The dozens of industry experts and thought leaders gathering at OMTEC 2015 will include the Keynote Panel, offering perspectives from Doug Kohrs, Past President and CEO of Tornier, B. Sonny Bal, M.D., J.D., Chairman, President and CEO of Amedica, and Rod Mayer, President of Nextremity Solutions. The three convened for a nearly three-hour conversation to discuss orthopaedic technology evolution at the ORTHOWORLD Symposium in January. In anticipation of OMTEC, we highlight some of their previous discussion on the latest technologies and players to enter the market.
Doug Kohrs: I want to touch on robotics, having studied it a lot over the years. Let’s divide it into the subsegments as I see them: knee and hip, we’ll keep those together; then spine, shoulder, foot and ankle. As you look at your extremities businesses, do you see a place for robotics in some of the more complex surgeries?
Rod Mayer: It’s amazing to me to see robotics and the part they play. I can remember a very gifted total joint surgeon who, using traditional instrumentation, skin to skin, did 30 minutes for a total knee replacement with excellent results...published results, in fact, showing 15-20 years of excellent results. That surgeon decided to embrace this concept of robotics, and his procedures turned lengthy with not necessarily the same outcomes.
As I think about our product portfolio and what we see as our pathway over the next three to five years, robotics doesn’t play a part in the foot and ankle space. Could it in upper extremity, shoulder? Perhaps, but a lot of foot and
ankle surgeons prefer to use their hands.
Dr. B. Sonny Bal: There are a lot of dimensions to this question. In robotics, presumably more inputs would lead to more accuracy if the surgeon or the team performing the surgery knows how to use the robot correctly. At the end of the day, it’s just a computerized algorithm that will give you garbage if you put garbage in. The published data is not showing consistent improvement; it does increase operative time. The promise of robotic technology was to make certain outputs consistent so that a surgeon who doesn’t do many primary knees and is doing his first one in two months can make cuts correctly. In hips, the idea was to avoid the common complications, leg length discrepancy being one of them.
I think robotics were a nice buzzword, like “Wi-Fi enabled” and “3D printing” that to some extent have been adopted by surgeons to market themselves and differentiate themselves. Patients love high tech; they hear buzzwords and they think they all sound good. I think robotics is an evolutionary technology. In the next wave, we’re already seeing many companies develop prenavigated cutting instruments. Let’s say you expose a tibia; this guide is already configured to fit like an erector set and is based on a computer algorithm that doesn’t use one or two points, but multiple points. There the accuracy is better. Not completely there, but better.
I know for a fact that many companies are working on hip systems now in which, during surgery, the equipment you use —the cutting guides or blocks—is predesigned to reference existing anatomic patient landmarks that we routinely expose. Why not use them to make the cuts more accurate? I think the result would be more consistent, the outcomes would be safer and patients would be happier. That’s the advantage of this technology.
Kohrs: I was reading an analyst’s report recently about Wright Medical. I think everybody knows that Wright is back on a pathway to get their new orthobiologic product approved through the PMA process. The article said that this will be the first orthobiologic approved through the PMA process in more than ten years. It’s an interesting thing to think about. If you go back 20 years, the buzzword was orthobiologics. They were going to change the world! A lot of products have come and gone, and people have gotten in trouble with orthobiologics—ones with products and ones without. I’ve worked on orthobiologics over the years, so many I can’t even remember. What do you see for the future?
Dr. Bal: I think application in cartilage is still in its infancy. Any field in which you don’t have all of the answers, there’s a lot of room for innovation.
Let’s get back to bone, which is basically the reconstruction of missing bone. You may have a structural loss, meaning something a patient puts weight on that you have to replace. The standard now is bone allograft, or some sort of porous metal. There is nothing on the horizon that I’ve seen that can provide structural replacement. Certainly a lot of research being done, though.