Implantologie si protezare

ortopedica

Dan Laptoiu

Curs

1.Introducere: istoric, exemple de aplicaii, necesitatea protezrii ortopedice

2. Aspecte medicale: fiziologie, mecanic, tipuri de esuturi osoase i articulaii

3. Materiale utilizate i selecia acestora pentru realizarea implanturilor i protezelor

ortopedice

4. Metode de obinere a implanturilor i protezelor ortopedice

5. Aspecte specifice privind biofuncionalitatea i biocompatibilitatea

6. Tipuri de fracturi i dispozitive medicale pentru fixare osoas (implanturi)

7. Proteze articulare

8. Interaciunea implanturilor i protezelor ortopedice cu esuturile

9. Testarea implanturilor i protezelor ortopedice

10. Evaluarea clinic a implanturilor i protezelor ortopedice

11. Standarde i norme internaionale

Curs!

1.Introducere: istoric, exemple de aplicaii, necesitatea protezrii ortopedice

2. Aspecte medicale: fiziologie, mecanic, tipuri de esuturi osoase i articulaii

3. Materiale utilizate i selecia acestora pentru realizarea implanturilor i protezelor

ortopedice

4. Metode de obinere a implanturilor i protezelor ortopedice

5. Aspecte specifice privind biofuncionalitatea i biocompatibilitatea

6. Tipuri de fracturi i dispozitive medicale pentru fixare osoas (implanturi)

7. Proteze articulare

8. Interaciunea implanturilor i protezelor ortopedice cu esuturile

9. Testarea implanturilor i protezelor ortopedice

10. Evaluarea clinic a implanturilor i protezelor ortopedice

11. Standarde i norme internaionale

Tematica de laborator

1. Analiza compoziiei i proprietilor esuturilor osoase

2. Echivalena mecanic a articulaiilor umane

3. Aspecte tribologice

4. Aprecierea biocompatibilitii i biofuncionalitii biomaterialelor utilizate2

5. Criterii de design pentru implanturile i protezele ortopedice 2

6. Metode de obinere a dispozitivelor ortopedice: turnare de precizie, deformare termomecanic 4

7. Probleme specifice dispozitivelor de fixare a fracturilor

8. Analiza micrii 2

9. Protezarea articulaiei oldului: tehnici de operare, tipuri de proteze

10. Protezarea articulaiei de genunchi: tehnici de operare, tipuri de proteze

11. Reacii inflamatorii

12. Rolul observrii postoperatorie a implanturilor ortopedice

2
4

2
2

TOP 5 Orthopedic

Historical
Orthopedic Market
Stryker
DePuy
Aesculap
Zimmer
Smith & Nephew
Synthes
Medtronic
Biomet
DJ O
Orthofx
Wright
Total

2008
$6.2
$5.5
$3.8
$4.1
$3.8
$3.2
$3.0
$2.2
$0.9
$0.5
$0.5
$33.7

2009
$6.4
$5.9
$4.0
$4.2
$3.8
$3.4
$3.1
$2.4
$0.9
$0.6
$0.5
$35.1

2009
Share
15.0%
13.9%
9.5%
9.8%
8.9%
8.0%
7.2%
5.5%
2.2%
1.3%
1.1%

Q1 2010
Knee
Hip
Spine
Extremity
Growth
Increase Increase Increase
Increase
8%
6%
5%
11%
8%
9%
12%
9%
3%
8%
9%

2%
3%

-2%
1%

6%
8%
10%
7%
7%

12%

6%
4%

Key 2009 Observations

Top 5 represents 59% of the market. Top 10 represents 77%.
Stryker / Zimmer / Depuy represent 70% of RECON
Extremities growth largely outside of Big 5

12%

14%

2%
6%

28%

11%
2%
8%

4%
5%

7%

2009 Market Share

22%
9%

Sports
Med
Total
-1%
3%
15%
8%
6%
2%
0%
6%
2%
7%
1%
2%
8%
5%
8%
4%

Stryker Corp.

Stryker Corp.

manufactures and sells a diverse product mix of medical and

orthopedic devices in the domestic and global marketplace, including
hip, knee and upper extremity replacement prosthetics, and spinal
implants.

The firm is also noted for its development, manufacturing and sales of
video-assisted surgical systems, powered surgical and collateral
equipment and instrumentation for minimally invasive surgery.

Among its innovative products is Endosuite, a functioning Operating

Room suitable for use in virtually all specialties.

It has headquarters in Kalamazoo, Mich. US

DePuy Orthopedics (a division of

Johnson & Johnson)

The largest and most diversified of the worlds healthcare companies,

Johnson & Johnson was founded in 1886.
Today, with operations in 54 countries, and sales in more than 175
countries, it is the premier purveyor of more than 200 medical devices,
including orthopedic and spinal products. J&J is also a global leader in
the sales of pharmaceuticals and packaged consumer healthcare
goods.
During fiscal 2007, Johnson & Johnson acquired two healthcare
companies: Conor Medsystems, a cardiovascular device company with
new drug delivery technology, and Robert Reid, a Japanese orthopedic
product distributor.

DePuys U.S. headquarters is in Warsaw, Ind. US

Zimmer

Founded in 1927, Zimmer Holdings In 2003, Zimmer Holdings acquired Swiss-based

Centerpulse, and became Europes leading orthopedic device company.

The company specializes in the development and manufacturing of reconstructive

implants and devices for spinal applications, and for knee, hip, shoulder and elbow
joints, and related orthopedic surgery products.

The firm is noted also for its innovation and the fast-growing spinal segment of its
business.
In April 2007, Zimmer Holdings acquired Endius, a company focused on minimally
invasive endoscopic spine surgery systems, and in Nov. 2007, it acquired ORTHOsoft.
In Oct. 2008, the company acquired Abbott Spine, a manufacturer of spine implants.

