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At OMTEC® 2023, we convened an expert panel of executives from orthopedic companies focused on technology. I asked those leaders about the opportunities and challenges in the orthopedic enabling technology space. Our conversation is excerpted below, but first, a little about the panel and the technologies that they have on the market:
- Kevin Hykes is the President and CEO of Augmedics, maker of the xvision augmented reality navigation system for spinal surgery.
- Kevin McGann is the President and CEO of Accelus, a spine company that recently sold its REMI robotic navigation system to ATEC.
- Eduoard Saget is a Co-Founder, Board Member and co-CEO of OrthoGrid Systems. The company uses AI to unlock the full navigation potential of fluoroscopy.
Enabling technology is not new in orthopedics, but adoption has stagnated recently. Why is that?
Kevin Hykes: Navigation was introduced in 1996 by Medtronic, and their Stealth system is the 80% market share leader today. After 26 years, it has not breached 20% adoption in the market. Compare that to DaVinci, the robot for prostatectomy, which is now at 85% procedural penetration after a little over ten years. So, there’s something wrong with the cost/benefit tradeoff for navigation.
Today’s systems require a physician to look away from the patient while operating on their spinal column, to look across the room at two-dimensional screens, and try to mentally form a three-dimensional model of the patient’s spine as they’re working. With today’s systems, every time someone reaches in or out of the field or leans forward, the navigation experience stops because the line of sight has been disrupted.
Kevin McGann: Speaking specifically of the robotic portion of it, number one is the cost. It’s a significant capital expense for the hospital. In addition to large footprints, these systems also have a learning curve. And there’s really no way to sell these into the ASC setting, where a lot of degenerative spinal fusion procedures are moving. Those are big hindrances from a cost-efficiency perspective.
Eduoard Saget: For me, it comes down to three things: the pace of innovation, form and function and the ability to integrate. It takes time to develop these things, and other industries must move in parallel at the same pace of innovation. The early adopters are willing to compromise, but for mass adoption, all of these things have to come together. If you solve the right clinical and financial problems without creating new ones, adoption will happen faster.
Developing and deploying these systems can be difficult. What are some of the internal challenges companies face as they try to commercialize technology?
Mr. Saget: We needed to know if we had the right people. Because some of these technologies are new, you don’t really know what the expertise level needs to be. The present job market is volatile, so retaining these experts is important. Because we have a data-driven system, data access becomes tricky. You need to have enough data and the right data. Everything we do is pre-trained, so we have to know ahead of time what problem we’re trying to solve.
Mr. Hykes: We learned early on that we couldn’t borrow HoloLens, Magic Leap or Oculus. They’re not medical devices. They’re not optimized for performing surgeries and can’t deliver the necessary performance. So, we bit the bullet and started a very expensive nine-year process to develop what we think is a best-in-class, head-mounted wearable navigation system that is optimized for surgery.
Deploying technology into a market requires a highly trained, motivated and well-paid clinical and capital-selling team. And we learned the hard way with spine surgeons, perhaps more than any other surgical specialty, they require and demand someone around them during the procedure. That costs a ton of money.
Mr. McGann: As a spinal implant company, our need to bring on software engineers was quite an expense. The sales channel is completely different as well. So now you have to go out and hire competent capital equipment sales folks. The supply component of it required additional vendors on the approved list, as well as additional quality and regulatory work. It was a major burden for us as an organization.
Despite the challenges, enabling technology is a rapidly growing space in orthopedics. What excites you most about these technologies?
Mr. Hykes: Our hope is to bring a 26-year-old proven benefit that’s not being used to the benefit of the other 80% of patients getting spine surgery. By using AI and AR, we want to make it almost a crime not to do surgery this way that helps patients and helps surgeons operate more effectively.
Mr. McGann: I’m excited about pre-operative planning. The outcomes for spinal fusion are still not as good as surgeries in other areas of orthopedics. Those other procedures are much more predictable, and the outcomes more consistent. I look at that opportunity moving forward in the spinal world to really be able to get to more objective evidence and better patient outcomes.
Mr. Saget: I have a huge passion for the intra-operative segment. What we’re finding is the more we start automating certain systems, when you get in the operating room, and things start working without a human interacting with it, it’s kind of magical.
But it is interesting to think about what else we can do with these digital tools. Rethinking the way instruments are designed and potentially sold. Also, maybe how they help sell implants differently is an exciting area. Take an instrument, for example. Can you make it disappear because, suddenly, it’s in a space where you really don’t want to see it? We’ve done that on a small-scale project. These things are super interesting to me because I find that orthopedic surgery has not really changed a lot. Go into the trauma space. It’s the same stuff I was selling in trauma 25 years ago.
At OMTEC® 2023, we convened an expert panel of executives from orthopedic companies focused on technology. I asked those leaders about the opportunities and challenges in the orthopedic enabling technology space. Our conversation is excerpted below, but first, a little about the panel and the technologies that they have on the market:
...
