The planet’s extremities market, long ignored by major orthopedic device manufacturers, is finally commanding respect as companies attempt to counterbalance sluggish growth in the saturated, maturing hip and knee replacement sectors. Fueled by an aging world population, more youth-related sports injuries, and rising rates of obesity, osteoarthritis, and osteoporosis, the global extremities market is projected to be worth $15.9 billion by 2024, according to Research and Markets data. Internal fixation devices such as plates and screws have dominated the sector in recent years due to the early functionality, abbreviated hospital stays, minimal scarring, and reduced non-union risk associated with these products. Acumed LLC has particularly benefited from the high demand for internal fixation, having sold 500,000 wrist fixation implants (Acu-Loc and Acu-Loc 2) in just two years.
Such promise, of course, is garnering interest among major orthopedic companies that traditional have overlooked the sector in favor of the more lucrative large-joint sector. ODT’s May/June feature story “Going to Extremes” examines the trends and challenges driving the extremities market as well as some of the latest technologies available to patients. Ryan D. Schlotterback, chief commercial officer of privately held musculoskeletal product development firm Nextremity Solutions Inc., was among the experts interviewed for the feature; his full input is provided in the following Q&A.
Michael Barbella: Please discuss the trends in the extremities market. What trends have you noticed this year and how do they differ (if at all) from past trends?
Ryan D. Schlotterback: Innovation with speed that advances the standard of care is a trend that continues in the extremities market. There are still many opportunities in the lower extremity market in particular, for new delivery systems and products, that allow patients to get back to daily life sooner and with better clinical outcomes. This is a trend that has, for the most part, already played out in many other areas of orthopedics. We’re excited about the future of extremities and we are continuing to identify opportunities with the help of our surgeon partners.
Barbella: What challenges face companies in the small joint (extremities) sector, and how are these challenges different than those faced by companies manufacturing large joints - i.e., hips and knees? How can companies in the extremities sector overcome these challenges?
Schlotterback: Many of the companies in the small joint (extremities) sector are smaller to mid-size companies with thinner product portfolios and immature or segmented sales and distribution networks. You really don’t see these type of companies in the hip and knee market anymore. Most of the players are the large OEMs with well-established sales and distribution networks. The small to mid-size companies face a host of challenges that make it difficult to bring some of these much-needed innovations to the market. Economies of scale, costs of sales, medical training and education (essential for innovative products), and barriers to entry in large hospital systems and ASCs all pose real challenges to the smaller companies (and their shareholders) in the extremities market. We’ve been able to overcome many of these challenges through our alliance strategy with the large OEMs in our space.
Barbella: What new technologies are on the horizon? What kinds of implants hold the most potential for patients and for market growth?
Schlotterback: We believe you’ll continue to see less invasive, more robust and reproducible solutions come to the extremity space. Not many patients enjoy, nor can they afford, being off their feet for six to eight weeks. Our surgeons believe there are better ways to approach these pathologies. Biologics and some of the newer resorbable materials will continue to play a larger role. We think the extremity space is still very well suited for the single-use, sterile pack delivery systems that we’ve been bringing to the market since we started over five years ago. I think you’ll continue to see some refinements on the sterile pack systems and more efficient methods of delivery.
Barbella: Where does innovation come from in the extremities market? How does Nextremity Solutions stay innovative?
Schlotterback: We believe strongly that you’ll continue to see innovation driven from the smaller, more nimble extremity companies. The large OEMs, although great at marketing, sales, and distribution, continue to face internal and external challenges when it comes to new product development. We’ve been able to structure Nextremity Solutions such that we can focus on what we do best—work with thought leaders and surgeons in the extremities market to commercialize innovative solutions quickly and efficiently. It’s the impetus for our i3 Strategic Solutions strategy. As our President and CEO Rod Mayer often states, we need to do more of what we do best, more profitably, every day. It’s part of the culture at Nextremity. We also have and will continue to partner and invest in startup companies and early-stage technologies that we feel are synergistic with our current business strategy and which will ultimately bring value to our industry partners and shareholders.
Barbella: Aside from the implants, how does the extremities market differ from large joints, or spine? What makes extremities implants a design challenge?
Schlotterback: As I stated earlier, the natural evolution of the orthopedic market from largely open, less instrumented fusions to less invasive, highly reproducible motion-preserving approaches has, for the most part, already occurred in the other areas of orthopedics such as large joint and spine. Those of us in the extremity space are challenged to address these same market needs and bring solutions that help make our surgeons better while allowing our patients to get back to daily life sooner with less pain. We still have some work to do to bring our clinical outcomes up to par with some of the other areas of orthopedics.
Barbella: Where do you see the extremities market five years from now?
Schlotterback: My hope is that five years from now we’ll have seen a host of new products come to the extremities market that will improve outcomes and lower overall cost of care, which is getting more and more focus. There is so much more to the overall cost of care then just the price of the implants. The extremity market has plenty of room for growth and I think it will continue to be a leader for growth in the orthopedic industry. Nextremity Solutions is excited to be able to participate with our surgeon and industry partners during this exciting time in the extremity market.