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What does the future of enabling and digital technology look like in orthopedics? Orthopedic companies and surgeons at recent meetings gave us a glimpse of the technologies that they’re commercializing and using. While robotics dominated the conversation a handful of years ago, there’s now a more evident movement toward technology ecosystems that include virtual reality, preoperative planning, robotics, augmented reality, navigation, wearables and artificial intelligence.
Orthopedic device companies have talked about the shift to technology companies for a few years. But some companies can now demonstrate how their data is being used to further orthopedic product development initiatives.
We spoke with Zimmer Biomet and Stryker at the American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting and heard dozen-plus companies present at the Canaccord Genuity Musculoskeletal Conference. We recap some of the insights we learned.
Zimmer Biomet Emphasizes Ecosystem Approach
Zimmer Biomet’s ZBEdge is the platform that integrates data from the company’s enabling and digital technologies, including ROSA, mymobility, and its new products WalkAI and OptiVu, an artificial intelligence-based platform and mixed reality for the O.R., respectively.
Liane Teplitsky, Global Vice President & General Manager of Technology & Data Solutions at Zimmer Biomet, described the company’s holistic approach to data collection.
Teplitsky said, “We’re looking further upstream, preoperatively, intraoperatively, as we always have done, and then postoperatively. ZBEdge has the power to do this by bringing data to the forefront. So, we’re trying to be smarter, faster and better. Smarter at bringing the objective measures of data across that continuum of care to enhance decision-making, so you have better-informed decisions from real data, real numbers. Then faster is the better efficiency, both intraoperatively, but we’re now doing a lot more pre- and post-operatively. You can see that with some of our mixed reality technologies. Then better is about better value and better experiences. What you’re used to having in your day-to-day life. It feels like medtech is a little clunkier, a little harder to use, but we’re bringing those better experiences across the board.
“As we talk about the different kinds of data that we have across the entire continuum of care, we consider four buckets – data quantity, quality, integration and ease of use.
“On the quantity part, everything we’re putting on the market now is collecting or generating high-quality data. It’s information that you would want to know. We want to make sure that we have great data that we’re collecting that will inform better decision-making, which comes through the data’s integration. That is where the rubber meets the road, as it relates to ZBEdge, is the integration of all these disparate data sources coming together and allowing for new insights that have never been known before. Whether that’s insights to inform better patient outcomes or insights that will help with efficiency, or insights that can help with even just the value-add across that continuum of care. We talked about the ease of use piece. If it’s hard to use, you can’t tell what’s happening, no one will use it.”
Technology Updates:
- Released WalkAI, an artificial intelligence model that identifies patients who are predicted to have a lower gait speed at 90 days after hip or knee surgery. WalkAI provides personalized predictions and identifies patients who may be exceptions to typical recovery curves in an effort to help surgeons mitigate or minimize poor outcomes.
- Introduced its OptiVu Mixed Reality platform that utilizes Microsoft’s HoloLens. Multiple applications will be launched, including instrument assembly guidance, and virtual collaboration in the O.R., whereby an offsite surgeon can see the performing surgeon’s view. An OptiVu integration with ROSA has been submitted to FDA.
Stryker Rolls Out New Implants Based on Blueprint Data Findings
Stryker launched its Tornier Perform Humeral Stem in the U.S. in 2021 and in Europe in 2022. The shoulder replacement system is paired with Blueprint, Stryker’s planning software.
We spoke with Tim Lanier, Vice President & General Manager of Upper Extremities, about how their software systems impact hardware development.
Lanier said, “The intelligence we get from our pre-planning software feeds our product development and tells us how to optimize sizes and shapes in different ways to look at a shoulder implant.
“The product that we’re highlighting is the Perform Humeral System, our new baseline shoulder system. It will meet some of the trends that we’re seeing in shoulder arthroplasty, and we’re excited about that. I think we’re setting the pace for what shoulder implant technology should be, and that’s because we have intelligence from our software platform.
“It’s an integrated system, meaning that it’s a system with which you can do an anatomic, reverse stem or stemless, whatever it is that you need, all of that is fully integrated using similar implants and instrumentation. We’ve been able to optimize how we think about delivering to the customer without jeopardizing patient outcomes.
“In the past, when we would build a humeral system, we would start with anatomic, and then do a reverse and then a stemless, and it was chunky. We had to figure out how to get them all to fit. This time, because of our digital platform, we were able to look at all four of those segments and design an implant that took into consideration from the beginning, based on the data we got, how we think about an anatomic or reverse and how they can be integrated to use similar instrumentation, same with stem and stemless. It’s all fully integrated so surgeons can use the same instrumentation and implants, whereas in the past, that was not the case.
“We’ve been able to reduce the cost of delivery to the hospital by over 40%. We’ve been able to streamline the amount of instruments and implants necessary, which is a big deal for the ASC environment. That will be important as the market changes over time.”
Technology Updates:
- Developing a Mako shoulder application. No launch date has been set.
- Launching mixed reality to visualize Blueprint surgical plans in O.R. Next phase, expected in 2023, is mixed reality guidance technology where surgeons can navigate their plans onto the patient’s anatomy.
- Launched patient-matched shoulder replacement implants. Expected to deliver implants within 10 days of surgeon planning.
Small Companies Take Stake in the Game
When large orthopedic players began rolling out robotic systems, we thought that small companies would remain focused on hardware. Our thinking was that if small device companies entered the software side of orthopedics, they would partner with other firms or latch on to open systems. Companies are proving us wrong.
Shoulder replacement companies Catalyst OrthoScience and Shoulder Innovations have launched surgical planning technology alongside their implant portfolios. The CEOs of both entities noted that their surgical planning software plays a significant role in their ability to be pure-play shoulder companies.
Life Spine is working on an augmented reality and 3D imaging system to streamline spinal fusions. The goal is to limit the amount of CapEx used in a procedure, said company President and CEO Michael Butler.
Canary Medical CEO Bill Hunter, M.D., spoke about the company’s focus on smart implants. Canary Medical has partnered with Zimmer Biomet for orthopedic applications, and the two received De Novo clearance for the Persona IQ knee in 2021. The implantable sensor tracks a patient’s range of motion, step count, gait speed, etc. As more data is collected, the company plans to shift to predictive analytics to target challenges like infection and loosening. Canary’s pipeline includes applications for hip replacement, trauma screws and spine devices.
A proliferation of smaller enabling and digital technology companies also seeks to find momentum with open platforms.
OnPoint Surgical is expected to launch its augmented reality guidance for spine in 2022. They’re targeting the ASC market and the “80% of hospitals that can’t afford robotics,” said their CEO, Philipp Lang.
THINK Surgical, which received FDA clearance for its second-generation robot in 2020, is working on a handheld robotic system. According to the company, seven device companies representing 40% of the knee replacement market are integrated with their robot.
Orthopedics is at an early stage with development, commercialization and integration of enabling and digital technology. Much of the technology aims to assist surgeon and patient decision making, while also helping companies enhance and advance their product portfolios. Conversations will undoubtedly continue around cost, adoption and improved outcomes as the successive iterations of enabling and digital technology are launched.
