For much of his life, David Cullity has maintained a long, unyielding intimacy with pain. 

During his tenure as a professional football player, the Southern California native simply accepted his recurrent knee troubles as one of the rare downsides of his job. “I’ve been an athlete my entire life. I was an all-conference player in college football, and I was able to play at the next level,” Cullity recalled in an online video. “While you’re going through that, yeah, you’ve got pain. [But] it was just part of the deal…you just had to work with it and as long as it wasn’t something that would sideline you as a player, you continue to play with that pain.”

Cullity did just that, even as a growing discomfort shot through his knees with steady insistence. Eventually, he learned to endure its rhythm, but that education came at a price: Cullity visited the injured reserved list three times in his four-year stint in the NFL (twice with the Cleveland Browns and once with the San Francisco 49ers).

The pain, however, didn’t end upon Cullity’s departure from the NFL; it continued well into his sedentary post-retirement career (financial advising), limiting both his mobility and sleep, and turning his life into a revolving door of doctor’s visits and knee surgeries.

Yet it wasn’t all those restless nights, or the restricted movement, or even the constant joint pain that convinced Cullity to consider undergoing a 14th knee procedure. Rather, the moment of truth occurred quite unexpectedly on the golf course during a casual round with friends.

“In my early 50s is when I started to really feel the results of the injuries in the past and the arthritis taking hold,” the now 61-year-old Cullity explained. “I was playing golf with the guys and I went to pull my ball out of the hole. As I knelt down to pick it up, my knee basically buckled and I dropped to one knee. What if I had my grandbaby in my hands? A 300-pound-plus guy at 6-foot 7, with that kind of possibility, it was an eye opener for sure.”

An eye-opener in more ways than one: Being—quite literally—brought to his knees made Cullity aware of the profound emotional toll his frequently failing joints were taking on his psyche. The decreased activity levels had drained his zest for life as well as his affability. 

That moment on the golf course marked the point at which Cullity’s life fractured—and quietly realigned.

“Physical pain leads to emotional pain, and I got to a point where I just didn’t want to deal with it anymore,” Cullity said. “I knew I had to do something.”

Doing something would likely require another surgery, though. The modest gains of earlier procedures offered ample reason for doubt, yet Cullity knew that without change, his life would never improve. He knew the path ahead would not be easy, but he was determined to reclaim his life from the relentless ache in his knees.

“I committed to myself that that’s what was going to happen. I needed to have this done,” he recollected. “New knee? This I can do. I went into it with an open mind and motivation to get through it and I did.”

Cullity’s steely resolve to restore his mobility undoubtedly played a crucial role in his recovery, but the implant he chose proved equally decisive. For his 14th and 15th—and hopefully final?—knee surgeries, Cullity chose to replace his patellofemoral joint with the Persona Knee from Zimmer Biomet Holdings Inc.

Designed to provide knee replacement patients with a more personalized fit, the Persona Knee comes in nine tibial sizes, 21 femoral profiles (with 2 mm increments available in standard and narrow), and multiple bearings to help surgeons establish proper anatomical marker alignment and accurate joint placement. 

The Persona Knee is comprised of Trabecular Metal components and a polyethylene bearing surface. The Trabecular Metal—a porous, three-dimensional material that resembles natural bone—allows for strong biologic fixation, while the plastic bearing surface is infused with vitamin E, an antioxidant that helps guard against wear and prevents the part’s breakdown.

Further ensuring the Persona Knee’s customized fit is the ROSA Robotic System, which uses real-time data to determine the precise positioning and fit. Specifically, ROSA controls the placement of cutting jigs and allows surgeons to use a preferred saw blade for bone resections and dynamic ligament balancing, according to study data. 

The ROSA System is part of Zimmer Biomet’s integrated platform of digital and robotic technologies designed to advance orthopedic care. Its ZBEdge Dynamic Intelligence offerings collect objective data before, during, and after surgery, delivering actionable insights that support informed decision-making for both clinicians and patients.

