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Focus on Joint Reconstruction Activity at AAOS 2015

The joint reconstruction market grew in the low single digits and surpassed $15 billion in 2014, according to ORTHOWORLD’s ORTHOPAEDIC INDUSTRY ANNUAL REPORT®. Price pressure from payors and hospital customers  is expected to remain; though new products, favorable (including younger) demographics and outpatient procedures is predicted to create forward movement.
With no individual solution to stave off price pressure, the key players in joint recon-struction have made and continue to make it an interesting time in the market as they execute different strategies to post positive growth and gain market share. This was evidenced by device company executives’ comments at the Canaccord Genuity Musculoskeletal Conference and the products launched at the AAOS 2015 Annual Meeting.
The following announcements were made during AAOS and, though descriptive, they don’t offer a holistic view of each company’s joint reconstruction strategy.

DePuy Synthes
DePuy Synthes has taken steps to enhance the patient experience and improve outcomes through virtual coaching tools. The company launched CareSense, a subscription-based software solution that supports health care providers in the collection and analysis of patient outcomes, satisfaction and cost before, during and after surgery. The video-based program PATIENT ATHLETE™ was also launched to provide joint replacement patients with self-guided lessons prior and post-surgery.

Furthering the jump into rehabilitation solutions, DePuy Synthes recently announced collaboration with IBM’s new Watson Health unit to develop mobile applications that build on the PATIENT ATHLETE platform. More than half of the patients surveyed in the PATIENT ATHLETE pilot said that they recovered more quickly and were less fearful of surgery because of the program.

Though a small player in joint recon, DJO executives said the company wants to be disruptive in revision knee arthroplasty, which has yet to receive the efficiency and cost attention as total knees.

DJO Surgical launched its Exprt™ Precision System for proficient revision knee surgeons. The system replaced the eight-tray setup used during complex total knee revisions with a two-tray system. The implant itself includes built-in augments, a single radius design and e+™ polyethylene. The streamlined design and decreased waste reportedly saves 40 to 70 percent of the cost of a comparable knee revision.

“The Exprt Precision System is starting with revision knees, because we feel like it’s an area that we could really improve with this simplified technology,” said Mark Russell, DJO Vice President, Strategic Accounts. “We’re excited about where we could go. This is the unveiling of our precision system, and we’re starting with the revision knee, but absolutely it’s going to go to other areas.”

Smith & Nephew
The rep-less sales model, Syncera, had its own branded booth at AAOS, further validating the company’s expectations for the solution. Announced in August 2014, the Syncera model replaced the sales rep in the distribution channel with a technology-driven logistics and inventory platform that offers solutions such as hospital and ASC training and implant tracking and reordering.

Smith & Nephew’s management has commented that this model has attracted a segment of their customer base that wants a lower-cost service that maintains use of clinically proven products; the GENESIS total knee and the SYNERGY cementless stem with REFLECTION acetabular cup total hip are the two products currently used by Syncera. Hospitals performing 700 procedures a year with the Syncera model will save an average of about $4 million in cash over the three-year contract.

Management has also noted that the business model is applicable to five to ten percent of the U.S. hip and knee market and it has signed partners to three-year contracts. The company won’t divulge the number of contracts signed, stating in the 4Q14 earnings call that it’s still in pre-launch mode and is happy with Syncera’s momentum.

Stryker announced regulatory clearance and launch of its robotic-arm assisted total hip arthroplasty application for use with the MAKO system. The system is compatible with a surgeon’s Stryker implant of choice. Since 2010, more than 7,000 total hip procedures have been performed with the MAKO system, which facilitates multiple surgical approaches including direct anterior, posterolateral, and anterolateral.

Stryker, which acquired MAKO in 2013, has announced that it expects regulatory clearance for its knees with the MAKO system by end of 2015. The company is considering a bi-cruciate retaining knee with MAKO, though it’s currently focused on a total knee application per comments by David Floyd, Group President of Orthopedics, at the Canaccord conference.

Making procedures more reproducible and predictable can support improved patient outcomes, meet the business needs of hospitals and overall take more market share in the space, Floyd said. The company maintained that meaningful impact from the robotic systems hip and knee revenue won’t be felt until 2016.

Focusing on the growing number of younger and more active patients receiving knee replacements and an increase in procedures performed in an outpatient setting, Zimmer launched the Z23 program which enables surgeons to use the Persona Knee for total knee replacement in an outpatient setting. Z23 includes extensive training that covers the simplified surgical approach, a personalized care plan and at-home recovery for select patients.

The program is based on a protocol that has been used by one of the Cleveland Clinic’s ASCs on nearly 1,000 patients over the past six years. The program is focused on establishing a quality team, systematic and predictable patient selection and strict adherence to and fulfillment of discharge plan objectives.

In line with last month’s ORTHOKNOW article regarding robotics, the technology continued to receive attention with a significant amount of new product launches at AAOS—all related to joint reconstruction.

•  ConforMIS introduced the next-gen iTotal® CR (cruciate-retaining) total knee, designed to further reduce intraoperative
   steps during knee replacement. Upgrades to the system include improvements to customized implants and iJig
   patient-specific instruments.

•  Exactech announced the next-gen ExactechGPS® Guided Personalized Surgery for total knee arthroplasty. Updates
   include a navigational screen that is three times larger and reduced instruments to fit in one tray.

•  DePuy Synthes signed an exclusive worldwide sales agreement to market Radlink’s Galileo Positioning System™ (GPS)
   for use with DePuy hip systems. The GPS provides surgeons with real-time intraoperative imaging and navigation.

•  Intellijoint Surgical commenced limited U.S. release of intellijoint HIP™, its miniature smart tool that supports
   intraoperative control of key measurements required to select and position an implant to accurately set a patient’s
   leg length. 

•  Stryker Orthopaedic received regulatory clearance and commenced launch of a robotic-arm assisted total hip
   arthroplasty application for use with its MAKO system. The system is compatible with a surgeon’s Stryker implant
   of choice.

•  Voyant Health, a Brainlab company, received FDA clearance to market TraumaCad® Mobile, a mobile solution for
   preoperative orthopaedic surgical planning and digital templating for total hip replacement.

Further insight into the $15.4 billion joint reconstruction segment can be found in the latest installment of THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT. Don’t forget, the report is a Member benefit.

Carolyn LaWell is ORTHOWORLD’s Content Manager. She can be reached by email