Enabling technology is ushering in a new era in orthopedics and challenging the status quo. Innovations from large companies and startup firms change how surgeons operate and reimagine what’s possible in orthopedic procedures. Emerging platforms are poised to improve patient outcomes as increased surgeon acceptance drives widespread adoption.
Here’s a look at how the orthopedic industry will evolve with creative solutions coming to market — and how the technology will work in combination to spur continued advances in surgical care.
Guiding Surgeons to Better Outcomes
Robotic assistance and surgical navigation are not new concepts, but the capabilities of emerging platforms are catapulting them into the next level of patient care. Chris Walsh, Co-Founder and CEO of Accelus, expected robotics to be used in 30% to 50% of orthopedic procedures in the next five to 10 years.
Walsh said that the Remi Robotic Navigation System from Accelus is designed to help surgeons place pedicle screws during one-, two- and three-level lumbar spine fixations in a highly efficient manner — and with a minimal learning curve and no significant increase in operative times.
“The system is quick to set up and break down and is highly portable, allowing it to be used in multiple rooms and during multiple procedures in a given day,” Walsh said. “We believe robotics needs to be practical, reproducible and cost-effective.”
Zimmer Biomet’s ROSA robot brings objective measures of data to the table, a benefit that could inform surgeons on ways to improve how they operate. “Surgeons can quantify the various aspects of surgery,” said Liane Teplitsky, President of Global Robotics, Technology and Data Solutions at Zimmer Biomet. “They can assess cut angles or a joint’s intraoperative range of motion, and correlate this information to objective measures of outcomes data.”
Data collected through the ROSA platform is one aspect of Zimmer Biomet’s ZBEdge Connected Intelligence Suite. The integrated collection of digital and robotic technologies provides valuable clinical insights across the entire continuum of care.
The suite’s mymobility app works with Apple Watches and iPhones to deliver a continuous loop of data and patient-reported feedback to physicians, as well as support and guidance to patients. It also enhances data with measurements from Zimmer Biomet’s Persona IQ, a smart knee implant that continually collects gait metrics from inside a patient’s knee. The high-fidelity data is automatically uploaded to a dashboard where physicians can access it for several years.
Zimmer Biomet partnered with Microsoft to develop the mixed-reality platform OptiVu, which utilizes Microsoft’s HoloLens 2 headset. The company also teamed up with Surgical Planning Associates to leverage OptiVu for HipInsight, a mixed reality-based system used during total hip replacements.
Surgeons use HipInsight to overlay holographic visualizations of clinical information — such as CT scans — in their field of view as they operate, allowing them to follow preplanned surgical pathways based on the patient’s specific anatomy.
Similarly, Exactech is exploring ways to create a continuous digital loop for surgeons during joint replacement surgery. The company’s ExactechGPS navigation system helps surgeons execute CT-based preoperative plans and provides dynamic intraoperative feedback.
“Surgeons are informed of the functional needs of individual patients to determine which implant to use and where to best position it to avoid defects,” said Chris Roche, Senior Vice President of Extremities at Exactech. “They’re making the best decision based on preoperative plans, which they execute in the O.R. Surgical navigations helps surgeons develop a consensus on optimal surgical care.”
Robotic assistance and surgical navigation quantify patient outcomes and lead to advanced surgical care.
Smart Implants Monitor Healing
Data collection has evolved past surgical robots and navigation software. Clinical information can now be collected through smart implants, which inform surgeons about the progress of their patients’ recoveries and allow them to make course corrections as necessary.
Some platforms can even promote healing.
DirectSync Surgical is developing implants that create small pulses of current with each step that patients take to stimulate bone growth in the spine at the site of implantation. The platform generates a dynamic force on the implant as the patient ambulates, and transforms that force into energy pulses.
“We like to say we’ve created human-powered smart implants,” said Leighton LaPierre, Co-Founder and COO of DirectSync Surgical. “We’ve applied the technology to a spinal interbody cage and have harnessed its power to create a therapeutic device. The literature and scientific data show negative current can regulate bone healing. We’re tapping into that potential.”
