By: 6 October 2014
Will stemless design gain popularity in shoulder replacement?

GlobalData, a market intelligence leader delivering the latest industry reports in the orthopaedic market, looks at the fastest growing market sector of all – joint replacements

The upper-extremity segment represents one of the more robust markets within the orthopaedic device industry. Orthopaedic devices involved in this sector aim at addressing diseases and conditions affecting digits, wrists, elbows and shoulders caused by arthritis, fracture and other problems. The majority of orthopaedic manufacturers supplying upper-extremity products focus on fixation and joint replacement. Shoulder replacement, in particular, has received increasing attention because it is not only the fastest-growing market sector of all joint replacements, but it is also the major segment driving the upper-extremity sales of most companies. Such as playing casino games online through casino sites. In the past few years, companies have utilised different kinds of strategies to capitalise on this high-margin market, such as the fine-tuning of modular systems to provide intraoperative flexibility to surgeons, and aggressive medical education to expand the usage of reverse shoulder systems. In recent years, some manufacturers have introduced bone-sparing stemless designs to the shoulder space in an attempt to broaden their product portfolios. But will the industry’s research efforts on these stemless designs translate to market success?

The concept of a stem-free or stemless shoulder replacement system was first introduced into the European market in the mid-2000s. This system offers a new solution for the shoulder replacement continuum of care, bridging the gap between traditional resurfacing and stemmed shoulder implants by eliminating the violation of the humeral canal. The stemless shoulder prosthesis adopts a bone-conserving design and is ideal for patients with early to mid-stage glenohumeral osteoarthritis and minimal articulate deformities who may be candidates for resurfacing, hemi-arthroplasty, and even total arthroplasty. Today, a decade after the first stemless shoulder system was created, only a limited number of stem-free shoulder prostheses can be found on the global market. The companies that have commercially launched stemless implants for shoulder replacement are Biomet, Tornier, Arthrex and Zimmer.

At present, all stemless shoulder implants are primarily marketed in Europe. Although ample opportunities exist for those who expect to capitalise on the budding stemless shoulder market, surgeons hold different opinions. While some expect to see stemless designs generating greater traction in the shoulder community in the next five years due to society’s focus on bone preservation and minimally invasive techniques, others argue that the long-term clinical efficacy of these systems remains unclear at this stage. In fact, although early results for stemless shoulder replacement indicate clinical efficacy with low complication rates, the results do not demonstrate superiority of stemless designs over standard stemmed anatomic shoulder implants.

According to GlobalData, in 2013, more than 100,000 and 65,000 shoulder replacement procedures (including partial, primary shoulder, reverse shoulder, and revision shoulder replacement) were performed in the US and Europe, respectively; the procedure numbers are expected to grow at a high single-digit rate in the following years in both regions. In a fast-evolving market like shoulder replacement, competition comes from all sides: big players with big budgets, and small players nibbling at market share. Companies need a strategic approach that will keep them growing as the market itself develops. The recent move to apply the bone-conserving stemless designs to the shoulder well embodies the supply side’s continuous effort to push the frontiers of shoulder replacement. As an increasing number of players start to jump on the stemless bandwagon, only those who can demonstrate value-added propositions will manage to overcome the adoption barriers. On the other hand, surgeons also addressed that in spite of companies’ marketing efforts on the stemless concept, these implants are less likely to contribute a significant amount to companies’ shoulder revenues, because they are only indicated for patients with mid-stage glenohumeral osteoarthritis.