“We have found that robotic assistance leads to improved implant positioning, alignment and ligament balance, which enable us to better replicate the patient’s natural anatomy,” said David J. Mayman, MD, chief of the Adult Reconstruction and Joint Replacement Service at HSS. “With our vast registry of patient data and strong commitment to research, HSS is in a unique position to continue leading the evolution of robotic assistance in the operating room.”

The first study found that the use of a surgical robot during total knee replacement surgery reduced the need for manipulation under anesthesia (MUA), an outpatient procedure that may be prescribed when physical therapy (PT) after surgery becomes too painful for the patient due to joint stiffness caused by scar tissue. During the course of care, approximately 3.5% of knee replacement patients undergo MUA, according to Seth A. Jerabek, MD, hip and knee surgeon at HSS and co-author of this study, typically within 90 days of their surgery. After MUA, patients are typically better able to participate in PT and progress in their recovery.

Investigators at HSS set out to determine if the use of computer navigation or robotic-arm assistance during surgery reduced the need for MUA. Previous studies have shown that the use of either tool leads to a more precise knee replacement.

The HSS researchers conducted a retrospective chart review of 21,893 knee replacement surgeries performed between April 2008 and December 2022. They found that the use of the robotic arm or computer navigation led to a significant decrease in the number of patients who needed MUA after surgery (2.7% of patients with robotic-assisted surgery; 2.8% of patients whose surgery was performed with computer navigation; 3.7% of patients whose surgery was performed without either technology).

“These results highlight the potential benefits of incorporating technological advancements into knee replacement surgery, offering improved outcomes and reducing the need for additional interventions such as MUA,” Dr. Jerabek said.

The second study compared short-term outcomes of the anterior versus the posterior approach in robotic-assisted total hip replacement (THR) surgery. “There is no consensus on which approach has a lower risk of postoperative complications,” said Elizabeth B.  Gausden, MD, MPH, a hip and knee surgeon at HSS and principal investigator of the study. “This can often lead to confusion on the part of the patient as to which approach may be best for them. Our objective was to compare rates of dislocation, re-operation, revision and patient-reported outcome measures of each approach performed with robotic assistance.”

Dr. Gausden and colleagues identified 2,040 consecutive robotic-assisted THRs for osteoarthritis in the HSS patient registry between 2017 and 2020. A total of 497 hip replacements were performed using the anterior approach; 1,542 were performed with the posterior approach.

At mean follow-up of 18 months, the researchers found no difference in the rate of dislocation, re-operation or revision surgery between the two approaches. At early follow-up of six weeks, the anterior approach was associated with a somewhat faster functional recovery. By 3 months following the THA, there were no longer significant differences between patients who had different approaches. “The take-home message is that hip replacement has excellent outcomes with each respective approach when performed by surgeons with extensive experience in that approach,” Dr. Gausden said. “While the goal of the study was not to compare robotic THA to manual THA, it is likely that the very low incidence of instability or dislocation overall can be attributed to the use of robotic technology for planning and execution.”

"As the use of robotic assistance in joint replacement surgery becomes more common, future studies should evaluate outcomes over longer periods of time,” concluded Dr. Mayman. “As a leader in the use of this technology, HSS continues to study various robotic systems to acquire the data needed to provide the evidence-based care that will benefit our patients.”  

References:

Robotic-assisted Total Knee Arthroplasty Is Associated with Decreased Manipulation under Anesthesia Compared to Manual Approach

Authors: Cale Pagan; David J. Mayman, MD; Douglas E. Padgett, MD; Jonathan M. Vigdorchik, MD; Peter K. Sculco, MD; Seth A. Jerabek, MD; Theofilos Karasavvidis, MD (HSS).

Program Number: P153 – February 14, 2024

Comparison of Short-Term Outcomes Between Direct Anterior and Posterolateral Approach in Robotic-Assisted Total Hip Arthroplasty

Authors: Nikhil Vasireddi, MHA (Case Western); Sonia Chandi, MD; Colin Neitzke; Agnes Cororaton, MS; Jason L. Blevins, MD; Jonathan M. Vigdorchik, MD; Alexander S. McLawhorn, MD, MBA; Elizabeth B. Gausden, MD, MPH (HSS).

Program Number: e076 – February 12, 2024

Research highlights include the evaluation of artificial intelligence (AI) chatbots to provide accurate answers to medical questions about spine surgery, and two retrospective studies analyzing outcomes in both knee and hip replacement surgeries performed with robotic assistance. 

HSS Research Evaluates Whether AI Chatbots Provide Reliable Medical Information

A study co-authored by Sheeraz Qureshi, MD, MBA, co-chief of HSS Spine and colleagues identified nine frequently asked questions about cervical spine surgery, which they considered to be of particular clinical relevance. Question topics ranged from the benefits and drawbacks of different surgical approaches to side effects and recovery after surgery. The questions were inputted one at a time into ChatGPT version 3.5. Two experts in cervical spine surgery who were not involved in designing the questions rated the chatbot’s responses on accuracy, appropriateness, and readability. On average, the responses received a score of 8.1/10, with a 3.9/5 for accuracy and a 2.2/3 for appropriateness. The main drawback the reviewers noted was that ChatGPT failed to provide comprehensive responses, often omitting important factors. AI chatbots are more accurate than expected when asked to answer medical questions about spine surgery, however patients still need to use extreme caution when turning to these tools for help with medical decision-making.

