Orthopedics: The New Automobile?

blank blank Feb 22, 2020

I have spent the last two decades collaborating with surgeons to develop devices and systems for improved patient outcomes focused primarily on three A’s of orthopedics:  Arthrodesis, Arthroplasty, and Arthroscopy.  I am now focused on the fourth A: automobiles.  That is right, automobiles.

I have noticed many parallels between the evolution of automobiles and orthopedic devices over the past 100 years.  In the 1920s, Henry Ford perfected mass production techniques to create a car for the masses, built on an assembly line with interchangeable parts.  Ford produced nearly 15 million Model T’s and established the blueprint for great American car companies to follow.  This revolution in assembly line-based mass production became the poster child of Industry 2.0 and lasted until the early 1980s.  

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An example of a personalized 3D printed spine fusion device created using predictive analytics.

So, what changed?  In the late 1970s, there was an oil crisis in the US.  The lack of availability of affordable gasoline created an immediate demand for smaller, fuel-efficient cars.  The big 3 automakers in Detroit were slow to respond to the growing market demand and stood by the Henry Ford model.

By this time In the East, Toyota had developed the next-generation model for a successful automotive company.  With the principles of just-in-time inventory, lean manufacturing, and 5S visual organization, Toyota delivered a high quality, affordable, and timely response to the changing US market dynamics.  The philosophy of the Toyota Way paired with the emerging technologies in computing and automation ushered in the rise of the 3rd industrial revolution.   The old model of mass-produced, interchangeable, assembly line produced automobiles had been replaced with a lean, build an on-demand model where the components needed to build each car in the factory were there for hours not months.  This was such a change in mentality and corporate culture, that it required visionaries like W. Edward Deming, Eliyahu Goldratt, and Kaoru Ishikawa to spend much of their lives leading the industry through decades of change.

Now we have entered the 4th industrial revolution, with the emergence of cyber-physical systems.  Advancements and integration of Artificial Intelligence (AI), advanced human-machine interface, internet of things (IoT) and decentralized cloud computing have enabled the emergence of the new automotive industry.  As unlikely as it may seem, Tesla is the most valuable US automotive company and has created the highest selling mid-size car in many markets by embracing a build-on-demand model and completely eliminating dealerships.

Orthopedic and spine surgery has followed a similar evolution.  The first hip arthroplasty system was developed by Sir John Charnley and the first pedicle screw spine fusion system was developed by Raymond Roy-Camille in the 1960s.  These two medical inventions created the modern hip arthroplasty and spine fusion industries, much in the same way that Henry Ford created the US automotive industry.  Medical device manufacturers used mass-production techniques to create millions of implants in standardized shapes and sizes to provide surgeons devices to treat the mass market.

In the 1990s and 2000s, automation and computing advances made their way to the operating room.  The integration of surgical navigation and surgical robotics for joint replacement and spinal fusion surgery has created a man-machine interface for the preparation and placement of various standardized implants.

There may be perhaps no better case study for the need for cyber-physical systems of the Industrial Revolution 4.0 to improve the treatment for arthrodesis, arthroplasty, and arthroscopy.  A surgical candidate can be triaged with human clinical expertise and AI-based on previous clinical data to determine the best possible treatment plan.  Personalized medical devices can be 3D printed to achieve an optimal plan.  Surgical navigation and robotics can be used for precise preparation and placement of each individualized implant.  IoT devices can monitor post-operative care and create better treatment planning models.  Telemedicine post-op follow-ups can live on the 5G network.

It will take luminaries the likes of Deming and Goldratt today to lead the culture change to make Orthopedics the new automobile.  Welcome to the roaring ’20s.

About the Author:

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Mike Cordonnier – CEO of Carlsmed, Inc.
Mike is CEO and co-founder of Carlsmed, a San Diego based Med Tech company. Carlsmed’s Corra system utilizes predictive analytics to create patient-specific surgical plans and 3d printed implants to improve patient outcomes for spine surgery.  Mike has held various leadership roles for large MedTech companies NuVasive, Zimmer Biomet, and Orchid Orthopedics as well as early-stage startups Ellipse Technologies and X-Spine Systems.  Mike is passionate about leveraging technology to improve patient outcomes and decrease the cost of healthcare.  Mike has a B.S. in Mechanical Engineering from the University of Dayton. He will be speaking and fundraising at 3DHEALS2020.

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