Clinica's Complete Guide to Orthopaedics: Volume 1 - Orthopaedic Product Developments and Market Analysis

Clinica's Complete Guide to Orthopaedics: Volume 1 - Orthopaedic Product Developments and Market Analysis

Clinica's Complete Guide to Orthopaedics provides all the information you need about the highly competitive orthopaedics sector.

It includes forecasts to 2002, company profiles, country profiles and the strategies of your competitors. Volume 1 (published February 2000) provides the vital market analysis and Volume 2 (publication April 2000) will allow you to get behind the thinking and rationale of the top 20 companies.

As product areas are becoming saturated, new markets are emerging. Volume 1 provides the vital market analysis you need to make informed business decisions.

Commencing with a global market overview, this report examines market sizes and growth rates for the world market for orthopaedic products and by individual product areas - enabling you to see which markets should be targeted for product placement
It compares the sizes of different country markets and discusses the factors influencing them.

The report reviews current orthopaedic products, the latest products to enter the market and future developments - allowing you to assess which products have the most potential for growth. It covers: total joint replacement; spinal products; trauma/fracture management products; tissue repair; and instruments/arthroscopy.

Orthopaedic Product Developments and Market Analysis contains in-depth profiles of the major orthopaedic markets: the US, Europe, Japan, France, the UK, Spain, Italy and Scandinavia. Profiles include healthcare expenditure, reimbursement process, scope of orthopaedic market and orthopaedic procedures.

PUBLISHED: FEBRUARY 2000
PAGES: 200+
REF: CBS832E
PRICE: £695/$1,460/¥167,000

For further information about this report, please contact our Customer Helpdesk on:
Tel: +44 (0)20 8332 8965 / 66
Fax: +44 (0)20 8332 8992
E-mail: [email protected]

CONTENTS
LIST OF TABLES
LIST OF FIGURES
EXECUTIVE SUMMARY
GLOSSARY AND ABBREVIATIONS
ACKNOWLEDGEMENTS

CHAPTER 1 INTRODUCTION
1.1 Aims of the report
1.2 Scope of the report
1.2.1 Products included
1.2.2 Markets included
1.2.3 Years covered
1.3 Methodology
1.3.1 Forecasting
1.3.2 Gross domestic product and gross national product data
1.3.3 Currency exchange
1.4 Medical conditions influencing the orthopaedics market
1.4.1 Arthritis
1.4.1.1 Rheumatoid arthritis
1.4.1.2 Reactive arthritis
1.4.1.3 Osteoarthritis
1.4.2 Osteoporosis
1.4.3 Congenital deformities
1.4.3.1 Spina bifida
1.4.3.2 Juvenile scoliosis
1.4.3.3 Congenital dislocation of the hip
1.4.3.4 Osteogenesis imperfecta

CHAPTER 2 MARKET OVERVIEW
2.1 Influencing factors
2.2 Global market
2.3 Geographical breakdown of the market
2.4 Product segmentation
2.4.1 Joint implants
2.4.2 Trauma fixation products
2.4.3 Spinal repair products and implants
2.4.3.1 Spinal repair products
2.4.3.2 Spinal implants
2.4.4 Arthroscopy products
2.4.5 Orthopaedic operating room supplies
2.4.6 Powered instruments
2.4.7 Electrical stimulation equipment
2.4.8 Casting materials
2.4.9 Rehabilitation products
2.4.10 Tissue engineering
2.4.11 Osteoporosis diagnostics
2.4.12 Image guided surgery equipment