New HSS Studies Highlight the Benefits of Robotic-Assisted Joint Replacement Surgery

HSS investigators presented two retrospective studies analyzing outcomes in both knee and hip replacement surgeries performed with robotic assistance.

The first study co-authored by HSS hip and knee surgeon Seth A. Jerabek, MD, and colleagues found that the use of a surgical robot during total knee replacement surgery reduced the need for manipulation under anesthesia, an outpatient procedure that may be prescribed when physical therapy after surgery becomes too painful for the patient due to joint stiffness caused by scar tissue.

The second study led by HSS hip and knee surgeon Elizabeth B.  Gausden, MD, MPH and colleagues compared short-term outcomes (e.g., rates of dislocation, re-operation, revision, and patient-reported outcome measures) of the anterior versus the posterior approach in robotic-assisted total hip replacement surgery. The investigators found that hip replacement has excellent outcomes with each respective approach when performed by surgeons with extensive experience in that approach. Additionally, it is likely that the very low incidence of instability or dislocation overall can be attributed to the use of robotic technology for planning and execution.

“In the past 20 years, the Internet has been probably the number-one place that people go for medical information,” says Sheeraz Qureshi, MD, MBA, co-chief of HSS Spine and co-author of the study. “I haven’t yet heard from any patients who have used ChatGPT or other chatbots in this way, but it’s definitely where we see things going. The same way that people use search engines to look for medical information now, we expect they will use chatbots in the future, including in their decision-making process.”

For this study a team of investigators identified nine frequently asked questions about cervical spine surgery, which they considered to be of particular clinical relevance. Question topics ranged from the benefits and drawbacks of different surgical approaches to side effects and recovery after surgery. The questions were inputted one at a time into ChatGPT version 3.5.

Two experts in cervical spine surgery who were not involved in designing the questions rated the chatbot’s responses on accuracy, appropriateness, and readability. On average, the responses received a score of 8.1/10, with a 3.9/5 for accuracy and a 2.2/3 for appropriateness. The main drawback the reviewers noted was that ChatGPT failed to provide comprehensive responses, often omitting important factors. For example, it described a particular procedure as being more challenging without mentioning that the level of challenge depended on patient indications as well as the surgeon's overall practice, training and comfort with the technique. 

The experts noted that the responses were easier for people to understand than research literature, which can be complicated for non-experts. Flesh-Kincaid Grade Level analysis determined that ChatGPT's responses were at the level of a junior in high school, compared with primary literature, which is aimed at scholars working in the field. They also appreciated that responses from ChatGPT were always prefaced with a statement regarding consulting an expert for medical advice.

Dr. Qureshi explains that one serious concern with using a chatbot versus a web search is that it’s not clear where the information is being sourced from. “Most people know not to blindly trust everything they find on the Internet,” he says. “If a search takes you to the webpage for HSS or another well-established medical center, you can feel confident that the information has been vetted by experts.”

The researchers plan to continue studying this topic to better understand how patients are using AI tools. Ultimately, their hope is to identify opportunities to ensure that when AI is responding to medical queries it is prioritizing the most reliable and credentialed information.

“The future of musculoskeletal care delivery will be driven by expertise increasingly augmented with data and technology to expand access, monitor musculoskeletal health, study movement, and prevent disease,” said HSS Chief Performance Officer Scott DeNegre. “We have a timely opportunity to marry the foremost experts in medicine, data science, and technology to design a better system of care.”

This support from Schmidt Futures, a philanthropic initiative founded by Eric and Wendy Schmidt, will be dedicated to creating the HSS Data Innovation Lab, with the mission of assembling exceptional artificial intelligence researchers and partnering them with clinicians to develop new technology and accelerate ongoing efforts to modernize care delivery. When grounded in trusted clinical expertise, artificial intelligence has the potential to transform healthcare delivery, unlocking the best practices in medical decision making and treatment planning, and enabling personalized, high quality, care to be delivered at scale.

“Together, we can not only revolutionize the delivery system, but also democratize high quality care and enable access for underserved communities across the globe,” said HSS President and CEO Bryan T. Kelly, MD, MBA.

The cornerstone of the HSS Data Innovation Lab will be the data ecosystem, which will enable the exploration of disease generation, injury risk factors, and successful treatment options across patients from different racial, ethnic, and socioeconomic backgrounds. The knowledge, mathematical models, and technology solutions developed in the lab will expand access to care, improve clinical outcomes, and advance our understanding of musculoskeletal disease. The output of the lab will be made available to healthcare providers and patients across the globe, laying the foundation for significant disruption in our field and enabling humans to live longer and healthier lives.

This innovative surgery revolutionizes conventional anatomical stemmed total shoulder replacement, using an elliptical-shaped head which is anatomically matched to the ovoid shape of the ball-and-socket joint in the human shoulder. The stemmed elliptical head enables surgeons to readily convert an anatomic total shoulder replacement prosthesis to a reverse shoulder replacement prosthesis, should a revision surgery ever be needed in the future. Dr. Blaine is the first surgeon in the world to use this advanced technology, placing an elliptical head on a stemmed implant.

