Technology

Interview with Mark Morrison, Manager, Materials Research and Tribology, at Smith & Nephew, USA.

Question: How is Additive Manufacturing actually used in orthopaedics and what are the prospects for the future?

The first widespread, commercial use of AM in the orthopaedic industry was the fabrication of patient-specific instruments for total knee arthroplasty. Since then, applications have expanded into the fabrication of implantable devices. In general, most of these products have been devices like acetabular shells with porous bone-interfacing surfaces that allow bone to grow into the pores to hold the implant in place. AM is particularly advantageous in this particular application because it allows for the creation of advanced, custom porous structures that can be fabricated in fully porous, bulk forms if desired. Finally, AM is being used to fabricate patient-specific implants for complex cases and/or deformities.

Q: Is Additive Manufacturing really set to revolutionize orthopaedic product manufacture?

“Revolutionize” is a strong word. AM is not a replacement for conventional manufacturing processes and probably won’t be. It is simply another tool in the toolbox. For the near future, AM is going to be used in applications where there is a clear value proposition over conventional, subtractive methods. As additive manufacturing becomes faster and cheaper, the applications with good value propositions will likely expand.

Ambulatory Surgery Centers to Perform 60% of US Surgeries by 2020 

by James B. Schultz, Executive Vice President Sales & Marketing, ECA Medical Instruments, USA.

Cervical OneTM single-procedure instrument set for securing cervical plates and interbodies. Photo courtesy of ECA Medical Instruments.

Outpatient surgeries are the way of the future. Overall process efficiency, cost savings, simplicity of operations and sterile-packed, surgery-ready instruments and implants are key to market adoption and scalability.  The 30-year legacy of high cost of sales, inefficient inventory management and spiraling logistics costs, which hobble OEM implant makers and are passed down to hospitals and ASCs, are no longer sustainable.

OEM implant companies profit and loss statements with their high SG&A charges as percentage of sales and balance sheets carrying depreciating instrument sets (they are never sold with 90%+ being loaners or on consignment) bear witness to the existing high cost of orthopaedic and spine implant products and downstream fulfillment costs making the US the world’s most expensive per capita healthcare system.

Paying over $400 per surgery for shipping costs alone to ferry in & out existing reusable instrument cases and trays is prohibitive, eating deeply into margins. This waste coupled with growing reprocessing costs and carbon footprint woes for both the OEM and end user to handle, clean and re-sterilize these instruments; the chronic spare, repair and re-calibration costs; the risk of surgical site infection, which can add over $28,000 in additional costs per case, and fact only 30% of the instruments prepared for a case are ever used, make the current model archaic. Add to this the delayed procedures or missed surgeries and lost implant sales created by waiting for reusable instrument cases and trays to arrive on site or be delivered from SPD.

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Read the full article here.

Interview with Sébastien HENRY, Founder & CEO of Pixee Médical, France.

Question: Is robotics a true revolution – set to change orthopaedic surgery completely? What does it actually give us that surgical navigation doesn’t?

Robotics presents are real potential in several surgical domains where we can easily imagine its clinical advantages in terms of precision.  The question remains in regard to orthopaedic surgery.  Let’s not forget that a robot is really navigation plus a robotic arm. Was the failure of navigation in the 2000s down to precision of incisions?  Of course not!

How then can we explain the interest in this technology in the orthopaedics field?  In my opinion it is a combination of hospitals’ and surgeons’ need to stand out in the highly competitive US market and that of Majors looking to differentiate themselves from their competitors. While robotics has achieved some encouraging results compared to traditional operating techniques, it has yet to completely prove its significant advantages over other, much less costly, navigation solutions.

Q: How involved are the Major orthopaedic companies in robotics?

The American Majors have been obliged to follow Stryker’s offensive in its take-over of Mako –examples include Zimmer-Biomet’s take-over of Medtech or Smith & Nephew with Blue Belt Technologie for lower extremities surgery. The same can be seen with spine surgery in the Medtronic/ Mazor partnership. All the majors are, to a greater or lesser extent, involved in robotics projects, in the short or medium term. However it’s a defensive strategy which has led these companies to investing in these projects.

Worldwide Orthopaedic market in 2016: 40.5 B US$ (+4.2%)

Source: European Orthopaedic Market report – May 2017 – Avicenne Consulting

The orthopaedics market, including hip, knee, spine, trauma, extremities and orthobiologics accounted for more than US$40B in 2016 – a growth of 4.2% Vs 2015.The United States remains the largest market due to historical trends & higher sale prices. In Europe, Germany is by far the biggest market for all segments. Followed by the UK, France & Italy.

The main drivers of the orthopaedics market remain demographic & economic parameters. Product innovation, resulting in a better (or higher) Product Mix, is boosting the market. They should remain the major growth contributors in the future. The trend towards reimbursement results in price pressure. This is the main limiter of the orthopaedic market. Price erosion of mature products in orthopaedics has been a constant over the past 20 years. We do not expect a major shift, but some countries will suffer more significant price decreases than others.

Revenues of the major Orthopaedic companies in 2016 (B US$)

Source: European Orthopaedic Market report – May 2017 – Avicenne Consulting

Even the 5 major companies, control more than 60% of the worldwide orthopaedics market, have continuously lost market share to the challengers. The challengers have gained 1 to 2% market share per year (MUS$400 to MUS$ 800 additional revenue), achieving US$15B in revenue in 2016 (Vs 14.5 BUS$ in 2015). A huge gap remains between the size of the Majors and that of the Challengers. The revenues of the Majors are 10 to 50 times bigger than the Challengers’. However, the Challengers are growing more rapidly, on average by two-digit growth due to their wider range of products and their local high-level services. They are also attracting new sales forces.

The challengers gained market share continuously (2013-2016)

Source: European Orthopaedic Market report – May 2017 – Avicenne Consulting

The only way for the Majors to have two-digit growth is by acquiring rivals (Depuy & Synthes, Zimmer & Biomet, Medtronic & Covidien).

Ali Madani,
Managing Partner – Avicenne Consulting

Come and meet the key-players of the orthopaedic industry at IMPLANTS conference!