Break the monopoly of intensive listing, Johnson & Johnson, Weigao have been encircled, surgical robots into the orthopedic top stream!

In recent years, the orthopedic industry has been bleak due to collection, but orthopedic surgical robots have become the brightest fire in the industry, and the entire orthopedic robot industry has slammed the throttle

Once, the RIO surgical robot developed by STRYKER's MAKO Surgical Corporation was the only approved joint surgery robot in China, and this dominant position was broken

During this year, domestic joint replacement surgery robot products were intensively approved, including Hehua Ruibo, Jianjia, Yuanhua Intelligent, and minimally invasive joint replacement surgery robots that have obtained registration certificates

This year, domestic joint replacement surgery robot products were intensively approved

At the same time, the giants of orthopedic consumable implants in the past have also begun to hold hands with orthopedic surgical robot companies

At the same time, the giants of orthopedic consumable implants in the past have also begun to hold hands with orthopedic surgical robot companies

Agents whose profit margins have been compressed after the collection have also begun to turn to surgical robots

Collection promotes orthopedic surgery

Collection promotes orthopedic surgery

Robots have become a hot spot in the industry

Robots have become a hot spot in the industry

Although this year's orthopedic surgical robots have received common attention from all parties in the industry, in fact, orthopedic surgical robots have been developed in China for many years, but the commercial performance in the past is not prominent

Stryker's RIO joint replacement surgery robot acquired by Mako was listed

Stryker's RIO joint replacement surgery robot acquired by Mako was listed

The earliest domestic product is from Tianzhihang

Although the product was listed earlier, But Tianzhihang is still in a long-term loss, Tianzhihang can sell more than 30 orthopedic surgical robots every year, each orthopedic surgical robot is priced at the million level, and there are follow-up sales of supporting consumables, but under the existing sales, Tianzhihang is still in a continuous loss

Orthopedic surgical robots are not unfamiliar to the industry, and the first entrants also let us see the barriers to the commercialization of orthopedic surgical robots, why this year the industry began to hold hands with orthopedic surgical robot companies?

Obviously, the trigger for the orthopedic industry to start paying attention to surgical robots is the orthopedic collection

Obviously, the trigger for the orthopedic industry to start paying attention to surgical robots is the orthopedic collection

For domestic leaders, the blow of collection and procurement is obvious

For domestic leaders, the blow of collection and procurement is obvious

With the collection of orthopedic trauma, joints, spine implants and the three main markets, orthopedic consumables have been collected without forbidden areas

Chunli Medical also replied to investors that it is developing orthopedic surgical robots
for hip, knee and other joint replacement surgery.

Even foreign companies with stronger anti-risk ability have begun to promote surgical robots after suffering from the cliff of product profits
.

Even foreign companies with stronger anti-risk ability have begun to promote surgical robots after suffering from the cliff of product profits
.

An industry insider said that taking artificial joints as an example, the price of a foreign company's Tao artificial hip supply agent and the price of terminal sales, the price difference is only 50 yuan, the profit is very low, so this year in the sale of artificial joint products also began to recommend the use of its surgical robot or surgical navigation software
.

From the existing price point of view, the price of orthopedic surgical robots is higher, leaving a large profit margin
for orthopedic enterprises.

From the existing price point of view, the price of orthopedic surgical robots is higher, leaving a large profit margin
for orthopedic enterprises.

The average sales price of Tianzhihang's trauma and spine surgery robots was 5.
2083 million yuan / unit before 2019, and the average sales price in 2020 and 2021 was 3.
7197 million yuan / unit and 3.
8234 million yuan / unit
, respectively.
Compared with the thousand-yuan artificial joint prosthesis, the surgical robot device is more attractive
.

In addition to surgical robotic devices, surgical robots often have proprietary consumables as well
.
Taking Tianzhihang as an example, the sales revenue of Tianzhihang orthopedic surgical navigation and positioning surgical robots in 2021 will be 110 million yuan
.
Revenue from ancillary equipment and consumables was $
14.
78 million.
Although from the perspective of revenue, the income of consumables is less at this stage, but the growth of consumables revenue is relatively fast, and the operating income from supporting equipment and consumables increased by 59.
07%
compared with the same period in 2020.