Anatomic total shoulder replacement arthroplasty is often advised for patients with osteoarthritis. This surgery replaces the ball and socket with artificial components, allowing younger patients to stay active and play sports. Reverse shoulder replacement is advised when patients have both arthritis and a deficient rotator cuff. The natural positions of the ball and socket are switched. A metal ball implant is placed where the patient's own natural socket was, and a plastic socket implant is placed on the top of the humeral head.

For the past 50 years, since they were first introduced by Dr. Charles Neer in the 1970s, the heads of the prostheses used in shoulder replacement surgeries have been spherically shaped. In the last several years however, two manufacturers have introduced elliptical heads which may improve range of motion and healthy shoulder functionality over spherical heads, according to some biomechanical and clinical studies.

“The main reason for implanting a convertible prosthesis in a patient’s shoulder is that an anatomic shoulder replacement provides a more normal shoulder than a reverse prosthesis in active patients.  However, if a patient ever had an injury or tear of the rotator cuff in the future, we now have better options with a stemmed prosthesis,” explains Dr. Blaine. “Up until now, we haven’t had convertibility from a standard ball-and-socket prosthesis to a reverse prosthesis. The stemmed elliptical head prosthesis for anatomic replacement gives us the ability to make this conversion in a more expedient way without having to remove the stem.”

“One of our primary goals at HSS is to reproduce or recapitulate the human anatomy,” Dr. Blaine adds. “The normal anatomy of the shoulder joint is an egg-shaped head, not a sphere. This new approach allows us to get closer to replicating the normal function of the human shoulder so patients can remain active well into their later years.”

These first procedures using elliptical head prostheses at HSS Stamford have been successful, and the technology is now being used at multiple centers throughout the U.S. Dr. Blaine also reports that HSS will soon be conducting a motion analysis study in conjunction with other institutions to compare shoulder replacement patients who received oval-shaped heads versus those who received spherical heads.

Through the HSS Innovation Institute, HSS and MARS will collaborate to advance musculoskeletal imaging and diagnosis, including evaluation of specific aspects of the MARS 5x120 Extremity Scanner and potential co-development of new scanning technologies and systems.

The MARS 5x120 Extremity scanner is based on detector technology that was initially developed as part of ongoing particle physics research at the European Laboratory for Particle Physics (CERN), where the Higgs Boson was discovered. The MediPix3 detector technology previously enabled MARS’s development of the world’s first commercial (2010) photon counting 3-D color x-ray, producing high contrast images of bone detail and assessment of bone density at a fracture site at a significantly reduced radiation dose compared to traditional CT. The MARS 5x120 Extremity scanner is designed as a “point-of-care” system, intended for use in clinical office and ambulatory settings, addressing clinical needs such as pre- and post-surgical planning, assessment of fracture healing, and identification of implant complications.

HSS Department of Radiology and Imaging Chairperson Hollis Potter, MD is enthusiastic about the HSS- MARS collaboration: “Our team looks forward to collaborating with MARS to assess the technology and pursue other new applications and development opportunities. We see this type of imaging modality and detector technology as the next evolution in CT scanners; as HSS physicians and innovators, our goal of continuously improving patient care and outcomes includes identifying and pursuing new technologies, as well as developing partnerships that leverage HSS’s expertise and innovative spirit with cutting-edge industry advancements to drive innovation.”

“We’re pleased that a world-class clinical organization like HSS sees the potential for the MARS CT scanning technology,” says MARS CEO Mark Figgitt. “Given their substantial experience and expertise in the field of musculoskeletal health, including the volume of orthopedic surgeries performed there, we are confident that HSS is the right partner to help us evaluate and develop our technology and clinical applications. We believe this will be a true collaboration where the complimentary expertise of both organizations come together to improve clinical care and lower costs.”

Michael Campbell, Spokesperson for the Medipix3 collaboration at CERN, said, “it is great to see the efforts of CERN and the Medipix3 Collaboration playing a pivotal role in bringing innovations in medical imaging for the benefit of the global medical community”.

 About MARS Bioimaging Limited

MARS Bioimaging was launched in 2007 by father and son team Professor Phil Butler, then Head of the New Zealand CERN research group, and his son Professor Anthony Butler, a clinical radiologist and Director of Radiology at the University of Otago, Christchurch. MARS was formed to commercialize the ground breaking MARS technology and bring photon counting CT to the clinic. To achieve this the company brought together an interdisciplinary research and development team of physicists, radiologists, engineers, computer scientists, orthopaedic and other surgeons, mathematicians, biologists, and cancer researchers. MARS systems are based on next generation x-ray detectors (Medipix3RX) developed under the Medipix3 collaboration hosted by CERN, and other partners, including the University of Canterbury (UC). In association with UC and University of Otago, Christchurch (UOC), MARS now has a team working on developing new preclinical and clinical applications for photon-counting technology. This includes, but is not limited to, bone and joint health, cancer, cardiovascular disease, and infectious disease. MARS has established itself as the world’s leading research and development group in spectral molecular imaging and to-date has delivered the world’s first commercial pre-clinical spectral CT scanner (MARS Microlab 5X120), as well as a compact human system for upper extremity evaluation (MARS Extremity 5X120). 

