Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

The Future of Personalized Implants in Joint Replacement: Additive, Robotics, Augmented Reality

893 views

Published on

Orthopedics is primed for mass customization of implants thanks to advancements in additive, AI and robotics. Fully leveraged, the technologies can produce patient-specific implants that achieve clinical benefit, decrease cost and maintain O.R. workflow. Founder and Chief Medical Officer of Monogram Orthopaedics, Douglas Unis, M.D., shares his reimagined vision of personalized joint replacement implants and just-in-time inventory solutions.

Published in: Health & Medicine
  • Be the first to comment

  • Be the first to like this

The Future of Personalized Implants in Joint Replacement: Additive, Robotics, Augmented Reality

  1. 1. Orthopaedics Reimagined
  2. 2. “…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
  3. 3. THE MONOGRAM SOLUTION
  4. 4. Why Orthopaedic Robotics Has Not Gone Away Perfect X-rays Better clinical results Improved survivorship
  5. 5. BUT GEN 1 ROBOTS STILL HAVE ISSUES Too expensive Too slow Too disruptive Too big
  6. 6. GEN 1 NAVIGATION
  7. 7. GEN 1 POINT CLOUD REGISTRATION
  8. 8. | 44 GEN 1 IN PRACTICE
  9. 9. 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
  10. 10. Gen 3 Orthobot Faster, less disruptive, less costly, and safer than Gen 2 AND Designed for patient specific implants that solve clinical problems
  11. 11. 3D Printed “Quick-Point” Guides for Rapid Registration
  12. 12. REIMAGINING KNEE IMPLANTS
  13. 13. REIMAGINING KNEE IMPLANTS
  14. 14. NOVEL IMPLANTS SOLVING REAL CLINICAL PROBLEMS
  15. 15. 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:
  16. 16. REIMAGINING HIP IMPLANTS
  17. 17. 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 =
  18. 18. 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
  19. 19. Mechanical Testing: Femoral Component 7206-4-Axial Compression Fatigue 7206-6-Neck Fatigue
  20. 20. 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
  21. 21. 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
  22. 22. 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
  23. 23. 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?
  24. 24. Good to the Bone

×