Top Orthopedic Stories of 2015

Readers of Orthopedics This Week have spoken with their mouse clicks and Google Analytics has identified the top read stories and topics chosen by our readers in 2015.

The consolidation of orthopedics, new technologies, sales rep anxiety, surgeon musical chairs, corruption, passing of an industry giant and finding pain relief for patients are what our readers cared most about.

In descending order here are the top read stories and topics in OTW for 2015.

10.  Stryker Gets Exclusive Rights to Osiris Bone Allograft

The march towards biologics in orthopedics continued with Osiris Therapeutics, Inc. and Stryker Corporation entering into an exclusive partnership at the end of 2014 for the commercialization and development of Osiris’ bone matrix tissue form.

The agreement gave Stryker exclusive rights to BIO⁴. BIO⁴ is “a structural extracellular matrix, osteogenic and angiogenic growth factors, endogenous mesenchymal stem cells and osteoblasts. It possesses osteoconductive, osteoinductive, osteogenic and angiogenic properties that are required for bone repair and regeneration.”

Osiris will be responsible for manufacturing, continued research and product improvements while Stryker will be responsible for the commercialization and marketing of the product.

9.   Major Study Update, Stem Cells Ease Back Pain

Reducing back pain continues to grab reader attention as a 2013 story reporting Mesoblast releasing the latest in a string of studies examining the ability of a certain type of stem cell to treat back pain demonstrated.

In one of the studies, (Journal of Neurosurgery: Spine May 2012; Vol. 16; No. 5; Pages 479-488), researchers injected allogeneic mesenchymal precursor cells (MPCs) into damaged intervertebral discs in what is, essentially, a one-hour outpatient procedure.

The data showed that a single low-dose injection of MPC significantly reduced low back pain in the treated patients and did so at a statistically significant way as compared to the control group, which received hyaluronic acid injections.

8.   Orthopedic Residents Trained Differently Than Neuro Residents in Spine

Alan Daniels, M.D., an orthopedic surgeon at Brown University told OTW, that unlike other specialties which have one training pathway, spine surgery specialists have two. One is orthopedic surgery residency and the other is neurosurgical residency.

This is a problem, says Daniels, because some residency programs provide inadequate spine training. “There is so much variability in the training for spine surgeons, and a lack of standards outlining adequate training for spine surgeons. This leads to a situation where some surgeons may be inadequately trained, and patients and other medical professionals become confused about the capabilities and areas of expertise of surgeons who perform spinal surgery in their communities.”

For instance, in Daniels’ training experience, the average number of spine surgery procedures performed during orthopedic residency was 160; for neurosurgery surgery it was 375 procedures. It was not only the number of cases which differed between the specialties, but also the types of cases performed. Daniels also found a significant difference in the average number of spinal deformity procedures between graduating orthopedic surgery residents (9.5) and graduating neurosurgery residents (2.0). He also found that orthopedic residents do a higher proportion of instrumentation and fusion procedures compared to neurosurgery residents, who participated in proportionally more decompression procedures.”

7.   More Cases Emerge From FBI’s California Spinal Cap Investigation

Like watching a car wreck, readers never tired of watching corruption unfold.

A series of stories coming out of a California FBI investigation, called “Spinal Cap, ” chronicled the guilty pleas of a corrupt hospital owner and marketing consultants who bribed spine surgeons and other providers to funnel patients to his hospital.

By taking advantage of an antiquated California worker’s comp law which paid 100% of the hospital’s documented costs, Michael Drobot’s hospital, Pacific Hospital of Long Beach, bilked the state and private payers for more than $600 million.

Drobot and others also formed shell companies to make unapproved pedicle screws and provide pharmaceutical management. By 2009, a pedicle screw that could be purchased for between $300 and $500 wholesale would end up on a hospital bill at approximately $12, 500. Profits soared.

When the California Legislature moved to close the spigot, Drobot allegedly bribed a committee chairman to keep the law on the books. The law was changed anyway and the, now former, state senator is under indictment.

On June 2014, 15 doctors, pharmacists and other medical professionals in Southern California were charged in a $25 million workers’ compensation scheme that prosecutors said was linked to the death of a baby.

One of the pharma professionals charged was, you guessed it, Michael Drobot, the managing partner of Industrial Pharmacy Management.

By the end of 2015, more indictments and guilty pleas were coming from spine surgeons who participated in the scheme. Prosecutors say there’s more to come in 2016.

6.   Dane Miller, Ph.D., Passes Away

It was with a heavy heart that we reported in early 2015 the passing of Dane A. Miller, Ph.D., founder and CEO of Biomet, Inc. He was 69 years old. Dane cofounded Biomet in 1977 and is one of this industry’s founding fathers.

Biomet’s CEO Jeff Binder reminded us that: “Dane thought of himself as an ‘environmental engineer, ‘ and he fostered an ownership culture where team members were empowered to make decisions, take reasonable risks and actively respond to the needs of our customers and their patients. Dane was one of industry’s first leaders to use the phrase ‘team member’ to describe his company’s employees. He once told me that the best description of Biomet’s culture was that of a ‘can-do family.’”

Where Dane Miller ended and Biomet began has always been hard to see. Customers who needed to call him could reach him at home. He also, famously, answered his own phone in the office.

He ate in the Biomet cafeteria where he stood in line, getting a tray and sitting with a new group of employees every week. On business trips, Dane visited hospitals, scrubbed up, put on the surgical gown and watched surgeries. With a doctorate in biomedical engineering, Dane was at home with surgeons, his employees, his products, and his company.

