The small joint and extremities reconstruction market is growing faster than the hip and knee replacement market. New advanced technologies will help this specialty market grow at a CAGR of about 9 percent over the next few years. Compared to replacement of large joints, small joint reconstruction is a far less common procedure, although the devices have been around for the last few decades. A steady stream of innovations, many developed by the surgeons themselves, underscores the urgent need to meet growing patient demand.
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The US and Europe account for the predominant share of the small joints replacement market. Emerging healthcare markets are currently focused on large joint replacements, although small joint procedures will soon catch up.
- Joint diseases will continue being the leading cause of disability in older people. Growth of this patient base is accelerating as populations around the world age, and rates of chronic inflammatory diseases, osteoarthritis and obesity soar.
- Despite the high complication rate, clinical studies from all over the world show that arthroplasty can be used to successfully treat degenerative diseases and repetitive motion injuries caused by sports and occupational tasks.
- Patient demands are also changing with increasing life expectancy. People with end-stage arthritis are looking for treatment alternatives to arthrodesis that restore mobility and offer a greater quality of life.
- Shoulder replacement or arthroplasty devices are the most common type of small joint replacements, accounting for almost three quarters of the $917million market in 2011.
- Elbow and ankle replacements offer high growth potential due to high rates of injury. There are only a handful of ankle replacement devices leaving a wide open field for new entrants.
- Extremities reconstruction, namely digits, comprises the smallest segment of this market, due in large part to procedural complexity.
- The severe shortage of trained surgeons is a major restraint needing to be addressed.
- More successful technologies are critical in clearing regulatory hurdles, improving reimbursement, and patient acceptance.
- The market is dominated by well-established joint reconstruction specialists such as DePuy, Tornier, Zimmer and Biomet, closely followed by other orthopedic giants like Stryker, Smith and Nephew and Wright Medical. These companies compete fiercely for high-end products with highly reputed niche players such as Integra Life Sciences and Small Bone Innovations.
Marketstrat’s report includes reconstruction devices intended to replace either a whole joint (total joint arthroplasty) or joint components (hemi-arthroplasty). Replacement devices are permanent devices implanted to restore movement, reduce pain and allow weight-bearing.
Clinical indications are primarily end-stage arthritis and trauma. Joint degeneration due to malignant tumors and congenital abnormalities are less common. Weight, activity level, age and other factors influence patient selection.
Joint reconstruction for extremities (digits) and small joints (shoulder, elbow, wrist and ankle) is relatively less common compared to knee and hip reconstruction. There a relatively fewer manufacturers and trained orthopedic specialists are hard to find, even in developed economies. However, this market is growing. Manufacturers are investing in research and development, introducing innovative technologies that address implant failure. Reconstruction of digits and ankle is particularly rare. Ankle injury rates are high and growing, creating a need for replacement devices.
Implants typically contain metal, plastic and ceramic components. Devices may be cemented and uncemented, bipolar and monopolar devices, total joint replacements or partial, single component or modular. New technologies feature a number of benefits ranging from new articulating surfaces, anatomical designs, enhanced range of motion, easy implantation and alignment, etc. Manufacturers offering small joints and extremities reconstruction devices are typically orthopedic device specialists.
Reimbursement is available for most types of joint reconstruction in the largest markets which are currently the US and Europe. Expansion of insurance coverage is dependent on the accumulation of evidence of safety, cost-effectiveness and clinical efficacy from post-market clinical studies. For many patients who opt for reconstruction surgery, cost prevents a barrier in the current economic landscape. In the US, decreasing Medicare coverage, loss of employer-sponsored insurance due to unemployment and potential healthcare efficiency measures that may be imposed on physicians and hospital systems all threaten the growth of the orthopedic reconstruction market in the near future.
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