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Orthopedic companies are racing to integrate technologies, capture data and produce meaningful insights from their efforts. Their investments are bearing out through market introduction and early adoption of new products.
Kevin J. McGuire, M.D., M.S., Section Chief of Orthopaedic Spine Surgery at DHMC’s Center for Pain and Spine at Dartmouth-Hitchcock Medical Center, is one of the early adopters. Last year, he used Medacta’s NextAR augmented reality (AR) navigation system to complete a lumbar fusion using intraoperative guidance.
NextAR displays superimposed surgical guidance onto the operative field in real time, allowing for data-driven decision-making based on the unique anatomy of individual patients. It’s part of Medacta’s MySolutions Personalized Ecosystem, an interconnected network of digital technologies that enable a holistic approach to personalized surgical care.
OrthoGrid also made news in 2022, introducing Hip AI to give surgeons access to real-time image analysis tools that enhance intraoperative fluoroscopy images and improve their decision-making during hip replacement surgery. The application helped usher in smarter hip navigation, an evolution the company says is redefining orthopedics.
“Surgeons are risk-averse decision-makers,” said Richard Boddington, Co-CEO of OrthoGrid. “They constantly interpret clinical information so they can make decisions that ensure reproducible outcomes for their patients.”
OrthoGrid provides data-driven solutions with an AI-powered ecosystem that detects and tracks specific anatomical landmarks through the company’s sophisticated grid network. The software is already helping surgeons achieve optimal anatomic and implant alignment while also tightening the surgical workflow.
Boddington called this development the true transformation of orthopedic surgery.
Smith+Nephew is also providing surgeons with the ability to use aggregate data with statistical tools and AI. The goal is to transform the information into actionable insights that ultimately improve patient outcomes and increase surgical efficiencies, especially as more patients present with similar needs. An essential component of this effort is ensuring that the data shared are objective and collected in a consistent manner, according to M. Scott McCaig, Ph.D., Director of Global Marketing and Digital Health at Smith+Nephew.
“The promise of linking integrated robotics, smart tools and AI to outcomes is based on large datasets that lead to better preoperative planning and intraoperative execution,” he said. “Digital ecosystems are seeking to make every surgery better than the one before.”
The Communication Continuum
Orthopedic companies are investing in digital ecosystems that include smart implants, preoperative planning software, enabling technology and wearables.
Zimmer Biomet introduced ZBEdge, a suite of integrated digital and robotic technologies that impact the overall continuum of care. “Devices must be connected for integration to happen,” said Rob Kraal, Vice President and General Manager of Connected Health at Zimmer Biomet. “ZBEdge connects our portfolio of technologies in a way that allows for the seamless integration of data, which produces valuable insights for providers and patients.”
For example, the company connected its mymobility care management app with the Persona IQ smart knee implant and ROSA robotics platform to drive clinical efficiencies and facilitate better overall outcomes. This effort extends beyond the O.R. in notable ways that impact the patient experience.
“Patients now receive their pre- and post-operative education, exercises and questionnaires on their mobile device at the appropriate time in the surgical journey,” Kraal said. “The data that is collected from the patient gives the care team some sense of how compliant, or not, the patient is to their prescribed protocols. Surgeons and their care teams can be alerted if the patient is starting to stray off course.”
ZBEdge allows all providers involved in the episode of care to have a better understanding of a patient’s pre- and post-op movement profile. They also gain greater insight into patient compliance with prescribed therapies and how much post-op pain individual patients experience.
Zimmer Biomet’s Persona IQ implant tracks the progress of patients’ recoveries straight from the source. “We have access to high-fidelity data that has never been seen before,” Kraal said. “We compare the data collected from Persona IQ and the ROSA robot to identify relationships between the sets.”
The company can drill down into kinematic data from the Persona IQ (the knee’s functional range of motion, for example) and from ROSA (such as cut validation) to assess the link between accurate implant placement and positive outcomes.
The information will inform the future of orthopedics, allowing providers to tailor care plans to the specific needs of individual patients. The plans are based on the real-time relaying of critical data points and machine learning’s ability to predict outcomes based on historical data. Zimmer Biomet wants to use this information to improve the outcomes of the 20% of knee replacement patients who report dissatisfaction with the results.
“We think that orthopedics is in an age of discovery, and the data collected and modeled will be key to unlocking insights that improve patient care,” Kraal said.
In many ways, digital ecosystems are already helping to reshape the industry. “Customers are realizing the potential of data-gathered insights,” Kraal said. “And we are just scratching the surface. I think business models will evolve as software solutions continue to show value.”
For example, combining a smart implant with intelligent robotics and highly personalized preoperative planning will change the value equation of enabling technology that could potentially unlock new commercial opportunities. “The value of digital surgery is still being proven,” Kraal said, “But that’s rapidly changing.”