Orthopedic businesses enter

Orthopedic businesses enter

Can you push up the market ceiling?

Can you push up the market ceiling?

With the intensive approval of domestic orthopedic surgical robots and the entry and promotion of orthopedic consumables enterprises, has the commercialization of orthopedic surgical robots begun to really accelerate?

From the advantage point of view, the biggest clinical value brought by orthopedic surgical robots is the ability to control the surgical accuracy to within millimeters
.
The accuracy of pedicle placement in spinal and trauma surgery robots is significantly better than that of traditional surgery; The joint surgery robot's navigation and positioning technology can guide surgeons to precisely cut their planned areas, helping to preserve healthy bones and soft tissue
.
Surgeons can also modify surgical plans during surgery to improve soft tissue balance and improve the accuracy of osteotomy and implantation
.

From the advantage point of view, the biggest clinical value brought by orthopedic surgical robots is the ability to control the surgical accuracy to within millimeters
.

Although there are advantages, there are still some shortcomings in orthopedic surgical robots
.

First of all, from the perspective of clinical value, it is not easy
for doctors to accept orthopedic surgical robots.
In joint replacement surgery, joint replacement is divided into hip replacement surgery and knee joint, for hip replacement surgery, surgery has been very mature, a mature doctor to complete hip replacement surgery only takes about ten minutes, the doctor's demand for surgical robots is not so high
.

First of all, from the perspective of clinical value, it is not easy
for doctors to accept orthopedic surgical robots.

In knee replacement surgery, good artificial joint replacement surgery should include good lower limb line of force, good soft tissue balance technique, consistent flexion and extension clearance, good patella trajectory, osteotomy and prosthesis placement that meets the requirements, strict sterility technology and minimally invasive concepts
.

The surgical robot should solve the three major problems
of consistent flexion and extension gap, osteotomy and prosthesis placement that meet the requirements, and soft tissue balance technology.
But the soft tissue balance problem, orthopedic surgical robot solutions need to be improved
.
Lower extremity alignment line and knee soft tissue balance are important factors
influencing patient satisfaction, clinical functional outcomes, and long-term survival of prosthesis after total knee arthroplasty (TKA).

In terms of soft tissue balance, despite the assistance of robots, the objective judgment of soft tissue balance and soft tissue tension is still difficult for
TKA.
In recent years, digital intraoperative gap pressure sensors, which have gradually been applied abroad, are expected to solve this problem well, with the verasense system (OrthoSensor, USA) being the most representative
of the application.
The Verasense system is a disposable sensor that measures joint space pressure and pressure distribution during TKA surgery, measuring the pressure of the internal and external joint space in real time when the knee is moving in full range
.

To address this, in 2021, two of the world's biggest orthopedic giants acquired two sensor companies, Zimmer Biomet acquired Canary Medical, and Stryker acquired OrthoSensor and its Verasense intraoperative sensor technology
.

To address this, in 2021, two of the world's biggest orthopedic giants acquired two sensor companies, Zimmer Biomet acquired Canary Medical, and Stryker acquired OrthoSensor and its Verasense intraoperative sensor technology
.

An industry insider explained: "The acquisition of two sensor companies is because it wants to put muscle tone data into the entire operation, if you can't solve the problem of muscle tension, just simply do bone marking, improve the accuracy of osteotomy, clinical value needs to be improved
.
" ”

Second, from the perspective of cost, the price of surgical robots is more expensive
.
Million-level surgical robots are more expensive for hospitals
.
For patients, the cost of surgery is also higher
.
Tianzhihang product start-up fee of 8,000 yuan, consumables package 11,000-13,000 yuan, patients choose to use orthopedic surgical robots and supporting consumables, will increase their burden of costs
.

Second, from the perspective of cost, the price of surgical robots is more expensive
.

And in the context of medical insurance control costs, the high price of surgical robots may also be compressed
.
This year, the Health Insurance Bureau issued two documents regulating the price of orthopedic surgical robots
.

