How can orthopedic manufacturers capitalize on the next wave of innovation? Which advancements will experience the greatest adoption in orthopedics, and why? The future of orthopedics is happening now. Progress is being made on materials that increase implant longevity, designs that improve patient outcomes and speed recovery, robotic and computer-assisted technologies that enhance accuracy, reliability and speed. This panel boasts future-minded surgeon entrepreneurs and researchers who have varied practical experience from the leading edge of tomorrow’s solutions. They shared perspective on what’s working in orthopedics, what gaps remain and how orthopedic manufacturers can develop new, relevant products that solve problems and alleviate pressures for surgeons and hospitals.

2. Moderator:
Robert A. Poggie, Ph.D.
Consultant in orthopaedic biomaterials and devices, BioVera, Inc., Montreal
Panelists:
Joshua J. Jacobs, M.D.
Hip and knee surgeon, Rush University Medical Center, Midwest Orthopaedics at Rush, Chicago
Kornelis Poelstra, M.D., Ph.D.
Spine surgeon, The Spine Institute on the Emerald Coast and Sacred Heart Hospital, Destin
The Robotic Spine Institute of Silicon Valley – Los Gatos, CA
Douglas B. Unis, M.D.
Hip and knee surgeon, Mount Sinai and Monogram Orthopaedics, New York City
KEYNOTE SESSION
Innovation in Orthopedics: Surgeon Perspectives

3. # 1: Stimulate discussion, answer your questions regarding past, current and
future innovations in orthopedic implant design, biomaterials, computer-
technology driven devices, surgical techniques and post-op care.
• Communicate panelists’ past and current professional
experience in technology innovation in orthopedics.
“What’s worked, and not.”
• Identify unmet clinical needs and problems ripe for improvement.
“Real-life clinical problems for patients and HCPs, e.g. infection.”
• Share and discuss predictions for the future of orthopedic innovation.
“Understanding past successes and failures illuminates the future.”
OBJECTIVES

4. • Since 1992, employed (S&N, Implex, Zimmer, Pipeline Orthopedics) and
self-employed (BioVera) in the orthopaedic industry.
• Applied in research, clinical affairs, regulatory affairs and medical education.
• R&D experience with Oxinium, Trabecular Metal, cross-linked UHMWPE,
resorbable polymers, titanium alloys, ceramics, surface engineering.
• Current focus includes strategy, tactics and execution of regulatory applications,
applied research, testing, biomaterials and commercialization in USA and Canada.
• BE in Mechanical Engineering and MS and PhD degrees in Materials Science &
Engineering, all from Vanderbilt University in Nashville, TN.
Robert A. Poggie, Ph.D.
Consultant in orthopaedic biomaterials and devices, BioVera, Inc.

5. UHMWPE in the 21st century, meaning:
• High mol. wt. resin, tightly-controlled time, pressure, heat of consolidation,
moderate to high cross-linking, and chemical stabilization (Vit E).
Porous metals for biological fixation, meaning:
• 50 – 80% porous, 250-750 micron pore size, open, 3D cancellous-like structure,
biocompatible (Ti, Zr, Ta…). Proven clinically in primary, revision and salvage
arthroplasty and bone replacement/reconstruction.
Ceramics, meaning:
• High resistance to wear & degradation in vivo, biocompatible. Solids such as
alumina, toughened-alumina, stabilized zirconia; coatings such as TiN, TiNbN;
Engineered surfaces (Oxinium)
And Not…Modularity for MIS, inadequately tested hard-on-hard hip bearings,
“low-stiffness” Ti alloys for hips, coatings for hip and knee bearings…
What's Worked, and Not: My Experience….

