Moderator Thornhill: Okay so we may be in a little bit of confusion of semantics, so Steve define what “robotics” mean to you.
Dr. Haas: I think robotics are using some enabling technology to set alignment and then some aid to help you also prepare the bone as well. It doesn’t have to be a big robotic arm, there are different kinds of robots, so it doesn’t have to be narrowly defined. It has to help you with navigation and aligning the knee, it should help you with some balancing and it should aid you in how you prepare the bone.
Moderator Thornhill: Okay, so you saw the list that Steve was calling navigation. Are any of those robotics?
Dr. Haas: Well, they’re part robot. They’re half robot.
Moderator Thornhill: You must have a comment on that MacDonald.
Dr. MacDonald: It’s not really that complicated. You either have a robot or you don’t. So, I was going to offer my services to Haas, I’d come to his OR, and for not even $2 million, for a million dollars, I’ll put a retractor in to prevent cutting the MCL [medial collateral ligament]. I mean, that’s kind of what we’re talking about, so it’s got special saws, it cuts the bone for you, and there’s a new one coming out that will theoretically burr some entry holes and it’ll guide it from there. That’s really robotic surgery.
Moderator Thornhill: Okay so you’re defining this as anything that gives you enabling technology in addition to the classic way of doing knees?
Dr. Haas: Well, that’s right because the robot does not have to make the bone cut for you. If the robot sets your alignment guides and you make the cut, it’s still a robot.
Moderator Thornhill: Let’s talk about cost versus need. Sometimes the people that may benefit more from this are the ones that don’t do as many. And cost is a big issue.
Dr. MacDonald: I don’t think anyone benefits from robotic technology. I think there’s people who benefit from navigation, which is completely different, and the evidence is registry-based and it’s pretty sound. I think your point being that if you do 10 knees a year versus 200 you’re going to see the benefit from tightening your outliers. The evidence for that isn’t strong but that’s what logic would dictate.
Dr. Haas: There are navigation systems with accelerometers that give you very accurate results, and those are little tiny devices. The idea that there is only one model of this I think that’s where we were wrong.
Dr. MacDonald: I mean yeah, I guess I was just basing my debate on now—not where we’re going to be in 2020.
Moderator Thornhill: How many people use some form of navigation rather than just standard instruments for their total knees, hands up. Okay so it’s not that many. What is going to be the tipping point that’s going to make us go to robotics?
Dr. Haas: I think that the cost of the current technology is too expensive but a million-dollar robot I think is not going to be what everybody’s going to use. Cost has to come down.
Dr. MacDonald: The thing that’s going to drive it, like most technologies, is going to be cost, I would agree with Steve there. I mean if you can get this in your OR at a reasonable cost, but I do think that if you’re in the robotics field, you need to show the value proposition above the more inexpensive enabling technologies that we both talked about.
Moderator Thornhill: What percentage of this is marketing?
Dr. MacDonald: At the moment, 100%.
Dr. Haas: Right, I think that in the total knees, a fair amount is marketing.
Moderator Thornhill: Alright, okay so thank you gentlemen for a nice discussion.
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