Devices & Diagnostics

The robotic have-not: How J&J plans to woo hospitals, knee surgeons

As the buzz around robotics grows, J&J ‘s DePuy Synthes is touting the clinical and economic evidence tied to its non-robotic knee platform to help hospitals navigate the bundled payments era, but will that sway them?

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Johnson & Johnson and Verily Life Sciences (formerly Google Life Sciences) have a joint venture to create the next generation of robotic surgery souped up with digital technologies in the future. (Watch out Intuitive Surgical.)

But when it comes to hip and knee replacement today, J&J Depuy Synthes is a robotic have-not.

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Competitors have robots or are close to having something robotic in joint replacement.

On Tuesday, Stryker launched its total knee application on the expensive Mako robot during the annual meeting of the American Academy of Orthopaedic Surgeons in San Diego. That same day at AAOS, Smith & Nephew previewed its hand-held robot-assisted device for total knee replacements in advance of a market release in the second quarter. And Zimmer-Biomet was also proudly displaying its robot on the exhibit floor — the Rosa robot acquired with the purchase of French firm Medtech SA – although the robot won’t be doing total knee replacements until 2018.

There is a general notion that robotics will gain ground in orthopedic surgery though the predictions around adoption pace vary greatly.

One analyst — Brandon Henry from RBC Capital Markets — believes Stryker will be the clear winner with the launch of its total knee on its Mako robotic system and will take market share away from Johnson & Johnson DePuy Synthes and Zimmer-Biomet in the next few years. Another — Richard Newitter from Leerink Partners — believes robotics adoption will be much more gradual and only in complex cases but still having one in the short term is better than not having one.

So in the meantime without a robot, how can J&J DePuy Synthes woo hospitals and knee surgeons, some of whom are part of Medicare’s mandatory 90-day bundled payment program called the Comprehensive Care for Joint Replacement.


Attune Knee on Bone

Company executives are relying on the wide breadth of J&J’s knee offerings, its services chops and a new company-sponsored whitepaper that touts the economic value of its Attune Knee.

“We as a company are moving from a titanium and steel focus to really looking at how can we bring more value to the surgeon,” said Ciro Römer, company group chairman, DePuy Synthes, in an interview on Wednesday at AAOS. “If you look at the actual [knee] platform, 400,000  have been implanted until now with outstanding outcomes. Not great outcomes only with regards to survivorship but more importantly the economic benefit of the Attune knee.”

So what are those economic benefits?

A whitepaper produced by the company and based on data from company-initiated studies, investigator-initiated studies, and independent studies and national joint registries found the following per a company news release: [ Note: Both the whitepaper authors are financially compensated by DePuy Synthes. Dr. David Fisher, director of the Total Joint Center of Excellence at OrthoIndy Hospital in Indianapolis, is a consultant. Co-author David Parkin, an honorary visiting professor at City University  London, and a senior visiting fellow, Office of Health Economics, London, has no formal consulting contract with DePuy Synthes but was paid to analyze the data and produce the report.]

  • The published report from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR) showed that the ATTUNE Knee’s estimated cumulative percent revision was 1.39% at three years (98.61% survivorship)for 4,463 knees, comparing favorably to the class of Cemented Total Knee Arthroplasty that has an estimated
    cumulative percent revision of 1.50%.
  • A U.S. hospital database analysis showed 39% lower odds of patient discharge to a skilled nursing facility when implanted with an ATTUNE Knee, compared to patients who received total knee replacement with a Triathlon Knee. [The Triathlon is the total knee implant made by Stryker.]

The latter data point is important at a time when hospitals are racing to reduce the post-acute costs of a joint replacement procedure. The rationale is that if you can reduce use of a skilled nursing facility after the joint replacement implant procedure, some dent may be made in the overall cost.

But not everyone is buying the easy correlation between implant quality and reduced skilled nursing facility use.

Dr. Thomas Barber, an orthopedic surgeon with Kaiser Permanente said he doesn’t pay a lot of attention to company-produced reports.

“You have to take them at face value,” Barber said in a media roundtable at AAOS on Wednesday. “I saw something the other day from a particular vendor who shall be nameless that said that using their total knee replacement will actually lead to lower SNF length of stay and lower SNF use, and I was like, “Really?”

Meanwhile, while such data may not sway hospitals and surgeons, the technology that DePuy Synthes possesses in it services suite might pique their interest.

The company has a partnership with IBM Watson Health through which the Big Data crunching supercomputer can comb through patient profiles and help providers understand their risk profile.

“The system is fed data about patient profiles and based on the patient profile — whether you have high BMI, whether you have diabetes — and that can help determine what kind of preparation, procedure and very importantly the kind of rehabilitation you will need to have and the most likely complication,” declared Juan-José Gonzalez, president, DePuy Synthes, U.S. in an interview with Römer. “No other company has those capabilities.”

Photo: jpa1999, Getty Images and Johnson & Johnson DePuy Synthes