Top 5 Technologies Taking Orthopedics Into the Future.

What to expect:

We are officially half way through 2022, and personally 6 months since I entered the fascinating world of Orthopedic and Spine Mectech, via Executive Search. After speaking to numerous professionals, experts and KOLs in the industry, I have a new founded interest and understanding of the remarkable tech that fuels this industry.

This months newsletter will acknowledge and celebrate the Top 5 cutting-edge technologies that in my opinion will revolutionise surgical procedures, and ultimately take orthopedics into the future! Keep reading to learn more!!

I am Henry Cooke, a senior business consultant for RW search in the Orthopedic and Spine space, and this is Morethopedics volume 3- Top 5 Technologies Taking Orthopedics Into The Future .

1- AI

It would be na?ve to say that AI is something new. Artificial Intelligence was coined as an academic discipline all the way back in 1956, and since has been become a ubiquitous feature of daily life used in search engines, personalised advertising, and more recently self-driving Tesla’s.

The usage of AI in the medicine has come leaps and bounds over the last few years, and innovation is not slowing down.

As touched upon in my previous newsletter, Zimmer biomet last month debuted the OmniSuite described as an intelligent operating room (OR), designed to optimize surgical workflow and procedural efficiency by automating manual tasks and streamlining unnecessary technology and redundant hardware. The system uses multiple AI features; one of which involving cameras to automatically recognize and timestamp key OR workflow milestones, including patient entry and exit, door count, the start and stop of anesthesia, surgery and cleaning (1). The use of AI in omnisuite is surely exciting for surgeons and hospitals, creating a more efficient and optimised surgery- great work from all at Zimmer!

Theator, an AI startup based in Silion Valley- California, is helping to pioneer the Surgical Intelligence revolution. Their technology is next gen AI in surgery, designed to improve surgeons expertise by giving real-time surgical decision support and AI-driven robotic procedures – all powered by surgical intelligence. Their mission is to ‘use real-world scientific data to develop advanced AI capabilities that will fuel more consistently successful surgeries, and ultimately, a healthier world’.

Their system optimises surgical steps, allows access to the words largest Surgical Data Registry with AI enriched footage, as well as being able to analyse surgical performance contextual insights (2). This technology could be used in a whole range of surgical procedures not just in orthopedics, which will no doubt improve countless surgical outcomes.

Preoperative planning is something that AI technology has completely revolutionised, and PeekMed, a Portuguese start-up formed in 2015, has certainly taken a handle on this gap in the market. They have developed a powerful system used by orthopedic surgeons around the world to plan their surgeries using 3D and Artificial Intelligence technology (3). The system allows the planning of a surgery and simulation of different outcomes and implant sizes in a matter of seconds. Therefore, when the “real” surgery occurs, it is an execution of what was planned. The company is is already CE marked, ISO 13485:2016 approved and FDA 510(k) cleared, and has also recently received backing in investment rounds to continue its international expansion (4).

2- AR/VR

Augmented reality and Virtual Reality is starting to take over the world. Within medicine, AR/VR is often combined with AI, and sometimes robotics, to attempt to make surgery more accurate, efficient, and ultimately improve surgical outcomes.

My favourite two companies working with AR & AI within orthoepdics are Proximie and Novarad.

Proximie, was founded by an NHS surgeon, Dr Nadine Hachach-Haram, who drew on her surgical experiences and her passion for innovation and education to create the company in 2016.

Nadine stated “I wanted to create a platform that could extend the reach of a surgeon’s expertise, and make that skill timeless. A multi-sensory experience that was a catalyst for collaboration, and that could eventually digitise a surgeon’s footprint.’

Proximie’s mission is ‘saving lives by creating a “borderless operating room”’. It uses augmented reality to allow a surgeon to remotely watch an operation and use their hands to demonstrate things to the surgeon conducting the operation, who sees the remote surgeon on a screen. The aim is to democratise access to the most up-to-date and skilled knowledge on surgery practice, by helping surgeons advise each other from different parts of the world (5).

“Proximie is helping to bridge the surgical training gap in hospitals across the world,” says Dr Nadine Hachach-Haram, "5bn people currently lack access to safe surgery", she says, and "over 18m people die every year from lack of access to surgery". Alongside helping surgeons collaborate, Proximie also records surgery to create a “digital footprint” of operations, a database of knowledge on surgery shared across the world (6). This is some really exciting medical technology with great motivations too; just last week they received $80 million in category C funding (7).

Novarad- The high-tec healthcare technology company have recently had has received FDA 510(k) approval for precision guided intraoperative spine surgery product- VisAR.

According to Novarad, VisAR transforms a patient’s imaging data into a 3-dimensional hologram that can be viewed through an optical visor and superimposed onto a patient with submillimeter accuracy. This allows surgeons to focus directly on the surgical objective without looking away at a separate monitor. Most surgeries are performed without navigation due to the impediments of cost and setup time, however the VisAR system marks a big step towards making precision surgical guidance widely available and economically feasible, Novarad stated.

