While attending the American Academy of Orthopaedic Surgeons (AAOS) 2019 annual meeting, I had the opportunity to sit down with a few companies who were excited to share their new products and provide insight on upcoming medical technologies.
In part 1, we’ll meet with Stryker’s Sports Medicine, learn how a cervical artificial disc company has revamped their design, and discover how 3D images are providing doctors with better measurements and information to treat their patients. In part 2, I’ll hone in on how virtual physical therapy is providing at-home healthcare and how the integration of tele-rehabilitation is helping patients with faster recovery times, specifically with knee replacements. Additionally in part 2, I’ll go over a few new medical technologies that DePuy Synthes showcased at AAOS.
Stryker’s Sports Medicine
At AAOS, Stryker’s Sports Medicine was featuring their HipMap and HipCheck patient-specific surgical planning. HipMap is a pre-operative planning tool that delivers a patient-specific, interactive 3D view of the hip to help with clinical decision making. In order for surgeons to better plan out their surgeries, the HipMap report provides cam and pincer analysis, version/torsion measurements, indications for instability, 3D heat maps, and more.
“Essentially HipMap saves time and gives the surgeon a full look at the anatomy of the CT scan, and that allows them to manipulate it in the sterile field,” says Stryker’s Sports Medicine VP and GM, Matt Moreau. “Also, on the tablet where you’d view HipMap, we have a product called HipCheck.”
HipCheck is an intra-operative resection planning and execution tool that enables surgeons to measure and resect cam lesions to a desired angle. By allowing a side-by-side comparison of pre-resection and post-resection fluoroscopy, surgeons can ensure the resection plan was executed correctly.
Moreau believes when these tools are used cohesively, the patient can experience a more transparent surgery, and the surgeon can gain access to more information.
“Both tools can be used for better patient interaction from the work that’s been completed,” says Moreau. “HipMap can be used prior to surgery to really walk the patient through what the surgeon is going to do.”
Simplify Medical is a cervical artificial disc company that uses a ceramic core in their Simplify Disc. The disc contains medical polymer endplates where the coating encourages bone ongrowth and has a retention ring that keeps the ceramic core within the disc. Currently, Simplify Disc is going through clinical trials, and David Hovda, President and CEO of Simplify Medical, says although time will tell, they are cautiously optimistic and pleased with the progress.
Unique to these discs is the fact that they are designed to match each patient’s anatomy, so the disc heights range from 3.7 mm to 6mm. Hovda says that often times women’s discs are smaller, but not many companies are making discs designed to go down to 3.7 mm.
“We did a lot of work looking at the actual cervical spine in terms of everyone’s designed disc replacements,” Hovda says.
He says on average women’s discs were 3.8 to 3.9 mm, and the most current available discs on the market are often 5.5 or 6 mm.
Although the clinical trials are a lengthy process, Hovda says they’re testing a device that’s supposed to last a lifetime, so the length of the trials make sense.
“We have to treat everyone and follow them for two years,” says Hovda. “FDA is saying we’re treating 42 year olds on average, so if all goes well, they’re going to have their discs for 40 to 50 years.”
A unique factor of the disc is the fact that Simplify Medical has eliminated the metal factor. Instead they’re using ceramic that’s designed to conform to the patient’s anatomy and provide maximum range of motion without any anatomic constraint.
Hovda says there are a couple patients in the clinical trial who have nickel allergies, which is a growing allergy in our population. Because there is no nickel element in their discs, Simplify Medical expects to get a nickel-free label associated with their product.
“A surgeon doesn’t want to implant something in you for the rest of your life that you’ve got an allergy to,” says Hovda. “If you have an allergy on your skin, the theory is that if it’s implanted inside your body, your body is going to attack it.”
Overall, Hovda says patients prefer to have implants that don’t contain metal anymore and believes Simplify Disc will be a positive alternative to cervical discs once completing its clinical trials.
“Everyone says they want the Simplify Disc because they don’t want all that metal in their cervical spine. Patients just don’t want a lot of metal in their bodies and it’s very minimalistic looking,” says Hovda. “It’s also easier to implant, so we have a lot of features that are appealing to both the patients and doctors.”
EOS imaging is a company that develops advanced imaging and image-based solutions for diagnosing, treating, and monitoring musculoskeletal pathologies. Their imaging system allows a full body, low-dose, weight-bearing biplanar Xray, according to Mike Lobinsky, CEO of EOS imaging.
“We do a patient head-to-toe biplanar Xray in roughly 20 seconds,” says Lobinsky. “The image resolution is outstanding.”
Their imaging system is currently installed in 300 facilities globally. Lobinsky says they’ve also implemented their 3D services and surgical planning solutions, which a lot of companies were asking for. The 2D/3D workstation, called sterEOS, and their suite of online, 3D surgical planning solutions for the spine, hip, and knee known as EOSapps, now pair together as an overall unit.
“It’s interesting in that our surgeons are asking for it because they want to be able to leverage these images,” says Lobinsky. “They can see how the spine will interact, and how the full body image is really going to apply for how they’re going to take care of their patients. It’s different because they haven’t had that option before.”
Now, EOS imaging uses the AP lateral images and sends them to the 3D services team. Within 24 hours the surgeons have all of the available images in 3D. So, the surgeons now have a three-dimensional view of the patient’s muscular skeletal system, and they can launch their EOS apps, which enables the hip, knee, and spine surgical planning solutions. This integration of 3D elements and their surgical planning solutions is something the medical front is seeing more of, Lobinsky says.
“Clearly integration is something you hear a lot and you’re seeing a lot,” says Lobinsky. “What does integration really mean? We see it as a couple things. First as an end solution where you have the imaging on the front-end, you have surgery planning via 2D and 3D, and you have intraoperative integration that helps you carry forward the surgical plan into the OR. Then, the postop data, or the ongoing data, helps surgeons better understand what their goals of the surgical plan were, if they obtained those goals, and how the outcomes were.”
Overall, Lobinsky believes that by being able to convert 2D images to 3D images, and provide a simulator range of motion of, for instance, virtually placing a hip implant to determine if the patient is going to dislocate, is something his company is pretty proud of.
“We see the ability for us to take current and future footprints of the solutions we have today, and solutions we’ll continue to integrate, to drive the future,” says Lobinsky. “We’re taking a series of things, such as predictive analytics, deep learning, AI, and machine learning, and taking this data to drive our solutions.”