6. Patient-specific and computer driven solutions, meaning:
• Computing power enabling: True, real-time (surgical schedule) patient-specific
implants; more accurate and reliable bone resections and positioning of implants;
real-time intra-op feedback…
Resorbable polymers & coatings for the 21st century, meaning:
• Biomaterials that perform the targeted clinical function (soft tissue repair,
augmentation, replacement…) without adverse tissue rxns.
Ceramics in the 21st century, meaning:
• Solid ceramics, coatings, and engineered surfaces that are stronger,
tougher and more affordable.
Anti-microbial technologies, meaning:
• Single-stage implants and therapies that reduce probability of infection
for patients at high-risk (oncology, salvage, revision, trauma...).
Current Trends, Future?: My Experience…

7. • Fellowship-trained adult reconstructive orthopaedic surgeon
• Vice President of Research, Rush University Medical Center
• NIH-funded researcher
• Past-President AAOS and ORS
• Current research focus: tribocorrosion performance of contemporary hip
replacements, systemic effects of total joint replacement, including metal allergy and
biological response to degradation products from permanent orthopaedic implants
• BS in Materials Science and Engineering from Northwestern University in Evanston,
IL; M.D. from the University of Illinois in Chicago, IL; Harvard Combined Orthopaedic
Surgery Residency Program, Boston, MA; Adult Reconstructive Orthopaedic
Surgery Fellowship, Rush University Medical Center, Chicago, IL
Joshua J. Jacobs, M.D.
Hip and knee surgeon, Rush University Medical Center
and Midwest Orthopaedics at Rush

8. The Operation of the Century:
Total Hip Replacement
Learmonth, ID; Young, C, and Rorabeck, C
Lancet 2007 Oct 27;370(9597):1508-19.
What's Worked, and Not: My Experience….

9. Historical Challenges in Joint Replacement:
Markedly Improved
• Aseptic Loosening
• Wear
• Osteolysis
What's Worked, and Not: My Experience….

10. Historical Challenges in Joint Replacement: Not Yet Solved
• Tribocorrosion
• Instability
• Infection
• Restoration of “Normal” Function and Activity Level
• Variations in Surgical Technique
What's Worked, and Not: My Experience….

11. Opportunities to further improve TJR:
• Utilize biochemical and biomechanical biomarkers to make appropriate
implant choices and/or to time targeted biological intervention
• Increase durability of TJR device with advanced testing protocols
• Include computer algorithms to predict wear in silico
• Eliminate/manage tribocorrosion
• New engineering tools in performance analysis

12. • Founder and Director of the Spine Center of Excellence at Sacred Heart Hospital
• Specialized in long-construct minimally invasive surgeries, adult deformity,
revision and oncologic conditions, fracture treatment, cervical arthroplasty
• World leader in robotic surgery; performed > 700 complex robotic cases
• Extensive background in implant-associated wound infections, novel materials,
and worked on stem cell implantation for spinal cord injury
• Ph.D., Biomedical Engineering from the University of Groningen, The Netherlands
• Pushed FDA for encouraging research and collaboration to identify alternate
materials for the design of novel (smart) implants…
• Transitioning to California – The Robotic Spine Institute of Silicon Valley
Kornelis Poelstra, M.D., Ph.D.
Spine surgeon, The Spine Institute on the Emerald Coast and Sacred Heart Hospital

13. 3D Printing and osteointegration:
• Excellent Young’s modulus for increasing osteoporotic patients
• Difficulty assessing true “fusion” – or is it even necessary?
MIS Spine surgery:
• Less is more…Some statistical ‘advantages’ have only limited clinical significance
• No true definition on what MIS means in Spine Surgery…
Molybdenum Rhenium (MoRe) implants:
• 2-3x stronger / Greater durability / Smaller implants / Less material
• Hydrophilicity / 3D printable / entirely new architecture possible
Robotics:
• Improved accuracy; reduced complications; reduced revisions
• Better prepared surgeons execute faster and safer complex operations
• Less stress – more attention to things beyond hardware placement…
And Not…
• Facet replacement and lumbar disc arthroplasty
• Preservation of adjacent motion segments to a fusion…
• Patient specific implants & lasers….
What's Worked, and Not: My Experience….

