The Future of Personalized Implants in Joint Replacement: Additive, Robotics, Augmented Reality
- 3. “…take an image and send out an instrument set and an implant that is going to fit perfect; it could dramatically improve the efficiency of how we deliver these products to our customers.” David Illingworth CEO, Smith & Nephew 2011 THE INDUSTRY SEES THE FUTURE
- 6. Why Orthopaedic Robotics Has Not Gone Away Perfect X-rays Better clinical results Improved survivorship
- 7. BUT GEN 1 ROBOTS STILL HAVE ISSUES Too expensive Too slow Too disruptive Too big
- 9. GEN 1 POINT CLOUD REGISTRATION
- 10. | 44 GEN 1 IN PRACTICE
- 11. Less Disruptive – Smaller/Lighter Faster (No haptics, streamlined registration) Less Expensive – Moore’s Law But still…Robots are being used to drive sales of the same old implants. BIG PLAYERS NOW INVESTING IN GEN2
- 12. Gen 3 Orthobot Faster, less disruptive, less costly, and safer than Gen 2 AND Designed for patient specific implants that solve clinical problems
- 14. 3D Printed “Quick-Point” Guides for Rapid Registration
- 17. NOVEL IMPLANTS SOLVING REAL CLINICAL PROBLEMS
- 18. Monogram Stryker Percentage Difference Axial Subsidence Drift (mm) 0.01206 0.03269 171% Axial Subsidence Cycle Range (mm) 0.09306 0.14035 51% AP Motion Drift (mm) 0.00886 0.01245 41% AP Motion Cycle Range (mm) 0.02870 0.03250 13% IE Rotation Drift (deg) 0.00563 0.00875 55% IE Rotation Cycle Range (deg) 0.03220 0.05723 78% AP Tilt Drift (deg) 0.01683 0.00555 -67% AP Tilt Cycle Range (deg) 0.02455 0.06448 163% VV Tilt Drift (deg) 0.00253 0.00937 270% VV Tilt Cycle Range (deg) 0.01886 0.02209 17% ML Drift (mm) 0.01017 0.00656 -36% ML Cycle Range (mm) 0.00866 0.00330 -62% Tibial Micromotion Study Summary:
- 20. NOVEL IMPLANTS SOLVING REAL CLINICAL PROBLEMS GENERIC BONE CONTACT 9X MORE ACCURACY 1.4CM OFF-CENTER vs. MONOGRAM STABILITY 6.3X BETTER ROBOTIC MANUAL PATIENT MATCHED =
- 21. Femur Micromotion Study Results: Average Monogram 14.302 5.544 0.764 8.272 Average Standard 66.798 71.23 33.68 40.258 Percentage Difference 367% 1185% 4308% 387% The Zimmer Biomet ML Taper implant had on average 634% higher final cyclic displacement
- 22. Mechanical Testing: Femoral Component 7206-4-Axial Compression Fatigue 7206-6-Neck Fatigue
- 23. Intellectual Property International Publication Number (WO 2017/177182 Al) - APPARATUS, METHOD AND SYSTEM FOR PROVIDING CUSTOMIZABLE BONE IMPLANTS Provisional Patent Number (62/811,811,855) - CUSTOMIZED TIBIAL TRAYS CONTACTABLE WITH AN UNDERLYING CORTICAL BONE, METHODS, AND SYSTEMS FOR KNEE REPLACEMENT Provisional Patent Number (62/834,692) - CUSTOM HIP DESIGN AND INSERTABILITY ANALYSIS ROBOT MOUNTED CAMERA REGISTRATION AND TRACKING SYSTEM FOR ORTHOPEDIC AND NEUROLOGICAL SURGERY A SYSTEM AND METHOD FOR INTERACTION AND DEFINITION OF TOOL PATHWAYS FOR A ROBOTIC CUTTING TOOL
- 24. ECONOMICS: INVENTORY HIP ARTHROPLASTY Actual Case Quantities: 80 Stems: $53,089 30 Boxes of Heads: $7,781 10 Shells: $3,429 60 Liners: $13,129 For cost approximations, manufacturing COGS generally 30% of ASP $77,428 of implant inventory for $4,949 of revenue Approximately 7 trays of underutilized instrumentation that needs to re-sterilized every case THIS DOES NOT INCLUDE: The average S&P 500 company turns over it’s inventory 6.6 times more than the average large orthopedic company. 6.6 times $1,565 of implant inventory for $100 of revenue
- 25. ECONOMICS: MARGIN ANALYSIS 3D Printed Stem: $525 (approx. 85% utilization) Machine/finish/package: $200-300 Coated Acetabular Cup: $265-400 Poly Hip Liner: $100-300 Femoral Head: $110-175 * Forge/Machine/Finish/Package: $280-380 $445 unoptimized cost delta Total Hip Arthroplasty ASP1 (2017): $5,136 THA 3D Printed Stem: $670 (approx. 65% utilization) Machine/finish/package: $170-300 Femoral Component: $250-500 Poly Insert: $120-250 Patella: $60-135 * Forge or cast/Machine/Finish/Package: $250-380 TKA Total Knee Arthroplasty ASP1 (2017): $4,547 $590 unoptimized cost delta
- 26. 26 HIP DISTRIBUTORS INVENTORY INVENTORY TURNOVER ZIMMER BIOMET $2bn 1.0x SMITH & NEPHEW $1.2bn 1.0x STRYKER $2.2bn 2.0x EXACTECH $66m 1.2x DJO SURGICAL | DEPUY SYNTHES - PRIVATE COMPANIES - THE MARKET IS READY FOR JUST-IN-TIME INVENTORY! DISTRIBUTORS CAN EASILY HAVE 40+ IMPLANTS ON HAND FOR ONE PROCEDURE MASSIVE COST OF INVENTORY MANAGMENT WHAT IS A 30%+ INVENTORY REDUCTION WORTH?
- 27. Good to the Bone