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Orthopedic R&D teams must embrace digital technologies and personalized care to remain competitive in the industry, said one of Stryker’s top engineering leaders. In his OMTEC keynote address, Robert Cohen, Vice President of Innovation and Technology for Stryker’s orthopaedics business and Chair of AdvaMed’s Digital Health Technology Board, presented a vision in which connected digital tools touch every step of the patients’ continuum of care and urged R&D teams to think strategically about how to integrate them into their daily workflows and product portfolios.
“There’s an expectation that if orthopedic companies want to be competitive, an implant alone won’t do it,” Cohen said. “You need to provide data on the patient.”
Many of these technologies — preoperative planning, additive manufacturing, robotics, navigation, AR/VR, postoperative monitoring — are used in isolation today and have gained varying degrees of adoption. Data ecosystems and artificial intelligence will lead to a new reality that will make orthopedic procedures more efficient and accurate and improve patient outcomes, Cohen predicted.
He backed his thesis with multiple points. Robotics and automation, personalized treatment pathways and AI applications are among the biggest drivers of change across the entire healthcare ecosystem today. Surgeons are being held accountable to improve patient outcomes. Most venture-backed money is funding digital health, software and enabling technologies, with less than 0.5% going to implant startups last year.
Cohen said he expects there to be naysayers about a data-driven future in orthopedics and used robotics as an example. “Whether you’re a robot lover or not, there is a reality,” he said. “There’s never been a robot that entered an industry and didn’t make it better. Orthopedic care will be no different.”
Questions remain about data ownership, collection and use, Cohen said. But patients and surgeons remain interested in access to high-tech tools that can provide them with updates on their recovery or ease their work in the O.R.
Here are just a few of the technologies Cohen believes will continue to reshape orthopedics.
Additive Manufacturing
Multiple types of additive manufacturing and 3D printing have gained significant adoption in orthopedics, especially for spine and joint replacement implants. While the industry has learned a lot about the technology, its innovation is incrementally moving forward, Cohen said.
“I started working on 3D printing in 2006 and thought by now we would use it the way it’s supposed to be used,” he said. “The purpose of 3D printing is not just to make implants for more bone on-growth. The purpose is to make implants that don’t look like the implants we have today.”
Cohen challenged the industry to think of disruptive ways to leverage additive manufacturing, such as making implants that lead to smaller incisions, less traumatic procedures and faster recoveries.
He also acknowledged Stryker’s significant investment in additive manufacturing and its bullishness on its future. 3D printing directly correlates with the advancement of personalized care, including patient-specific implants and instruments. It also plays into the industry’s digital transformation with its connection to preoperative planning and robotics, and the integration with AI.
Preoperative Planning
Preoperative surgical planning has become a significant market for competition and will only grow with AI and enhanced visualization software, Cohen said. The technology will advance to where surgeons will upload a CT scan and AI will generate a three-dimensional image of the patient’s anatomy to show arthritis, abnormalities and alignment issues. AI will then allow the surgeon to plan the procedure and determine the best implant size and shape and patient-specific instrumentation before executing the plan in the O.R.
The technology has evolved over the last decade and has been especially useful in complex cases. Stryker’s Blueprint Digital Platform, which was acquired from Wright Medical, has helped the company’s rapid growth in the total shoulder replacement market and implements many of the steps outlined above.
Cohen said preoperative planning will move to more procedures and traditional cases due to the accuracy it provides for th and the ability to decrease inventory and integrate with robotics. Further, ease of use will allow surgeons to leverage the software from their iPhones while sitting at home.
Mixed Reality
Mixed reality will evolve to assist surgeons with preoperative planning and procedure execution as the glasses and software become more advanced, Cohen said. The benefits are a “custom cockpit” in the O.R. that allows surgeons to access and overlay clinical information alongside the patient’s anatomy. Further, mixed reality allows surgeons to keep their eyes on the patient instead of looking up at monitors to navigate the procedures.
“Why do we have surgeons take their eyes off the patient to look at monitors that are all around the operating room?” Cohen said. “We want the surgeon focused on the incision.”
Artificial Intelligence
AI is overhyped, Cohen said. Companies started talking about the technology too early and set expectations that they couldn’t deliver on. “It needs to be regulated, it needs to be safe, it needs to be without bias, and it needs to use proper data sets,” he said. “It’s not easy.”
That said, the technology is being used to do remarkable work, like recognizing tumors and fractures, Cohen said. As it advances, AI will be pulled into daily tasks and transform orthopedic product development, manufacturing and delivery.
“If we can make a design engineer 10% or 15% more productive because they use AI, sign us up,” Cohen said, adding that the technology is not meant to replace jobs. “Our R&D headcount is higher than it’s ever been. The aim is to make people more productive, so that we can get a product out sooner, reduce the number of iterations and do virtual prototyping. All of those can have a huge impact on speed to market.”
Looking Forward
Earlier this year, Stryker launched its SmartHospital Platform, which connects Stryker’s devices and data to support clinical and operational workflows across the continuum of care.
It calls for ambient intelligence in the O.R., with computer vision, AI and contextual data to help surgical teams with setup, staffing needs and technology use. Sensors in Stryker hospital beds can track whether a knee replacement patient stands up. Robust clinical communications systems can support timely information flow.
Of course, the company continues to expand applications of Mako SmartRobotics and its navigation platforms.
Cohen imagines companies could extend their portfolios beyond state-of-the-art implants and siloed systems and embrace the digital technologies taking shape around them.
“We’ve had an amazing journey over the last 20 years, with new materials, 3D printing and robotics. Now it’s the time to take those out of isolation,” Cohen said. “What is the benefit of putting all of these technologies together into one package with the overlay of digital innovation to further enhance them? As great as the last 10 to 20 years have been, I’m actually more excited for the future. We have more tools available to us now than ever before.”
