Robot wars: knee surgery marks new battleground for companies
Robot wars: knee surgery marks new battleground for
companies
* Robots promise better results for tricky knee
operations
* Stryker and Smith & Nephew face off with rival
systems
* Aim to emulate da Vinci robot success in abdominal
surgery
* Clinical trial results still needed to prove case
By Paul Sandle and Ben Hirschler Thursday, 6 July 2017
14:30 GMT
LONDON, July 6 (Reuters) - The world's top medical
technology companies are turning to robots to help with complex knee surgery,
promising quicker procedures and better results in operations that often leave
patients dissatisfied.
Demand for artificial replacement joints is growing fast,
as baby boomers' knees and hips wear out, but for the past 15 years rival firms
have failed to deliver a technological advance to gain them significant market
share.
Now U.S.-based Stryker and Britain's Smith & Nephew
believe that is about to change, as robots give them an edge.
Robots should mean less trauma to patients and faster
recovery, although they still need to prove themselves in definitive clinical
studies, which will not report results for a couple of years.
Fares Haddad, a consultant surgeon at University College
London Hospitals, is one of the first in Britain to use the new robots and has
been impressed. However, he agrees healthcare providers need decisive data to
prove they are worth an investment that can be as much as $1 million for each
robot.
"The main reason for using a robotic system is to
improve precision and to be able to hit very accurately a target that varies
from patient to patient," he said. "It is particularly useful in
knees because they are more problematic (than hips) and there are a chunk of
patients that aren't as satisfied as we would like with their knee
replacement."
Satisfaction rates are only around 65 percent for knee
operations, against 95 percent for hips, according to industry surveys.
The rival types of robots vary in cost and
sophistication, assisting surgeons with precision image guidance for bone
cutting and the insertion of artificial joints.
PRESTIGE MACHINES
Orthopaedic companies hope to emulate the success of
Intuitive Surgical, an early pioneer of robots in hospitals, which now has more
than 4,000 of its da Vinci machines installed around the world for procedures
including prostate removal, hernia repair and hysterectomies.
In addition to selling into big Western markets, they
also want to expand robot use in India, China and other emerging markets, where
owning a prestigious high-tech system can be a marketing advantage for private
hospitals.
Stryker is leading the charge with its MAKO robotic arm,
a platform it acquired for $1.65 billion in 2013 and which has pioneered
robot-assisted whole-knee operations by determining optimal positioning and
then helping with bone cutting.
But it has competition from smaller rival Smith &
Nephew, which last week launched a cheaper product called Navio for total knee
replacements in the United States. The British group bought the company behind
Navio for $275 million in 2016.
That has kicked off the battle in earnest, since both
companies are now able to do total knee replacements, which represent the vast
majority of knee procedures.
MAKO, which uses only Stryker's joints and implants,
costs around $1 million to install, while Navio, which does not have as many
features and is not tied exclusively to Smith & Nephew's products, is less
than half the price.
Both companies believe their robots will help them
capture a bigger share of an orthopaedic market that has been split between
four big players for more than a decade.
Indeed, Smith & Nephew Chief Executive Olivier Bohuon
said it was his company's most important strategic investment for a decade.
"We are now basically head to head with
Stryker," he said in an interview. "I do believe we are going to gain
market share due to the fact we have robots, whether it's Stryker or us."
COST-EFFECTIVENESS QUESTION
Stryker, meanwhile, expects its MAKO system to start
delivering market share gains from the end of 2017.
"As we exit this year, we expect to start to see
evidence in our knee market shares," Katherine Owen, head of strategy at
Stryker, told an investment conference in June. "Our goal with MAKO on
knees is to capture hundreds of basis points of market share. What that time frame
looks like, we haven't been specific about."
Zimmer Biomet and Johnson & Johnson, the two other
big players in orthopaedics, are lagging in the robotics race but both have
plans to enter the area in different ways.
J&J is working on surgical robotics with Verily, the
life sciences arm of Google parent Alphabet, while Zimmer last year bought a
majority stake in France's Medtech, a specialist in neurosurgery.
Analysts at Morgan Stanley believe robots have the
potential to disrupt a market in artificial joints that has arguably become
commoditised, with no knee or hip implant emerging as supreme in recent years.
That chimes with the view of Smith & Nephew's Bohuon,
who argues that robots give his company a chance to punch above its weight,
despite ranking No. 4 in reconstructive surgery.
He reckons robotics could account for 20 to 40 percent of
knee operations.
Much will depend, however, on how the rival systems stack
up.
Jefferies analysts said the semi-automated bone resection
offered by MAKO might well win out in the long term, but Navio offers a far
cheaper option and is still well ahead of anything the other two major
manufacturers have today.
Orthopaedic surgeon Haddad, who has experimented with
both, said the machines were very different and healthcare systems would need
to assess their cost-effectiveness in the light of clinical trial results.
"I think the clinical benefit will be pretty obvious
but whether that justifies the upfront outlay is a big question." (Editing
by David Stamp)
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