CHAPTER 3 PRODUCT AND CLINICAL DEVELOPMENT
3.1 Product segmentation of orthopaedic companies
3.2 Hip systems
3.2.1 Overview
3.2.2 Hip designs
3.2.3 Design elements
3.2.4 Design considerations
3.2.4.1 Cemented versus uncemented hips
3.2.4.2 Metal-on-metal implants
3.2.4.3 Ceramic implants
3.2.5 Developments
3.2.5.1 Developments in materials
3.2.5.2 Developments in design
3.2.5.3 Developments in hip operations
3.3 Knee systems
3.3.1 Overview
3.3.2 Knee designs
3.3.3 Design considerations
3.3.3.1 Mobile-bearing knees
3.3.4 Developments
3.3.4.1 Developments in materials
3.3.4.2 Developments in design
3.3.4.3 Developments in knee operations
3.4 Fracture management
3.4.1 Overview
3.4.2 Product designs
3.4.2.1 Intramedullary nails
3.4.2.2 Dynamic hip screws
3.4.2.3 Compression screw fixation systems
3.4.2.4 Compression plating systems
3.4.2.5 External fixators
3.4.2.6 Cannulated screw fixation systems
3.4.2.7 Maxillofacial screw and plating systems
3.4.2.8 Wiring systems
3.4.2.9 Cerclage systems
3.4.2.10 Specialist screw fixation systems
3.4.2.11 Severe bone loss systems
3.4.2.12 Fracture healing acceleration
3.4.3 Developments
3.4.3.1 Developments in materials
3.5 Spine products
3.5.1 Overview
3.5.2 Product designs
3.5.2.1 Products for the treatment of scoliosis
3.5.2.2 Pedicle screw spinal fixation products
3.5.2.3 Interbody fusion cages
3.5.3 Design considerations
3.5.3.1 Pedicle screws
3.5.3.2 Interbody fusion cages
3.5.3.3 Disc augmentation
3.5.4 Developments
3.5.4.1 Developments in materials
3.5.4.2 Developments in design
3.5.4.3 Developments in spinal operations
3.6 Arthroscopy
3.6.1 Overview
3.6.2 Arthroscopy products
3.6.3 Developments
3.7 Tissue engineered products
3.8 Arthritis treatment

CHAPTER 4 THE US MARKET
4.1 Organisation of the US's healthcare system
4.1.1 Medicare
4.1.2 Medicaid
4.1.3 Private insurers
4.1.4 Uninsured
4.2 Reimbursement in the US
4.3 The US orthopaedics market
4.3.1 Arthritis
4.3.2 Orthopaedic procedures in the US
4.3.2.1 Hip implants
4.3.2.2 Knee implants
4.3.2.3 Spinal implants
4.3.2.4 Trauma fixation

CHAPTER 5 THE JAPANESE MARKET
5.1 Organisation of Japan's healthcare system
5.2 Japan's medical device regulations
5.3 Reimbursement in Japan
5.4 The Japanese orthopaedics market
5.4.1 Population
5.4.2 Arthritis
5.4.3 Orthopaedic procedures in Japan
5.4.3.1 Hip implants
5.4.3.2 Knee implants
5.4.3.3 Spinal implants
5.4.3.4 Trauma fixation
5.5 Market size

CHAPTER 6 THE GERMAN MARKET
6.1 Organisation of Germany's healthcare system
6.2 Reimbursement in Germany
6.2.1 Reimbursement rates
6.2.2 Reimbursement categories and schemes
6.2.3 Reimbursement catalogue
6.3 The German orthopaedics market
6.3.1 Population
6.3.2 Arthritis
6.3.3 Orthopaedic procedures in Germany
6.3.3.1 Hip implants
6.3.3.2 Knee implants
6.3.3.3 Spinal implants
6.3.3.4 Trauma fixation
6.4 Market size

CHAPTER 7 THE FRENCH MARKET
7.1 Organisation of France's healthcare system
7.2 Reimbursement in France
7.3 The French orthopaedics market
7.3.1 Population
7.3.2 Arthritis
7.3.3 Orthopaedic procedures in France
7.3.3.1 Hip implants
7.3.3.2 Knee implants
7.3.3.3 Spinal implants
7.3.3.4 Trauma fixation
7.4 Market size

CHAPTER 8 THE UK MARKET
8.1 Organisation of the UK's healthcare system
8.2 Reimbursement in the UK
8.2.1 Principles
8.2.2 Process
8.3 The UK orthopaedics market
8.3.1 Population
8.3.2 Arthritis
8.3.3 Orthopaedic procedures in the UK
8.3.3.1 Hip implants
8.3.3.2 Knee implants
8.3.3.3 Spinal implants
8.3.3.4 Trauma fixation
8.4 Market size

CHAPTER 9 THE ITALIAN MARKET
9.1 Organisation of Italy's healthcare system
9.2 Reimbursement in Italy
9.3 The Italian orthopaedics market
9.3.1 Population
9.3.2 Arthritis
9.3.3 Orthopaedic procedures in Italy
9.4 Market size

CHAPTER 10 THE SPANISH MARKET
10.1 Organisation of Spain's healthcare system
10.2 Reimbursement in Spain
10.3 The Spanish orthopaedics market
10.3.1 Population
10.3.2 Musculoskeletal disease
10.3.3 Orthopaedic procedures in Spain
10.4 Market size

