Realizing the Point of Developing Smart Implants

Many years ago, I heard about the coming of smart implants and how they could help detect problems such as infection following surgery. The goal would be to get ahead of the problem so revision surgery would not be required. This futuristic technology was spoke of as what’s ahead for orthopedics.

Fast-forward several years and the promise has never materialized. Further still, I just about stopped hearing of this innovation that was “just around the corner” and was supposed to be here sooner than I could imagine. Sure, the occasional startup floated the idea in a technology they were developing, but the majors never even whispered about smart implants. They were much more focused on smart solutions around the implant, such as robotics and artificial intelligence.

Those advancements were fantastic additions to the industry, for sure, but the implant itself remained relatively unchanged as far as the “smart” aspect. In fact, when I would bring up the topic of smart implants with representatives from implant OEMs, they would flip the question back at me with something like, “Wouldn’t it be better to determine how to combat infection more effectively rather than create an implant that can detect it at its early stage?”

It’s a fair point and I accepted that line of thinking. The problem was, however, I was missing the entire point of smart implants from the start. It’s not about detecting an infection after the surgery (well, not entirely). There are so many more applications for which smart implants can be used.

Smart implants are a tool for gathering data on the patient’s condition. This means signs of infection, but it also can be used to monitor recovery, measure improvements in range of motion, analyze the patient’s gait, and more. Detecting a potential infection is such a small piece of what’s possible with a smart implant that it should hardly be considered the reason for or against its development.

Much of this came out of a discussion I had earlier this year with Dr. Bill Hunter, founding member and CEO of Canary Medical. Dr. Hunter’s company is responsible for the “brains” in Zimmer Biomet’s Persona IQ, the first “smart knee.” The implant gained the FDA’s OK in August last year and in October, it was placed into the first patient. The surgery was performed by Peter Sculco, M.D., and Fred Cushner, M.D., orthopedic surgeons at Hospital for Special Surgery.

“The smart knee uses the same material and technology found in implanted cardiac devices such as pacemakers,” explained Dr. Cushner, who is also a founder and chief medical officer of Canary Medical. “It collects data every day during the first year following surgery, providing objective, accurate information on how the knee is functioning. Patient monitoring can continue for much longer, though, as the battery that powers the device was made to last at least 10 years.”

In addition, the more patients who receive this implant, the more data will be collected on all the aspects around it, such as those mentioned previously. Eventually, machine learning algorithms could be developed that will analyze a patient’s gait and range of motion to determine if their recovery is on target or requires intervention. Further still, it could be coupled to a digital rehab solution that makes adjustments to a patient’s rehabilitation exercises to attempt to make up for shortcomings in the recovery.

The Canary Medical/Zimmer Biomet pairing is reported as being an exclusive arrangement, but is that only limited to knee implants? Might another company leverage the technology (or similar innovations) for the hip, spine, or some other type of implant? What does the potential hold with regard to orthopedics?

For example, could the tech be incorporated into spinal fusion implants where the condition and health of subsequent vertebrae above and below the fusion are monitored? What about the condition of the entire spine? Staying within the spine, would the technology be beneficial in capturing the ongoing progress of scoliosis? Is it important to have a regular status on the speed at which scoliosis is occurring?

Looking ahead, could data be used to affect therapy? In the example of bone lengthening technology, might the device adjust automatically based on healing and progress of bone regrowth? Could it be used in conjunction with pain management devices?

The promise of smart implants has yet to be realized but the Persona IQ marks a significant first step in what I think is the right direction. What’s realized going forward has yet to be determined, but I hope my ideas here illustrate the potential. Or am I yet again thinking too small? Let me know if you think I’ve missed the point again! 

Sean Fenske, Editor-in-Chief
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