The winners in the market will likely be the companies that can develop digital solutions that work seamlessly with established systems. “Ecosystems will need to expand to include interoperable platforms that work best for the end user,” Kraal said.
Transformative Data
One of the greatest benefits of digital technology is its ability to learn from real-world use and its capability to improve its performance, according to Monica Burt, Senior Partner at MB&A Consulting. “It’s situated to become a powerful medical tool and useful in terms of replicating patient outcomes through the use of real-time data,” she said.
As such, enabling technology seems to be poised for growth over the next few years. Tech innovator THINK Surgical, for example, has raised $100 million with the goal of accelerating commercial launches of several robotics platforms.
“The growth of orthopedic surgical robots has been extraordinary, and it shows no signs of slowing down,” said Park Mehendale, Vice President of Operations at THINK.
Data is becoming a major asset driving robotic-assisted surgical systems, according to Dr. McCaig. Smith+Nephews’s CORI platform collects intraoperative data that includes granular information on anatomical landmarks, implant positioning and joint balancing.
“The connected platform shows surgeons, through filters and dashboards, how preoperative plans and intraoperative decisions impact postoperative outcomes,” Dr. McCaig said. “This will continue to evolve as preoperative and postoperative kinematic data is collected from patients, as well as patient outcomes in kinetic spaces and objective outcome measurements.”
How this data is used ranges from providing surgeons with meaningful insights into their surgical workflow in real time to developing more accurate and effective patient treatments and recovery plans.
To that end, Smith+Nephew is focused on building smart tools that provide consistent measurements of data points during every step of surgery, from pre-planning to post-op care. “There is no doubt that enabling technology and digital ecosystems will continue to evolve,” Dr. McCaig said. “New commercial models will be developed around the ability to link outcomes to company-provided solutions.”
Using large data sets to evaluate the impact of material technologies and digitally enabled solutions on patient outcomes will support further investment in smarter tools. Newer systems are designed with better integration, including improved patient engagement through wearables.
Ultimately, Dr. McCaig said, reducing cost while increasing patient satisfaction with improved surgical outcomes will drive innovation and adoption.
Ease of Use and Affordability
OrthAlign is intent on creating user-friendly, cost-effective solutions for achieving precise limb alignment and stability during joint replacements. Lantern, the company’s handheld smart tool for knee replacement surgery, is used across an array of platforms to deliver accurate, individualized joint alignment. Its intuitive interface streamlines workflows and reduces O.R. times, factors that appeal to the surgery center market.
Lantern’s benefits include giving surgeons intuitive and accurate surgical decision-making in real time and less blood loss because of its ability to help surgeons identify the femoral head and perform accurate distal femoral resection. It’s said to reduce outliers and revisions, with more accurate replacements overall.
Michael Ask, M.D., an orthopedic surgeon at the Hospital for Special Surgery in New York City, was the first surgeon to use Lantern to perform a total knee replacement. He said it was one of the most simple and efficient systems you can bring into a hospital or ASC.
Nic Aldrich, OrthAlign’s marketing manager, said that smart technology must be easy to use and affordable. “Surgeons,” he explained, “are driving toward personalized care plans based on the anatomy of individual patients. Technology is paramount for that.”
Solutions that target accurate anatomic measurements while allowing for the precise alignment and positioning of implants are particularly important, Aldrich said. It is mission-critical for these tools to be highly adaptable without extensive training time. They must also provide a calculable, value-added experience for surgeons and patients.
Aldrich predicts that robotic and AI-driven solutions will ultimately become easier to use and more affordable as they are integrated into surgical workflows. “A lot of tech that’s brought into the O.R. adds time to a surgery,” he said. That doesn’t include the learning curve for surgical teams to get comfortable using it. “The biggest competitive advantage right now is practical accessibility.”
Tech that fails to cross the chasm tends to be too complicated to use, according to Aldrich. “Early adopters are far more willing to accept changes to the standard workflow,” he said. “They see early value in technology. But platforms still must be efficient and easy to use to gain widespread acceptance among providers.”
Enabling technology appears to provide value for the interim future. “Robotics is leading the way in terms of understanding the full ecosystem of data, especially as more efficient tech drives the market,” Aldrich said. “Investment around robotics is becoming an important economic model, especially in surgery centers.”
Trends captured by the American Joint Replacement Registry (AJRR) 2022 Annual Report appear to support that notion. The use of robotics in total hip replacement has more than doubled since 2017 and computer navigation use has increased 84% in that same period, according to the report.
Over the past five years, utilization of robotics in total knee replacements has increased six-fold and is now used in almost 12% of procedures, noted the AJRR. The use of navigation has remained relatively stable, however, hovering between 3% and 4% of cases, according to the report.
The data collected by robotics and navigation systems today will ultimately benefit the patients of tomorrow. “One of the biggest factors driving adoption of digital platforms is the acknowledgment that smart technology and deep data produce better outcomes,” Aldrich said. “Every patient should have access to that.”
