Total Knee Replacement (TKR) is a viable treatment option for patients whose knees have become excessively worn or degenerated due to osteoarthritis. Modern TKR can be traced back to the 1970s, and since then, research into implant and instrumentation design has greatly improved outcomes such that TKR now demonstrates long-term survivorship. Despite these progressive developments, there are mounting financial costs, both direct and indirect, associated with managing osteoarthritis of the knee. As a result, major orthopedic companies are pursuing alternate avenues to increase efficiency and reduce the economic burden of TKR. There are three potential strategies that medical device companies can adopt to drive value in joint replacement procedures: capital equipment-focused, commodity-focused, and patient-specific innovation.

For a capital equipment-focused approach, surgical robot assistants like Stryker’s MAKO total knee system will be employed, resulting in consistent, reproducible implant placement, as well as less soft tissue damage and shorter rehabilitation periods. Although these systems will require a huge capital investment up front, the rationale is that there will be lower post-surgical costs and therefore increased profitability over time. This front-load strategy will be most suitable for hospitals in developed countries with a robust healthcare infrastructure that can afford the initial capital investment.

The commodity-focused approach will emphasize the use of inexpensive generic implants, like Medtronic’s Responsive Orthopedic portfolio, which would decrease the direct cost of surgery. To reduce the rate of post-surgical interventions, an adapter design could be agreed upon between various implants, such that only the components closest to the joint articulation will differ. In the case of the knee, standard stems will exist that fit into tibial trays and femoral components from multiple manufacturers. This strategy will leverage economies of scale in production and improve inventory management, which will be suitable for price-sensitive providers in developing countries.

The patient-specific approach would focus on custom implants, like Conformis’ iTotal Knee System, which will potentially lead to fewer complications and reduce post-acute care costs. The viability of this method as a scalable cost-saving measure is heavily predicated on the rate of advancement in technologies such as 3D printing and telerobotics. This strategy will be more suited for healthcare facilities in countries with an adequate infrastructure but without the funds to afford expensive capital investment.

These three strategies, which are neither mutually exclusive nor collectively exhaustive, give some insight into the direction of the large joint reconstruction space. Consequently, companies will have to choose which strategy to pursue based on the value proposition and how well each approach fits with their strategic vision. Invariably, improvements in robot-assisted technology will improve a commodity and custom-implant approach. At the same time, custom implants will help decrease incidences of malalignment in computer-assisted surgeries. As a result, the future of knee implant devices for each company will be heavily determined by company resources and the target market.