May 2019 Issue: Is the orthopedic device space in the midst of a robot revolution?

Are robots the future of orthopedic surgery?

Experts tell me that there used to be a lot of skepticism in the orthopedic device space when it came to using robots to assist in knee, hip, shoulder and spine surgeries.

Two events in recent years changed everything: Stryker paying $1.7 billion for Mako Surgical so that it could sell robotic systems to aid knee and hip replacement surgeries, and Medtronic spending $1.7 billion on Mazor Robotics to expand into the robot-assisted spine surgery space.

Both Stryker and Medtronic made expensive bets that robotic systems would provide unmatched accuracy and precision in ortho surgeries, transforming them from art to science.

Now all the other big ortho device companies – including Johnson & Johnson’s DePuy Synthes business, Zimmer Biomet and Smith & Nephew – have either launched or are preparing to launch their own robots.

This year’s American Academy of Orthopaedic Surgeons (AAOS) meeting in Las Vegas, in fact, was reportedly abuzz about robotics.

“Even if not necessarily proven to be better medicine, you can’t afford not to have an answer to robotics. There’s a strategy now where having a robot is better than not having a robot,” SVB Leerink analyst Richard Newitter told Medical Design & Outsourcing.

Even for a major orthopedic device industry supplier such as Tecomet, the shift to robotics has had an effect, with a need to forge relationships earlier, manufacture at times for tighter instrument tolerances and much more.

The curious thing about the trend is that evidence is actually scarce when it comes to whether robot-assisted ortho surgery improves outcomes over the long term.

Officials at companies such as Stryker and Medtronic point to a host of evidence that robots make a difference over the short-term, improving everything from readmission and reoperation rates to time in the operating room. They suspect the short-term improvements are a good sign that there will be long-term benefits, too.

The long-term data, though, simply isn’t there yet.

And skepticism still remains. Serial ortho device entrepreneur Doug Kohrs, for example, actually predicts that enthusiasm for robotics in ortho surgery could be short-lived. In two to three years, patient-specific implants produced from surgical planning data – combined with computer-assisted navigation – could provide a more economical alternative, the former Tornier and American Medical Systems CEO told MDO.

Stryker’s Robert Cohen countered that the company’s Mako system allows for new ways of positioning implants that older manual instruments can’t achieve. Perhaps more important, he said, are the digital capabilities Stryker can layer on the top of the technology.

It seems only time will tell whether the $500,000 to $1 million a health provider pays for a robot-assisted ortho surgery platform is truly worth it.

Chris Newmarker
Managing Editor
Medical Design & Outsourcing
cnewmarker@wtwhmedia.com