I joined Optimized Ortho as a graduate and then transitioned to Corin, working in what we call the production process to deliver the reports and guides for surgery on patients. I became a team leader of Corin’s OPS™
(Optimized Positioning System) production team after two years and moved from Sydney to Corin’s UK headquarters to set up a team for OPS™ in the UK.
At university I really liked the mechanics and dynamics kind of subjects and I could really understand reaction forces and material behaviour. That naturally led to orthopaedics, combining my interests of mechanical engineering with the human body.
In Australia it’s quite rare for companies to develop orthopaedic solutions, mostly the companies there are regional sales offices, so my first choice out of university was Optimized Ortho. I landed a trial week, and then got a full-time position as everything was being signed off for Corin’s acquisition of Optimized Ortho.
I remember everyone at Optimized Ortho seeming quite excited, because suddenly the acquisition by Corin gave them access to greater resources.
What do you do at Corin?
When I first started, I was processing the cases to produce the reports and surgical guides. For these we receive the imaging CTs and X-rays from the hospital and then go through a defined process to take measurements and understand the how the patient moves. We create models of the bones, find landmarks on them, measure angles on X-rays and run it through a simulation to position the implants.
From this, guides are created for the surgeon in CAD software so they can achieve the planned implant positions.
Patients can be very different and the most critical part in the process is the implant positioning: for some people you need to lengthen their legs to balance them out again.
Some surgeons want to have a discussion with the engineer for each case, certainly for their early cases, or more complex cases, and this really makes you feel a part of their surgical team.
What continues to get you up in the morning?
The thought of: “Alright we've got to get these cases out for these patients or they're not going to have what they've been promised.”
The surgeon has told them they're getting a personalised treatment. If we don't finish the analysis in enough time for everything to run smoothly then they're not going to get the treatment they were told they'd get.
How has your role evolved?
I now work across lots of different parts of the company from production to R&D as well as working directly with the surgeons: probably 20 per cent of surgeons will, at least once a week, want to clarify something. This may be more information, or a request to run an analysis with a minor change to see the effect - lengthening the leg, for example.
When surgeons start with OPS™ they typically want to have the conversations on almost every case until they are more comfortable and trust the reports. We’re on hand when they need to go into more detail, and so are the sales team - and cascading that knowledge down with the sales reps has been very important.
How do you feel you support the surgeon?
Everything we do is set-up to support the surgeon, giving them the insight to perform the operation more successfully. The data suggests about 17 per cent of the population has an excessive change in pelvic tilt. And you can't tell who that 17 per cent is until you do the analysis.
We quite frequently get surgeons asking us "should I give you a really hard case for my first one?”, often they'll give us a random patient and it will happen to show a problem they hadn't expected. Every patient has the potential to be that patient.
In addition to the pelvic tilt analysis, there's also the femoral side to define the height of the implant. Several surgeons have told us they used to just put their thumb on a certain landmark and cut at that height, regardless of how small or large a person is. I think the femoral planning is a huge benefit.
Anecdotally, there are quite a few surgeons who now feel like they wouldn’t want to do a surgery without OPS™, at least having the reports, if not the guides as well. So from that point of view it feels like it must be making quite a big difference. Surgeons are quite hard to convince.
How have things changed and how will they?
The process has and continues to improve, with more data to base development off. And we can support more surgeries.
I remember going out for lunch 3 years ago to celebrate doing 30 cases in a month. Two years ago it would have taken about 10 hours to produce the patient analysis. It now takes roughly 4. And we just completed analysis on 300 cases in the last month.
A lot of this time saving has been through automating the process and making sure everything in the process is very defined. In the medical environment everything has to be very consistent, so a report looks the same if I do the analysis for a case or someone else in the team does it. This saves time and removes ambiguity.
What effect are you seeing for the patient?
The Australian National Joint Registry would seem to suggest that the revision rate using OPS™ could be lower, however, revision is multifactorial so right now it is difficult to say, ongoing clinical research will need to continue to confirm this.
With OPS™, the acetabular placement is accurate to a patient-specific orientation and at least one study has been published that demonstrates the femoral osteotomy with OPS™ is extremely accurate, compared to what was a very rudimentary process before.
The Australian Registry data shows a correlation with OPS™ becoming more widely adopted and an improved survival rate for Corin implants. But it's still probably too early to tell.
What additional insights are you working on?
Spino-pelvic tilt is a topic that's been picked up by all the major conferences worldwide: the BOA meeting, the DKOU in Germany, the AOA in Australia, the AAOS in the USA all have sessions that are now dedicated to spino-pelvic tilt which definitely wasn't the case when I started.
I remember it taking literally hours to explain to surgeons what spino-pelvic motion was and what it was all about, whereas now pretty much everyone would have a basic understanding.
Originally we had the acetabular offering. Then we added the femoral side. We've added range of motion through implant impingement analysis. And this means greater insight for the surgeon (and better outcome for the patient) as we move forward in time. We’re also developing a revision OPS™ solution.
The 3D-printed guides, which are made from surgical grade materials, are quite an expensive part of the process. Obviously that's something hospitals are concerned about these days. We're therefore working on offering alternative delivery methods for the technology. The planning is now extremely detailed. There's little bits and pieces we can add but the fundamental parts being the cup orientation, based on the spino-pelvic motion, and the leg-length / offset change for the femoral side.
These evolutions and system developments will continue to improve outcomes for patients, and help drive efficiency within the hospital.
Reduced revision rates are a key factor in the decision of orthopaedic supplier, and OPS™ feeds into to the delivery of increased value in healthcare. Greater insight and accuracy enables surgeons to get it right first time.