MARS’s technology and company have received several awards, including: HealthTech Award for Best Translational Project in HealthTech Week; Supreme Small Enterprise in the Champion Canterbury Awards; and Best Health and Science Innovation and Best Emerging Innovation at the NZ Innovation Awards.

Through the HSS Innovation Institute, HSS and Lazurite will collaborate to advance surgical technology and techniques, including evaluation of specific aspects of ArthroFree and potential co-development of new arthroscopic technologies. HSS will conduct training sessions at the HSS Simulation Learning and Training Center and may also work with Lazurite on the co-development of future technologies that leverage the ArthroFree wireless camera and proprietary Meridiem™ light technology.

By eliminating conventional camera cables that tether surgeons to the surgical tower and hinder their movement, the ArthroFree System is expected to increase OR efficiency, improve OR safety and lower customer costs. With its solid-state, low-heat, high-efficiency Meridiem light technology, the system also promises to eliminate camera-related patient burns and OR fires. The modular system is designed to be drop-in compatible with existing patient data consoles, surgical displays and endoscopes found in minimally invasive operating rooms. 

“HSS is excited to collaborate with Lazurite to evaluate the ArthroFree Wireless Surgical Camera System, provide insights into a next generation of the existing device, and potentially co-develop other medical device products utilizing this technology,” said Michael P. Ast, MD, chief medical innovation officer and a joint replacement surgeon at HSS. “As HSS physicians and innovators, our goal of continuously improving patient care and outcomes includes identifying and pursuing new technologies and developing partnerships that leverage HSS’s expertise and innovative spirit with cutting-edge industry advancements to drive new innovation forward.”

“Given HSS’s substantial capabilities in research, including the experience and expertise of its medical staff and the volume of orthopedic surgeries performed there, we believe that HSS is a great partner to conduct the various non-clinical assessments and other collaborations outlined in the agreement,” said Lazurite Board Chair Mark Froimson, MD.

“We’re pleased that a world-class clinical organization like HSS sees the potential for the ArthroFree System to become the standard of care in the minimally invasive OR,” Lazurite President and General Counsel Leah Brownlee said. “HSS has been a pioneer in orthopedic research and innovation for decades. The hospital performs more than 32,000 surgical procedures annually, including more hip surgeries and more knee replacements than any other hospital in the country. We believe this will be a beneficial experience for both HSS and Lazurite.”

About Lazurite

Lazurite is a medical device and technology company. Its ArthroFree™ System—the wireless camera for arthroscopy and general endoscopy—is designed for surgeons seeking surgical tools for greater agility in the OR. ArthroFree is drop-in compatible with current OR technologies, and it promises to eliminate cable-related patient burns, OR fires, and staff trips and falls. With the ArthroFree System, Lazurite ushers in the wireless era of surgical visualization. Lazurite’s intellectual property portfolio also includes the low-heat Meridiem light technology and products in development. The pre-revenue company is located in Cleveland, OH (est. 2015), and to date has raised ~$25M from institutional investors, family offices, and more than 75 physician champions. The mission: solve impossible problems to improve people’s lives. The 10-year vision: better outcomes for 10 million patients—and thousands of clinicians, too. For more information, see: https://lazurite.co

Forward-Looking Statements

This press release includes “forward-looking statements.” Forward-looking statements can be identified by words such as: “anticipate,” “intend,” “plan,” “believe,” “project,” “estimate,” “expect,” “may,” “should,” “will,” “designed,” “milestone,” “promises,” and similar references to future periods. Examples of forward-looking statements include, among others, statements we make regarding the expected impact of the ArthroFree System on the field of minimally invasive surgery, and particularly arthroscopic surgery, and our future sales of the ArthroFree System. Forward-looking statements are neither historical facts nor assurances of future performance. Instead, they are based only on our current beliefs, expectations, and assumptions regarding the future of our business, future plans and strategies, projections, anticipated events and trends, the economy, and other future conditions. Because forward-looking statements relate to the future, they are subject to inherent uncertainties, risks, and changes in circumstances that are difficult to predict and many of which are outside of our control. Our actual results may differ materially from those indicated in the forward-looking statements. Therefore, you should not rely on any of these forward-looking statements. Any forward-looking statement made by us in this press release is based only on information currently available to us and speaks only as of the date on which it is made. We undertake no obligation to publicly update any forward-looking statement, whether written or oral, that may be made from time to time, whether as a result of new information, future developments or otherwise.

Lazurite™, ArthroFree™, and Meridiem™ are trademarks of Lazurite Holdings LLC.

The BrightPoint^TM Epidural Needle Guidance System, Lumoptik’s first product, is a low cost, easy to use device which can help clinicians better perform epidurals using the standard-of-care Loss of Resistance (LOR) technique. BrightPoint^TM utilizes a specialized reflectometer that shows the clinician the color of the tissue at the tip of the needle in real time while inside the patient, thus providing an additional, objective indication that the needle is in the correct position. BrightPoint^TM is designed to work as part of the LOR technique, in combination with standard needles and syringes and can help clinicians perform LOR epidurals more safely and reliably than traditional methods.

