The orthopedic and spine device market is a constantly changing dynamic field and companies at need to stay at the cutting-edge of surgical technique and development to market the most successful products. Expert analysts from Millennium Research Group discuss the current trends in total joint replacement and spine surgery devices.
1. Minimally invasive procedures. Even though there can be a steep learning curve for training in minimally invasive orthopedic and spine procedures, more and more surgeons are becoming proficient in those types of techniques. "Minimally invasive surgery is something that has been discussed and is growing due to its advantages, such as less blood loss, shorter hospital stays, and quicker recovery times," says Deanna Vankessel, Senior Analyst with Millennium Research Group. Device companies are beginning to bring an increasing number of minimally invasive devices to the market, such as SI-BONE's iFuse minimally invasive surgical device to treat sacroiliac joint pain.
2. Shoulder implants. Compared to hip and knee replacement surgery, shoulder arthroplasty has shown tremendous growth in the reconstructive joint implant market over the past several years, says Melissa Hussey, Senior Analyst with Millennium Research Group. Companies are focusing research and development resources into advancing shoulder surgery products. The increasing volume of shoulder arthroplasty procedures is driven by improved technology and a growing number of patients who need shoulder arthroplasty, she says. "For example, relatively new reverse shoulder implants allow patients with soft tissue damage to obtain reconstructive shoulder surgery. Shoulder resurfacing implants represent another innovation and are growing in popularity because only minimal bone stock is removed to implant the device."
3. Hip implants and resurfacing products. Throughout 2010, there was ongoing attention in clinical studies and media reports questioning the performance of metal-on-metal primary total hip arthroplasty and hip resurfacing implants, says Ms. Hussey. The scrutiny into the safety and efficacy of the devices intensified after DePuy Orthopaedics recalled its ASR hip implant. Despite the controversy surrounding DePuy's metal-on-metal hip replacement, companies like Smith & Nephew and Stryker quickly released clinical data showing their metal-on-metal hip replacements are effective. "Overall, there is still considerable surgeon interest in innovations for hip implants. This includes alternative bearing surface materials such as ceramic," she says.
4. Smaller implants for knee surgery. Both physicians and patients are increasingly focusing on early intervention for knee conditions. "This trend is supported by advancements made to reconstructive knee implant technologies that preserve patients' natural bone and offer a better range of motion compared to previous-generation devices," says Ms. Hussey. By using smaller implants that allow surgeons to remove a smaller portion of the patient's bone during joint replacement surgery, patients are able to obtain surgery sooner rather than waiting for osteoarthritis to deteriorate before undergoing joint replacement.
5. Lateral interbody fusion devices. After NuVasive experienced success with their flagship product, XLIF (eXtreme Lateral Interbody Fusion) for spinal fusion surgery, other major spine device companies began to develop and release their own lateral interbody fusion systems, says Ms. Vankessel. K2M and DePuy Spine are among the more recent competitors that have entered this fast growing market with the recently launched RAVINE and COUGAR LS, respectively. XLIF allows a reproducible direct lateral retroperitoneal approach to the intervertebral disc space. A probe is used to guide the surgical instruments and detect nerves along to spine to avoid unnecessary damage during the procedure. Large insurance companies, including most recently CIGNA and Humana, cover the device and procedure.
6. Bone morphogenic proteins. Spine device companies are increasingly focused on developing and testing bone morphogenic proteins for use during spine surgery. Surgeons have used BMPs during spinal fusions for several years, but there are still some patient safety concerns related to the procedure. BMPs are also expensive compared with other treatment options. Medtronic's INFUSE is the industry standard against which other companies measure the effectiveness of their BMP product, says Ms. Vankessel. "A lot of the biologics are very similar," she says, such as Medtronic's AMPLIFY. Stryker recently sold its BMP products, OP-1, to Olympus Corp. for $60 million. The companies need to show that their product works just as well as INFUSE and are on the market for a decreased cost.
7. Non-fusion spine procedures. "There are several companies working on non-fusion technologies, most significantly artificial disc solutions for spine surgery," says Ms. Vankessel. "There is still a strong need for clinical data, however, and outcomes data comparing multiple artificial discs and artificial discs compared to spinal fusion is becoming increasingly necessary for adoption and reimbursement," she said. An artificial disc, such as Medtronic's PRESTIGE cervical disc, allows surgeons to treat back pain while maintaining motion in the spine as opposed to fusing the levels causing pain.
Learn more about Millennium Research Group.