U.S. base in Warsaw, Ind., the company markets its products in more than 80
countries.

Medtronic

Founded in 1949, Medtronic is one of the leaders in innovative medical

technologies and surgeries, with focus on diagnosis, prevention and
monitoring of chronic conditions.
Among the firms innovations of special interest to orthopedic surgeons
are its bone graft and Minimal Access Spinal Technologies and imageguided surgical navigation procedures.
In Oct. 2007, the Company launched the CD HORIZON LEGACY
Anterior Spinal System and in July 2008, Medtronic completed the
acquisition of Restore Medical, manufacturer of devices to treat sleepdisordered breathing.

The firm, headquartered in Minneapolis, Minn., sells its products in

more than 120 countries.

Siemens Medical Solutions

Siemens Medical Solutions provides a comprehensive mix of

consulting services, including a variety of orthopedic-related devices
and equipment.

Among the innovative firsts developed by Siemens are the first x-ray
tube patent, the first hearing aid with amplification adjustability, the first
real-time ultrasound, the first whole body fast volume Spiral CT and
the first PET-CT hybrid scanning system.

Based in Erlangen, Germany, the firm was founded in 1877.

Smith & Nephew

Smith & Nephews orthopedics division is a global provider of leadingedge joint replacement systems for knees, hips and shoulders, as well
as devices for orthopedic trauma procedures.

The specialist market helps drive the companys annual $3.4 billion in
sales, according to the company, by continuously developing new
materials and techniques to meet the growing demands of procedures
and facilities for tougher, long-lasting implants and less invasive, fasterto-heal surgical products for use across patient populations.

Smith & Nephew was founded in 1856 and is headquartered in the

United Kingdom.

It is now the UKs largest medtech company and one of the top
companies in its field in the world. Their units jointly offer over 1,000
product ranges.

5 New Developments in Orthopedics

1.Biologics

The use of biologics is changing the nature of orthopedics,

as surgeons begin to understand and modulate how cells
interact to enhance patients' own healing responses,

One example is platelet rich plasma therapy PRP, in which a

patient's own platelets are spun out and harvested and then
injected into the injury site to promote accelerated and focused
healing of the soft tissue.
Another example is the introduction of bone morphogenic protein
BMP, which stimulates the patient's ability to create more bone.

2. Practice management shifts.

Orthopedic surgeons are moving from a freelance to

an employed model, frequently aligning with

hospitals that agree to take over the management
functions of their practices,

The challenges of integrating information-technology

platforms, higher practice costs and flat or declining
reimbursements all are driving this trend.
"Before, we'd just go to the operating room". "We're
managers now, and that's a new role."

3. Computer navigation in the operating

Computer-assisted surgery is being taken to new levels with
room.
methods that allow surgeons to make instruments patientspecific, and the use of this technology is likely to increase
greatly in orthopedics in the near future.

Orthopedic surgeons now can use pre-operative MRI or CT

scans to make individualized templates to customize the
guides they use for knee replacement surgery, for example.
"More companies now are investing in this technology,
whether to provide easier navigation in the operating room or
to pre-navigate by getting 3-D scans of the knee to make a
pre-custom knee"

4. Rise in minimally-invasive surgery.

Patients continue to gravitate toward minimally-invasive

procedures, a trend that crosses all orthopedic subspecialties.

Whether it's an endoscopic discectomy vs. an open lumbar

disc surgery, a total hip replacement vs. a less-invasive hip
resurfacing, or a minimal approach to lumbar fusion, patients
are attracted to the idea that less surgical trauma leads to a
better surgical result.
"Adaptability is becoming a very important quality in your
surgeon"

5. The patient as consumer.

Perhaps the biggest development shaping

orthopedic practice is a trend toward more educated

and discerning patients.
"The patient is no longer just a passenger here"
"They're actively investigating their care, they have
access to information sources they didn't have
before, they're smarter, they're sometimes better
informed than the doctor is."

The Current Landscape2012

Segment Evolving
Hip & Knee Growth Moderating
Extremities Leading RECON Growth
Spine Market in Decline
Procedures decreasing based on
co-pay
Pricing pressures based on overall
market
Outcomes
Trauma / Sports Medicine unfazed by
economic challenges

19

The Current Landscape2012

Materials

Based on combination of lack of innovation, outcomes of current

forms and cost opportunities

Trends

20

Movement away from science project materials

Powdered metal growth based on porous opportunities
Continued Peek growth
Considerable focus on Titanium solutions from MIM to Casting.
Hard on hard but moving away from CC on CC.
Absorbable metals

2011+
Projections
2009 Orthopedic Market
$38.6B

21

6.4% Growth

2013 Orthopedic Market

$50.2B

6.8% CAGR

Key Observations
Sports/Trauma growth continue to lead all segments
Spine projected to rebound to 2nd largest market
Greater than 75% Implants/Implants (Class I & II Devices)
Price erosion to continue at 1-2% per year or 5% during period

Making Small Smaller

An Example: Electronics-Microprocessors

microscale

nanoscale
macroscale

ibm.com

Specialized Nano-Coatings
Inframat
hardened
coatings for
Navy
high-wear parts

Self-cleaning
surfaces - like a
Lotus leaf
(ultrahydrophobi
c)

Biocompatible
coatings for long
lasting orthopedic
joints

Nano for Regenerative Medicine

Super Adhesives

Adhesive force of a single gecko foot-hair

Nature 405, 681-685 (8 June 2000)
Microfabricated Adhesive Mimicking
Gecko Foot-Hair Nature Materials 2, 461463 (2003)

Questions

26