Healthcare 2023: Transformative trends in Orthopedics and Interventional Cardiology

Dr. Richard Iorio and Dr. Sahil A. Parikh highlight the most important trends shaping orthopedics and interventional cardiology in the year ahead.

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By Shagun Singh
Published March 2, 2023 | 4 min read
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Key Points

  • Vascular procedure volumes have returned to pre-COVID levels and are growing, with winter favoring more urgent procedures and more emergent cases returning in spring and summer.
  • In orthopedics, hospital recon volumes are expected to rise further in the year ahead, although the realization of backlog will depend on the level of capacity constraints.
  • In a competitive landscape, robotic penetration within recon also has room for further adoption, and could approach 90% in knees.
  • Capital spending could be lower y/y in 2023, but alternative financing will continue to drive placements.
  • The shift of total joint replacement care to value-based care (VBC) is a key longer-term trend to watch.

Orthopedics and interventional cardiology were big themes at the RBC Capital Markets Healthcare Private Company Conference, as innovation continues to power the industry through short- to medium-term headwinds.

Dr. Sahil A. Parikh, Director of Endovascular Services at Columbia University Irving Medical Center, and Dr. Richard Iorio, Chief, Adult Reconstruction and TJA at Brigham and Women’s Hospital, shared their market outlook on key orthopedic and cardiology products in a highly competitive landscape, covering the major talking points across the capital, regulatory and procedural trends in their respective sectors.

Orthopedic recon demand projected to grow

According to Dr. Richard Iorio, several macro headwinds are currently impacting hospital recon procedures. A major factor for the year ahead will be staffing pressures, where hospital volumes are continuing to face shortages in nurses, CPD technicians, and anesthesiologists.

There is a six-month backlog in recon, but the ability to realize it in 2023 will be dependent on the pace at which capacity constraints ease. Some states also have restrictions on opening up ambulatory surgery centers (ASCs), which will make it harder to go through pent-up demand.

Volumes in the first quarter of 2023 may also be lower than the last quarter of 2022, driven down by restrictions in surgeries because of hospital overcapacity due to Covid, RSVs, and flu cases, as well as due to typical adverse seasonality and weather conditions.

However, even though some headwinds are likely to persist, the demand side of the equation remains strong. With volumes currently standing at 85% of pre-Covid levels, Dr. Iorio believes the number of recon procedures will rise in 2023 compared to 2022, a trend which should continue into 2024.

The rise of robotic surgery

Robotic penetration within recon also has room for further adoption, says Dr. Iorio, who believes the next generation of surgeons will only be used to performing recon procedures using robotic surgery, which will become the new standard of care.

The competitive landscape around recon robotics is evolving, and Dr. Iorio sees a strong rationale behind open systems that could position smaller players to re-capture procedures.

In the near future, Dr. Iorio estimates over 90% of knee procedures will use a robot. This adoption will be spearheaded by the robotic manufacturers who continue to make implant deals that include both the robot and the implant.

“There’s no doubt that ten years from now, all residents and fellows will be trained on robotics. There are surgeons now that won’t do knees without robotics. They already feel it's part of their workflow.”

Dr. Richard Iorio, Chief, Adult Reconstruction and TJA, Brigham and Women’s Hospital


Capital expectations

Given reduced hospital revenues, increased pressure on margins, and decreased reimbursement, Dr. Iorio expects to see less upfront capital spending going into 2023. However, alternative financing will continue to drive placements.

The move to operating leases for equipment is fiscally smart and will ‘absolutely’ help hospitals, while volume-dependent deals will help sellers and manufacturers do better in a potential recession. In addition, there are companies that focus on refurbishing disposable robotic pieces and are reselling them back to hospitals for half the price.

Investing in a new era of value-based care

With the Center for Medicaid and Medicare Services (CMS) now moving towards episodic-based total joint replacement care for orthopedics and cardiology, Dr. Iorio sees the shift of total joint replacement care to value-based care (VBC) as a key longer-term trend to watch.

CMS' goal within the next ten years is to have all Medicare-based total joint replacement care within Accountable are Organization (ACO) models focused on the end result of lowering the overall cost of care – a shift which will have large implications for VBC in the coming years.

Cementless knees adoption

Dr. Iorio expects cementless knees adoption to continue to gain market share, and could potentially be 90% of the knee market in 5-10 years. This will lead to the premium on cementless ultimately declining as it becomes the standard of care.

Healthy growth for cardiovascular demand

According to Dr. Sahil A. Parikh, Director of Endovascular Services, Columbia University Irving Medical Center, coronary and peripheral vascular procedure volumes are back to pre-COVID levels and growing.

On the vascular side, Dr. Parikh notes that, while arterial is growing, it has been impacted by a shift in venue from hospitals to OBL or ASC settings. Venous intervention is also a key growth area, and growth is also 'out of proportion' on the pulmonary embolism (PE) side.

Volume growth has accelerated due to the aftermath of COVID-19, which caused many thrombus and clot-related complications. The colder season also tends to favor more urgent versus elective procedures, as a more aged patient population are less willing to come in for elective procedures in the winter-time than in spring or summer.

Despite a potential recession risk in 2023, Dr. Parikh expects both emergent and urgent procedures to increase in 2023, as COVID deferrals work themselves through the system.

Strategies to address physician shortages

In order to meet the increased patient demand expected in 2023, many practices are hiring more doctors and physicians. While Dr. Parikh believes that staffing issues won't normalize soon enough, he has started to see hospital systems move away from using travel nurses/workers to train and grow 'at-home' employees.

The disequilibrium in staffing dynamics varies from region to region, but Dr. Parikh also notes there are some general and temporal trends in terms of the types of jobs and the salaries potential employees are pursuing.

“In terms of staffing issues, market forces have dictated salaries that have really impinged on the bottom line of a number of large health systems. We're looking to either train or grow at home employees that will hopefully be coming into the workforce in the near future.”

Dr. Sahil A. Parikh, Director of Endovascular Services, Columbia University Irving Medical Center


Finally, Dr. Parikh cautions that some of the new vascular procedures that are expected to be introduced into the market may be slowed by the economic forces of a recession, due to their elective nature.

This content is based on commentary and analysis from RBC Capital Markets Healthcare Private Company Conference hosted in New York, NY on December 15-16 2022. For more information about the conference, please contact your RBC representative.

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