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Orthopedic surgeons have long relied on tribal knowledge, experience and feel to properly align implants during joint replacement surgery. Their ability to qualify surgical outcomes relied on subjective patient responses on satisfaction surveys.
That’s no longer the case. Hip, knee and shoulder replacements are becoming more of a science than an art.
“Orthopedic manufacturers are empowering surgeons with data, artificial intelligence and precision robotics to remove the guesswork from procedures and strive toward improved, consistent and reproducible results,” said Liane Teplitsky, Zimmer Biomet’s President of Global Robotics and Technology and Data Solutions.
Emerging technologies continue to transform joint replacement care as an increasing number of cases shift to ambulatory surgery centers (ASCs).
Several industry leaders shared their take on the current landscape of this exciting and growing segment and discussed how device manufacturers should respond with a strategic approach to innovation.
Informed Decision-Making, Better Outcomes
Teplitsky pointed to the importance of creating an interconnected ecosystem of technologies that seamlessly share data to inform decision-making in all aspects of patient care, improve surgical efficiencies and enhance the patient experience.
For example, Zimmer Biomet’s ZBEdge platform enhances patient outcomes through data collected before, during and after surgery. Its suite of integrated technologies includes advanced planning software, a care management platform, robotics and smart implants.
“Enabling technologies and digital care management platforms go hand in hand in efforts to provide more effective and efficient surgery,” Teplitsky said. “It’s important to enable data-driven decision-making based on insights gained through the integration of pre-, intra- and post-operative information.”
Outcomes data — in some cases obtained directly from replaced joints through smart implants — provide a greater understanding of what successful surgery looks like and how to put processes in place to repeat the results. “That should ultimately enhance outcomes and clinical efficiencies,” Teplitsky said. “Objective measures of data will improve the standard of care in orthopedics.
“Our approach to advancing joint replacement care is grounded in the integration of data and technology, with a focus on improving the surgical journey for patients,” she continued. “We’ve long recognized that the patient experience starts well before surgery and ends well after the recovery period begins.”
The increasing personalization of joint replacement surgery has the potential to significantly improve the results, according to James Paiva, Vice President of Marketing at Conformis, a company specializing in knee and hip replacement technology.
Paiva said the benefits of using navigational software to preplan surgeries and determine optimal implant placement — less time in the OR and fewer instrument sets needed — have been well-documented in peer-reviewed journals.
Replacing joints more efficiently and effectively with the help of computer navigation and robotic assistance also minimizes blood loss and leads to less reliance on intramedullary femoral guides to optimize implant alignment and provide superior bone coverage. The technologies allow surgeons to perform procedures more accurately, which contributes to faster recovery times and a quicker return to normal activities for patients.
Conformis offers two patient-conforming knee replacement options: the fully personalized Identity implant and the data-driven, made-to-measure Imprint system, which is built from data compiled from the CT scans of more than 85,000 patients.
According to Paiva, clinical data and dozens of peer-reviewed studies show that personalized total knee systems have contributed to improved outcomes characterized by significantly higher KOOS and patient satisfaction scores. He said the systems have also been shown to enhance joint kinematics with no condylar lift-off, provide normal lateral rollback through the knee’s complete range of motion, and improve implant fit and joint alignment.
“Personalized implant systems have been clinically proven to improve joint motion, restore normal knee function and reduce complications,” Paiva said.
Orthopedic device companies should focus research and development efforts on enabling technologies that advance patient care, according to Paiva. “Seek innovative solutions supported by clinical results and data, with the clear intent to improve outcomes and clinical efficiencies,” he said.
Overcoming Hurdles to Widespread Adoption
Resource utilization is an often-overlooked challenge to the widespread adoption of enabling technologies. More joint replacement surgeries are moving to outpatient settings, where cost containment and space constraints are key considerations.
Some joint replacement systems and digital platforms require significant setup and breakdown time in addition to cleaning and sterilization demands. “That puts a drain on facilities and their employees,” Paiva said. “Innovation must consider those factors.”
He said personalized knee systems are well-suited for outpatient settings and touted the benefits of the surgery-in-a-box concept, which involves delivering patient-specific instruments and implants to facilities in a pre-sterilized kit. This service streamlines workflows and reduces implant inventory requirements in facilities where space and staffing are at a premium.
“Bulky or costly systems will struggle to gain a foothold in ASCs – regardless of the level of innovation they appear to provide – so orthopedic device companies should focus on streamlined solutions as they develop new products,” said Paiva.
Promising technologies have the potential to improve patient care and reduce costs, but companies that invest in innovation also run the risk of pushback from providers. “It’s critical to ensure that advancements in care are practical to implement,” Paiva said. “They must make sense for the demands of the surgical environment in which adoption is targeted.”
Enabling technologies must seamlessly integrate into the episode of care without adding extra steps to established clinical routines, according to Teplitsky. She highlighted the need for orthopedic manufacturers to consider these factors when making decisions about adding to their product portfolios.
Teplitsky also said the clinical utility of emerging platforms must drive a shift in the patient care paradigm. “As surgeries become less invasive, risks decrease and recovery times shorten, inpatient procedures will continue to migrate to outpatient settings,” she explained. “We’ve focused on understanding and addressing the needs of ASCs with the goal of helping them improve efficiencies and minimize waste.”
Total joint replacements are operationally complex, so process flow and care optimization are critically important to ensure success in an outpatient setting. “Our ASC portfolio offers tools to coordinate every step in the episode of care to support the shift in procedural volume to surgery centers,” Teplitsky said.
She identified other key trends in the orthopedic market that impact the uptake of new technologies: patients taking a more active role in their care decisions, a growing emphasis on value over cost and the importance of practical innovation.
“Orthopedic manufacturers shouldn’t introduce enabling technologies simply for the sake of doing so,” Paiva said. “While these platforms hold theoretical advantages, they must provide real-world clinical and economic benefit.”
