The keynote of OMTEC® 2022 featured executives from some of the most prominent players in orthopedics. The panel, moderated by Piper Sandler’s Matt O’Brien, included:
- Curt Hartman, President and CEO, CONMED
- Brady Shirley, President and COO, Enovis
- Rebecca Whitney, Senior VP and President Global Spine, ZimVie
- Eric Major, Entrepreneur and Advisor, Major Advisory Group
The panel discussed the state of orthopedics today and in the future. Below are some of their takeaways regarding procedure volumes, supply chain disruption, the future of advanced materials, the role of enabling technology and the shift of procedures out of hospital settings.
Seasonal Volume Norms Not in Play
Orthopedic elective procedure volumes recovered more than expected in the first quarter of 2022, but the situation remains clouded. Early indications for the second quarter point to fair volumes but a deceleration in recovery. Enovis President and COO Brady Shirley said, “The thing that has been strange to me is that seasonal norms are not really in play. Regionally, different places are up and down. What we’ve historically seen in different periods has been very predictable for joint replacement. That has changed, and I think that’s where we’ll be for the rest of the year.”
CONMED CEO Curt Hartman said the complete shutdown of procedures in March 2020 was straightforward in hindsight. Since then, the totality of the environment has become more variable and challenging to manage. In addition to disruption from COVID and staffing shortages, more patients are putting off elective surgeries due to economic uncertainty.
Supply Chain Partnerships Tighten
Closer collaboration with supply chain partners has been a critical adaptation for device companies throughout the pandemic. Hartman said, “The bigger factor from my chair is the supply chain and global logistics, and how those are impacting everyone’s capabilities. Our organization is putting a lot of focus, it feels almost hourly, on connecting with our supplier base. Not only our tier-one suppliers, but tiers two and three.”
Managing relationships and teams have been more challenging during the pandemic, especially for those like Eric Major, who played a pivotal role in the global integration of Stryker and K2M. The rapid adoption of virtual and remote work revealed a sharp generational divide in the workforce. He said, “How are companies going to function going forward when we’re hiring a new generation that wants to work from home? I believe a lot of work gets done in person, around the table.”
The Future of Advanced Materials
K2M adopted additive manufacturing relatively early compared to the rest of the orthopedic industry. Major sees another advancement coming soon. He said, “We had titanium in the late '90s, then the market shifted to PEEK and then additive manufacturing. We should all be watching what is next. I think it happens every ten years.”
Hartman sees an opportunity to personalize care through patient-specific combinations of implant materials and orthobiologics. Cobalt chrome will continue to be “under fire” because of infection rates and could bring an opportunity for more ceramics in the market, according to Mr. Shirley. He believes that the market could see more implants using a combination of existing materials.
Enabling Technology Discussion
Rebecca Whitney, ZimVie’s President of Global Spine, believes the real opportunity for innovation in orthopedics lies beyond the implant. While there’s room for improvement, current implant technology is closer to its full potential than enabling technology. Artificial intelligence and predictive analytics have nearly untapped potential in orthopedics.
While robotics dominates much of the discussion around enabling technology, Whitney believes each procedure has a unique set of requirements. She said, “Robotics is growing very quickly, but we don’t yet see it taking hold. Some of that is due to cost constraints, frankly. It is priced out for smaller community hospitals, and globally it can be cost-prohibitive. It is very difficult for most surgery centers to acquire a robot. We’re focused on bringing the right enabling technology to the right procedure.”
Brady Shirley takes a conservative approach to the potential of today’s enabling technology, pointing out there is a scarcity of clinical data showing improved outcomes. However, he believes the data can be extremely valuable when tracking the entire patient journey. He said, “Where the big data matters is pre-operative care, surgical intervention and post-surgical protocol. When you track across all of those, caregivers will make different decisions.”
ASCs Reach Inflection Point
The shift of procedures out of the hospital started a long time ago, but recently gained momentum from the pandemic and changing hospital attitudes. According to Eric Major, hospitals had been “very uptight” about losing procedures to ASCs but are now more open to partnerships and ownership stakes in outpatient centers.
Rebecca Whitney ran Zimmer Biomet’s ASC business before her role at ZimVie, and called the space a “win, win, win.” She said it’s better for the patients, providers and payors. Patients strongly prefer ASCs and are increasingly informed about their surgical options.
The panel agreed that most orthopedic procedures would eventually move to the outpatient setting, but some hurdles remain. These settings have space constraints, fewer offered services and must carefully consider patient selection. Additionally, Shirley called managing inventory for a surgeon customer at multiple sites a “devastating challenge.”
Several panel members reflected that many of these trends have been visible on the horizon for years. Change in medicine takes a long time. However, orthopedics is current at a confluence of events that is accelerating the rate of adoption and change. We expect the orthopedic industry will look very different in the next ten years.