Implants are becoming “smart” in orthopedics

In knee replacement surgery, an orthopedic surgeon replaces the surface of the bone and cartilage in the knee with an artificial joint. The procedure, which was first performed in the 1960s, is designed to help patients with arthritis or who have suffered an injury, so that they can continue to walk and do other daily activities without pain. .

Surgeons at the Special Surgery Hospital are still trying to determine what types of patients are best suited to benefit from the smart implant. This is something they plan to study through multiple research studies. So far, patient selection has focused on “tech-savvy” patients interested in accessing this data, according to Sculco.

“This is uncharted territory,” Cushner said. “We are going to learn from the data that we collect, and that will guide us.”

It is no longer a “pipe dream”

Smart implants have been a topic of interest in orthopedics for years, but the drive to connect data across the continuum of care and advances in sensor technology have made it a reality.

“Maybe 10 years ago, it was more of a pipe dream,” said Dr. Antonia Chen, research director for arthroplasty services at Brigham and Women’s Hospital in Boston and chair of the program committee of the American Association of Hip and Knee Surgeons. “Finally having a product on the market is very exciting. I think there will only be more there.

Ultimately, the vision behind smart implants is for the devices to give orthopedic surgeons more information, Chen said. This could someday mean implants that detect problems such as infections or if the implant itself loosens, allowing these problems to be detected at an earlier stage and in some cases potentially avoiding having to reoperate a patient.

The average rate of reoperation for a total knee replacement, in which a surgeon would replace all or part of the original implant, one year after surgery is 1.6%, according to a study published last year, each costing around $ 20,000. Almost half of readmissions within 90 days of total knee replacement surgery were associated with reoperation within the first year.

Traditionally, it has been difficult to get sensors small enough to fit into the structure of an implant without significant modifications, said Eric Ledet, director of the Health Innovations Incubator at the Center for Disability Services in Albany, New. York, and professor of biomedical sciences. engineer at the Rensselaer Polytechnic Institute who studies orthopedics.

Knee implants have been refined and improved over the years. Manufacturers don’t want to develop a completely new, unproven device just to be more compatible with a sensor.

“It’s potentially taking several steps back in terms of the safety and effectiveness of the implant if any significant changes need to be made,” he said. “As detection technology has become more mature (and) more advanced, there are now more and more opportunities to integrate detection technology into implants without having to modify the implant as much. “

The Persona IQ product adds a sensor from Canary Medical in a rod extension on the implant, which is typically a “solid piece of metal,” said Dr. Bill Hunter, Founder and CEO of Canary Medical. It made sense for Zimmer Biomet and Canary Medical to start with a smart knee, as the sensor and electronics are about the size of an AAA battery and a knee is large enough to accommodate that without changing the size. of the implant.

The sensor doesn’t have software that needs to be updated, according to Hunter. The implant mainly collects and transmits data, while data analysis takes place outside the implant.

The push to integrate sensors into implants also coincides with a growing interest in equipping patients with connected devices that further displace home care and monitoring.

The COVID-19 crisis has spurred new efforts to keep care out of hospital, replacing some office visits with video visits and using remote patient monitoring tools to alert care teams when patients deteriorate. In recent months, health systems and businesses have formed coalitions to lobby for “hospital-to-home” programs.

The Centers for Medicare and Medicaid Services had already aligned some incentives for following up patients after joint replacement procedures with the Comprehensive Care for Joint Replacement Model, a pooled payment model that covers a patient’s episode of care from their admission up to 90 days after discharge, creating an opportunity for technologies that the developers believe can help surgeons improve outcomes.

In recent years, CMS has also released billable codes for remote monitoring of patients, paving the way for clinicians to spend more time with this data.

“This opened up, much more widely, the possibility for doctors’ offices and clinicians to be paid for another (care) vector,” said Matt Miksic, an analyst at Credit Suisse who covers medical supplies and devices, citing an estimate that surgeons could be reimbursed $ 200 per month per knee patient with remote patient monitoring codes.