At OMTEC® 2023, we convened an expert panel of executives from orthopedic companies focused on technology. I asked those leaders about the opportunities and challenges in the orthopedic enabling technology space. Our conversation is excerpted below, but first, a little about the panel and the technologies that they have on the market:
- Kevin Hykes is the President and CEO of Augmedics, maker of the xvision augmented reality navigation system for spinal surgery.
- Kevin McGann is the President and CEO of Accelus, a spine company that recently sold its REMI robotic navigation system to ATEC.
- Eduoard Saget is a Co-Founder, Board Member and co-CEO of OrthoGrid Systems. The company uses AI to unlock the full navigation potential of fluoroscopy.
Enabling technology is not new in orthopedics, but adoption has stagnated recently. Why is that?
Kevin Hykes: Navigation was introduced in 1996 by Medtronic, and their Stealth system is the 80% market share leader today. After 26 years, it has not breached 20% adoption in the market. Compare that to DaVinci, the robot for prostatectomy, which is now at 85% procedural penetration after a little over ten years. So, there’s something wrong with the cost/benefit tradeoff for navigation.
Today’s systems require a physician to look away from the patient while operating on their spinal column, to look across the room at two-dimensional screens, and try to mentally form a three-dimensional model of the patient’s spine as they’re working. With today’s systems, every time someone reaches in or out of the field or leans forward, the navigation experience stops because the line of sight has been disrupted.
Kevin McGann: Speaking specifically of the robotic portion of it, number one is the cost. It’s a significant capital expense for the hospital. In addition to large footprints, these systems also have a learning curve. And there’s really no way to sell these into the ASC setting, where a lot of degenerative spinal fusion procedures are moving. Those are big hindrances from a cost-efficiency perspective.
Eduoard Saget: For me, it comes down to three things: the pace of innovation, form and function and the ability to integrate. It takes time to develop these things, and other industries must move in parallel at the same pace of innovation. The early adopters are willing to compromise, but for mass adoption, all of these things have to come together. If you solve the right clinical and financial problems without creating new ones, adoption will happen faster.
Developing and deploying these systems can be difficult. What are some of the internal challenges companies face as they try to commercialize technology?
Mr. Saget: We needed to know if we had the right people. Because some of these technologies are new, you don’t really know what the expertise level needs to be. The present job market is volatile, so retaining these experts is important. Because we have a data-driven system, data access becomes tricky. You need to have enough data and the right data. Everything we do is pre-trained, so we have to know ahead of time what problem we’re trying to solve.
Mr. Hykes: We learned early on that we couldn’t borrow HoloLens, Magic Leap or Oculus. They’re not medical devices. They’re not optimized for performing surgeries and can’t deliver the necessary performance. So, we bit the bullet and started a very expensive nine-year process to develop what we think is a best-in-class, head-mounted wearable navigation system that is optimized for surgery.
Deploying technology into a market requires a highly trained, motivated and well-paid clinical and capital-selling team. And we learned the hard way with spine surgeons, perhaps more than any other surgical specialty, they require and demand someone around them during the procedure. That costs a ton of money.
Mr. McGann: As a spinal implant company, our need to bring on software engineers was quite an expense. The sales channel is completely different as well. So now you have to go out and hire competent capital equipment sales folks. The supply component of it required additional vendors on the approved list, as well as additional quality and regulatory work. It was a major burden for us as an organization.
Despite the challenges, enabling technology is a rapidly growing space in orthopedics. What excites you most about these technologies?
Mr. Hykes: Our hope is to bring a 26-year-old proven benefit that’s not being used to the benefit of the other 80% of patients getting spine surgery. By using AI and AR, we want to make it almost a crime not to do surgery this way that helps patients and helps surgeons operate more effectively.
Mr. McGann: I’m excited about pre-operative planning. The outcomes for spinal fusion are still not as good as surgeries in other areas of orthopedics. Those other procedures are much more predictable, and the outcomes more consistent. I look at that opportunity moving forward in the spinal world to really be able to get to more objective evidence and better patient outcomes.
Mr. Saget: I have a huge passion for the intra-operative segment. What we’re finding is the more we start automating certain systems, when you get in the operating room, and things start working without a human interacting with it, it’s kind of magical.
But it is interesting to think about what else we can do with these digital tools. Rethinking the way instruments are designed and potentially sold. Also, maybe how they help sell implants differently is an exciting area. Take an instrument, for example. Can you make it disappear because, suddenly, it’s in a space where you really don’t want to see it? We’ve done that on a small-scale project. These things are super interesting to me because I find that orthopedic surgery has not really changed a lot. Go into the trauma space. It’s the same stuff I was selling in trauma 25 years ago.
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ME
Mike Evers is a Senior Market Analyst and writer with over 15 years of experience in the medical industry, spanning cardiac rhythm management, ER coding and billing, and orthopedics. He joined ORTHOWORLD in 2018, where he provides market analysis and editorial coverage.
