Originally Published MDDI April 2005

NEWSTRENDS

Keep the Procedures Simple, Orthopedic Surgeons Say

Erik Swain

The key to getting an orthopedic device accepted, say orthopedic surgeons, may not be how dazzling the technology is, but how simple the procedure is.

That was the main message from two panels at a recent healthcare investors' conference. One, on spine surgery, discussed the effect of the new artificial disks coming onto the market as an alternative to fusion. The other, on joint replacement surgery, did the same for artificial knees and hips.

Thomas Errico is chief of the Spine Service at New York University's Hospital for Joint Diseases. He said artificial spinal disks represent “a real advance because they do not bring too much trauma to the patient and allow for quicker recovery” than from spinal fusion surgery.

John Sherman, a spine surgeon who runs Twin Cities Orthopaedic Consultants (Edina, MN), noted, however, that surgeons might be hesitant to do the operation. He thinks their reluctance may be because the incision is made in unfamiliar territory: the front, not the back, of the body. This concern, along with issues about reimbursement, could slow the procedure's adoption, he said.

“The aorta and the vena cava are in the way” between the point of incision and the spine, Sherman said. “Thus the procedure requires a different skill set from that of the typical spine surgeon. The biggest challenge is being able to safely negotiate the vena cava and the aorta.”

That issue could eventually make cervical disks more accepted than spinal disks, they said. There are no cervical disks currently on the U.S. market, though four are in clinical trials.

“The risks relating to disks in the neck are significantly lower,” said Sherman. “Some of the hurdles that are required in lower-back surgery do not exist in neck surgery.” A crucial difference, he said, is the lack of major organs between the incision point and the cervix. Errico said cervical disks have the potential to “cannibalize 75–80% of the cervical market.”

Surgeons on the joint replacement panel said they consider the time a procedure takes to be crucial. For example, they can do more surgeries per day if they choose to do a procedure that takes one hour instead of two.

Touting a procedure as “minimally invasive” won't do much to convince surgeons of its worth, they said, as most knee and hip replacements now use as small an incision as possible. In fact, the term minimally invasive without specifics is nearly worthless, said Richard Laskin, cochief of the Knee Service at the Hospital for Special Surgery (New York City).

“I do all total knees through a small incision, and many hips too, though it depends on the size of the patient,” he said. “We're all making [incisions] smaller. The real difference is how complex the procedure is. If it requires all kinds of extra equipment, it may not be economically feasible.”

Investment bank Piper Jaffray & Co. (Minneapolis) sponsored the conference, held in January 2005 in New York City.

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