CHAPTER 11 THE SCANDINAVIAN MARKET
11.1 Organisation of the healthcare systems in Scandinavia
11.2 Reimbursement in Scandinavia
11.3 The Scandinavian orthopaedics market
11.3.1 Population
11.3.2 Arthritis
11.3.3 Orthopaedic procedures in Scandinavia
11.3.3.1 Hip implants
11.3.3.2 Knee implants
11.3.3.3 Spinal repair
11.4 Market size

APPENDIX 1 EXCHANGE RATES
REFERENCES

LIST OF TABLES
Table ES.1 Ranking by growth of the top 10 orthopaedic product sectors, 1999
Table ES.2 Ranking by value of the top 10 orthopaedic product sectors, 1999
Table ES.3 Ranking by value of various orthopaedic markets, 1999
Table 2.1 Estimated value of the global orthopaedics market, 1998-2002
Table 2.2 Estimated geographic segmentation of the global orthopaedics market, 1999
Table 2.3 Estimated value and growth of the joint implant market, 1999
Table 2.4 Estimated value of the hip and knee joint replacement markets, 1999
Table 2.5 Estimated value and growth of the trauma fixation products market, 1999
Table 2.6 Estimated value and growth of the spinal repair products market, 1999
Table 2.7 Leading companies operating in the spinal repair products market
Table 2.8 Leading companies operating in the spinal implants market
Table 2.9 Estimated value and growth of the arthroscopy market, 1999
Table 2.10 Estimated value and growth of the orthopaedic operating room supplies market, 1999
Table 2.11 Estimated value and growth of the powered instruments market, 1999
Table 2.12 Estimated value and growth of the electrical stimulation market, 1999
Table 2.13 Estimated value and growth of the casting materials market, 1999
Table 2.14 Estimated value and growth of the rehabilitation products market, 1999
Table 2.15 Estimated value and growth of the tissue engineering products market, 1999
Table 2.16 Estimated value and growth of the osteoporosis diagnostics market, 1999
Table 2.17 Estimated value and growth of the image guided surgery market, 1999
Table 3.1 Product segmentation summary of leading orthopaedic companies
Table 3.2 Summary of orthopaedic companies producing implants for joints other than the hip and knee
Table 3.3 Summary of hip systems
Table 3.4 Summary of knee implant systems
Table 3.5 Summary of typical intramedullary nails
Table 4.1 Medicare cover - the main differences between Parts A and B
Table 4.2 Estimated number of orthopaedic operations performed globally and in the US, 1999
Table 4.3 The US's population and predicted demographic development, 1993-2020
Table 4.4 Number of persons reported with arthritis per 1,000 population, by sex and age in the US, 1995
Table 4.5 Number of persons reported with arthritis in the US, 1985-2020
Table 4.6 Number of persons in the US affected with arthritic conditions, 1995
Table 4.7 Number of hip joint replacements in the US, 1993-2002
Table 4.8 Age of hip implant recipients in the US, shown as a percentage of the total, 1996 and 1998
Table 4.9 Number of knee joint replacements in the US, 1993-2002
Table 4.10 Age of knee implant recipients in the US, shown as a percentage of the total, 1994 and 1998
Table 4.11 Number of spinal surgical operations performed in the US, 1993-2002
Table 4.12 Number of fractures requiring fixation in hospital in the US, 1993-2002
Table 5.1 Japanese reimbursement reductions, 1997-1998
Table 5.2 Estimated number of orthopaedic operations performed globally and in Japan, 1999
Table 5.3 Japan's predicted demographic development, 1993-2020
Table 5.4 Growth of the number of orthopaedic departments in Japan, 1993 and 1996
Table 5.5 Number of hip joint replacements in Japan, 1995-2002
Table 5.6 Number of knee joint replacements in Japan, 1995-2002
Table 6.1 Estimated number of orthopaedic operations performed globally and in Germany, 1999
Table 6.2 Germany's population and predicted demographic development, 1993-2020
Table 6.3 Number of patients receiving hospital treatment in Germany for osteoarthritis and spinal disorders, 1995
Table 6.4 Estimated number of orthopaedic departments in Germany and other European countries, 1998
