The next decade of orthopedics will be defined by technologies like 3D printing and robotic navigation systems.
Here, Robert Cohen, Stryker's chief technology officer and vice president of research and development, elaborated on 3D-printing and the company's long term vision for the implants and robotics spaces.
Note: Responses were edited for style and content.
Question: How has 3D printing improved total joint replacement procedure performance?
Robert Cohen: Without question, additive manufacturing, or 3D printing, has allowed engineers to become more innovative. Now we can design and produce implant geometric configurations and surfaces that we were unable to in the past.
Research and development has been constrained by decades-old conventional manufacturing processes such as casting, machining and molding. These processes limited our design potential. Today, with 3D printing technology, every aspect of an implant or instrument part is 100 percent engineered. Every surface, every dimension. We computer program off 3D solid models and that drives the 3D printers.
For Stryker, those parts include protheses for spine interbody fusion, primary total hip, and primary and revision knee joint replacement. For example, Stryker’s 3D printed Triathlon Tritanium tibial component has a unique bone interfacing surface that provides the high level of friction needed for initial stability with a fully interconnected porous scaffold surface that allows bone ingrowth for long term fixation. 3D printing allowed this tibial component to be produced with an optimized initial stability and biological fixation configuration.
At Stryker, we recently processed our 1 millionth titanium alloy metal 3D printed implant in our own facility. We are accelerating the adoption of the technology at a fast rate, incorporating it into many active development programs. 3D printing is a core R&D technology pillar that will be incorporated into our future plans as we work to further improve outcomes.
Q: Looking to 2020 and beyond, how will orthopedic surgeons be able to use surgical robots for total joints?
RC: When you look back at how the total joint market has transformed over the 13 years since Mako Robotic Technology launched, it’s clear that robotics on orthopedic hip and knee procedures will continue to expand at a fast rate.
A word of caution here in that the term "robot" has become extremely broad. All robots are not the same and each robot offers different capabilities, different levels of accuracy and precision. Our Mako System has power instruments attached to a robotic arm to provide a high level of beneficial contribution to the orthopedic procedure. With 800-plus current Mako System placements around the world and surgeons collectively exceeding 10,000 Mako procedures per month, the adoption rate of Mako has been extraordinary.
The reasons for this are relatively straightforward. Surgeons realize quickly the clinical benefit in [robotics is] less short-term pain, more accurate placement of the implant in that specific individualized patient and greater patient satisfaction. Beyond 2020, we will be releasing updates for partial, total hip and total knee software to enable additional features, such as hip pelvic tilt that needs to be accounted for in lumbar multilevel fusion, and we continue to work on Mako clinical applications beyond hips and knee. The current Mako System hardware has infinite possibilities.
Q: What's the ultimate vision for Stryker's robotic tech?
RC: We are on track for that ultimate vision. With Mako now, we have an accurate 3D model of the patient preoperatively to plan the case off of. We have a Mako System in the OR to assist the surgeon in modifying their plan based on complex anatomy or following assessment of the articulating joint and soft tissue laxity.
Our vision is about getting to individualized medicine where more information about the patient is known to the surgeon. We'll provide the surgeon their best options for that patient and the best implant and robotic tools in the OR to accomplish what's best for the patient. The ultimate success of robotics is gained, we believe, with a Mako System in the OR to assist the surgeon with the final assessment of the patient and then with precision and accuracy, executing that plan — and now add to that, the world of digital health.
Stryker has been actively working on data analytics and cloud-based data acquisition. The Mako System will soon be [web-enabled]. For those surgeons and patients that want to go on the data journey, we will be able to capture preoperative data, comorbidities, intraoperative change of the preoperative plan, extract out the final three-dimensional placement of the implant in the patient into [EHRs], and with postoperative applications, have patient, physical therapy and sensor input as to the performance of that patient and implant months after the surgery.
We will get to a place of predictive analytics, presurgery and during surgery, that it is believed may improve outcomes and play a role in healthcare economics. Robotics combined with digital health data can be amazingly impactful. Stryker R&D is on this journey.
Q: Investing in surgical robots remains a topic of discussion in hospitals. Will there come a time when robotic technology is available for every hospital regardless of infrastructure available and how will Stryker play a part in that?
RC: To date, we haven’t seen restrictions on acquiring a Mako System based on infrastructure. In fact, out of our 800 plus systems around the world, we have Mako placements in ambulatory care centers, rural hospitals, academic teaching institutions and all sizes of community hospitals. Each setting seeing success with their Mako programs.
The rate of new Stryker Mako placement continues where we don’t necessarily see a specific infrastructure having a unique influence over another. Now that the Mako System has over 135 peer-review publications and positive clinical data seen in numerous government run joint registries, the outcomes and publications are supporting the adoption and benefits of Mako robotics in all types of infrastructures.