Justifying the Hype of Robotic Orthopedic Surgery

The robots are coming. But they’re not yet seeking subjugation of the human race. Instead, they want to perform surgery on our joints and spine.

Last year’s “Top 10 Global Orthopedic Device Firms” reports made it clear robotic- or computer-assisted surgical capabilities are paramount for the largest orthopedic manufacturers. Stryker and Smith & Nephew have introduced total knee procedures to their respective Mako and Navio platforms. Medtronic began its takeover of surgical robotics firm Mazor with a 15 percent stake (and eventually acquired the company). Globus Medical launched its ExcelsiusGPS robotic guidance and navigation system. DePuy Synthes acquired a robotic-assisted surgery solution, hinting at a possible application for the long-heralded Verb Surgical partnership with Google’s Verily.

With this much hype for a technological trend—particularly a “sexier” one like robotics—many, myself included, wondered if it was just another fad. ODT editor-in-chief Sean Fenske lamented the false promise of orthopedic “smart implants” in an Editor’s Letter last year: “the combination of sensors, connectivity, IoT, and miniaturization could be leveraged to enhance the level of orthopedic care provided to patients requiring joint replacements” but “as I had come to discover, efforts are ongoing…”

However, as he pointed out, “unlike smart implants, surgical robotics are becoming pervasive within the industry at a rapid pace, especially in orthopedics.” M&A and robotic offerings persisted and even flourished beyond last year’s report, proving robotics to be a long-term investment.

Globus brought ExcelsiusGPS to Europe early last December, with its first procedures performed in hospitals in Italy and Germany. Clinicians lauded the level of accuracy the technology brought to both open and minimally invasive spinal surgeries. “We are excited about the potential impact that robotic guidance and navigation may have in improving screw placement accuracy, MIS [minimally-invasive surgical] efficiency, and reducing radiation exposure,” commented Professor Peter Douglas Klassen with Bonifatius Hospital in Lingen, Germany.

Zimmer Biomet joined the party in late January with an FDA nod for the ROSA Knee System for robotically-assisted total knee replacement (TKR) surgeries it had acquired in 2017 from French firm Medtech SA. ROSA was already used for brain and spinal surgeries before the knee clearance. ROSA Knee enhances TKR surgery with 3D preoperative planning tools and real-time, intraoperative data about soft tissue and bone anatomy. These features help improve bone cut accuracy and range of motion gap analysis, potentially boosting flexion and restoration of natural joint movement.

“ROSA Knee functions as a surgical assistant that gives me the tools and real-time data to perform bone cuts with greater precision and improve patient-specific soft-tissue balancing and implant alignment, without losing my feel for a natural fit and flexion,” said Christopher J. Cannova, M.D., Washington Joint Institute at OrthoBethesda.

Shortly after acquiring Mazor Robotics, in January Medtronic launched the Mazor X Stealth edition for spine surgery. Co-developed between Medtronic and Mazor, the system debuted at Norton Healthcare in Louisville, Ky., and Reston Hospital Center in Reston, Va. Mazor X Stealth Edition incorporates technology that enables workflow predictability and flexibility through real-time image guidance, visualization, and navigation informed by interactive 3D planning and information systems.

“The marriage of robotics and navigation represents the future of computerized planning and execution in spine surgery. Robotics and navigation have both been shown to improve accuracy and precision in spine surgery,” commented Christopher R. Good, M.D., F.A.C.S., spine surgeon at Reston Hospital Center, director of Scoliosis & Spinal Deformity and president of The Virginia Spine Institute. “The Mazor X Stealth Edition uses cutting-edge software to plan the surgical procedure, then uses a robotic arm to guide implants and instruments through the steps of the surgical procedure with precision, while simultaneously using real-time imaging feedback to ensure the plan is being carried out as desired.”

Although M&A activity in orthopedic robotics has slowed somewhat, Corin Group began the acquisition of OMNI Orthopaedics, a pioneer in robotic-assisted TKR, in early March. OMNI’s OMNIBotics combines a robotic cutting guide with a robotic tool to measure ligament function, tailoring implant positioning to each patient. Corin already touts its Optimised Positioning System for hip replacement, and adds OMNIBotics technology to optimize TKR using the company’s APEX knee replacement.

“The U.S. market for robotics in orthopedics is growing at a very rapid pace, and with the addition of OMNI’s technologies, we expect Corin to remain at the forefront of development in robotics and computer-assisted surgery,” commented Henry Minello, principal in the Healthcare team of Permira, the investment firm that owns Corin.

If anyone is wondering about the efficacy of robotic- or computer-assisted orthopedic surgeries, Exactech released research in early March that both demonstrated positive surgeon experience and improved accuracy in total joint replacement using the ExactechGPS computer-assisted technology.

Two studies evaluated implantation of Exactech knees with ExactechGPS. One showed significantly improved joint alignment, increasing the percentage of surgeons who had achieved desired resections compared to conventional instrumentation—regardless of their experience with computer-assisted surgery or TKR in general. Another study demonstrated the system helped eliminate alignment outliers for improved accuracy.