Orthopaedics robotics in Asia Pacific

1. Knee joint robotics boasts the highest penetration, while hip is an emerging segment

• Over the last decade, robotics usage for the knee segment has seen increasing awareness. Its rising trajectory is anticipated to continue in APAC, bolstered by growing clinical evidence     
• There are clear clinical studies showcasing better patient outcomes in terms of knee flexion and recovery through improved implant positioning with robotics usage over a conventional approach     
• Hip, on the other hand, is at a nascent stage for robotics. Awareness of benefits through richer clinical evidence is critical to support uptake. However, hip robotics penetration will see an increase, although on a longer time scale compared to the knee segment

2. Knee and hip procedures are growing across APAC

• The upward trajectory is catalysed predominantly by an aging demographic, a trend consistent amongst all countries.
• The impact of aging on hip and knee procedures is clear—prevalence of osteoarthritis, a chronic joint condition which may necessitate a replacement     
• The EIU forecasts the aging population (i.e. more than 65 years of age) to grow at 3.5% from 2023 to 2026 in APAC, an increase compared to 2.7% from 2020 to 2023. The forecasted increase is expected to result in a sustained demand for hip and knee replacement procedures

3. Robotic installations are increasing year-on-year

• Robotic installations are on the rise in tertiary hospitals       
• A look at robotic installation trends in APAC—Australia, South Korea, India and Malaysia predominantly see robotic installations in the private hospital segment, while public housing is in its infancy. China and Singapore see higher uptake in the public hospital segment, compared to private. In Thailand and Japan, equal share of installations are seen in both public and private
• A common goal driving robotic installations is a sheer desire to stay ahead of medical innovation to deliver better patient outcomes. Within the private, there is understandably an aspiration to showcase their branding for innovation and retain the country’s top talented orthopaedic surgeons, and attract patients seeking top class medical care     
• Given the vast investment required, a well-observed scenario for robotics installation is one installation per hospital. This, however, is quickly changing. A look into developed APAC markets, such as Singapore and Australia, shows that established hospitals have installed or are looking to install more than one robotic system to meet the growing demand for joint- replacement procedures. 
• Barriers behind robotics adoption are the perceived lack of awareness on cost savings achievable with robotics

4. Joint robotics market is more than just multinational corporation (MNC) branding; regional players are quickly entering the scene and winning

• MNCs have long captured the robotics market—these include Stryker (Mako), Zimmer Biomet (Rosa), Smith & Nephew (Navio / Cori), Johnson & Johnson (Velys)      
• However, a closer analysis of the supply side shows a dynamic development. For instance, between 2022 and 2023 saw a slew of local knee robotics players gaining approval in China. This includes TiNavi, Hurwa, Microport, Yuanhua and Jianjia     
• The notable regional player is surprisingly not from China. Curexo (Cuvis) from South Korea, has enjoyed a rapid uptake of its systems in countries like South Korea and India. They are expected to diversify their international presence in APAC, expanding to places such as Australia and Indonesia     

5. Robotics utilisation sees room for improvement

• While installations are growing across APAC, increase in utilisation has been modest in both knee and hip     
• There are several reasons for this trend. The unsurprising reason, yet a major factor, is the cost of robotics procedures to patients, which sees no reimbursement in most countries across APAC. This necessitates a need to generate clinical evidence on cost-savings achievable through robotics over a conventional approach to change the perception of cost
• Costs aside, there is a perception amongst surgeons of long operating time with robotics usage over conventional. Robotics nearly doubled the time to achieve procedure completion compared to conventional. Hence, surgeons turn to faster conventional techniques to meet the growing demand for replacement procedures
• Finally, there is a clear demand by surgeons to be better trained in robotics usage from various suppliers. A main theme of interest is on shortening the operation time by being well-versed on preoperative planning, tracker placement, landmark registration, bone preparation and cutting

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