“HSS looks forward to working with Lumoptik to evaluate and assess the BrightPoint^TM Epidural Needle Guidance System and work on new uses for Lumoptik’s innovative platform technology,” said Michael P. Ast, MD, chief medical innovation officer and a joint replacement surgeon at HSS. “This partnership is a great example of HSS being able to leverage all areas of its expertise, including anesthesia, in improving musculoskeletal care.”

The HSS Innovation Institute played a central role in bringing together the appropriate HSS skillsets and expertise to optimize the collaboration with Lumoptik. “Our mission to advance patient care through new technologies and partnerships aligns with the potential of Lumoptik’s technology and our anesthesia team to drive this new innovation forward,” said Doug Leach, vice president of Device Innovation at HSS.

“Using epidural anesthesia with patients who have musculoskeletal disease can be particularly challenging given the impact that arthritis and injury can have on the spine,” said Michael Singleton, MD, an anesthesiologist at HSS. “I am excited to see Lumoptik’s use of technology in an area that is ripe for modernization.”

“We are very pleased that a world class clinical organization like HSS sees the opportunity for our BrightPoint^TM Epidural System to potentially become the standard of care. We also look forward to working with them to develop additional high value medical products based on our platform technology. We believe this will be a fruitful relationship for both HSS and Lumoptik,” said Frank Lyman, CEO of Lumoptik.

About Lumoptik

Lumoptik, Inc. is a medical device company that has developed the BrightPoint^TM Epidural System to assist physicians with needle placement during epidural procedures for childbirth, spine/back pain and surgical procedures such as knee and hip replacements. Over 11 million epidural procedures are performed in the US each year with over 30 million performed worldwide. BrightPoint^TM is a platform technology with multiple potential medical uses in orthopedics, pain management, neurology, vascular access and urology. Lumoptik is a private company with a diverse investor base. For further information, please visit www.lumoptik.com or contact Frank Lyman, CEO at frank.lyman@lumoptik.com.

About Zimmer Biomet

Zimmer Biomet is a global medical technology leader with a comprehensive portfolio designed to maximize mobility and improve health. We seamlessly transform the patient experience through our innovative products and suite of integrated digital and robotic technologies that leverage data, data analytics and artificial intelligence.  

With 90+ years of trusted leadership and proven expertise, Zimmer Biomet is positioned to deliver the highest quality solutions to patients and providers. Our legacy continues to come to life today through our progressive culture of evolution and innovation. 

For more information about our product portfolio, our operations in 25+ countries and sales in 100+ countries or about joining our team, visit www.zimmerbiomet.com or follow Zimmer Biomet on Twitter at www.twitter.com/zimmerbiomet.

One case was a hip procedure performed by hip and knee surgeon Robert L. Buly, MD, at HSS in New York City, while the other was a shoulder procedure performed by orthopedic surgeon Patrick Connor, MD, at the OrthoCarolina Center in Charlotte N.C.

Luigi Ferrari, LimaCorporate CEO, stated, “The successful completion of these first two ProMade surgeries produced at the ProMade PoC Center is a source of pride for LimaCorporate. It demonstrates what can be achieved when our technology and know-how are combined with leading expert surgeons, such as Dr. Buly and Dr. Connor, and the visionary health care institution of HSS.  We’re all united by the same goal: to advance patient care and to restore the eMotion of Motion.”

The ProMade PoC Center offers the opportunity for enhanced collaboration between the design and manufacturing engineers and the surgeons to develop patient-specific solutions before being 3D printed in the onsite facility. It reduces by weeks the time to surgery and has become a resource available not only to HSS physicians, but to providers and hospitals throughout the U.S.

“The accessibility of the ProMade PoC Center is greatly beneficial to providers to meet the needs of patients with especially unique cases,” said Dr. Connor. “Such customized solutions may provide a viable opportunity to those individuals who face very limited options for reconstruction and improve the chances for success.”

Dr. Buly added, “3D printing has advantages over conventional machining particularly for the ease with which very complex shapes can be made. It is important for orthopedic implants to match the anatomical requirements of the individual, and I’m thrilled to have addressed my unique case in collaboration with ProMade engineers to develop a patient-specific component and expedite what was once a time-intensive, international production process.”

The center, established through a long-standing strategic relationship between HSS and LimaCorporate, is an FDA-regulated commercial facility located at the HSS main campus in New York City.  The aim of this innovative, first of its kind project is to provide faster and more accessible care for U.S. patients requiring personalized and unique complex joint replacement solutions.

“We couldn’t be more excited to see our vision for the ProMade PoC Center realized with these first patient-specific implants,” said Louis A. Shapiro, President and CEO of HSS. “HSS has always been focused on advancing the field of orthopedics, and we’re proud to offer solutions that benefit providers and patients across the country. This center and our ongoing partnership with LimaCorporate represent HSS’ innovative spirit. By sharing our knowledge and creating new levels of access to custom 3D printing capabilities, we hope to continue to empower best-in-class patient care and accelerate the development of new complex musculoskeletal solutions.”
 