“Across orthopedics, we’re seeing a clear shift toward connected, intelligence-driven ecosystems that enhance efficiency while helping to support stronger patient outcomes,” observed Shaun Braun, senior vice president, chief Information and Technology officer, at Zimmer Biomet. “For years, hardware, software, and data tools were developed and sold in silos, but the real value and impact emerges when these components are interoperable and integrated across the entire episode of care. This is why at Zimmer Biomet, we have deployed ZBEdge as our agentic AI layer connecting and empowering the surgeon, patient, and care teams with data insights to enable personalized and optimized treatment pathways. People are capturing rich movement and wellness data long before they enter an orthopedic physician’s office. Combining this data with clinical data informs insights that help physicians personalize treatment pathways and guide more informed decision-making.”

Better-informed decisions are just one of the many benefits that technologies like robotics, artificial intelligence (AI), augmented reality, and data analytics are bringing to orthopedic surgeons and patients. Once considered extraneous, these enabling technologies are now as central to musculoskeletal care as the implants and instruments themselves.

Enabling technologies also have become central to companies’ growth strategies as digitization and AI are further embedded into orthopedic care. Zimmer Biomet and other device manufacturers, large and small, are shifting their strategic focus to developing enabling technology platforms that augment their implants and instruments.

Orthofix Medical Inc.’s 7D FLASH Navigation System, for instance, delivers advanced image-guided navigation for both spine and cranial procedures on a single, versatile platform. Its real-time navigation capability generates an instant correlation between surgical tool interaction and CT or MRI images, and the system’s machine vision technology integrates 3D image guidance from roughly 250,000 data points to inform clinical decision-making.

Machine vision modalities are a foundational element of Globus Medical’s enabling technology suite as well. Like its rival, the Audubon, Pa.-based company offers image-guided navigation for spine and cranial applications through its ExcelsiusGPS and ExcelsiusXR platforms.

ExcelsiusGPS is billed as the “first and only” robotic navigation system offering comprehensive spine and cranial procedural support, with repeatable and accurate trajectory alignment and navigation for screw placement, interbody implants, and cranial instrumentation. The system works with any preoperative CT, intraoperative CT, and intraoperative fluoroscopy imaging modes, with additional MR compatibility for cranial applications.

ExcelsiusXR, on the other hand, is a wearable extended-reality navigation headset that seamlessly integrates visualization and control in a cockpit-like environment, enhancing ergonomics, maintaining uninterrupted workflows, and allowing surgeons to remain focused on the patient. It uses integrated machine vision cameras and tracking disks to maintain unimpeded line-of-sight to eliminate challenging disruptions that may be experienced in 3D navigation.

“Enabling technologies are transforming orthopedics by making procedures more personalized, more predictable, and more data-driven,” Braun stated. “Pre-operative planning and robotics allow surgeons to tailor alignment and soft-tissue strategies to each patient’s anatomy and functional goals. Intra-operative analytics provide real-time feedback to surgeons, supporting more consistent execution. Digital health tools extend visibility into real -world recovery, giving care teams insights that inform both implant alignment and recovery pathways.”

Zimmer Biomet gleans such insights from its ZBEdge platform, a suite of integrated technologies that generate data-powered intelligence to shepherd critical patient care decisions, increase efficiency, and improve clinical outcomes. ZBEdge provides healthcare professionals with various tools to bridge procedural and patient data. 

The mymobility platform, for example, delivers continuous information and patient-reported feedback to facilitate care, outcomes, and satisfaction about patients’ surgical preparation and recovery. The platform encompasses patient education, surveys, check-ins, messaging, video-guided post-operative exercises, gait and mobility metrics, analytics, and telehealth applications. 

mymobility offers care plans for nearly all joint- and spine-related procedures; its industry-first WalkAI program generates daily personalized predictions for recovering hip and knee surgery patients. Using AI and machine learning, the program helps determine the subjects most likely to be at risk of a low 90-day (post-surgical) gait speed outcome.

Other ZBEdge tools designed to bridge critical data and enhance patient-clinician connectivity include:

• The Signature ONE Surgical Planning System, which provides a 3D image-based approach to preoperative visualization, surgical planning and patient-specific guide creation. This solution offers a tailored approach to shoulder arthroplasty based on patient anatomy, proprietary algorithms, and known anatomical landmarks.
• The iAssist Knee System, a compact, electronic guidance system that helps surgeons align and validate bony resections in real-time.
• The OrthoIntel Orthopedic Intelligence Platform, a solution that combines pre-, intra-, and post-operative ZBEdge data to help surgeons uncover clinical insights.
• Omni Suite, an operating room consisting of surgical lights, equipment booms, and integration solutions, all of which aim to drive efficiency through space-saving configurations and a streamlined implementation process. 