“This is transformational technology that provides the precision of a robot, the portability of a stethoscope and the versatility of human powered intelligence,” said Dr. Wendell Gibby, Novarad CEO and co-creator of VisAR (8).

Whilst AR has taken a front seat in terms of surgical procedures, VR has become widely used in surgical training; providers such as Osso, and PrecisionOS producing great solutions. A 2019 study at the University of California, Los Angeles found that medical students who learned with VR tools completed a given orthopedic procedure an average of 20 percent faster than those in the traditionally trained group — and they completed 38 percent more steps correctly in the procedure-specific checklist, according to the Harvard Business Review (9).

One final interesting use of AR/VR technology, is within Stryker HoloLens. Stryker has partnered with Microsoft HoloLens AR headset to virtually create the perfect and most efficient Operating Room Design. Utilising the HoloLens headset, designers and doctors can test out different designs and layouts and even pick which configuration of equipment they would prefer, before a single piece of equipment is moved (10).

3- Personalised/Custom Surgery

Customised and Personalised are usually words attributed to perhaps a tailormade suit, one off jewellery, or a modified sports car. Customised products/items are made specifically for the customer, with sizes, shapes, styles, needs all taken into account. Personalised and customised products no longer just refer to consumer goods however, as the medical device world has almost unanimously agreed that orthopaedic implants, and sometimes even surgical tools, can have a much better surgical outcome if they are made to be patient-specific, and customised for the patients needs. This technology has been around for a while, however is slowly but surely becoming less expensive, quicker to produce, and henceforth more accessible for suregons/patients alike.

3D Preoperative analysis software/anatomic models are usually used to analyse the patients condition/needs; this is then combined with 3D printing/additive manufacturing of the patient specific implant, which will then be used in surgery. I will now list a few of the innovative companies that are involved in Personalised Custom Surgery:

Lima

• - Italian Based LimaCorporate are one of the market leaders in 3D Printed personalised implants.

• US- based Conformis have had great success selling personalised Knee Replacement implants.

?

• Canadian based startup bodycad, focus their personalised technology on Osteotomy.

4- Robotics

It’s a common prophecy within the sector that robotics is the future of surgery; why rely on the human race who, although in the form of a professional surgeon are highly skilled and impressive individuals, do make mistakes and just do not have the accuracy and precision that a robot can provide? Over the last 10 years, there has been a race within the medical tech world, for who can design and sell the best, most marketable, and generally most impressive surgical robot, so I’ve put together a list of some of the robots that are in contention, used in orthopedics and spinal surgery.

Stryker- Mako- The first on this list needs little introduction. Stryker acquired this robot in September 2013 for an estimated $1.65billion (11), and since its first ever surgery ( Partial Knee Replacement Procedure) in 2006, 615,000+ mako procedures have been performed globally. Mako SmartRobotics combines three key components: 3D CT-based planning, AccuStop haptic technology, and insightful data analytics into one platform that has shown better outcomes for total knee, total hip, and partial knee patients. The acquisition of Mako by Stryker was a stroke of genius, albeit an expensive one; data showed that in 2020 44% of Stykers knee replacement surgeries, were completed with Mako (12).

Zimmer Biomet- Rosa- Rosa is the main rival to Strykers Mako, and within the orthopedic and spine space, there is a heated debate about which robot is superior. The Rosa Knee received FDA clearance in 2019, whilst ROSA Hip received FDA approval in 2021, both of these are used for total joint procedures. The portfolio also includes ROSA partial Knee, and also the ROSA ONE which is used for complex minimally invasive neurosurgical procedures.

A key difference in the way that the ROSA works is by using X-ray data or an image free analayis, unlike the costly CT scan that Mako requires. Mike Matson, an industry analyst from Needham & Company, claimed that neither Mako nor ROSA are clearly superior after reviewing The American Academy of Orthopedic Surgeons (AAOS) meeting in March 2021. “Mako has a bone saw attached to its robotic arm and [Stryker] seems to be focusing most on haptics as a key point of differentiation and the main driver of the improved outcomes it is seeing with Mako,” explained Matson. “In contrast, Rosa has a cutting guide attached to its robotic arm and [Zimmer Biomet] points out that Mako’s haptics can become annoying to surgeons by limiting their control and ability to fully complete bone cuts”(13).

These two robots are the mostly commonly used in orthoepedics and have now cemented their place in 1000s of hospitals and medical centres globally. I will now touch upon a robotic system that is somewhat less spoken about in the industry.

Monogram- The Texas based startup has plans to ‘break’ the total knee market, by combing AI, 3D printing, and surgical robotics to offer an unmatched personalised approach. ?Monogram’s navigated robot features several enhancements that will improve user experience compared to robots currently in use. Specifically, the Monogram robot will feature tracking cameras mounted directly on the robot to mitigate line-of-sight issues. The robot will feature seven degrees-of-freedom (used to measure range of motion) with control algorithms that leverage kinematic redundancy execution. The robot will also utilize complex tracking capabilities for gentle navigation. Monogram are truly the next gen of total joints, and actually raised a serious amount of its investment from crowdfunding campaigns a total of $34million dollars, shattering their expectations (14). Monogram are still very much in the R&D phase in terms of their robotics, however definitely one to watch out for.