About LimaCorporate

LimaCorporate is a global orthopedic company, focused on digital innovation and tailored hardware, which advances patient centred care.  Its pioneering technological solutions are developed to empower surgeons, and to improve patient outcomes from joint replacement surgery.  Its primary focus is on providing reconstructive and custom-made orthopedic solutions to surgeons, enabling them to improve the quality of life of patients by restoring the joy of movement.

Headquartered in Italy, the company operates in over 20 countries around the world. LimaCorporate offers products ranging from large joint revision and primary implants, to complete extremities solutions, including fixation.

For additional information on the Company, please visit www.limacorporate.com 
 

Since 1979, HSS has been a pioneer in creating and bringing innovative technology to market to advance patient outcomes. HSS has led the industry in musculoskeletal innovation by supporting new ideas from inventors and by partnering with HSS experts to improve wellness, performance, and patient care. The HSS Innovation Institute was established in 2016 to accelerate state-of-the-art concepts and inventions through partnerships with industry, investors, and entrepreneurs and deepen relationships between engineers, physicians, researchers, surgeons, and scientists.

Today, the Institute is working to advance the use of patented hardware and analytical software, intelligent strength training and rehabilitation techniques, and devices to reduce pain, increase stability, correct deformities, and restore functions.

“HSS is the leader in musculoskeletal health around the world, and for decades our clinicians, scientists, and biomechanics engineers have been working side by side to advance technology and accelerate the discovery of treatment options,” said Mr. Shapiro. “We are excited to welcome Dr. Ast to our executive leadership team to help us remain laser focused on our approach to innovation, to drive forward-thinking leadership, and create new pathways that benefit patients everywhere.”

“HSS is uniquely positioned to capitalize on our expertise and leadership to continue to advance the field of musculoskeletal care across the world,” said Dr. Kelly. “The importance of collaborating is paramount now more than ever to ensure that we fulfill our responsibility to discover and improve treatment solutions for the routine and the most complex cases.”

In his new role, Dr. Ast will work closely with Mr. Harmon and the Innovation Institute team to support new, viable offerings that can improve clinical outcomes, enhance the patient experience, or lower the cost of care delivery in a meaningful way. 

“We are honored to welcome Dr. Ast to the Innovation team,” said Jordan Harmon, VP, Chief Innovation and Commercialization Officer at HSS. “Creating innovative healthcare solutions requires collaboration between clinical, administrative, and business experts. The HSS Innovation Institute will benefit greatly from Dr. Ast’s expertise in these areas. Dr. Ast will bring his vast knowledge and pioneering expertise from both a medical and business perspective, which will be invaluable as we navigate the healthcare landscape of tomorrow.”

“As a surgeon with both academic and private practice experience, I understand the challenges of a clinical practice and how innovation can offer solutions,” said Dr. Ast. “I look forward to utilizing my background in value-based care implementation, advanced technology for surgical training, and data integration and analytics to help achieve the goals of the HSS Innovation Institute.”

Dr. Ast added that innovation is more than product development. “As healthcare becomes more complex, we must continue to innovate care delivery strategies, education, and data management,” he explained. “Looking to the future, innovative solutions in healthcare will require a multifaceted team effort with viewpoints from the clinical, administrative, and business sides.”

As a member of the Adult Reconstruction and Joint Replacement Service at HSS, Dr. Ast’s clinical practice focuses on rapid-recovery, short-stay, and outpatient joint replacement surgery. He has extensive experience in robotic and computer-assisted surgery. Dr. Ast is a published researcher and noted speaker nationally and internationally on topics including technology in and around the surgical episode, healthcare economics and the business of clinical orthopaedics. Dr. Ast completed his fellowship in Adult Reconstruction and Joint Replacement surgery at HSS and went on to develop and direct one of the largest and most successful outpatient joint replacement programs in the northeast before returning to HSS in 2018.

HSS is an academic medical center specialized in rheumatic and musculoskeletal health, ranked no. 1 in orthopedics worldwide by Newsweek and nationwide by US News & World Report. CLEAR is a touchless identity verification platform used by millions of people across North America for safe and easy access to third-party services and travel.

CLEAR's Health Pass is a free, mobile experience on the CLEAR app, which securely connects a person's verified identity to their proof of vaccination, to reduce public health risk. The service is approved by New York City and has been used by more than 130 organizations across the country. HSS patients who choose to use CLEAR’s Health Pass for proof of vaccination in advance of their next visit will experience a touchless and expedited check-in once onsite. Guests who do not wish to use this technology will continue with staff-guided screenings and check-in onsite. The free, optional service is now available across HSS locations in New York City, with further expansion planned to HSS locations in other parts of New York as well as Connecticut, New Jersey, and Florida.

“I’m pleased that this collaboration provides assurance and convenience for our patients today, but more excited by how HSS and CLEAR can together advance personalization for healthcare consumers more broadly,” said Louis A. Shapiro, president and CEO of HSS. “This combines our commitment to superior care with a shared vision for digital innovation, data integration, and state-of-the-art technology: together we have uniquely valuable opportunities.”