Table 6.5 Number of doctors specialising in orthopaedics in Germany, 1990-1997
Table 6.6 Number of orthopaedic beds in Germany, 1993-1996
Table 7.1 Estimated number of orthopaedic operations performed globally and in France, 1999
Table 7.2 France's population and predicted demographic development, 1993-2020
Table 7.3 Incidence of rheumatoid arthritis per 100,000 population in France, 1994
Table 7.4 Number of consultations for backache in France, 1992 and 1996
Table 7.5 Estimated number of orthopaedic departments in France and other European countries, 1998
Table 7.6 Number of hip joint replacements in France, 1992-2002
Table 7.7 Number of knee joint replacements in France, 1992-2002
Table 8.1 Estimated number of orthopaedic operations performed globally and in the UK, 1999
Table 8.2 The UK's population and predicted demographic development, 1993-2020
Table 8.3 Number of persons reported with arthritis in the UK, 1991
Table 8.4 Regional breakdown of persons reported with arthritis in the UK, 1991
Table 8.5 Estimated number of orthopaedic departments in the UK and other European countries, 1998
Table 8.6 Number of hip joint replacements in the UK, 1993-2002
Table 8.7 The number of FCEs for hip replacements in the UK, 1993-2002
Table 8.8 Number of knee joint replacements in the UK, 1993-2002
Table 8.9 Number of FCEs for knee replacements in the UK, 1993-2002
Table 8.10 Number of spinal surgical operations in the UK, 1993-2002
Table 8.11 Number of FCEs for spinal surgical operations in the UK, 1993-2002
Table 8.12 Number of closed reduction of fractures in hospitals in the UK, 1990-2002
Table 9.1 Estimated number of orthopaedic operations performed globally and in Italy, 1999
Table 9.2 Italy's population and predicted demographic development, 1993-2020
Table 9.3 Number of new cases of arthritis in the Italian population, 1993-1996
Table 9.4 Number of persons reported with osteoporosis in Italy in 1995
Table 9.5 Estimated number of orthopaedic departments in Italy and other European countries, 1998
Table 9.6 Number of orthopaedic and trauma operations in Italy, 1990 and 1993
Table 9.7 Estimated number of specific orthopaedic and trauma operations in Italy, 1999
Table 9.8 Estimated market size of various orthopaedic sectors in Italy, 1999
Table 10.1 Estimated number of orthopaedic operations performed globally and in Spain, 1999
Table 10.2 Spain's population and predicted demographic development, 1993-2020
Table 10.3 Number of deaths from musculoskeletal disease in Spain, 1984-1994
Table 10.4 Number of deaths from musculoskeletal disease in Spain by gender, 1994
Table 10.5 Number of consultations for musculoskeletal disease in Spain, 1990-1994
Table 10.6 Discharges and the number of patient days in hospital for rheumatoid arthritis in Spain, 1992-1995
Table 10.7 Estimated number of orthopaedic departments in Spain and other European countries, 1998
Table 10.8 Number of bone fractures in Spain, 1992-1995
Table 10.9 Estimated numbers of specific orthopaedic and trauma operations in Spain, 1999
Table 10.10 Estimated market value of various orthopaedic sectors in Spain, 1999
Table 10.11 Value of imports of orthopaedic equipment into Spain, 1993-1997
Table 11.1 Healthcare expenditure in Scandinavian countries, 1990-1997
Table 11.2 Healthcare expenditure per capita ($) in Denmark, Finland, Norway and Sweden, 1990-1997
Table 11.3 Estimated number of orthopaedic operations performed globally and in Scandinavia, 1999
Table 11.4 Percentage of age distribution of Denmark, Norway and Sweden, 1998
Table 11.5 Denmark's population and age range expressed as a percentage, 1998-2030
Table 11.6 Populations of Scandinavian countries and their predicted development, 1990-2020
Table 11.7 Incidence of various population groups reported with rheumatoid arthritis in Norway, 1988-1993
Table 11.8 Estimated number of orthopaedic departments in Scandinavia and other European countries, 1998
Table 11.9 Number of hip joint replacements in Norway, 1993-2002
Table 11.10 Number of knee joint replacements in Norway, 1994-2002

