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Australian Market Overview for Orthopedic Large Joint Devices 2016 - MedView

Australian Market Overview for Orthopedic Large Joint Devices 2016 - MedView

  • January 2015
  • 39 pages
  • ID: 3911602
  • Format: PDF
  • iData Research, Inc.

Summary

Table of Contents

There is an increasing trend towards marketing patient-specific implants, especially those targeted at women. This follows the overall trend of greater product diversification and provides a synergy with consumer-directed marketing. One of the key drivers is the Internet, with acknowledgement that patients who have educated themselves are not only more likely to choose implantation surgery over other options but also to choose a specific brand of implant.The original technique of arthroplasty involved cementing the implanted device with bone cement, which provided immediate fixation. This is beneficial from the standpoint of recovery, as a strongly fixated joint allows for more successful rehabilitation and an earlier return to active living. The significant disadvantage is that the process of cementing kills bone cells. As bone naturally replenishes itself, the reduced stock of bone building osteoblast cells means that the device-bone interface weakens over time, resulting in a loosening of the joint.Simultaneous bilateral implantation is a procedure that involves replacing both left and right joints in the same surgical operation. The benefit of doing so is reduced overall surgical time and a shortened combined rehabilitation period for patients. The main drawback is increased blood loss during the operation.Minimally invasive surgery (MIS) is sometimes regarded as much of a marketing term as it is a method of surgery. While all parties define MIS as surgery that requires a lesser degree of tissue disruption, there is no concrete way of quantifying what objective measures describe MIS surgeries.

Computer-guided systems represent a small portion of the joint replacement market at present. Alignment is more precise and incisions are smaller, but issues remain with obtaining accurate patient landmark data during surgery. These systems need to be properly oriented in order to obtain accurate navigation, but this depends greatly on patient positioning. Most systems require patients to be precisely repositioned during surgery, which increases time spent in the operating room as well as the chance of infection.Because of an understandable aversion to surgery, implantation technology will likely face competition from therapies that require less invasive procedures. Most of these technologies are focused on regenerating the diseased cartilage layer rather than eliminating it, as is performed with joint replacement.Reconstructive implants are grouped into four broad categories: primary (total) replacement, partial replacement, resurfacing and revision.Total joint replacement (TJR) involves replacing both sides of the natural joint. These devices are the most frequently used reconstructive procedures in the United States.Partial joint replacements restore one side or a portion of the joint. These procedures have the advantage of preserving more bone and soft tissue but have historically been prone to a higher complication rate than total joint replacements. Partial replacement, also known as hemiarthroplasty, provides an alternative to joint fixation, or arthrodesis, in some instances of skeletal trauma.Joint resurfacing attempts to preserve as much of the original bone stock as possible by placing a cap over the diseased joint surfaces. The cap is anchored by a short stem within the bone. These procedures are performed more frequently in younger patients, as the preservation of bone stock allows for better outcomes when the implant is eventually replaced later in life.

Revision implants are not a specific product type but refer to the replacement of implanted devices that have either reached the end of their useable lifespan or have become loosened through trauma or pathology. This may entail either the replacement of part of the implant or the entire implant. In general, revision implants require longer stems to anchor in the bone. Conservative estimates indicate that 15 years is an appropriate lifespan to expect from an implant regardless of its construction or method of fixation; however, newer devices are likely to exceed that time frame. If anything, the trend towards younger patients has meant that the market has been even more mindful of preparing for the eventuality of revision because of the increased average lifespan for these surgical candidates. Implants are subject to their own wear issues. Regardless of the type of construction, there are some basic safety concerns. Like the cartilage that it replaces, the articulating material is subject to wear. The concern remains with debris generation. While the material itself is inert, the body’s immune response to stray fragments creates the potential for osteolysis, the destruction of bone. There are similar concerns with devices using hard-on-hard articulating surfaces, as early ceramic materials were prone to chipping.

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