14. Automation of Surgical Procedures:
• Robotics and Navigation will rule through
• Direct Visual input (Lidar-type navigation)
• Radiographic assistance 2D / 3D (utilizing WiFi sensors for RealTime UltraFidelity navigation)
SMART Implant technology with MoRe implants:
• Identify bone healing remotely through patient’s personal smart-phone
• Energy transfer to interbody sensors – communication with PRO-devices
• Micro strain sensors on spine rods / inside interbody cages to assess fusion
Technology hubs:
• Academic centers are traditionally slow to adopt… Privademic hubs
• Trainees are behind the times when they come out, or
• Trainees require advanced equipment/nav/robots to even consider a job
Considerable difficulty to get paid…:
• Technological and material advancements are costly while payors / ASCs and
hospital systems are feeling reimbursement-pressures and reduce implant &
technology capital expense budgets
Current Trends, Future?: My Experience….

15. • Associate Professor, Icahn School of Medicine at Mount Sinai
• Founder and Chief Medical Officer of Monogram Orthopaedics
• Research interests: 3D printing of custom implants, AI in medical image modeling
and robotic assisted surgery
• Pioneering disruptive, just-in-time technology delivering clinically superior,
cost-efficient solution for adult joint arthroplasty
• Consultant, DePuy
• Extensive experience in Direct Anterior THA and Kinematically Aligned TKA
• M.D.-Case Western Reserve University; Residency-Northwestern, Fellowship-Rush
Douglas B. Unis, M.D.
Hip and knee surgeon, Mount Sinai and Monogram Orthopaedics

16. Robotics:
• Not going anywhere and still in gen 1!
• Mid-term evidence of higher survivorship
• Net stress reliever for surgeons
Kinematic Alignment TKAs:
• Data showing we’re closing in on the elusive 20% less than satisfied pts.
• Will not get struck by lightning if tibia in a touch of varus
Dual Mobility:
• Address spine/pelvis issues
Outpatient Joints/RRP:
• Cost Savings, ASUs
• Equivalent or better outcomes
• Risk Stratification and multidisciplinary pathways, enabling technologies
And Not…PSI, Cementless tibias, HA
What's Worked, and Not: My Experience….

17. Mass customization-Possible, practical, economical, beneficial:
• 3D Printing in metal continues to evolve
• Inventory solution
• Medical image modeling faster, more precise with AI
AI/Deep Learning:
• Rapid image processing and algos will support new technologies
Better cementless knees:
• Fixation, Bone Prep, Balancing, Custom Implants
Smart Implants:
• Embedded Sensors to detect loosening, wear, infection, motion, stability
Trackerless Robotic Surgery & Machine Vision:
• Cut out registration time and fiddle factor
Current Trends, Future?: My Experience….

18. Where is innovation taking us today?
Trends in biomaterials.
Lessons learned and applied in implant design.
Trends in computer aided and robotic surgery.
Trends in patient-specific instruments & implants.
3D printing of devices, at point of care and manufacturers.
Trends in patient care, from diagnosis, to surgery, to post-op.
DISCUSSION, Q&A

19. Moderator:
Robert A. Poggie, Ph.D.
Consultant in orthopaedic biomaterials and devices, BioVera, Inc., Montreal
Panelists:
Joshua J. Jacobs, M.D.
Hip and knee surgeon, Rush University Medical Center, Midwest Orthopaedics at Rush, Chicago
Kornelis Poelstra, M.D., Ph.D.
Spine surgeon, The Spine Institute on the Emerald Coast and Sacred Heart Hospital, Destin
The Robotic Spine Institute of Silicon Valley – Los Gatos, CA
Douglas B. Unis, M.D.
Hip and knee surgeon, Mount Sinai and Monogram Orthopaedics, New York City
KEYNOTE SESSION
Innovation in Orthopedics: Surgeon Perspectives