An innovation in the growing field of remote patient monitoring, it is the first implantable device approved to collect data on an individual’s progress after a total knee replacement − vital information securely relayed to a cloud-based platform for the orthopedic surgeon to review.

Known as the Persona IQ, the smart knee was granted authorization from the U.S. Food and Drug Administration (FDA) in August. Although the technology doesn’t preclude office visits altogether, it enables the doctor to actively monitor a patient’s recovery with real-world, objective data to supplement their care.

Remote monitoring can be especially useful during the early post-operative period, Dr. Sculco says. “In the first several weeks following knee replacement, hard work is required from the patient, and there can be deviations in recovery that can set people on the wrong path. The earlier you identify a patient who may not be progressing as well as you would like, the sooner you can intervene,” he explains. “This could mean a change in an individual’s physical therapy plan, enhanced patient education, anti-inflammatory medication or the use of an ice machine. When I go into the exam room to see a patient at the six-week follow-up visit, I should have a very granular understanding of how his or her recovery is going.”

The smart knee contains a sensor that is integrated into the joint replacement prosthesis. Once implanted, it records and wirelessly transmits gait data and other information to a personal base station, about the size of a modem, that plugs into an outlet at the patient’s home. The data is then securely sent to a cloud-based platform where the orthopedic surgeon can review it and check on the patient’s progress and recovery.

“The smart knee uses the same material and technology found in implanted cardiac devices such as pacemakers,” explains Dr. Cushner, who is also a founder and chief medical officer of Canary Medical, the company that designed the sensor technology. “It collects data every day during the first year following surgery, providing objective, accurate information on how the knee is functioning. Patient monitoring can continue for much longer, though, as the battery that powers the device was made to last at least 10 years.”

Dr. Sculco notes that as time goes by and more patients receive the smart implant, it has the potential to amass a vast amount of information on gait metrics following knee replacement. Down the road, orthopedic researchers could potentially use data analytics and machine learning to translate that information into evidence-based recommendations to ultimately improve outcomes and enhance patient care.

HSS is the world’s leading academic medical center specializing in orthopedics, rheumatology, and related disciplines. In Orthopedics, HSS is ranked No. 1 in the world by Newsweek, and No. 1 in the nation – for the past 11 years – by U.S. News & World Report. VRE is the developer of TESLASUIT, the world’s first smart full-body suit designed to improve the user’s motor skills through electro-stimulation in XR (VR/AR) training, utilizing rich real-time data. 

The collaboration is the first aimed at assessing and fundamentally improving human movement and physical rehabilitation using full body sensors, covering 95% of the muscle mass of the human body. It combines 157 years of accumulated HSS knowledge of musculoskeletal health with TESLASUIT smart technology, which integrates biometry, motion capture and haptic feedback. Through the HSS Innovation Institute, the partnership aims to advance personalized, real-time diagnostics, training and physical rehabilitation. 

“HSS has a unique responsibility and opportunity to advance the field of musculoskeletal health, combining our expertise and state-of-the-art technology for better wellness, injury prevention, diagnosis, treatment and recovery,” said Louis A. Shapiro, President and CEO of HSS. “This partnership with TESLASUIT is another example of how we are fulfilling our Purpose, to help people get back to what they need and love to do better than any other place in the world.”

The TESLASUIT award-winning smart bodysuit offers a combination of integrated technologies and is the first wearable technology in the market to combine haptic feedback biometry, advanced motion capture system which alongside EMS and TENS, can deliver a wide range of sensations and collect rich data from the body for real-time tracking that can enable detailed analytics.

“Our products’ effectiveness for enhancing human performance is already proven for XR synthetic training across many of the world’s largest companies and research institutions. So partnering with HSS makes perfect sense to utilize TESLASUIT’s technologies in innovative medicine, combining our advanced systems’ technologies and joint expertise. Together we can significantly improve the quality of patient care. Our partnership with the Hospital for Special Surgery will extend our capability to be at the forefront of immersive technology, powering the future of medical healthcare solutions,” said Sergei Nossoff, CEO of VR Electronics Ltd.

In Medicine and Rehabilitation, the TESLASUIT combined technologies allow physicians to process and analyze biometry and movement data for diagnostics and monitoring purposes, allowing instant haptic feedback, to extend each session using advanced EMS & TENS to enhance user performance and experience throughout the rehabilitation lifecycle.

“Integrating HSS knowledge and expertise within TESLASUIT technology will continue to propel HSS ahead in Next Generation Care. This is another example of how HSS is bringing technology to the world through development of high-quality remote diagnostics, virtual monitoring, and data-driven training across the continuum of care.” said Jordan Harmon, HSS Vice President of Care Delivery Innovation. 

This collaboration will further support HSS’s plans to expand its footprint in Performance and Prevention, using data science as a backbone to improve motion analytics for musculoskeletal care, and leverage wearable technology for a connected healthcare experience.

“This partnership will bring together the best minds across musculoskeletal health and wearable technology market-leaders to help empower patients and consumers to move better, train better, rehab better, and live better.” said Leonard Achan, President of the HSS Innovation Institute. 

