With the cost and frequency of revisions increasing for total and partial knees, hospitals will seek out solutions.
Excerpt from South County Hospital (RI) article, JAN 2013:
"Recently released clinical research data* confirms what many orthopedic surgeons recognized early on: MAKO offers significant improvement in patient outcome for total hip replacement and for knee resurfacing because of the technology. These improved outcomes result from superior implant positioning, which directly affects patient mobility, implant longevity, and patient satisfaction. The studies compared MAKO with “manual” procedures at a number of highly-regarded U.S. hospitals, performed by some of the most respected orthopedic surgeons in the country.
A long-term study, in which leading orthopedic surgeons at Massachusetts General Hospital participated, showed that optimal cup positioning in manually performed total hip replacement procedures was achieved in only 47 percent of cases. This compares to 96 percent in MAKO assisted total hip replacement procedures (other studies show rates of 100 percent), as determined by 2-dimensional X-rays. (Optimal cup positioning has been determined to be a 30° to 45° inclination and 5° to 25° version.)
For partial knee replacement, studies looked at patients 2 years after surgery, which is when accurate data on revision rates can be determined. The results: patients who had undergone MAKO knee resurfacing showed a rate of only 0.4 percent revision, which compares with a rate of between 4 percent to more than 6 percent in manually performed partial knee replacement. Also, comparing MAKO knee patients in which both compartments of the knee had been replaced, with traditional total knee replacement patients, studies showed that MAKO patients had greater range of motion, greater quad strength, and higher functional activity at 2, 4, and 6-weeks after surgery."
Sentiment: Strong Buy
Hip replacement growth in 2013 is the key catalyst to Mako's comeback. The research done by Dr. Henrik Malchau at UMass shows amazing value in using RIO robotic alignment. The Metal-on-Metal disaster scaring the be-jesus out of the public is due primarily to initial bad "manual" (I like this word) alignment. The metal joints deteriorate due to the excessive rubbing and enters the blood system. As surgeons and hospitals get over the initial shock of what is happening and has happened, they will see robotic alignment as the only viable safe solution used in combination with larger joints that do not have metal on metal - as Ferre mentioned, the larger joints require even MORE alignment precision.
Unfortunately, the statistics of bad total knee replacement is not very significant (4-6% misaligned), some patients will see the risk/value trade off of doing TKA over Partial - many surgeons tell patients that they will eventually need to address the other compartment(s) - this adds to the costs of doing Partial over TKA. This will really s*ck for a start-up like Bluebelt.
Longer term, as surgeons are "forced" to use Mako to do proper hip, they will see the value in using Mako for other types of orthopedic/joint surgery - knee, shoulder, spine, etc. it will literally extend the longevity of surgeons very much like what they are saying about DaVinci for urological and vascular surgeons.
FWIW, this is how I see this playing out.
I am curious what the cost difference is between Mako revisions when needed and traditional surgery. That averaged with the lower need AND increased patient satisfaction should be well received by hospitals and surgeons.
Does Mako charge the hospital the same fee when a revision is needed? That would lower the overall cost of revisions even more. Or am I missing something?
The bigger question may be what are revisions costing hospitals in addition to increased litigation risk. Not a lot of data on partial knees as its an expanding market. But there is data for the costs associated with total knee revisions and the costs are staggering. Makoplasty research indicates a lot of these costs can be eliminated or put off for longer with the use of MAKO technology.
"The popularity of total knee arthroplasty combined with the aging US population indicates a dramatic increase in revision TKA procedures. Our objective was to project revision sur- gery costs in the United States, and to estimate the financial burden for hospitals historically under-reimbursed for these complex surgical procedures. Inflation adjusted charge data derived from a series of knee revision surgeries performed by a single surgeon practice (CJL) (n = 100) were applied to population projections of the number of revision surgeries expected for the Medicare population from 2005–2030.
The average charge of TKA revision surgery was $73,696, (Cost was $36,848) with substantially higher costs for patients un- dergoing surgery because of deep joint infection, patients receiving a three component exchange, and patients receiv- ing hinged or constrained condylar knee implants. The num- ber of revision procedures is expected to increase from 37,544 in 2005 to 56,918 in 2030. Projected hospital costs for these procedures may exceed $2 billion by 2030. The number of revision knee surgeries may increase by 66% in the next 25 years. Reimbursement rates will not cover hospital costs for this procedure despite recent increases in Medicare pay- ments for revision arthroplasty."
Replace * (2)
Sentiment: Strong Buy
A little more info on the sources of the data, presented at ISTA and Harvard:
"Clinical Research and Marketing — Efforts to build a strong base of clinical evidence for both partial knee and total hip MAKOplasty continue, with over 70 clinical studies currently in process. During the third quarter, MAKOplasty was discussed in five presentations at the International Society for Technology in Arthroplasty (ISTA) 2012 Meeting in Sydney, Australia and in three presentations at the Harvard Advances in Arthroplasty Meeting in Boston, Massachusetts.
Two MAKOplasty presentations at these meetings were of particular significance. At ISTA, the two year survivorship data on MAKO's RESTORIS MCK onlay medial unicompartmental implant using the RIO system was presented. This four-site study reported on two year post implantation outcomes for 224 patients, and showed a 0.4% revision rate at two years for MCK implants using the RIO, as compared to revision rates for manually placed unicompartmental knees, which are documented at 4.0% in the Swedish and 4.9% in the Australian registries.
At the Harvard meeting, Dr. Henrik Malchau compared acetabular cup placement in 77 MAKOplasty THA cases done at four hospitals to the results presented by Callanan et al in the 2011 Clinical Orthopaedics and Related Research (CORR) Charnley Award Paper. Based on 2D image evaluation of the post-op x-rays, 84% of the RIO cases were inside the Massachusetts General Hospital restricted safe zone compared to 47% reported in the CORR paper, while the 3D image evaluation of the data showed that 96% of the cases were within this restricted safe zone."
Sentiment: Strong Buy