Some other notable robots in orthopedics and spine include: Globus- ExceliusGPS, Smith + Nephew- NAVIO, Medtronic- Mazor X Stealth, DePuy Synthes- Orthotaxy.

Orthobiologics

Orthobiologics are substances that orthopadic surgeons use to help injuries heal more quickly. They are used to improve the healing of broken bones and injured muscles, tendons, and ligaments. These products are often made from substances that are naturally found in your body(15).

On the the surface, biologics may not have the same appeal and intrinsic fascination as the likes of surgical robotics, or VR within surgery. However many orthopedic surgeons agree that the use of biologics in all forms of surgery and for promoting healing is extremely exciting.

C. Thomas Vangsness Jr., MD, emeritus professor of orthopedic surgery at Keck School of Medicine, University of Southern California Los Angeles, and co-founder and chief scientist of Mend Biotech Inc., commented: the future is having biologic injections done in clinics, as well as the development of better definitions of stem cells and exosomes. “They are the future of medicine,” he said (16).

For minimally invasive therapies, the orthopedic industry is leading in its utilization of biologics. Available treatments include:?

1.??????Bone allografts or transplant of live bone into a wounded site.

2.?????Bone substitutes: these often include items such as 3-D printed bone replacements, often infused with healing properties such as stem cells in their scaffold

3.??????Growth factors: These are the critical proteins that facilitate the healing cascade that in induced under the right conditions.

4.??????Chondral scaffolds: These facilitate the restoration of the articular surface after the surface was degenerated via stresses or wear and tear (17).?

The orthobiolgics market was valued by the Transparency Market Research to be at $4.8 billion in the year of 2017 and the industry is set to mark the evaluation of whopping $7.9 billion by the end of the forecast period in 2026. They also predict that the global orthobiologics market will expand at a steady CAGR of 5.5 % over the forecast period of 2018 to 2026 (18), showing massive potential.

Key players in the orthobioloigcs market include:

DePuy Synthes, Seikagaku Corporation, MTF Biologics, Arthrex, RTI Surgical, Inc., Exactech, Inc., Integra Life Sciences, Medtronic, Sanofi, Stryker, Johnson & Johnson, Bioventus, Zimmer Biomet, Alphatec Spine, Inc., and Globus Medical, Inc. ?

The road ahead:

Artificial Intelligence, AR/VR, Personalised Surgery, Robotics, and Biologics, all play a notable part in the current world of Mectech. Constant innovation by the key players, as well as the disruptive start-ups within these technologies area making sure that they continue to be at the forefront of surgery with the future in mind. With the Orthopedic and Spine industry set to grow over the next decade, these 5 technologies are surely the ones to watch!!

As always if you are interested in featuring in the next volume of this newsletter, or are interested in our recruitment services at RW please get in touch

[email protected].

My market knowledge alongside careful and consistent strategies for executive search, allows me to have great success in even the most difficult fills.

See you next month!

Henry

References:

(1) https://www.zimmerbiomet.com/en/products-and-solutions/specialties/intelligent-integration.html

(2) https://theator.io/surgical-intelligence-platform/

(3) https://www.peekmed.com/?

(4).??https://www.medgadget.com/2021/05/peekmed-raises-e3-million-in-series-a-round-to-continue-its-international-expansion.html

(5) https://hbr.org/2019/10/research-how-virtual-reality-can-help-train-surgeons

(6)?https://www.proximie.com/about-us/

(7)??https://orthofeed.com/2022/06/14/softbank-backs-proximie-in-80m-round-for-ar-surgery/

(8)???https://www.auganix.org/novarad-announces-fda-501k-approval-for-its-visar-3d-augmented-reality-surgical-navigation-system-for-precision-spine-surgery

(9) https://hbr.org/2019/10/research-how-virtual-reality-can-help-train-surgeons

(10) https://www.gmw3.com/2017/03/medical-technology-firm-stryker-using-hololens-ar-to-design-operating-rooms/

(11)???https://www.wsj.com/articles/stryker-to-acquire-mako-surgical-for-about-165-billion-1380114400

(12) https://www.stryker.com/us/en/portfolios/orthopaedics/joint-replacement/mako-robotic-arm-assisted-surgery.html

(13) https://www.docwirenews.com/docwire-pick/robot-wars-in-medicine-mako-versus-rosa/#:~:text=Another%20key%20difference%20that%20Matson,promotes%20cost%20and%20time%20efficiency.

(14) https://www.monogramorthopedics.com/

(15)?https://orthoinfo.aaos.org/en/treatment/helping-fractures-heal-orthobiologics/

(16)?https://www.healio.com/news/orthopedics/20210601/speaker-biologics-are-the-future-of-medicine

(17)?https://orthopaedic-surgeon.com.au/the-future-of-medicine-orthobiologics-and-your-health/

(18):?https://www.einnews.com/pr_news/577267437/orthobiologics-market-to-exceed-us-7-9-billion-by-2026-finds-tmr