The SourceTrust custom contracting team recently traveled to Las Vegas for the 2015 Annual Meeting of the American Academy of Orthopedic Surgeons (AAOS), the nation’s leading educator in the specialty. The team met with suppliers, networked with peers and learned about the latest technologies and trends in orthopedics. Hot topics this year included:

1. 3D printing technology: Biomet released the G7 OsseoTi shell, to be used with its acetabular platform launched last year that employs color coding to reduce instrument sets and increase efficiency flow in the OR during hip arthroplasty procedures. One of the surprisingly innovative aspects of this product is the use of human CT data in combination with 3D printing technology to build a structure purported to directly mimic that of human cancellous bone. Biomet claims that this process generates a single porous architecture allowing creation of complex shapes while maintaining the consistent porosity and strength necessary to facilitate bone and tissue ingrowth and implant stability.

2. Advanced technology for total knee revision arthroplasty: One innovative technology for revision knee procedures is DJO Global’s Exprt System, which has the potential to improve patient outcomes as well as efficiencies in the operating suite. Exprt’s streamlined, compact design reduces turnaround times, minimizes waste and has proven implant design technology―all for 40 to 70 percent of the cost of comparable knee revision systems. A simple, comprehensive two-tray system replaces the traditional eight-tray setup used during complex total knee revisions, reducing prep time, eliminating unnecessary surgical steps and improving the precision skills of revision surgeons.

Lowry Barnes, M.D., chairman of Orthopaedics at University of Arkansas for Medical Sciences, comments that “the Exprt approach leads to efficient operations that save both time and money, while providing excellent early results. My operating team especially appreciates the fact that only two pans of instruments are opened. I believe that I can speak for the entire Exprt design team when I say that we have met our goals in offering a high-value, high-quality revision knee system for the accomplished surgeon.”

“In today’s value-driven healthcare environment, cost effectiveness is crucial in order to provide stakeholders with a high-quality result at a reasonable cost,” says Dr. Richard Lorio, chief of Adult Reconstructive Surgery at NYU Langone Medical Center. “Putting the patient ahead of profits, the Exprt System allows skilled surgeons to provide TKA [total knee arthroplasty] patients with a functional knee at a fraction of traditional costs.”

3. Robotics: As with AAOS 2014, robotics continues to be an area of great interest. The two main players in this arena are MAKO Surgical Corp. and Blue Belt Technologies. Limitations of the former include restricting surgeons to using only MAKO or Stryker implants, increasing disposable costs. In addition, MAKO manufactures implants for use in total hip and partial knee arthroplasty (although it anticipates launching a total knee platform later this year). Acquiring MAKO robotics is also costly. Blue Belt is more economical and provides surgeons with the option of using its STRIDE implants as well as those manufactured by Smith & Nephew, DJO Global, StelKast and DePuy Synthes. However, Blue Belt is currently approved only for partial knee procedures. Like MAKO, it expects to release a total knee implant in late 2015.

4. Patient-reported outcomes measures (PROM): These days, surgeons and hospitals can’t just say they are good at orthopedics. To gain market share, they have to prove they are clinically excellent. That means demonstrating that they are high-quality, low-cost providers of care while providing a good patient experience. The measures used to prove value are evolving from research-focused tools toward scoring instruments that are meaningful to patients. A good example is PROMIS, a means of measuring patient-reported physical, mental and social health status that is backed by the National Institutes of Health. InVivoLink demonstrated its platform for capturing PROMIS scores pre- and post-procedure to better understand clinical performance across patients, procedures and surgeons. When these PROM measures are analyzed along with implant consumption and cost data, they’re a powerful tool for driving surgical volume, surgeon engagement and cost savings. 

5. Outpatient surgery: To get ahead of this increasing market trend, Zimmer rolled out its Z-23 initiative that endeavors to limit hospital stays for hip replacement patients to no more than 23 hours. The program stresses the importance of better patient selection and creating efficiencies in the OR. More total joint procedures are moving entirely to outpatient settings thanks to better medications and anesthesia, the popularity of minimally invasive approaches, younger patients seeking such procedures, and private payer support.

6. Shoulder market: Matthew P. Willis, M.D., a fellowship-trained orthopaedic surgeon at Baptist Hospital and TriStar Centennial Medical Center in Nashville who specializes in disorders of the shoulder, discussed emerging technologies and pricing in the shoulder market at a HealthTrust-sponsored dinner during the annual meeting.

“More than hips or knees, shoulder technology continues to make significant advances,” Willis says. “This is particularly true with regards to reverse shoulder arthroplasty technology. Impending developments such as universal glenoid baseplates for total and reverse arthroplasty as well as patient specific instrumentation are on the horizon.”

Willis also addressed pricing and reimbursement. “As reimbursements for hospital systems continue to decline, competitive pricing on shoulder implants becomes more important than ever. There are no shoulder implant companies that currently offer technology to justify significantly higher pricing than [their] competitors.”

On the subject of hospital and physician alignment, Willis says the “best approach to achieving hospital and physician alignment is for the two parties to have open and transparent discussions about what is important to each. Most physicians are willing to help on cost containment if approached with reasonable alternatives and accurate data. The best case scenario is when both parties are incentivized to manage costs. If not currently, such a model may be attainable in the future. “