Orthopedic’s Future with Robotics and AI

The orthopedic industry can, at times, seem like it lags behind in terms of the pace of innovation when compared to other areas of medtech. With traditional implant technology generally looking the same as it has for numerous years, it’s no surprise the sector has that image. Unfortunately, it’s not an accurate portrayal. Sure, at a glance, hip and knee systems appear the same as they did about 20 years ago. Even technologies for trauma and spine seem similar to what’s been on the market for quite a while. But when you dig just a little deeper, you see just how revolutionary the orthopedics device industry is.

In past Editor’s Letters, I’ve written about “smart” technologies, augmented and virtual reality, biologics, plastic replacing metal, and, of course, robotic systems. These types of innovations represent the next generation of orthopedics. Implants aren’t going anywhere anytime soon, but these other technologies are most certainly permeating the fabric of the industry and becoming a valuable aspect.

After co-authoring (along with my editorial colleagues, Michael Barbella and Sam Brusco) this year’s series of Top Company reports contained within this issue, the last item on that list emerges as an obvious frontrunner among the technological innovations reshaping the sector. And with this specific invention, the orthopedic industry is essentially leading the pack within healthcare. Sure, the robotic debut from Intuitive—the da Vinci Surgical System—emerged around the start of the millennium and is generally credited as being the first major robotic-assisted offering, but since then, the orthopedic industry has taken that ball and run with it. In fact, the da Vinci system, some 20 years later, still does not have applications in place for the orthopedic industry. Yet, the majority of companies in the enclosed top 10 list have a robotic system on the market or in development. Meanwhile, most of the rest of the medical device industry is floundering to launch their own robot to compete with Intuitive for other, non-orthopedic procedures.

These robots aren’t going anywhere anytime soon. But you don’t have to listen to me say it; following is what Omar Ishrak, Medtronic’s recently retired CEO, said about robotic systems during a fiscal 2020 first quarter conference call (which took place in August 2019). “…we expect to be leaders over the long term, and not just in one procedure, because—across all procedures, and be the company who rewrites the way surgery is done in the next decade. So make no mistake, this is a core area for us, and we’ll see much more of—about robots than just the two that you’re looking at today in the future.”

Couple this robotic revolution with the rapid emergence of artificial intelligence (AI) and something truly exciting begins to emerge. AI is already being used for the robotic systems on the market. Complex algorithms are being leveraged to limit the surgical field to a specific area, aid the clinician in planning the procedure, and help steer instrumentation. AI and robotic surgical systems are traveling toward a convergence that will ultimately enhance healthcare. Or, as Ishrak put it, “rewrite the way surgery is done.”

The further combination of these two technologies leaves me dreaming of a healthcare system that no longer features robotic-assisted surgical systems. Rather, I’m left wondering when the first physician-assisted robot surgical system will debut. Sure, we’ve got a long way to go before we’re there, but the foundation is being built today. It will come; it’s just a matter of when.

Unfortunately, there remain challenges to overcome. Devices from different manufacturers are often communicating via proprietary or dissimilar platforms. As such, an imaging system from one manufacturer may not communicate seamlessly with a robotic surgical system or with the patient monitoring equipment. While this may be beneficial from an OEM’s viewpoint (that is, it could offer the opportunity for a manufacturer to be the exclusive provider to a hospital or at least its operating rooms), is it the best care solution for patients? Whether we’re talking about networked ORs or AI-embedded systems, these products must have the ability to communicate with each other without interruption or failure. The inability to find common ground on an open communication network that functions across all devices will ultimately limit the benefits of all healthcare technology systems.

Until then, however, there’s plenty of other work that needs to happen before R2-D2 is performing a total knee replacement—under the watchful eye of an orthopedic surgeon standing nearby, of course. It may seem like science fiction, but I agree with Ishrak, who foresees significant changes coming to surgical suites in the next decade.

See what trends or points of interest you uncover in this year’s top company reports. I hope you enjoy perusing them. 

Sean Fenske, Editor-in-Chief
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