Read other coverage on the orthopedic and spine device industry:
- Orthopedic and Spine Device Industry Post-Reform: 6 Challenges
- Orthopedic Device Trends: Q&A With Marc Viscogliosi of Viscogliosi Brothers
- Spine Surgery Research Update: Biologics in Spine Surgery
1. Minimally invasive procedures. Even though there can be a steep learning curve for training in minimally invasive orthopedic and spine procedures, more and more surgeons are becoming proficient in those types of techniques. "Minimally invasive surgery is something that has been discussed and is growing due to its advantages, such as less blood loss, shorter hospital stays, and quicker recovery times," says Deanna Vankessel, Senior Analyst with Millennium Research Group. Device companies are beginning to bring an increasing number of minimally invasive devices to the market, such as SI-BONE's iFuse minimally invasive surgical device to treat sacroiliac joint pain.
2. Shoulder implants. Compared to hip and knee replacement surgery, shoulder arthroplasty has shown tremendous growth in the reconstructive joint implant market over the past several years, says Melissa Hussey, Senior Analyst with Millennium Research Group. Companies are focusing research and development resources into advancing shoulder surgery products. The increasing volume of shoulder arthroplasty procedures is driven by improved technology and a growing number of patients who need shoulder arthroplasty, she says. "For example, relatively new reverse shoulder implants allow patients with soft tissue damage to obtain reconstructive shoulder surgery. Shoulder resurfacing implants represent another innovation and are growing in popularity because only minimal bone stock is removed to implant the device."
3. Hip implants and resurfacing products. Throughout 2010, there was ongoing attention in clinical studies and media reports questioning the performance of metal-on-metal primary total hip arthroplasty and hip resurfacing implants, says Ms. Hussey. The scrutiny into the safety and efficacy of the devices intensified after DePuy Orthopaedics recalled its ASR hip implant. Despite the controversy surrounding DePuy's metal-on-metal hip replacement, companies like Smith & Nephew and Stryker quickly released clinical data showing their metal-on-metal hip replacements are effective. "Overall, there is still considerable surgeon interest in innovations for hip implants. This includes alternative bearing surface materials such as ceramic," she says.
4. Smaller implants for knee surgery. Both physicians and patients are increasingly focusing on early intervention for knee conditions. "This trend is supported by advancements made to reconstructive knee implant technologies that preserve patients' natural bone and offer a better range of motion compared to previous-generation devices," says Ms. Hussey. By using smaller implants that allow surgeons to remove a smaller portion of the patient's bone during joint replacement surgery, patients are able to obtain surgery sooner rather than waiting for osteoarthritis to deteriorate before undergoing joint replacement.
5. Lateral interbody fusion devices. After NuVasive experienced success with their flagship product, XLIF (eXtreme Lateral Interbody Fusion) for spinal fusion surgery, other major spine device companies began to develop and release their own lateral interbody fusion systems, says Ms. Vankessel. K2M and DePuy Spine are among the more recent competitors that have entered this fast growing market with the recently launched RAVINE and COUGAR LS, respectively. XLIF allows a reproducible direct lateral retroperitoneal approach to the intervertebral disc space. A probe is used to guide the surgical instruments and detect nerves along to spine to avoid unnecessary damage during the procedure. Large insurance companies, including most recently CIGNA and Humana, cover the device and procedure.
6. Bone morphogenic proteins. Spine device companies are increasingly focused on developing and testing bone morphogenic proteins for use during spine surgery. Surgeons have used BMPs during spinal fusions for several years, but there are still some patient safety concerns related to the procedure. BMPs are also expensive compared with other treatment options. Medtronic's INFUSE is the industry standard against which other companies measure the effectiveness of their BMP product, says Ms. Vankessel. "A lot of the biologics are very similar," she says, such as Medtronic's AMPLIFY. Stryker recently sold its BMP products, OP-1, to Olympus Corp. for $60 million. The companies need to show that their product works just as well as INFUSE and are on the market for a decreased cost.
7. Non-fusion spine procedures. "There are several companies working on non-fusion technologies, most significantly artificial disc solutions for spine surgery," says Ms. Vankessel. "There is still a strong need for clinical data, however, and outcomes data comparing multiple artificial discs and artificial discs compared to spinal fusion is becoming increasingly necessary for adoption and reimbursement," she said. An artificial disc, such as Medtronic's PRESTIGE cervical disc, allows surgeons to treat back pain while maintaining motion in the spine as opposed to fusing the levels causing pain.
Learn more about Millennium Research Group.
Read other coverage on the orthopedic and spine device industry:
- Orthopedic and Spine Device Industry Post-Reform: 6 Challenges
- Orthopedic Device Trends: Q&A With Marc Viscogliosi of Viscogliosi Brothers
- Spine Surgery Research Update: Biologics in Spine Surgery