How Latecomers Can Gain an Edge in the Crowded Orthopedic Surgical Robot Market

In recent years, robotic orthopedic surgeries have been successively included in the medical insurance reimbursement catalogs of multiple provinces and municipalities, marking a critical step toward large-scale clinical adoption. In August 2022, the Beijing Municipal Healthcare Security Administration issued new regulations stipulating that, effective October 23, robot-assisted orthopedic surgeries would be included in Beijing’s Category A medical insurance coverage, eligible for 100% reimbursement.

From the perspective of clinical demand, with the intensifying aging of the population and the growing need for joint replacement, the number of artificial hip and knee replacement surgeries in China exceeded 900,000 in 2019. However, medical resources in China are unevenly distributed between doctors and patients. Orthopedic surgeries heavily rely on surgeons’ technical skills and experience. Surgeons with insufficient experience and proficiency may not only cause prosthetic loosening due to human factors but also inflict unnecessary trauma on patients and lead to a series of postoperative complications.

From the perspective of the competitive landscape, the market for orthopedic joint surgical robots is populated by both listed companies and startups. International players such as Medtronic and Stryker have entered the field, while domestic companies like Tinavi and MicroPort have been highly active. In 2022, at least 10 products in the orthopedic surgical robot sector received regulatory approval.

From the perspective of the policy environment, the national government encourages the development of high-end medical devices such as surgical robots, and regions including Beijing and Hunan have successively introduced relevant reimbursement catalogs. In early 2023, the Ministry of Industry and Information Technology and 16 other departments jointly issued the Implementation Plan for the “Robot+” Application Action, proposing to accelerate breakthroughs in basic theories, common key technologies, and innovative applications of robotics and medical artificial intelligence.Encourage hospitals with the necessary conditions and demand to use robots for precise minimally invasive surgery。

In summary, the orthopedic surgical robot market offers substantial growth potential but faces intense competition. In this sector dominated by industry giants, where do latecomers find their opportunities?

Innovation is the most defining characteristic of medical robots, and innovative surgical procedures develop in tandem with the advancement of medical robotics.

Previously, orthopedic joint robots were primarily designed for open surgical approaches. Traditional open total hip arthroplasty is associated with significant trauma (with incisions approximately 16–20 cm in length) and slow recovery. Moreover, this approach has a relatively short learning curve, allowing surgeons to perform the procedure under direct visualization after brief training. With the advancement of minimally invasive techniques, surgical procedures are becoming increasingly minimally invasive, precise, and suitable for ambulatory care. Consequently, the adoption rate of minimally invasive procedures in clinical practice continues to rise. Given the higher technical difficulty of minimally invasive techniques and the uneven distribution of medical resources between doctors and patients in China, there is a stronger demand for robot-assisted surgery.

At the clinical application level, orthopedic surgical robots are currently concentrated mostly in Grade 3A hospitals in first-tier cities, with low utilization rates. This has resulted in a situation where specialists lack adequate access while grassroots institutions cannot afford them. Such circumstances clearly contradict the original design philosophy of surgical robots, which aimed to “enhance the operational proficiency of grassroots physicians and alleviate the surgical burden on doctors in Grade 3A hospitals.”

Huang Xiongzhan, Chief Operating Officer of Qishan Lake Medical, stated: “In addition to factors such as high costs and expensive startup fees, most orthopedic joint robots are designed for open hip arthroplasty. Physicians can master these systems after more than two years of training, while senior experts require no additional training at all. The average procedure time is approximately 20 minutes; thus, using robotic systems actually increases physicians’ workload and time commitment. Hospitals also need to renovate operating rooms and equip relevant teams. Our robot targets innovative minimally invasive surgical techniques, and the surgical robot is expected to shorten the learning and adaptation period for young surgeons.”

Debates over value and price have long surrounded the orthopedic robotics market. Therefore, rather than discussing the future of product commercialization, let us revisit the fundamental logic underlying product design.

Qishan Lake Medical’s Q1 joint surgery robot is compatible with endoscopic supine minimally invasive direct anterior approach total hip arthroplasty (hereinafter referred to as “Endo-DAA”), a minimally invasive surgical technique pioneered globally by Xu Jie, Vice President of Fujian Provincial Hospital. This approach allows access to the joint through intermuscular planes without damaging muscle or nerve function. The surgical incision is only 5–6 cm in length, resulting in minimal trauma, faster postoperative recovery, and fewer complications.

Efficient day-surgery procedures entail greater technical complexity and impose higher demands on orthopedic surgical robots. The robotic arm must operate within a confined visual field and limited space, while the positioning and navigation system provides surgeons with real-time, accurate intraoperative data. Q1 is the result of successive and collaborative efforts by hospitals, universities, and enterprises.Professor Xu Jie’s team at Fujian Provincial Hospital identified the clinical needs and completed the clinical technical design; the Smart Medical Engineering technology team at Fuzhou University handled the engineering design; and Qishan Lake was responsible for translating research achievements into practical applications, driving the marketization and commercial implementation of the joint robot project.

In addition to adapting to innovations in surgical techniques, Q1 has also achieved leapfrog improvements in technology.

Most joint robots employ optical positioning and visual localization technologies, which require substantial workspace, are highly sensitive to intraoperative interference, and necessitate physician cooperation to avoid occlusion and control orientation. The Q1 surgical robot adoptsPioneering Adaptive Position-Aware Encoding—Haila Code and Distributed Visual Localization System, enabling real-time tracking of surgical instrument positions and their projection onto human body images, tolerating up to 95% occlusion; the navigation and positioning system achieves an accuracy of 0.5 mm, while the end-effector positioning accuracy of the robotic arm reaches 0.1 mm.

