Dr Ju Zhang

Biomedical engineer Dr Ju Zhang likens the problem solved by the company he co-founded seven years ago to trying to build a car with the wrong size parts.

Except the parts Formus Labs works with – human joints – are a little more organic. And instead of keeping an automotive assembly line running smoothly, Formus helps orthopaedic surgeons fit replacement hips, knees, shoulders and other joints with the best chance of success.

It turns out success is far from a sure thing when it comes to joint-replacement surgery. Ju points out that one in five knee replacements prove unsatisfactory and one in 10 hip replacements need later revision, costing billions of dollars.

Yet the standard tool used to work out the size and shape of a replacement joint has been a two-dimensional X-ray, perhaps explaining why the surgery can be so hit or miss.

“You wouldn’t build a car without knowing the parts fit and it shouldn’t be any different with joint-replacement surgery,” Ju says.

Nearly two decades on from undertaking a bioengineering and biomedical engineering degree at the University of Auckland, Ju has developed a world-first artificial intelligence-based method of planning orthopaedic surgery.

“My undergrad, PhD, and post-doc in biomedical engineering set the foundation for both myself and the technological underpinnings of Formus Labs,” says Ju. “So the University of Auckland really has been the foundation of my success.”

The technology, commercialised by Formus, has reduced a process that used to take weeks to just one hour. Formus has grown to 25 people, partnered with one of the largest orthopaedic companies in the world, raised capital of US$6 million and received Food and Drug Administration (FDA) regulatory approval in the US.

With collaborators, Ju has come up with a way to transform a scan of the target joint into a fully interactive three-dimensional model, enabling patient-specific implant selection and placement.

Ju says getting the FDA green light in May 2023 for Formus’ hip-replacement pre-op planning system means the company can now start making the solution widely available to surgeons and healthcare providers.

“Nearly two million joints are replaced every year worldwide and that number is set to double by the end of the decade. Automated pre-op planning gives surgeons a custom surgical plan in advance for every surgery, without taking up their precious time or that of costly engineers.”

That’s good for time-constrained surgeons, but it also has the potential to improve the outcomes for their patients, says Ju.

“FDA clearance serves as significant validation of the accuracy and rigour of our AI models.”

Reaching this point has been a non-stop learning journey, says Ju.

“It has to start with my parents, who not only gave me a work ethic that has been very useful, but also taught me the grace of humility and the value of sacrifice.”

He also credits his PhD supervisors for providing him with the foundation for solving big problems pragmatically, and his post-doctoral supervisor and Formus co-founder Thor Besier for providing the spark and ongoing support to commercialise their research.

“Taking an idea through research then commercialisation is a continuous exercise in scaling. Scaling myself, a project, a team and a business is one big continuous learning that doesn’t and shouldn’t stop.

“So being comfortable with that continuous uncertainty, figuring out how to get ahead of it at each step and yet acknowledging that I’ll never have it all figured out is probably the overall challenge and learning.”

Ju says running a start-up was not where he thought his study would lead him.

But having ended up there, his greatest reward is seeing the people around him getting excited and deriving purpose and fulfilment from what they are doing, “whether they are team members, our customers or our surgeons”.