LaPierre said the company is now pursuing ways to use generated power to measure factors such as force and load. “The goal is to give surgeons data to make better decisions and monitor patients’ recoveries in better ways,” he said.
The proposed device would feel the weight of the spine — the amount that isn’t already managed by implanted rods and screws — while the patient walks. “As the spine begins to fuse, the mass and the force felt by the device would become less over time,” said Zygmunt Porada, Co-Founder and CEO of DirectSync Surgical. “We might be able to measure the amount of fusion that takes place without the use of radiographs. We also anticipate surgeons being able to determine when hardware fails and identify when patients who aren’t healing as quickly as expected need interventions.”
DirectSync Surgical’s stimulator therapy has the potential to increase the understanding of bone growth and could lead to applications across load-bearing anatomy outside of the spine, increasing the size of the patient population that could benefit from the technology.
Intelligent Implants is taking a similar tact with its SmartFuse technology, which incorporates the sensor of a smart implant with the ability to administer a therapeutic treatment. “We’re delivering electrical stimulation across an array of electrodes that are embedded in the implant to generate targeted bone growth and accelerate healing,” said Benjamin Hertzog, Ph.D., the company’s CEO. “The information is wirelessly transmitted to the cloud, where surgeons and patients can monitor how recoveries are progressing.”
The technology allows surgeons to not only improve postoperative healing, but also to react and dynamically adjust therapies based on what the data show. Dr. Hertzog expected to collect initial clinical evidence of the device in 2024 with a lumbar spine application.
Dr. Hertzog said 10% to 40% of spinal fusions fail, depending on the risk profile of the patient. “But we don’t always know which patients are at increased risk of a failed procedure,” he added. “The cost of premium smart implants would be justified if surgeons could use the systems to track recoveries and use the data to identify patients who are statistically at increased risk.”
Surgeons who remotely monitor the recovery of their patients in real time would see which patients aren’t healing on their own. “Smart implant technology provides that opportunity without the patient coming in for follow-up care or incurring the additional expense of postoperative imaging,” Dr. Hertzog said.
The orthopedic industry needs to figure out ways to seamlessly integrate smart implant technology into surgical workflows and extract real value from the data that’s collected, according to Dr. Hertzog.
“Smart implants have historically involved adding sensors to hardware and collecting data, but the new frontier is smart implants that also provide a therapeutic benefit,” he said. “The technology has the potential to move the needle on patient outcomes more than what’s been possible so far.”
On the Precipice of Improved Care
How can device manufacturers fill knowledge gaps to enhance the patient experience throughout the entire episode of care and improve surgical outcomes? A variety of companies are approaching the issue from diverse angles, but they’re all focusing on collecting robust data through digital tools and applying the data in meaningful ways.
Robotics, surgical navigation and smart implants will continue to drive innovation over the next 10 years, according to Roche. “But what I’m most excited about is adding data scientists to our teams, creating predictive analytic tools and making more evidence-based decisions,” he said. “Many of those experts don’t currently work in orthopedics, so we’re preparing to translate competencies from other industries into our field.”
Bill Hunter, M.D., CEO of Canary Medical, agrees that the real impact of emerging technologies will be felt by pooling the clinical data they provide. Canary Medical partnered with Zimmer Biomet on its Persona IQ smart knee implant. “Integration of the various platforms will spur innovation,” Dr. Hunter said.
The orthopedic industry is on the precipice of enabling and digital technologies changing the current landscape of care. Companies are exploring more ways to integrate data-generating platforms into their portfolios to improve surgical planning, outcomes and long-term care.
Many surgeons lose half of their patients to follow-up, according to Dr. Hunter. “Some patients don’t even show up for their first scheduled visit,” he said. “Being able to maintain interactions with patients after surgery, track their recoveries and see what’s working will be very impactful.”
Crosstalk will occur as platforms mature. “Preoperative data will inform operative interventions and postoperative data will inform the entire scope of surgical care,” Dr. Hunter said. “I think we’re two or three years away from having numerous platforms integrate with each other. Orthopedics will benefit from big data assimilated from multiple different sources.”
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