All GLG News Analyses Filed Under: Orthopaedics

Sales of Infuse product will likely decline with closer scrutiny of off-label use

December 1, 2008

Analysis by: GLG Expert Contributor

Analysis of:Medtronic Says Device for Spine Faces Probe | online.wsj.com

Medtronic might see a significant drop in its sales as a result of closer scrutiny of off-label use of its products.  Infuse has been a cash cow for Medtronic, and if sales drop, it will reflect deeply in the sales numbers.

Joint replacement surgery is a trade not a visit to the fountain of youth

October 13, 2008

Analysis by: GLG Expert Contributor

Analysis of:Unclear how much pounding new hips, knees can take | news.yahoo.com

Patients, especially so called "boomers" can have unrealistic expectations of appropriate activity levels after joint replacement surgery. Like an mecahnical sytem they are subject to fatigue which could lead to early failure. It is up to surgeons to set realistic expectaions for patients, al;though competitive forces make this difficult.

Mixed Blessings for Medtronic in Professional Spinal Surgery Organizations

October 10, 2008

Analysis by: GLG Expert Contributor

Analysis of:Letter to CMS from a Coalition of Spine Care Professional Societies | www.spine.org

The data presented by multiple professional societies does not lend clinical support of many Medtronic products in the Medicare population.  The data does not support the use of disc arthroplasty in the Medicare population, and does not find any clinical advantage of kyphoplasty over vertebroplasty.  This may mean reduced sales of the Kyphon line of products as well as reduced sales of the Prestige implant, should CMS adopt some of these recommendations.

The Reality of Orthopaedics

October 9, 2008

Analysis by: GLG Expert Contributor

Analysis of:Unclear how much pounding new hips, knees can take | news.yahoo.com

From the day that Charnley first developed the artificial hip, there has never been a question that eventually revisions would become a larger market than primary hips and knees.  Joint reconstruction with metal and plastics was never intended, even with today's technology, would be consider capable of restoring a patient's previous lifestyle.  However, our passion for Entitlement to Quality of Life, seems to carry a disruption to the realaties of medical outcomes.    Other contributing factors to increasing revisions factors are imbedded within the Compounding of Demographics, the Margin Reward of Newer Technology and the Competitive Basis for US Orthopaedic Practices.   An obvious outcome from this environment reaches out for the continual search in the means to maintain the highest degree of mobility until death.  Just as obvious then is developing technology that plans for these revisions . . . . resurfacing.    

More questions than answers:

August 6, 2008

Analysis by: GLG Expert Contributor

Analysis of:Drugs to Build Bones May Weaken Them | www.nytimes.com

 Should bisphosphonates be stopped in patients who have been taking them for many years?  Should they be used at all?

Giles ScuderiDirector, Orthopedic SurgeonInsall Scott Kelly Institute

There is a need for a total joint registry in the United States

August 6, 2008

Analysis of:New York Times July 29, 2008 A call for warning system on artificial joints | www.nytimes.com

The AAOS has established the need for a total joint registry however there are financial and legal hurdles that must be overcome. The value of total joint registries have been realized in Europe and Australia with a significant reduction in the revision rate of implants. A joint registry can provide an early warning system on issues or problems related to a particular implant design or surgical technique. With the rising cost of healthcare, a registry in the United States can be a cost effective use of our limited healthcare resources. If the data can be delivered to the orthopedic community in a timely and understandable fashion, it should and will influence the surgeon's behavior and decision making such that patients and society are benefited.

Patients will continue to decrease the use of these agents for reasons that I can speculate are largely related to lack of perceived efficacy the fear of the unknown

July 28, 2008

Analysis by: GLG Expert Contributor

Analysis of:Drugs to Build Bones May Weaken Them | www.nytimes.com

This should not deter the practicing physician to prescribe these agents osteoporosis will reach epidemic proportions and if we can reduce fractures by 50% the savings within the healthcare system will be enormous that's not to say that individuals albeit rare may have a propensity to develop fractures with these drugs a better understanding within the each individual's bone metabolism will be greatly helpful

Richard AmerlingDirector of Outpatient DialysisBETH ISRAEL MEDICAL CENTER (INC)

The Dark Side of Fosamax

July 25, 2008

Analysis of:Drugs to Build Bones May Weaken Them | www.nytimes.com

Considering the effects of fosamax and other bisphosphonates on bone remodeling, it is not at all surprising to see problems arising with the long term use of these agents.  

Over Suppression of Bone Turnover May Be Harmful

July 21, 2008

Analysis by: GLG Expert Contributor

Analysis of:Drugs to Build Bones May Weaken Them | www.nytimes.com

Bisphosphonates, including medications like Fosamax, prevents normal bone turnover and metabolism.  Nephrologists had anticipated similar findings as these recent reports as over-suppression of normal bone turnover may be associated with adynamic bone disease and possibly fractures.  The process in kidney disease patients cannot be extrapolated to the normal, non-kidney disease patients directly but these recent findings suggest that similar clinical manifestations may be present in the wider community.   

Potential Side Effects May Take Years to Become Visible

July 21, 2008

Analysis by: GLG Expert Contributor

Analysis of:Drugs to Build Bones May Weaken Them | www.nytimes.com

As in so many other instances, some potential side effects will only show up once the number of patients has grown far beyond the number studied in pre-marketing studies.

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