One of the UK’s many world-first medical achievements is the total hip replacement. Now Cirencester-based orthopaedic company Corin is driving innovation to deliver better patient outcomes
Total hip replacement started to be widely used in the UK when orthopaedic surgeon John Charnley developed and introduced the Charnley hip at Wrightington Hospital near Manchester in 1960.
Fast forward more than five decades and every year around 160,000 total hip and knee replacement procedures are performed across England and Wales, alongside many more hundreds of thousands across the world.
Knighted for his efforts, Professor Sir John Charnley’s procedure has been so effective that a total hip replacement today doesn’t look that dissimilar to one carried out in the 1960s, and it’s not uncommon for a hip replacement to last around 20 years.
What has changed are the materials used in their manufacture (crosslinked polyethylene has replaced original materials which were prone to oxidation and cracking), the coatings used on the metal parts and more recently a heavy investment in pre and post-operative analysis to ensure surgeons have increasingly detailed information on individual patients. And the patients themselves are more personally involved in their own recovery.
Much of this innovation is taking place at Corin Group, which manufactures hip, knee and ankle replacements. Founded in Cirencester in 1985, Corin has become a global orthopaedic solutions provider, employing more than 350 people at its headquarters and manufacturing facility in the town, and approaching 800 people worldwide.
Corin’s Chief Operating Officer, Jonathan Lettin, joined the company in 2015. He has spent more than 30 years in the orthopaedic sector and can speak from extensive personal experience, having had a hip replacement some years ago. His mother had two total hip replacements and his father, an orthopaedic surgeon, had one hip and a knee replaced. If anyone can see the benefits from all sides, it’s Jonathan.
Driving improvement in patient outcome
The fundamentals of a total hip replacement procedure haven’t changed that much. But Corin is investing heavily in improving patient outcomes through personalising each procedure for their benefit.
“We are developing an eco-system of technology to help the surgeon undertake extensive pre-operative planning and track the patient afterwards”
“Alongside our clinically-proven implant range, we are developing an eco-system of technology to help the surgeon undertake extensive pre-operative planning and track the patient afterwards,” he said.
The greater the understanding of an individual patient before they enter the operating theatre — their general state of health, how they move their hip, their size and flexibility — the more efficient surgery will be and the faster the recovery.
“Surgeons talk about the forgotten hip, because replacements are so good these days it can be easy to forget you’ve had the surgery, if it’s done well”
The world orthopaedic market is dominated by four big companies which between them have a massive 80 per cent share: Stryker, Zimmer Biomet, Johnson & Johnson and Smith & Nephew. Corin sits in the top quartile of the second tier, as a fast growing, innovative challenger.
Corin’s size is an advantage because the company is able to take a more agile and innovative approach.
In 2014, Corin bought Australian company Optimized Ortho. Developed in conjunction with biomedical engineers and orthopaedic surgeons, Optimized Ortho’s technology uses advanced computational modelling to simulate how a patient’s hip joint moves through a range of daily activities.
Everyone’s pelvis moves differently, said Jonathan. “The data gathered by our software informs the surgeon exactly how their patient’s hip will behave if they follow a particular plan. We now employ around 25 bio-engineers in Australia and the UK who are developing plans for surgeons all over the world.”
Earlier this year, Corin acquired US-based OMNI Orthopaedics, a pioneer in robotic assisted total knee replacement. OMNI has developed the world’s first robotic tool to measure ligament function, resulting in less patient pain and faster rehabilitation. The company’s robotic tensioning device is unique.
Jonathan explained “Surgeons talk about the forgotten hip because replacements are so good these days it can be easy to forget you’ve had the surgery, if it’s done well.
“But people tend to know that they have had a total knee replacement. The incidence of discomfort after total knee replacement surgery can be up to 20 per cent. It is believed that this is because the surgeon isn’t always able to balance the knee throughout the range of motion.
“Corin’s OMNIbotics allows the surgeon to pre-programme the robot so that the knee is kept in balance during the operation.
“It’s a much smaller piece of robotic engineering than other systems developed by some of our larger competitors, which can take up a lot of space within an operating theatre and require considerable time to programme, all of which adds to the cost of surgery.”
These innovations are backed up by Corin’s new app called my recovery which monitors a patient’s health before the operation, including how they are sleeping, which is a good indicator of pain. After the operation the surgeon can track their recovery more efficiently.
The app can also flag up other issues early. This is particularly important in the USA where surgeons only have a short window of opportunity to rectify an operation if problems occur, for health insurance to be valid.
Operating more efficiently
Improved monitoring of a patient before and after an operation means the surgeon has a great deal more information on the
patient before undergoing surgery, and less time is spent in the operating theatre. This is a rare win/win situation which delivers a better outcome for the patient while being more cost-effective for the hospital.
In the past, without the pre-operative information now available on an individual patient, the surgeon had to order many sizes of hip and knee replacements from the manufacturer, along with hundreds of instruments to fit them, because they could only select the correct sizes once the patient was on the operating table.
Corin’s Optimized Positioning System (OPS™) gives an accuracy of hip size and movement within 95 per cent, allowing hospitals to order a fraction of the quantity.
Ambition drives external investment appetite
Corin has ambitious plans for growth over the next five years, which is one of the reasons that private equity company Permira acquired a majority stake in the company last year.
“Permira is engaged with our strategy and likes our ambition,” said Jonathan. “We are making increased headway in the USA, have gained significant market share in Australia, and Japan is a particularly promising market for us. We are there already with plenty of room to grow. We don’t sell into China, but France, Germany and the UK are longstanding European markets and we are expanding into Switzerland.
“We have the technology, we have a really, really good implant range and we are in all the important geographies. We have doubled the business every two to three years over the last six and we manufacture all our products in the UK.”
The biggest threat to Corin, as to practically all other UK manufacturers, is Brexit. Over the last year the company has done everything it can to mitigate the issues if the UK leaves the European Union without a deal. “We increased our inventories, product and packaging by a significant margin, but who really knows what will happen as we continue down this road?” said Jonathan.
There are also new global medical device regulations, which could restrict innovation across the entire sector because there will be a requirement for longer-term trials of new products.
For Corin, this is less of an issue because it already has a good range of clinically proven products, and the company is moving towards software development to support the operation.
“We are driving innovation down a different track. From robotics to planning and software design,” said Jonathan.
“The holy grail in any development is to satisfy a clinical need. The proof of our strategy will come through our own clinical trials, and more importantly for wider validation, in the UK’s National Joint Registry, which independently monitors all hip, knee, ankle, elbow and shoulder replacements in the UK, and monitors the effectiveness of different types of surgery.”