And in the context of medical insurance control costs, the high price of surgical robots may also be compressed

At the beginning of March, the National Medical Insurance Bureau issued the "Guidelines on Improving the Price of Auxiliary Operations and Related Policies such as Orthopedic "Surgical Robots" and "3D Printing" (Draft for Comment)", which began to regulate the orthopedic robot market, restrict and control the price of orthopedic surgical robots, and guide the healthy development of the industry, which has a greater impact on
the entire industry.

In the "Opinions on the Centralized Procurement and Use of Supporting Measures for High-value Medical Consumables (Artificial Joints) organized by the State", it is also mentioned that public medical institutions that use intelligent systems such as "surgical robots" to assist surgical operations, adhere to the principle of balancing labor value and equipment contribution, charging and function matching, in accordance with the actual function of the intelligent system, on the basis of the "artificial joint replacement" project price, a certain proportion of additional revenue is added, and no separate charging items
are set up.

Finally, the challenge of commercialization of orthopedic surgical robots also includes fierce competition
.
According to Frost & Sullivan, the number of robotic-assisted joint replacement surgeries performed in China each year increased from zero in 2015 to 243 in 2020, and is expected to further increase to 79,964 cases
in 2026 at a COMPOUND annual growth rate of 162.
8% from 2020.
The penetration rate of robotic-assisted joint replacement surgery in China is less than 0.
1% in 2020 and is estimated to reach 3.
1%
in 2026.

Finally, the challenge of commercialization of orthopedic surgical robots also includes fierce competition
.

Although the number of surgeries is expected to grow rapidly, it is worth noting that the current ability to afford orthopedic surgical robots are all tertiary hospitals or orthopedic specialty hospitals, but the domestic large orthopedic centers are limited, and there are only three or four large orthopedic centers in
each province.
If the grass-roots market is not developed, the market space for orthopedic surgical robots is limited
.

There are more than ten enterprises that have seized large-scale orthopedic centers in
China.
The spine certified manufacturers are Medtronic, Zimmer Bangmei, Xinjunte (approved in 2021), Zhuzheng (approved in 2022); Joint certified manufacturers include Stryker, Minimally Invasive Medical (approved in 2022), Bone Shengyuanhua (approved in 2022), Jianjia (approved in 2022), and Hua Ruibo (approved in 2022).

There are also a number of companies whose products are in the clinical trial stage, and the fierce competition can be seen
.

Fewer hospitals with the ability to pay are not just a feature of the
domestic market.
In the United States, Stryker's more commercially successful Mako surgical robots have also encountered the challenge
of limited hospital payment capacity.

Fewer hospitals with the ability to pay are not just a feature of the
domestic market.
In the United States, Stryker's more commercially successful Mako surgical robots have also encountered the challenge
of limited hospital payment capacity.

Stryker's Q2 2022 earnings report shows that sales of its Mako surgical robots increased by 19%
in the second quarter compared to the same period in 2021.
However, as more hospitals turn to lease agreements or financing rather than buying equipment directly, the company's quarterly revenue is decreasing
.

In general, the development of orthopedic surgery in the direction of digitalization is the trend of medical development, and its future market space is large and the growth rate may be difficult to measure
with past industry historical data.

However, the products that can really open the market need to be recognized by many parties, under the influence of collection, the recognition of the orthopedic industry for orthopedic surgical robots has been greatly improved, and with the help of the mature commercialization experience of orthopedic enterprises, the channels for orthopedic surgical robots to enter the clinic have been opened
.
But for clinicians and patients, orthopedic surgical robots also need long-term market education and product improvements
.

The existing orthopedic surgical robots are divided into spinal surgery robots and joint surgery robots, and one surgical robot is not suitable for all orthopedic surgeries
.
For hospitals to buy two orthopedic surgical robots at the same time is too cumbersome, the current orthopedic surgical robots need more integration, but also need more innovation
.
Only those companies that have the ability to continuously innovate and listen to solve clinical needs can continue to survive, not those that cater to the market
.