“We’ve built a deliberately connected ecosystem. ZBEdge integrates robotics, digital care management, preoperative planning, and smart implants into a platform designed from day one to function as a unified system, not a collection of stitched-together tools,” Braun explained. “ZBEdge operates on a unified, modern architecture designed from the start as connective tissue, enabling Zimmer Biomet to accelerate into the future world of agentic AI.”

Zimmer Biomet is not barreling towards that world alone, though. Startups like Redefine Surgery, VISIE Inc., and Inkwell Health are joining the race for enabling technology market share with their respective AI-powered and digitally driven solutions. VISIE’s 3D spatial computing platform, which allows for robotic knee surgery without tracking pins, arrays, or manually registering anatomy, took top honors at last year’s OrthoPitch competition, held during the American Academy of Orthopaedic Surgeons (AAOS) 2025 Annual Meeting. 

That event (AAOS) featured some of the latest advancements in orthopedic enabling technology: Johnson & Johnson MedTech and Stryker Corp. each touted their robotic system innovations (VELYS and Mako, respectively), while Smith+Nephew peddled its pre-op planning/modeling solution (Coriograph) and image- agnostic approach to large joint replacements (CORI Surgical System), and Exactech (now Advita Ortho) promoted its data-powered surgical ecosystem.

“The shift toward personalized, data-driven healthcare is one of the most influential trends shaping the future of orthopedics,” Advita Ortho CEO Aurelio Sahagun told ODT. “Surgeons are increasingly seeking technologies that reflect patient-specific anatomy rather than relying on one-size-fits-all approaches. That demand is driving out focus on intelligent planning, real-time intraoperative guidance, and post-care insights that are fully integrated within our Active Intelligence platform to support more informed decision-making across the continuum of care.”

Advita Ortho’s Active Intelligence platform is a data-driven ecosystem of digital solutions supporting the full orthopedic care continuum. Among its core elements is the GPS System, a computer-assisted surgical technology that delivers real-time, accurate insights for total joint replacement. The surgeon-controlled navigation system supports knee, shoulder, and ankle arthroplasty, enhancing implant placement and procedural efficiency; it brings advanced guidance to the clinical setting without the capital-heavy footprint.

GPS Knee provides surgeons with dynamic soft tissue analytics, pre-resection insights, full-range personalized planning, and ligament-driven symmetry. The latter capability is delivered through the company’s award-winning Newton knee Balancing Technology, which measures real-time ligament laxity under controlled tension. By applying a controlled force across the knee’s full motion arc, Newton Balancing Technology isolates ligament behavior, reducing the variability that can occur with manual methods, studies show. Integrated with Active Intelligence GPS, Newton displays real-time gaps, thereby helping surgeons make informed decisions about implant size, alignment, placement, and soft tissue balance. 

Clinical data demonstrate that Newton’s technique outperforms manual methods in reliability and reproducibility and improves patient-reported outcome measures.

Similar scientific support exists for Advita Ortho’s GPS Ankle and GPS Shoulder solutions, both of which are promulgated as industry firsts: the former as the world’s first navigation system for total ankle replacement, and the latter as the “first and only” shoulder navigation technology that connects the preoperative plan with real-time intraoperative instrument guidance and verified implant placement.

“Our GPS navigation platform is uniquely positioned as the only system that supports shoulder, ankle, and knee procedures within a single platform, informed by extensive real-world clinical experience, and supported by established evidence demonstrating the clinical benefit,” Sahagun remarked. “The system is compact, mobile, and surgeon-controlled, and the technology delivers real-time intraoperative guidance and verified implant placement entirely within the sterile field. Its portability allows surgeons to easily use it in both hospital operating rooms as well as in same-day surgery centers, and its availability without capital investment removes a significant barrier to adoption, expanding access to advanced navigation without disrupting workflow.”

Portability and cost efficiency are also among the key selling points of Smith+Nephew’s handheld, radiation-free robotic solution. The CORI Surgical system features image-agnostic smart mapping to register 3D models of the joint, real-time planning for personalized surgery, handheld precision milling, and intra-operative gap balancing. The robotic device’s ergonomic handpiece (with burr designs) deliver twice the cutting volume and 29% faster resection, according to the company; the system also comes with an interactive software tool (the CORI Virtual Planner) to help familiarize users with creating a surgical plan.

