A Medical Device Daily
The European market for hip and knee replacements is expected to grow from $1.4 billion in 2004 to $1.83 billion by 2010, said international consulting firm Frost & Sullivan (F&S; London), citing a combination of demographic factors and technological advances.
The total hip replacement market, currently the larger segment, is expected to grow at a compound annual growth rate (CAGR) of 3.7% from 2003-2010 to reach $885.7 million by the end of the decade.
F&S said that the smaller, but faster-growing, knee replacement market would overtake hips in size by the end of the period. At a CAGR of 5.7%, knees will account for 51.6% of market revenues by 2010 at $945.3 million, while hips will grow at 3.7% a year over the period to reach $885.7 million, it said.
Frost & Sullivan said the rapid graying of Europe's population, "with related increases in the incidence of musculoskeletal problems (particularly osteoarthritis)," is expected to be a key driver for orthopedic prosthetic implant devices over the long term.
And, it said, "enhanced clinical outcomes and clinical efficacy are boosting the number of procedures carried out on patients in younger age groups."
F&S said continued pressure to reduce the number of people waiting for joint replacement surgery in Europe "has been paralleled by a spurt in total knee and hip replacement procedures from major joint replacement centers to more general acute hospitals." This, it said, "has reduced waiting times, augmented the number of procedures being carried out and stimulated market growth."
Emerging as a key growth segment in the overall market is revision surgery. "Although primary joint replacement has established a success rate of nearly 95% over the past decade, the number of revision total joint replacements is increasing," Frost & Sullivan said. It estimated the annual growth rate for revision implant products during the past several years has been estimated at between 12% and 15%, more than double the growth rate for primary implants over the same time frame.
Market growth also is buoyed by technological advances in materials, operative procedures, product design and manufacturing processes, the company said.
It cited computer-aided design/computer-aided manufacturing; new materials technology such as bone substitutes, bio-absorbable products and specialized alloys; and innovative joint replacement product designs, "which support improved performance characteristics and/or multiple applicability."
Other technological progress mentioned by Frost & Sullivan in its analysis include medical robotics; computer-assisted surgery, including image-guided technologies; minimally invasive joint replacement surgery and bio-engineered technologies. While those already are in use, their further advance is projected to "significantly influence" the development and design of new innovative products.
Frost & Sullivan Industry Manager Tanya Pullen said, "The challenge to industry is to overcome some of the natural prejudices that the surgeons may have concerning robotics and computer assistance during surgery and ensure that implant technologies complement the use of computers during surgery."
She added that companies need to address issues of safety, "as there is an urgent requirement for a consensus on what is 'safe practice' concerning both human-guided and autonomous robots as well as concerns and misconceptions related to robots replacing surgeons in the operating theatre."
Pullen cited as another challenge the need for industry to involve itself with the creation and development of national arthroplasty registers that identify best-performing products and surgical techniques and analyze patient outcomes.
Frost & Sullivan said the competitive landscape has been shaped by a series of major acquisitions, mergers and joint ventures. Prominent examples of this trend, it said, "have been the joint venture between Biomet [Warsaw, Indiana] and Merck [Darmstadt, Germany], the acquisition of DePuy [Warsaw, Indiana] by Johnson & Johnson [New Brunswick, New Jersey], that of Howmedica [Allendale, New Jersey] by Stryker [Kalamazoo, Michigan] and most recently the acquisition of Centerpulse [Zurich, Switzerland] by Zimmer [also Warsaw]."
These structural changes, F&S said, "have led to a streamlining of operational logistics, including restructuring of manufacturing and sales and marketing activities together with a rationalization of the product portfolio and product group responsibilities."
Pullen added: "The market has seen a slow but deliberate emphasis away from the use of local distributors, a consolidation of related orthopedic products and service activities, and a greater emphasis on supplying the market directly through subsidiaries."
This is seen, she said, as a method of improving profit margins and retaining greater operational control of distribution and customer service."
More critical-care beds in UK
Statistics released earlier this month show there are a record number of critical-care beds in the UK's National Health Service (NHS).
Health Secretary John Reid said there were 3,213 such beds in January of this year compared with 2,362 in January 2000 – a 36% increase. The number includes 1,426 high-dependency beds, an increase of 77% since 2000.
The number increased by 70 beds since January 2004, a 2.2% gain.
Reid said, "The hard work of the NHS, together with the 285 million in additional funding that we've specifically provided for critical care since 2000, has meant that we've exceeded the target set four years ago to increase the number of beds." The NHS Plan included a commitment to increase the number of adult critical care beds in England by 30% between 2000 and 2003.
"However, I know we need to do even more to increase capacity," said Reid. "That's why I'm committed to putting record levels of investment into the NHS so that critical care can be further improved."