In an era of industry consolidation, Dane helped engineer a deal that would keep Biomet a hometown company, with the merger with Warsaw, Indiana, crosstown rival and his former employer, Zimmer Holdings, Inc.

The passing of Dane Miller reminded us that Warsaw spawned DePuy, which begat Zimmer, which begat Miller and finally reunited Zimmer and Miller.

5.   Riew, Lenke and Lehman Leaving Wash U Academic Institution

Not since the famous departure of Masters and Johnson and their sex study from Washington University in St. Louis, did the exit of surgeon scientists from the institution garner as much attention as the departure to New York of Larry Lenke, M.D., Dan Riew, M.D. and Ron Lehman, M.D.

The trio left Wash U to establish a one-of-a-kind spine hospital at the New York Presbyterian Hospital at Columbia University College of Physicians and Surgeons.

Dr. Riew told OTW that William Levine, M.D., the Frank E. Stinchfield Professor and recently appointed Chairman of Orthopedic Surgery, had the vision and was willing to make a solid commitment to developing the top spine program in the United States—and was willing to dedicate unprecedented resources and funding to build the program.

4.   Smith & Nephew Goes Rep-Less With Some Hips and Knees

Nothing gave sales reps more anxiety than the move by hip and knee makers to sell some of their products with a “no-frill” option that excluded logistical support or an onsite technician.

Smith & Nephew, plc announced that it expected to cut some orthopedic implant prices in half for the target market of 5% to 10% of U.S. hospitals with its Syncera program, which replaced the technician with an iPad app.

When Wright Medical Group, Inc. offered a similar program in 2013, Bank of America analyst Bob Hopkins called it the “Death of the Device Salesman.”

There are roughly 6, 000 hospitals in the U.S. where about 10% of the U.S. hip and knee procedure market is institutionally driven. That was up from about 5% only two or three years ago and an expected 15% to 20% in the next couple of years.

3.   Orsinger Out at DePuy Synthes, J&J Reorganizes Device Business

When Johnson & Johnson acquired Synthes, Inc. for 21.3 billion in 2011, it made Synthes CEO Michel Orsinger the face of the combined medical device business. By some accounts, including public admissions from company leaders, the integration of the two companies with different cultures and distribution logistics, did not go smoothly.

Then Orsinger was arrested on April 5, 2015, for allegedly assaulting a female family member outside a Sunday morning church service at St. Thomas Monastery in Radnor, Pennsylvania.

According to police reports, the family member saw Orsinger sending text messages during the church service. She asked to speak with him outside the church and allegedly took his cell phone from his hands and ran off. Orsinger pursued her and when he caught her puller her hair and then tackled her after she broke free.

By early May, J&J announced the company was creating a single Medical Devices Group by integrating its surgery and orthopedics business under the leadership of Gary Pruden, then head of J&J’s surgery business.

A company spokesperson told OTW the two events were completely unrelated and had no comment on the situation involving Orsinger. “It’s a personal matter as far as we are concerned, ” said the spokesperson.

2.   The Best Spine Technologies

Innovation still matters to our readers. Each year, OTW opens the doors for spine technology companies to compete for the OTW Best New Spine Technology Award.

This annual award rewards inventors, engineering teams, surgeons and their companies who’ve created the most innovative, enduring and practical products in the past year to treat back pain. To win the award, a new technology must meet the following criteria:

1. Be creative and innovative.
2. Have long-term significance to the problem of treating the diseases of the spine. Does this technology have staying power?
3. Solve a clinical problem. To what extent does this technology solve a current clinical problem or problem that is inadequately solved today?
4. Does it have the potential to improve standard of care?
5. Is it cost effective?
6. I would use it?

In 2015, 39 new products were submitted and four judges, Frank Phillips, M.D., Steven Garfin, M.D., Stephen Hochschuler, M.D. and James Schwender, M.D., selected nine winners. Biologics and Imaging technologies impressed the judges the most.

The winners were; 7D Surgical, Aspen Medical Products, Benvenue Medical, Inc, Cytonics Corporation, Invuity, Inc., LifeNet Health, LinkSPINE, Spine Wave, Inc. and Titan Spine LLC.

1.   Employees of Zimmer Biomet, What to Expect

By far, the biggest story of the year for OTW readers was the $14 billion merger of Zimmer Holdings, Inc. and Biomet Inc.

A series of stories chronicled the behind the scenes maneuvering and negotiations between Zimmer’s CEO Dave Dvorak and Biomet’s CEO Jeff Binder, the tortuous regulatory pathway through the Federal Trade Commission, European and Japanese regulators and the business implications of the creation of this new orthopedic “Superpower.”

But the single story that attracted our readers most was a guest feature story written by Dru De Angelis, titled, “Employees of Zimmer Biomet, What to Expect.”

Over 25, 000 employees at both companies wondered about their jobs and careers. As a former Zimmer sales executive turned human resources expert, De Angelis said that, “Merger and Acquisition 101 teaches that the top brass must convey the message that ‘everyone is going to be fine! Don’t run away.’ But as we all know, cuts will come. The issue is how will you maneuver in the new corporate mash-up?”

De Angelis’ message was that cuts will come, political players will win and employees must follow the power and build alliances.

Lastly, said De Angelis, “If you are one of the unfortunate ones who get laid off, don’t take it personally and don’t let it drag you down. There IS life after Zimmer/Biomet. Keep your chin up and strive toward finding a great place for you to contribute to the ongoing success of a new team. Leverage your talent and experience in a fresh environment. Godspeed!”

So another year of laying down the first draft of orthopedic history has passed and as usual, our readers keep reminding us of what is important. 2015 is dead. Long live 2016.