AAOS 2017: Implant Manufacturers Now Eying Entire Episodes of Care

Knee and hip prosthesis

The transition to value-based care models was evident on the exhibit floor—highlighted by robotic technology to reduce post-operative complications and readmissions as well as new software and service solutions to support both patients and providers throughout the entire joint replacement episode.

The exhibit hall floor at the American Academy of Orthopaedic Surgeons (AAOS) 2017 annual meeting in San Diego, California was buzzing with new product launches beyond the metal and plastic on display in years past. With the inaugural mandatory bundled payment program for lower extremity joint replacement entering year two, major implant manufacturers have shifted their focus from the development of new hip and knee implants to adding value across entire episodes of care.

Several companies introduced robotic and navigation systems touting economic advantages as a result of reduced complications and readmissions. Another major theme was the development of services and digital solutions to assist hospitals in the transition to value-based care models. In the traditional orthopedic implant space, the emphasis was on small joints with the launch of several new shoulder systems and the first total ankle revision products. Here’s an overview of some of the new products:

Robotics and Navigation

  • Commercial launch of Stryker’s MAKO robotic arm total knee application. Stryker is the current market leader in robotics with approximately 350 systems placed in the U.S. At a million-dollar price point, the MAKO robot is now the only system offering applications for total knee, partial knee and total hip. Stryker built significant momentum leading up to the total knee launch with 1,400 surgeries performed across four countries. The system is compatible with Stryker’s Triathlon knee.
  • Smith & Nephew presented a total knee application for NAVIO, a handheld robotic technology. Acquired through the purchase of Blue Belt Technologies, the NAVIO surgical system is currently approved for partial knee replacement systems. The device is significantly less expensive than the MAKO and carries a smaller footprint as it is handheld and imageless. Smith & Nephew expects the total knee application for its JOURNEY II, GENESIS II and LEGION systems to be approved in the second quarter of 2017.
  • Zimmer Biomet revealed prototype for ROSA total knee application. Zimmer Biomet entered the robotics market in July 2016 via the acquisition of Medtech’s ROSA surgical robot. Currently, applications are approved and in-use only for brain and spine procedures, but Zimmer expects the total knee application for the Nexgen, Persona and Vanguard knee systems to be in clinical use by the second half of 2018.
  • More GPS offerings from Exactech. The company’s computer-assisted surgical technology now includes the first application for total shoulder arthroplasty as well as new knee applications.
  • Next tier players introduced advancements in the computer-assisted surgery space. Corin, Intellijoint, and THINK Surgical brought new applications for total hip arthroplasty while OrthoAlign launched a handheld surgical navigation device for unicompartmental knee arthroplasty.

Bundled Payment Services and Digital Solutions

  • Launch of Zimmer Biomet’s Signature Solutions. The offering consists of a suite of services and technologies to support facilities and surgeons in the management of entire total joint episodes of care. Highlights include a partnership with HealthLoop, software that offers patient engagement tools, facilitates the capture of patient-reported outcomes and provides insights into post-discharge patient care pathways. The offering also includes RespondWell, a virtual rehabilitation company allowing patients to perform physical therapy at home. By layering existing consulting services with these and other technologies, Zimmer Biomet is working to offer a comprehensive value-based care solution.
  • Johnson & Johnson promoted its Orthopaedic Episode of Care Approach, expanding CareAdvantage capabilities. First introduced in January 2017, the approach includes digital care navigation and patient engagement, episode performance management, infection risk management, procedural standardization and perioperative efficiency, and end-to-end supply chain optimization.
  • Consensus Orthopedics debuted TracPatch, a wearable device for real-time post-surgical patient monitoring. TracPatch will remotely monitor patient activity (e.g., ROM and ambulation), exercise compliance and wound site temperature trends in real-time following a total joint replacement procedure. Data from the device is accessible to care providers through a mobile app or web dashboard.

Small Joint Implant Systems

  • DJO Global launched the AlitVate anatomic shoulder system. The system features a short, bone-sparing stem with P2 technology (a proprietary “porous porous” coating) to promote bony ingrowth, but also allows for use of a standard-length humeral stem. An additional feature is a new glenoid component with patent-pending “Drop and Go” technology for immediate initial fixation. The system adds to DJO Global’s current shoulder arthroplasty offering that includes the popular AltiVate reverse shoulder system.
  • INVISION Total Ankle Revision System announced by Wright Medical. Expected to launch in the summer of 2017, the system complements both the INBONE and INFINITY total ankle products. Through the introduction of revision implant options, Wright Medical is working to encourage market adoption of total ankle arthroplasty.
  • Arthosurface highlighted the OVO Primary Stemless Total Shoulder system. The design consists of a non-spherical, stemless cobalt chromium head and polyethylene inlay glenoid. The former allows for the minimization of bone removal and postoperative lifestyle restrictions in appropriately selected patients, and the latter is intended to lessen component loosening.
  • Integra LifeSciences introduced the Press-Fit Reverse Shoulder for Fracture for the Titan Modular Shoulder System. The product features a two-piece stem design that does not require cement due to its direct implant-to-bone fixation below the fracture line in the humeral canal.

Notable Hip and Knee Product Launches

  • Depuy Synthes – launched the ATTUNE Revision Fixed Bearing Tibial Base and 14×50 mm Cemented Stem
  • DJO Global – announced FDA 510(k) clearance to market the Exprt Revision Hip
  • Exactech – announced the full launch of three new revision systems: the Equinoxe Humeral Reconstrution Prosthesis for complex shoulder arthroplasty; the Optetrak Logic CC Revision Knee System, including redesigned instrumentation; and the Alteon Monobloc Revision Femoral Stem for hip arthroplasty
  • Stryker Instruments – introduced System 8 power tools, including the EZout Powered Acetabular Revision System

Author Information

Kelsey Duggan

Kelsey Duggan

Kelsey Duggan is a clinical director on the inSight Advisory – Medical Device Management team at HealthTrust. She previously worked as director of bundled payment programs for an orthopedic and spine care management platform and level III implant registry. Duggan holds a PhD and an MBA from Vanderbilt University in Nashville, Tennessee, and a bachelor’s degree from Wofford College in Spartanburg, South Carolina. More Articles by This Author »

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