Trauma Trends

An industry analyst and orthopedic surgeon provide insight into market forces.

Christopher Delporte

At roughly $4 billion in revenue worldwide (depending on whose estimate you use), the trauma market is a significant slice of the orthopedic pie that has shown year-over-year double-digit growth during the past few years. Orthopedic companies have responded to physician demands for more durable devices and implants requiring less-invasive procedures. Locking plate and screw systems are the name of the game today, but advances in resorbable implant technology currently in development could mean significant breakthroughs for surgeons and patients and continued market growth for orthopedic manufacturers. To take a look at current market conditions and sector trends, Orthopedic Design & Technology spoke with Aarti Shetty, a medical device industry analyst for Frost & Sullivan, a business research and consulting firm headquartered in San Antonio, Texas.

The following are excerpts from the interview:

Orthopedic Design & Technology: Growth in the trauma marketin recent years seems to have outpaced other orthopedic sectors such as large joint. To what do you attribute this growth? Do you expect it to continue?

Aarti Shetty: The trauma market is expected to grow in coming years as the U.S. population ages and suffers from increased in-stances of osteoporotic fractures. With the demand for technically superior procedures rising, investment in innovation has been a rising feature in the U.S. trauma fixation market. As a result, manufacturers of fixation devices are researching newer and improved ways of adding value to the existing levels of technology available in the market. The high growth rates in the trauma market are expected to continue for the next five to seven years, with some segments [growing] faster than the others.

ODT: What are the overall market trends that have characterized the market during the last few years?

Shetty:Increased interest and growth in the external fixation market has been an interesting trend in the trauma market in the last few years. The trauma fixation device market is ruled by certain major players, and it becomes increasingly difficult for smaller participants to penetrate the market space. Thus, it becomes even more important for players to carve their position in the market through innovation and differentiat-ion, and some players have been able to do this by identifying certain niche market needs and providing for them. Innovative products have given rise to price pressures in the market.

ODT: What technological advances (materials, design, manufacturing, etc.) do you feel have aided innovation in the trauma market?

Shetty: The biggest story in the plate-and-screw segment of the trauma market is the impact of locking plates and screws. Initially developed by Synthes (LCP) and more recently adopted by Smith & Nephew (Peri-Loc), Zimmer (Periarticular Locking Plates), Stryker (Numelock II), and DePuy (Polyax), locking plates are thought to increase the stability of the plate/screw construct. We are seeing many ad-vances in the external fixation market in recent years. Although orthopedic surgeons have used external fixation products in the past, the growing popularity of this method coupled with the introduction of newer products by device manufactures has allowed the emergence of growth opportunities in this market. The technology in this field can be considered mature, but the varied application of this technology to develop better products sets this market in a growth phase in the next five to 10 years.

ODT: Have trauma products benefited from advances in other areas such as spine and large-joint? Do you think it works in reverse?

Shetty: The joint replacement market has grown at a much higher pace than the trauma fixation market. Surgeons, now well versed with a variety of joint replacement techniques, have expanded their scope of applications beyond the traditional hip and knee sites. Their confidence in this regard has increased collectively, and so has the influx of instruments and allied resources for replacement procedures. Success rates have climbed consistently, and with the mass introduction of reconstructive joints for a variety of anatomical sites, replacement surgery options are much more varied and attractive to the average patient. This market has achieved maturity since joint replacement is now widely accepted as a commonplace procedure. In addition, surgery times have steadily dropped as a result of improvements in partial and revision joint reconstruction methods. With the advancement of technology in this area, better and more biocompatible products, each with a custom-design alternative, are now available. Though some experts may say this is a restraint to the trauma fixation market, we can expect to see both markets complementing each other and growing in the next few years as long as the trauma market continues to produce novel products with great clinical outcomes.

ODT: How does surgeon (or even patient) input lead to changes in product design and manufacturing?

Shetty: Today’s patients are more aware of the medical technology available to them and are making sure they’re updated about the latest developments that could aid their treatments. They relay their needs to their surgeons and, in turn, the surgeons demand better products from the manufacturers. Manufacturers use end-user research to obtain insight from surgeons about their various requirements. Manufacturers of trauma fixation in-struments have proactively created a collaborative culture involving surgeons in the crucial steps of the development process. Companies have expended a great deal of effort, time and dollars toward achieving this critical objective, and have efficiently carried through the endeavor by providing practical training and support to the surgeons.

ODT: What kind of innovation is ahead for the trauma market? How will advances in areas such as biologics, for example, shape trauma offerings in the future?

Shetty: Advanced biologic proteins like rhBMP-2 [recombinant human bone morphogenetic protein 2] are clearly envisioned, and are on the way toward being the standard of the future of surgery for all manners of spinal disorders.The osteoinductive [any substance that stimulates bone formation] properties are projected to minimize invasiveness of surgery going forward. Consequently, this is expected to be the key driver in the path toward reducing pain and discomfort associated with surgery, and with it, the lead time to resuming common daily activities. In the highly competitive orthobiologics sector, there appears to be a growing preference toward the use of synthetic materials rather than traditional autografts and allografts. Thus, growth factors—in particular, bone morphogenic proteins—also are becoming increasingly popular, although their higher cost is an ongoing issue.

ODT: How has the current economic downturn affected the trauma market? Any product categories harder hit than others?

Shetty: In the last couple months, hospitals have been reporting reductions in elective procedure volume, which may include trauma surgeries that do not require immediate attention and pain that can be alleviated through adequate medication. The combination of the hospital financial environment and the recession will reduce hospitals’ purchasing volume and reduce the average sales price for the devices they purchase. This will affect the revenue and growth of the trauma industry in the long run.