Considered a groundbreaking advancement in orthopedic robotics for its modular design and image-free smart mapping, the CORI system offers surgeons broad capabilities across an expanding range of joint reconstruction procedures, including total and partial knee surgery; revision knee surgery;and total hip surgery (software only, RI.HIP NAVIGATION). 

“Many of our enabling technologies have evolved from a pioneering position in the industry,” noted Brian Blacquier, vice president of global marketing, Arthroscopic Enabling Technologies, Smith+Nephew. “For example, Smith+Nephew’s COBLATION (controlled ablation) Technology, which is celebrating its 30th anniversary in 2026, is clinically proven to improve patient outcomes compared to mechanical debridement. Our patented bipolar COBLATION plasma technology creates a controlled, stable plasma field to precisely remove tissue at a low relative temperature, resulting in minimal thermal damage to surrounding soft tissues.”

In the three decades since its introduction, Smith+Nephew’s COBLATION technology has become a cornerstone of its arthroscopic enabling technologies lineup and helped foster other innovations, most notably the WEREWOLF FASTSEAL 6.0 Hemostasis Wand, FLOW IQ Technology, and DYONICS PLATINUM resection technology.

“COBLATION continues to be a highly valued platform among arthroscopic surgeons and has given us a foundation on which to build and bring enhanced offerings to market, like the WEREWOLF FASTSEAL 6.0 Hemostasis Wand for use in sports medicine and orthopedic procedures for hemostasis of soft tissue and bone. And FLOW IQ Technology, which automatically regulates saline outflow and when combined with COBLATION energy, enables tissue removal with both speed and precision. We like to think that our enabling technologies help surgeons to see more clearly through sharp video images and effective fluid management, work more quickly through efficient resection, and connect with their patients and colleagues better through effective image management.”

Backup Support

Clearly, enabling technologies have evolved from optimal add-ons into essential products. Virtual surgical planning, robotic assistance, and real-time 3D navigation have transformed procedures such as total knee arthroplasty and hip replacement by delivering unprecedented accuracy and shorter recovery times. The integration of artificial intelligence, advanced imaging, and 3D-printed, patient-specific implants further enhances surgical precision, reduces intraoperative risk, and enables more personalized care.

Major implant makers offering these solutions often depend on contract manufacturing partners for technical support. To gain better insight into the roles these support staff play, ODT spoke to nearly a half dozen experts over the last few weeks:

• Michel Caillibotte, business development director, Cousin Surgery
• Ryan Heniford, director of Global Sales & Business Development for Medical Devices, Evonik
• Alain Jablonowski, director, U.S. Sales, Exalta Group
• Corey Seacrist, Ph.D., sales and marketing manager, Poly-Med
• Fabien Verrat, group vice president of Operations, Tecomet

Michael Barbella: How is your company supporting next-generation enabling technologies for orthopedic implants?

Michel Caillibotte: We support next-generation enabling technologies by focusing directly on the implant itself. While major advances have been made in instrumentation, robotics, and surgical environments, implant evolution must keep pace. Our efforts center on implant sizing, modularity, and presentation to better match patient anatomy and evolving surgical techniques.

Our solution platforms are structured across the full care pathway:

• Pre-surgery: Digital planning, modeling, and compatibility with robot-assisted preparation.
• Per-surgery: Compliant, modular implants designed for new surgical techniques and robotic instrumentation.
• Post-surgery: Tracking, monitoring, and performance assessment.

We also support this ecosystem through digital configurators that allow marketing and engineering teams to pre-design implants and collaborate efficiently with surgeons.

Ryan Heniford: Evonik advances orthopedic implant technology through a portfolio of customizable biomaterials, including RESOMER and RESOMER Select. We provide strong processing and prototyping capabilities such as micronization, extrusion, and comprehensive application support. Additionally, we offer additive manufacturing-ready options and maintain a global network of facilities to deliver localized technical assistance.

