Trends to Watch in Orthopedics

1. BRIC

BRIC = Brazil, Russia, India, China.   BRIC is the future for the large mature Orthos that have fully penetrated the US and EU.  With the sales slowdown to ~5%, the big Ortho companies are investing in BRIC for future growth.  Medtronic annoucned that they are growing to 2,000 employees in China.  Smith + Nephew announced a reorganization to strategically focus on BRIC and is pumping more R&D money into BRIC products.

2. Generic Implants

Here come the legacy implant copies at a fraction of the cost of the new technology implants from the big Ortho company, but these generics come with a great track record and no service reps. There is no stopping this economic trend.  At least 5 companies have appeared to deliver these solutions to Hospitals.  Beating High Orthopedic Implant Costs: How to Save Money With Generics ,
Get Ready for Generic Implants in Orthopedics – Quality Legacy Products + No Sales Rep

  1. OrthoDirectUSA  (Sports, Hip, Knee, Spine)
  2. White Box Orthopedics  (Hip, Knee)
  3. Emerge Medical   (Trauma)
  4. Convenant Orthopedics (?)
  5. Ortho Implant Company  (Trauma)

3. Orthoplasty

Why use an artificial prosthesis… when you can transplant living tissue?  Dr. Scott Levin is challenging the use of implants by transferring living tissue to solve orthopedic issues. The technique is called CTA – composite tissue allograft – but nicknamed Orthoplasty.
U of Penn ,  HSS case study , Biologic Knee Replacement

4. Arthroscopic Hip Surgery

Arthroscopic repair of labrum tears can eliminate pain, restore function and ultimately delay the need for total hip replacement in the younger patient
New study finds arthroscopic hip surgery may fully restore function in athletes (Rush University)
http://www.usatoday.com/news/health/2009-07-19-goodhips_N.htm

5. Medical Tourism

In 2010, six million Americans traveled outside the United States for health care, many travel for cheaper Orthopedic procedures. The scale is huge and the logistics are being worked out seamlessly.  If you don’t believe it, just take a look at Planet Hospital as an example.

6. Smart Implants

Sensors are coming to Orthopedics. This is driven by a convergence of three areas – new technology capabilities in embedded sensing, a growing understanding of embedded chip capabilities by Orthopedic manufacturers, and incentives for manufactures (product differentiation) and healthcare providers (more cost effective care).
Get Ready for Smart Implants

7. FDA is shutting down Innovation

Recently the FDA has become abusively and unrealistically conservative. Orthopedic PMA devices are now on a drug timeline to clearance…  and the 510(k) pathway will require clinical data.  Unfortunately, the end effect will be a lack for innovation for patients in the US.  And this will contribute to Medical Tourism.  Most innovation is happening in Europe now.

8. Decreases in Length of Stay

Today, Orthopedic procedures average a 4.5 day hospital stay, but in ten years the average will fall to just 3.5 days. Joint replacement stays will be cut in half. Length of Stay is one of the few ways that hospitals can improve profitability.

9. Osseointegrated Protheses for Lower Limbs

No more prosthetic socket problems! Dr Horst Aschoff and his team (Germany) have shown that people with the lower-limb implants move more naturally than those with traditional prostheses, have a more symmetrical gait, and use less energy to perform the same movement. His solution is the Osseointegrated Prosthesis.

10. Postponing Elective Procedures

This is a shortterm trend until the economy recovers. Economic conditions are forcing patients to reconsider surgery because of costs, potential missed work days, or lack of available family support once they get home.

11. More Demanding, More Informed Patients

Well-informed patients are pushing their Orthopedic Surgeon to consider specific treatments or implant systems. Surgeons say ALL patients come in with Web research and pre-determined treatment opinions that the surgeon has to unwind.

12. Younger People Getting Joint Replacements

Years ago, suregons would not put a new joint in anyone under 60, then under 50, now its anyone. From 1996 to 2001, the number of total knee replacements for patients aged 38-56 years doubled from 23,000 to 48,000. Younger people are now getting Joint Replacements.

13. Heavier Patients

Unfortunately in the US, bariatric surgery has become a specialty and challenges the way an Orthopedic surgeon approaches a procedure and may even dictate unique implants designs.

February 22, 2012

  • Editor – Tiger Buford

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