DePuy Synthes introduced its ATTUNE Knee, designed to provide better range of motion and address the unstable feeling some patients experience during everyday activities, about seven years ago. Last year, the company expanded the platform by introducing the ATTUNE Cementless Knee in select markets around the world. This launch combined the technologies of the ATTUNE Knee designed to provide stability while the knee is in motion with DePuy Synthes’ extensive heritage in rotating platform knees and cementless technology. The company noted that the demand for cementless knee replacement is increasing, specifically for younger, more active patients for whom biological fixation and in-growth of the implant to bone may help meet the demands of their active lifestyle.Image Credit: DePuy Synthes
In recent years MD+DI has reported on a number of ways emerging technologies such as artificial intelligence (AI) and machine learning (ML), surgical robotics, and 3D-printing are impacting a number of different sectors in medtech. In 2020, we expect these technologies to become even more releavant in the industry, particularly in orthoedics.
MD+DI recently spoke with an expert at DePuy Synthes for insight into how key trends are impacting the total knee replacement (TKR) market, and how emerging technologies can be part of the solution. Rajit Kamal is vice president and global franchise leader of the knee business at Warsaw, IN-based DePuy Synthes, a Johnson & Johnson company.
Outpatient Is No Longer Just a Niche
"We are seeing a very persistent shift toward outpatient or ambulatory surgical care centers and we think that shift makes sense, Kamal said, pointing out several benefits of this trend, including faster recovery and a lower cost of care.
“We think anything that makes sense for the patients clinically and economically is the right thing to do,” he said.
While outpatient will never be right for every patient, Kamal said up to 70% of TKRs could eventually be handled in outpatient settings such as ambulatory surgical centers (ASCs).
“Outpatient is not a niche," Kamal emphasized. "Outpatient is the site of care of the patient. So when we develop our portfolio, when we drive innovation, it is with outpatient in mind.”
What that means from an R&D perspective is that companies in the TKR space like Depuy Synthes need to keep in mind the fact that ASCs are smaller than in-patient hospital settings.
"We are making sure we are developing the portfolio that is enabling our customers to be able to operate in this site of care and that means developing products that are portable, smaller, and cost effective," Kamal said.
Kamal sees opportunities to address these and other unmet TKR needs with emerging technology such as AI, ML, robotics, and 3D printing.
"We think technology has the potential to transform total knee replacement, and we are at the leading edge of that transformation," Kamal said. "Technology has unlocked a lot of constraints that we had."
Here are three examples of how technology can play a role in TKR trends:
1. Enhancing Patient Selection and Optimizing Pre-Operative Care
Today, one in five patients who undergo total knee replacement surgery are not fully satisfied but surgeons are perplexed by this problem. Sometimes a patient will come in for a follow-up appointment and everything looks perfect from the surgeon's perspective, yet the patient is not happy with the outcome of their procedure. Other times, a surgeon may expect a particular patient to be unhappy with their TKR results but the patient will surprise them.
The solution, according to Kamal, is to drive personalization, automation, efficiency, and connectivity. All of these together can really transform total knee replacement, he noted.
"Today, if you go to five different surgeons and ask them which patient is the right patient for surgery you will get five different answers," Kamal said.
For example, some surgeons will not operate on a patient whose body mass index (BMI) is 35 or higher, while other surgeons are willing to operate on patients whose BMI is 50 and those surgeons say their BMI 50 patients are their most satisfied TKR patients, Kamal explained.
Kamal says this is where AI and machine learning tools could go a long way toward enabling surgeons to not only make the right decision on patient selection, but also help them optimize their pre-operative care pathway.
"So if a patient is not the right patient today, the surgeon can work with them and get them in the best shape before they go through surgery," he said.
2. Enhancing Efficiency with AI and Robotics
Today, if two different TKR patients go to the same surgeon they are likely to get a similar procedure based on that particular surgeon's training and clinical experience. Surgeons tend to perform the same procedure on all of their patients because it makes them more efficient, Kamal said.
Once again, AI can help surgeons develop a very personalized surgical plan that analyzes each case based on dynamic motion of the knee and other variables, without costing the surgeon any efficiency.
Surgical robotics also comes into play here.
"We think the right robotic solution should be easy to use, it should be portable, and it should be cost effective," Kamal said.
Technology also enables surgeons to better monitor their patients remotely.
"Five years ago a patient would be sent home after surgery and come back six weeks later and that's the first time they saw the surgeon post-op. Or you would end up in the ER if you had a problem," he said. "Sometimes six weeks might be too late. Technology has unlocked that constraint."
3. Taking Implant Design to the Next Level with 3D Printing
The emergence of 3D printing in medical device manufacturing has benefited companies like Depuy Synthes not only in terms of cost but in terms of design.
"3D printing enables us to develop designs that we couldn’t do with traditional manufacturing," he said. "So we are actively investing in all of these technologies because we truly believe that it has the potential to take a very successful procedure to the next level."
Bringing It All Together
DePuy Synthes recently unveiled its Velys Digital Surgery platoform, which will consist of connected technologies that leverage data insights for patients, surgeons, and healthcare systems across the continuum of care. Today, the new platform will focus on joint reconstruction including existing technologies like the Kincise System and the Jointpoint System, the company noted. Over time, DePuy Synthes plans to add new technologies like its orthopedic robotic solution, patient selection tools, andvanced visualization, sensors, and mobile apps. Read more about the Velys Digital Surgery platform here.