LIST OF FIGURES
Figure 2.1 Estimated value of the global orthopaedics market, 1998-2002
Figure 2.2 Estimated geographic segmentation of the global orthopaedic markets, 1999
Figure 3.1 The hip joint (anterior view)
Figure 3.2 The knee joint (side view)
Figure 3.3 The vertebral column
Figure 4.1 Percentage of public and private healthcare expenditure in the US, 1992-2003
Figure 4.2 The US's population and predicted demographic development, 1993-2020
Figure 4.3 Number of hip joint replacements in the US, 1993-2002
Figure 4.4 Number of knee joint replacements in the US, 1993-2002
Figure 4.5 Number of spinal surgical operations performed in the US, 1993-2002
Figure 4.6 Number of spinal fusion cage procedures in the US, 1996-2002
Figure 4.7 Number of spinal cage procedures in the US as a percentage of total spinal operations, 1996-2002
Figure 4.8 Number of fractures requiring fixation in hospital in the US, 1993-2002
Figure 5.1 Healthcare expenditure in Japan, 1990-1997
Figure 5.2 Percentage of public and private healthcare expenditure in Japan, 1993-2002
Figure 5.3 Japan's population and predicted demographic development, 1993-2020
Figure 5.4 Number of hip joint replacements in Japan, 1995-2002
Figure 5.5 Number of knee joint replacements in Japan, 1995-2002
Figure 6.1 Healthcare expenditure in Germany, 1992-1997
Figure 6.2 Percentage of public and private healthcare expenditure in Germany, 1992-2003
Figure 6.3 Germany's population and predicted demographic development, 1993-2020
Figure 7.1 Percentage of public and private healthcare expenditure in France, 1992-2003
Figure 7.2 France's population and predicted demographic development, 1993-2020
Figure 7.3 Number of hip joint replacements in France, 1992-2002
Figure 7.4 Number of knee joint replacements in France, 1992-2002
Figure 8.1 Percentage of public and private healthcare expenditure in the UK, 1992-2003
Figure 8.2 The UK's population and predicted demographic development, 1993-2020
Figure 8.3 Number of hip joint replacements in the UK, 1993-2002
Figure 8.4 Number of knee joint replacements in the UK, 1993-2002
Figure 8.5 Number of spinal surgical operations in the UK, 1993-2002
Figure 8.6 Number of fractures requiring fixation in hospitals in the UK, 1990-2002
Figure 9.1 Healthcare expenditure in Italy, 1990-1997
Figure 9.2 Percentage of public and private healthcare expenditure in Italy, 1992-2003
Figure 9.3 Italy's population and predicted demographic development, 1993-2020
Figure 9.4 Number of persons reported with osteoporosis in Italy in 1995
Figure 10.1 Healthcare expenditure in Spain, 1990-1997
Figure 10.2 Percentage of public and private healthcare expenditure in Spain, 1992-2003
Figure 10.3 Spain's population and predicted demographic development, 1993-2020
Figure 11.1 Healthcare expenditure in Scandinavian countries, 1990-1997
Figure 11.2 Healthcare expenditure per capita ($) in Denmark, Finland, Norway and Sweden, 1990-1997
Figure 11.3 Denmark's population and age range expressed as a percentage, 1998-2030
Figure 11.4 Populations of Scandinavian countries and their predicted development, 1990-2020
Figure 11.5 Number of hip joint replacements in Norway, 1993-2002
Figure 11.6 Number of knee joint replacements in Norway, 1994-2002

EXECUTIVE SUMMARY
The global market for orthopaedic products is vast, comprising an estimated 9% of the total market for medical devices in 1999. This market is highly fragmented and whilst some orthopaedic product segments grew by as much as 43% from 1998 to 1999, others have expanded by only 4%.

Market growth has been driven by two major factors:

The introduction and acceptance of new technologies
An increased demand for orthopaedic products due to the growing number of over 65-year olds in the world population

The orthopaedic product sectors that have expanded most rapidly are those composed mostly of novel technologies, whilst the slower growing sectors are those that contain more traditional products and whose expansion relies on the increasing penetration of existing markets. Table ES.1 lists the major orthopaedic product sectors ranked by growth.

Table ES.1: Ranking by growth of the top 10 orthopaedic product sectors, 1999

Ranking	Product sector
1	Image guided surgery
2	Spine repair
3	Tissue engineering
4	Electrical stimulation
5	Trauma fixation
6	Rehabilitation products
7	Powered instruments
8	Arthroscopy
9	Casting materials
10	Joint implants

Whilst the product sectors leading Table ES.1 are the fastest growing, and therefore worth investing in, they are not the most valuable. Many of the larger orthopaedic companies are, therefore, concentrating on developing their core product ranges in the more valuable sectors, for example joint implants (see Table ES.2) in order to be able to finance research in the more rapidly growing sectors.