Alain Jablonowski: Exalta was formed in 2025 by the fusion of three major medical device manufacturing players reknown for their strategic approach to partnering with the MDM/OEM from innovation to production. In that commitment, we ensure to partner at every stage of the product life cycle from ideation, innovation to industrialization at scale through a global footprint by anticipating and by providing deep contract manufacturing expertise with integrated OEM solutions development.

Dr. Corey Seacrist: Poly-Med specializes in the design and manufacture of high-performance absorbable biomaterials that enable the production of medical devices with increased performance compared to their random copolymer or homopolymer-based counterparts.

Our team of material scientists have developed a novel material within our Lactoprene biomaterial portfolio, Lactoprene HMX, that exhibits a Young’s modulus up to 2.2X higher than PLLA & PLGA 8515, and up to 1.5X higher than PEEK. Additionally, we have shown Lactoprene HMX exhibits significantly less creep than PLGA 8515 in static creep testing and is up to 2X more resistant to failure compared to PLLA. Notably, we also observe similar increases in Young’s modulus for Lactoprene HMX in filament-based 3D printing formats.

Additionally, we have demonstrated that Lactoprene HMX’s material properties lead to significant reductions in screw torque insertion compared to standard lactide-based materials, a key metric for developing bone screws. This finding enables the production of improved orthopedic implants, including but not limited to bone screws, suture anchors, CMF plates, and pins.Our team is also supporting next-generation fiber-based orthopedic implants through the development of high-performance long-lasting absorbable monofilament and multifilaments that can be used in a variety of biomedical textiles, including absorbable knitted meshes & braided bands for use in tendon reinforcement applications and multifilament braided orthopedic sutures for use in tendon approximation applications.

Fabien Verrat: As a CMO, Tecomet supports our customers’ next generation of enabling technologies by employing next-generation manufacturing technologies to reliably deliver a top quality implant per their specifications, in the most efficient and cost-effective manner of process development and production. These manufacturing technologies primarily focus on improved throughput and limitation of process variation.

Barbella: What orthopedic industry trends are influencing your enabling technologies product roadmap?

Caillibotte: We position ourselves as a key partner in this evolution by supporting both OEMs and instrumentation or robotic system manufacturers with the right implant solutions. Being aware of these trends—and acting at the right time—is a gold standard of our activity. Key trends shaping our roadmap include:

• Rapid adoption of enabling technologies driving (extra) minimally invasive surgery
• Strong demand for implant pre-conditioning and pre-loading to simplify workflows
• Increasing need for full compatibility between implants, instrumentation, and robotics
• Integration of monitoring features and sensor-enabled implants for post-surgical follow-up

Heniford: Key trends shaping our roadmap include the growing demand for personalized, procedure-specific devices enabled by 3D printing and unique architectures. We also see significant growth in orthobiologics, where combining biologics with devices enhances patient regeneration and outcomes. Furthermore, the expansion of sports medicine, particularly in extremities, continues to influence our priorities.

Jablonowski: Along with the digitalization of the procedures, the features of the mechanical assemblies in the orthopedic navigation systems and robot-assisted systems continuously advance to challenge the limits of the movement efficiency and of the precision guidance. Our product and technologies roadmap considers the needs of the market our OEM partners and customers operate in. The general trends with navigated instruments, minimally invasive procedures, and robotic-assisted systems drive us to be the leader in the integration of innovative manufacturing processes and best practices.

Dr. Seacrist: The growing interest in implantable medical devices that provide reinforcement during critical healing periods and subsequently absorb once support is no longer required drives Poly-Med’s team of material scientists and engineers. Their work focuses on developing advanced biomaterials and engineered constructs that enable high-performance devices tailored to the demands of modern, active patients. We focus on not only developing base materials, but also the processing required for translating these enabling technologies into usable form factors that could be purchased as an unfinished component or finished medical device.

Verrat: In the manufacturing industry the trends around enabling technology are focused. A number of areas such as better material utilization, which is relative to advanced forging processes, are achieved through advanced forging software simulation and automated processes of many types, from casting to forging, machining, finishing, and inspection methodology. Automation enables us to eliminate human error and variation, resulting in a more predictable manufacturing process. In addition to our manufacturing technology roadmap, we follow a product capability roadmap with robotic-assisted surgical procedures leading the way. From that roadmap we focus on improving our capabilities and efficiency to produce both robotic components and assemblies.