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. Emad Abdelnaby, senior director, Trauma and CMF for DePuy Synthes, 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?
Emad Abdelnaby: The extremities market is growing at double digit rate vs core trauma with specific segments of foot and ankle driving the bulk of this growth.
In my opinion there are three major drivers of this growth. There is the macro trend of the aging population who are living longer and are far more active than previous generations. They may have more of a propensity for injuries due to age and their level of activity. Additionally, there has been a lot of investment around new technology in these types of procedures with more streamlined solutions for surgeons, hospitals and Ambulatory Surgical Centers, so you are seeing a broader variety of product offerings to treat extremities cases. And finally, there is a trend toward more elective procedures particularly in the foot and ankle space for which patients can decide whether or not to undergo treatment, which is driving growth for the segment as a whole.
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?
Abdelnaby: At DePuy Synthes, we help our customers treat patients along the continuum of care from early intervention options to total joint replacement. The breadth and depth of our portfolio is vast as we manufacture products for spine, for trauma, for craniomaxillofacial, for both small and large joints. But, customers need to be served very differently in each of these segments and it’s important to recognize that the anatomy is very different therefore the products must be different. There is core trauma which typically encompasses larger bone structures and then there are extremities—as a company we need to be able to pivot between them. The bone structure in extremities is different than in a tibia or a hip. There is also a big difference in how we serve our customers. In foot surgery in particular, there are a large number of podiatrists who are playing an increasingly more prevalent role in diagnosing and performing foot surgery so the needs are going to vary in how you support them with their cases.
Barbella: What new technologies are on the horizon? What kinds of implants hold the most potential for patients and for market growth?
Abdelnaby: We are consistently looking at ways we can fill portfolio gaps through both internal innovation as well as external acquisitions and alliances. An excellent example of this is our acquisition of BioMedical Enterprises (BME), which is a leading manufacturer of Nitinol orthopaedic implants for small bone fixation. These implants are used to treat bunions, hammertoes and other foot and ankle deformities, as well as hand and wrist deformities. BME was one of the first U.S. manufacturers of Nitinol metal implants for musculoskeletal fixation and is a market leader in the use of memory metal implants for bone fixation. Nitinol is a nickel-titanium alloy that provides dynamic continuous active compression, which helps to promote healing after bone fixation. BME implants come ready-to-use on a sterilized, pre-loaded, fully disposable insertion tool.
BME will help us to better serve our customers in the extremities market as these procedures become increasingly more common.
Barbella: Where does innovation come from in the extremities market? How does DePuy Synthes stay innovative?
Abdelnaby: The surgeon, our customers, our patients are front and center for us as we develop solutions to best meet their needs. The insights we generate by listening to our customers gives us the opportunity to work towards meeting them where they are and it is where true innovation comes from.
Barbella: Aside from the implants, how does the extremities market differ from large joints, or spine? What makes extremities implants a design challenge?
Abdelnaby: With extremities, the intricacy of the anatomy is very different so we need to develop plates, screws and solutions that may be appropriate for the average patient’s anatomy, but it also needs to be customizable. Traditional plates and screws won’t necessarily work in such a complex part of the anatomy.
Barbella: Where do the extremities and trauma markets overlap? How do they differ?
Abdelnaby: The fundamental principles of internal fixation that are applied to core trauma are applied to extremities, however the biggest distinction between the extremities and trauma markets is in the urgency of the intervention. Some of the procedures within the extremities market are elective and therefore don’t require such immediacy of treatment.
Barbella: Where do you see the extremities market five years from now?
Abdelnaby: As the market for extremities evolves the opportunity for growth will continue to be significant as our population ages and becomes increasingly more active. We expect that investment in new technologies will still be critical and the trend toward more elective procedures will continue to rise.