions holistically.
“We must create ways to increase operational efficiencies to improve resource utilization, including implant and instrument inventories, to lower costs in all surgical settings. Finding ways to provide cost-effective care is critical as more hip replacements move to ASCs.”
Richard Boddington, CEO of OrthoGrid, agreed that the automation of hip replacements will help move more cases to outpatient facilities. Boddington, whose medtech firm is focused on transforming orthopedic surgeries through digital solutions, also pointed out that hip replacement’s latest technological advances will be adopted in the ambulatory setting when the costs of the platforms decrease.
That adoption will be key as interest in having surgeries performed in same-day settings increases among surgeons and patients.
“Computer-assisted surgery is key to optimizing performance outputs and increasing efficiencies in the O.R.,” he added. “This will reduce surgical times, which addresses case volume challenges caused by the increasing demand for hip replacement procedures.”
Searching for Intelligent Solutions
Although recent technological advancements are disrupting the hip replacement market, some believe developments, such as robotic assistance, remain unproven.
“We have yet to see sufficient clinical evidence that robotic assistance provides significant clinical improvements or safer outcomes, compared to personalized instruments and implants,” Paiva said. “Robotic devices can add additional setup time, complexity and overall costs to surgery. The platforms provide clear theoretical benefits. Hopefully, future iterations will achieve those benefits for patients.”
Boddington believed robotics will become more mainstream but will require other technologies — such as AI — to reach its full potential. “The promise of minimally invasive hip surgery will be realized through the fusion of technological advancements such as intra-operative imaging and data collected by smart implant sensors,” he said.
Boddington’s company is focused on transforming hip replacements through data and AI. The goal, he explained, is to ensure optimal results for all patients in terms of surgical outcomes and performance outputs.
Orthopedic manufacturers are leveraging AI to analyze large quantities of clinical data to tailor devices for outpatient settings and meet increasing demands for hip replacement procedures, according to Boddington. However, he cautioned, transitioning to complex platforms like AI is not a quick or easy process.
It takes many years to collect and mine data to optimize models or algorithms that allow surgeons to perform more efficient and accurate surgery, according to Boddington. “It also takes time and expertise to build digital solutions and, most importantly, to build them right,” he added.
“We’ve spent five years building and perfecting AI-powered models,” Boddington said. “Implant companies are watching for opportunities and exploring options in the AI space. We’re focused on building effective models to optimize our position in that market.”
Based on the recent enabling technology product launches from implant companies and software firms, it’s clear that there’s much work left to do to optimize hip replacement outcomes. Boddington pointed to the generation of real-time intra-operative intelligence that’s driven by data and powered by AI as a next step in the advancement of surgical care.
“The integration of AI and robotics is what we’re working toward,” he said. “We intend to help surgeons perform better surgery with data and AI.”
