Smart Surgical Solutions
A low-cost device to guide knee surgery and improve patient outcomes
Orthopaedic surgeons could soon benefit from a smartphone-based navigation system which helps precisely guide knee operations in real-time and ultimately improve outcomes for patients.
Imperial researcher Dr Shuqiao Xie co-founded Smart Surgical Solutions (S3) in 2022, after taking part in the MedTech SuperConnector business accelerator programme.
As Chief Technology Officer (CTO), Dr Xie has helped to assemble a world-class team at S3, which includes co-founders Professor Anthony Bull, Head of Imperial’s Department of Bioengineering; Mr Pierluigi Cuomo, Consultant Orthopaedic Surgeon and researcher; and engineering project manager Dr Marco Hanaman.
The technologies and intellectual property they are developing have been protected as two pieces of know-how and a PCT patent has been published; meanwhile the company has recently secured funding including £645,000 from InnovateUK.
Pain points for knee surgery
Knee replacement surgery, which involves damaged and worn cartilage and bone substituted for artificial implants, is a well-established procedure. However, around 20% of patients are dissatisfied with the outcomes and 7% choose to undergo revision surgery. Part of the problem is the tight margins involved in this procedure, as Dr Xie explains:
“The load needs to be transferred from your upper body to the lower body, within a certain line. Imagine if this is off, just by a few degrees, it means the load is not actually transmitted perfectly, and that will have an effect on joint performance, potentially causing patient side-effects and reducing the life of the implant.”
Operating surgeons have access to patients’ CT scans to help guide them, but the procedure is largely manual, by eye. The most well-resourced clinics have started to use robotic surgery, which can achieve a very high level of precision, but that is likely to remain prohibitively expensive in most cases.
Over a decade of research
S3 has developed a low-cost end-to-end solution centred around a typical smartphone, with some software and hardware add-ons – dubbed M.A.R.I.O (Mobile Assisted Reconstruction In Orthopaedics). The first innovation lies in the pre-op surgical planning software, which is underpinned by more than 15 years of fundamental research on statistical shape models (SSM) at Imperial.
During the operation itself, the smartphone (loaded with the software) is paired with a special mount which interfaces directly with patient’s knee and guides the surgeon at each stage in terms of where to place the implants correctly.
Dr Xie comments: “We’re relying on the power of the smartphone’s CPU and camera, and so it’s a very cost-effective solution. We’re just hoping that every single patient can get back to their normal life, improve their quality of life and that their implant can last longer.”
Bridges to bones
Dr Xie actually started out as a civil engineer but made the jump from “bridges to bones” completing his PhD in bioengineering at the University of Edinburgh, followed by a research position at Imperial. He was also involved in a collaboration with major orthopaedic implant manufacturer.
“That was the point where I really understood the importance of connecting my research with industry to help tackle real problems, rather than it being all ‘on the paper’, in theory. That’s why I moved into medical device development rather than purely fundamental research.”
Some fortuitous introductions led to the S3 co-founders realising how their skills could synergise to potentially transform knee surgery and the foundations for a new venture began to form.
Dr Xie successfully applied to the MTSC in 2021 and S3 was incorporated in 2022. He says that the experience of the MTSC programme helped in navigating the regulatory landscape and gave the team “confidence in using a smartphone in the operating theatre context and a clear strategy of how to get regulatory approval.”
Speaking more generally about the MTSC, Dr Xie comments: “Something that was very useful was the Venture Review Sessions held every single month – that was a chance to talk to other entrepreneurs on the programme, get feedback from the experts and practice your pitching skills.”
Dr Xie and S3 have won numerous awards and accolades including an Enterprise Fellowship at the Royal Academy of Engineering; EPSRC Impact Acceleration Account award.
Major funding has come in the form of a £645,000 grant from Innovate UK’s Biomedical Catalyst and a £160,000 investment from an angel investor. The plan is to raise an additional £2 million by the end of the year to provide support for the regulatory framework and experimental validation.
The company is now looking to expand the team, by recruiting an experienced Biomedical Engineer and a web developer to support the product development and pre-clinical work.
With the compound annual growth rate (CAGR) of the knee replacement market at 4.3%, S3 looks to capitalise on this and make a real difference to patients’ lives.
“…I really understood the importance of connecting my research with industry to help tackle real problems, rather than it being all ‘on the paper’. in theory.”
Dr Shuqiao Xie