Currently, there are two common registration methods for surgical navigation systems. The first requires the implantation of fiducial markers into the patient’s body, causing additional trauma. The second relies on intraoperative C-arm scanning, which increases radiation exposure for medical staff; furthermore, if the patient moves during surgery, re-registration is required.Q1 employs an intraoperative surface-contact registration method for the acetabulum via a minimally invasive approach, eliminating the need for intraoperative scanning or fiducial markers.

Some companies adopt a robot hand-eye calibration approach, which can only abstractly register key points and coordinate systems of surgical instruments, as well as simple devices such as visualization probes. This method is not suitable for more complex or customized instruments. Q1Pioneering Pixel Sculpting Method, providing more vivid visualization, a streamlined shape registration workflow, and suitability for more complex, customized devices.

Building on these technological innovations, the Q1 joint surgery robot has lower requirements for operational complexity and surgical environment. It provides precise preoperative planning and real-time intraoperative tracking, allowing for the preoperative determination of key parameters such as the appropriate joint prosthesis size, bone resection areas, and prosthetic implantation angles, with real-time monitoring and comparison during surgery. Furthermore, the Q1 features a compact, flexible robotic arm that can adjust its angle with agility and actively halt movements during procedures, thereby enhancing operational precision.

Huang Xiongzhan from Qishan Lake Medical summarized: “Our product’s technological logic differs disruptively from competitors, enabling procedures with no additional trauma, streamlined regulatory registration, real-time feedback, and strong anti-interference capabilities, without restricting clinicians’ intraoperative maneuvers. Furthermore, the corresponding surgical technique minimizes incision size, aligning with new clinical objectives in arthroplasty: minimally invasive, intelligent, precise, accelerated recovery, and long-term implant survivorship. As the learning curve for this procedure is comparable to or shorter than that of the Direct Anterior Approach (DAA) for hip arthroplasty, the robotic system can be deployed after only a few familiarization cases, while also assisting in simplifying operational steps, thereby further reducing the learning curve for early-career surgeons.”

August 2022,Q1: Minimally Invasive Robotic Total Hip Arthroplasty System Completes First Research-Clinical Case, currently undergoing further optimization based on clinical feedback.

Regarding future market commercialization, Qishanhu Medical has a clear roadmap. For large tertiary Grade-A hospitals or orthopedic specialty centers, the company offers complete system sales or leasing options. For primary healthcare institutions with limited budgets, it provides standalone sales of components such as the navigation and positioning system and the preoperative planning system. The company aims to achieve late-mover advantage by leveraging superior product value and competitive pricing as its key entry points.

Amid the aging trend, the number of patients with joint diseases in China has increased, driving up the clinical demand for joint replacement surgeries and raising the proportion of minimally invasive procedures. Furthermore, since the launch of centralized volume-based procurement (VBP) for orthopedic consumables in China in 2021, the average price of selected hip implants has dropped from RMB 35,000 to around RMB 7,000, while that of knee implants has fallen from RMB 32,000 to approximately RMB 5,000, representing an average price reduction of 82%. The resulting decrease in surgical costs has spurred growth in the volume of joint replacement surgeries.

It can be said that the orthopedic joint robot market still holds significant growth potential, where technology, products, and high-quality teams are all indispensable.

The technical team behind Qishan Lake Medical is the Fujian Provincial Joint Engineering Research Center for Smart Medical Engineering, jointly established by Fuzhou University and Fujian Provincial Hospital. With 18 years of technological accumulation in the field of medical engineering, the center’s core technical team comprises seven faculty members and over 50 master’s and doctoral degree holders, and has undertaken numerous national and provincial-level scientific research projects.

To achieve better integration of medicine and engineering, at the end of 2022, Weiming Group jointly established the Fuzhou University Weiming Medical Robotics Institute with the Fujian Provincial Smart Medical-Engineering Joint Engineering Research Center. The institute focuses on overcoming key technologies and applications of medical robots in fields such as minimally invasive techniques and rehabilitation therapy, and conducts in-depth industry-academia-research collaboration in areas including machine vision, surgical robots, flexible sensing and perception, and intelligent device design and optimization.

Therefore, although Qishanhu Medical is a new company established in 2022, it is backed by years of technological accumulation and expertise. Currently, the operations and management of Qishanhu Medical primarily rely on Weiming Group. The group has previously collaborated with renowned institutions such as Ludwig Maximilian University of Munich and RWTH Aachen University in its traditional business activities. Core team members Chen Xiang and Huang Xiongzhan both possess extensive experience in managing large-scale projects and commercialization.

Based on the robotics technology platform, Qishan Lake has three main development directions for the future:First, the company’s Q1 surgical robot will expand its applications from minimally invasive hip replacement to include knee joints, dentistry, and spine surgery. Second, the existing measurement and positioning systems of the Q1 can be extended to fields such as spinal and oral surgery; hardware components like robotic arms and navigation modules can be retained, requiring only software updates. Third, the company’s pioneering Hela Code can be applied in multiple domains, including motion capture, 3D imaging, and augmented reality, not limited to healthcare.

Currently, Qishan Lake is conducting its Pre-A round of financing to seek more like-minded partners.