Severe arthritis in his right wrist caused ongoing pain and prevented Mr. Eisen, who lives in Atlanta, from engaging in activities he enjoys. He is right-handed, which makes it even more difficult. Seven years ago, he started to investigate treatments and learned about total wrist replacement surgery. But unlike knee and hip replacements, which are common and have excellent outcomes, wrist replacement surgery has not enjoyed the same degree of success.

Mr. Eisen’s online research prompted him to take his first trip to New York for a consultation with Dr. Wolfe in 2014. Mr. Eisen had read about Dr. Wolfe’s extensive research into how the wrist moves and learned that he and his long-time colleague and co-inventor, Joseph J. (Trey) Crisco, III, Ph.D., Director of Bioengineering at the Warren Alpert Medical School, Brown University and Rhode Island Hospital, were working on designing a new, more durable wrist replacement. Mr. Eisen has been following their progress for the past seven years.

Last year, the KinematX™ Total Wrist Arthroplasty System, which is manufactured by Extremity Medical, LLC, received 510(k) clearance from the US Food and Drug Administration (FDA). The design is the culmination of three decades of award-winning research by Dr. Wolfe and Dr. Crisco. Over the years, they and their colleagues have received more than $10 million in research grants from the National Institutes of Health to study the wrist.

Mr. Eisen is looking forward to regaining the use of his wrist. “It had become more painful over the years, with the pain often radiating up to my forearm,” he explains. “My wrist movement was severely restricted, making it difficult to do anything that required me to bend my wrist. Everyday activities like cooking, working around the house or picking up a pot of coffee with my right hand were difficult and painful.”

Dr. Wolfe believes the KinematX™ has advantages over traditional implants. “Our extensive research into how the wrist moves helped us design a device that more closely matches the anatomy and motion of a normal wrist,” he explains. “This should allow for more natural movement and increased durability compared to currently available implants. Some studies report failure rates of 50% within 5 to 10 years, mainly due to loosening of the implant components.”

“In our view, the KinematX™ will be a game changer in the field of wrist replacement surgery,” said Doug Leach, managing director of Biomechanical Innovation at the HSS Innovation Institute. “Current wrist replacement devices are relatively dated. The new implant design leverages the clinical and bioengineering experience of Drs. Wolfe and Crisco, their seminal research, and modern-day engineering and design principals of total joint replacement in general.”

Wrist arthritis is one of the most common and debilitating conditions treated by hand surgeons, affecting about 5 million people in the United States, according to Dr. Wolfe. A fusion of the wrist bones can alleviate pain, but patients are often limited in performing some activities. Wrist joint replacement surgery was proposed five decades ago as an option to relieve pain and restore function.

When Drs. Wolfe and Crisco set out to design a better wrist replacement, the first step was to unravel the complexity of how individual bones move in a normal wrist and in one that has sustained an injury. Their research led to the design and validation of a noninvasive three-dimensional motion analysis system to measure wrist kinematics, which describes the wrist motions necessary for a wide range of activities. Armed with that information, they sat down at Dr. Wolfe’s kitchen table and started sketching out their idea for a novel wrist replacement.

The wrist is highly complex, made up of more than a dozen individual joints formed by eight small bones that collectively make up the wrist. It was previously believed that the wrist moved the hand in two different planes – up and down or side to side. The research by Drs. Wolfe and Crisco demonstrated that during many activities, such as throwing a ball, hammering a nail or pouring a glass of water, the wrist doesn’t move in just one of these directions. It accomplishes the action by combining movements in both planes.

“Traditional wrist replacements often constrain the wrist to move in one plane at a time, and this puts stress on surrounding joints," said Dr. Wolfe. “The increased loads on the implant-bone interface often lead to prosthesis loosening and mechanical failure. In addition, traditional implants often make it difficult or impossible to return to some activities, such as tennis or golf.”

The KinematX™ is the only wrist replacement that is computer-designed to mimic the kinematics, or motion, of a human wrist – movements that are instrumental in throwing, hammering and other high-performance activities, according to Dr. Wolfe. The unique design should enable the implant to be more durable than traditional wrist replacements.

Surgery with the KinematX™ entails replacing the proximal carpal row bones of the wrist, which are those most severely affected by osteoarthritis. The device utilizes modular components in various sizes to replicate the complex anatomy of the wrist and allow the motion necessary for occupational, recreational and household activities.

The Innovation Institute at HSS played a key role in the development of the new wrist replacement, working closely with Drs. Wolfe and Crisco to obtain a patent for their research and design ideas. The patent for the wrist replacement was licensed to Extremity Medical, LLC, a privately funded medical device company in New Jersey.

“Our goal is to work with talented HSS physicians, inventors and entrepreneurs to empower them to develop innovations in musculoskeletal health that could improve or even revolutionize patient care,” Mr. Leach said.

A patient registry will be established at HSS and other leading medical centers across the country to track data on outcomes. Mr. Eisen says he will gladly report his progress. After recovery, he looks forward to going back to playing golf, fishing, working around the house and waxing his car.

To see a video of Dr. Wolfe discussing the new wrist replacement, visit: https://www.youtube.com/watch?v=BWgd-NtW5PI