By: 22 April 2024
Rethinking the orthopaedic surgery funding model

Dr. Eduardo Gonzalez-Hernandez, MD and Founder of Toby Orthopaedics, discusses how investing in infrastructure and equipment is crucial for delivering optimal patient care.

The orthopaedics market is poised for substantial growth from 2023 to 2027, with a projected CAGR of 3.1% globally [1]. In the United Kingdom alone, the orthopaedic devices market is forecasted to reach US$1.74 billion in revenue by 2024, expanding to US$2.03 billion by 2028 at a CAGR of 3.93% [2].

Despite this promising trajectory, orthopaedic surgery, like the whole healthcare sector, still grapples with a short-term cost-cutting approach in provisioning that often leads to inadequate investment in crucial surgical tools. This in turn can force surgeons to improvise during procedures creating makeshift tools to bridge the provisioning gap. Prioritizing investments in essential surgical tools ensures smoother and faster surgeries, facilitating the treatment of more patients and alleviating backlog issues.

Improving access to simple yet effective orthopaedic tools can make a huge difference, particularly when operating hand injuries in intricate anatomical areas like “no man’s land”.

“No man’s land,” or Zone II, is a segment of anatomy in the hand from the mid-palm where the flexor tendons of each finger glide back and forth inside a tight tunnel structure called the flexor tendon sheath, or pulley, system. When situated within the flexor tendon sheath and under tension, the tendon remains healthy. However, if a tendon gets lacerated and slips out of the pulley system, it swells and frays, making it challenging to return it to its sheath. Concurrently, the flexor tendon sheath, devoid of the tendon, contracts over time, eventually deteriorating. Aside from lacerations, certain sports activities like football, wrestling, rugby, or rock climbing can lead to flexor tendon injuries, and health conditions such as rheumatoid arthritis can weaken flexor tendons, increasing the likelihood of tears. Surprisingly, tendon damage can occur without obvious injury, with individuals suddenly noticing a loss of finger mobility without recalling the cause.

This delicate area presents intricate challenges for surgeons, that often face difficulties in repairing tendons in this area, leading to prolonged surgeries and increased risks of soft tissue trauma. Additionally, successful treatment of tendon injuries becomes increasingly difficult after three weeks from the initial laceration.

Considering the hand’s vital role in daily activities, injuries in this area present significant challenges for patients, as they can severely impact quality of life, compromising the ability to carry out routine tasks, participate in leisure activities, and maintain independence. Simple activities like dressing, eating, and writing can become arduous or even impossible with a hand injury, resulting in frustration, reliance on others, and a loss of confidence.

Furthermore, hand injuries are often an obstacle to productivity in both personal and professional lives, leading to diminished productivity and the potential risk of job loss. This decline in productivity not only affects the individual but also carries broader economic implications, contributing to reduced output and heightened healthcare expenses.

Therefore, the importance of swiftly restoring full mobility after a hand injury cannot be emphasized enough. Positive surgical outcomes must be combined with immediate rehabilitation to expedite recovery, enabling individuals to regain independence and resume their normal activities promptly. Additionally, rapid return to full mobility can mitigate secondary complications like muscle atrophy and joint stiffness, which may result from prolonged immobility. From the patient’s perspective, achieving mobility quickly is paramount, as any setback requiring a return to surgery prolongs the recovery process, potentially delaying the return to work and normal life by up to two years.

Orthopaedic surgery plays a pivotal role in facilitating this restoration of mobility and productivity, laying the groundwork for effective and rapid rehabilitation and recovery. However, essential surgical instruments for interventions in critical anatomical areas are often not covered by insurance, depriving many patients of the benefits of tools specifically tailored to support surgeons in complex procedures. In the absence of appropriate tools surgeons resort to makeshift solutions in the operating room, utilizing whatever materials are available, ranging from wires to paediatric feeding tubes. While these improvised tools are grounded in solid anatomical and medical knowledge, they lack the specific design and testing required for surgical purposes, relying on the surgeon’s quick thinking and improvisation. While commendable, these makeshift solutions are time-consuming, often inadequate, and yield less reliable results compared to regulated medical devices. Therefore, ensuring access to proper surgical instruments is imperative for enhancing surgical outcomes and optimizing patient care in orthopaedic surgery.

While cost-cutting remains a priority in healthcare, the long-term cost savings of investing in essential surgical tools outweigh short-term expenses. In fact, when a wider range of factors than the simple cost per item of surgical tools is taken into account, it becomes clear that getting surgery right quickly, simply and first time equates to a huge saving. The longer surgery takes, in fact, the higher the costs to the healthcare system as more staff are occupied for longer, using more resources such as anaesthesia and monitoring machinery as well as occupying the OR longer, reducing the number of surgeries that could be carried out by the surgical centre in any given day. Moreover, inadequate tools not only prolong surgeries but also compromise patient safety and surgeon well-being. Surgeons resorting to makeshift instruments face ethical dilemmas and diminished job satisfaction, highlighting the need for systemic support in healthcare provisioning.

Addressing these challenges requires systemic changes that prioritize patient well-being and surgical excellence. Healthcare institutions must ensure surgeons have access to essential tools, fostering optimal patient outcomes and sustaining surgeon morale.

Surgeons, bound by their oath to heal the sick, find themselves in difficult positions where the tools and resources at their disposal may not suffice to achieve the best possible results. This predicament not only compromises patient care but also inflicts a heavy toll on the morale and job satisfaction of surgeons themselves. Surgeons facing resource limitations and inadequate tools are thus placed in untenable positions, where their ability to fulfil their professional duties is compromised. In fact, NHS data shows waiting times for surgeries exceeding 78 weeks in March 2023, as highlighted by the Royal College of Surgeons of England. Patients in need of hip and knee replacements and general surgeries endure the longest waits, with over 804,180 awaiting Trauma & Orthopaedic treatment [3]. Moreover, a survey covering a quarter of UK surgeons revealed that 56% consider access to operation theatres a significant obstacle. NHS doctors’ walkouts for better pay in 2023 and reports of over 3,000 surgeons contemplating leaving the NHS, citing burnout and work-related stress as their main challenges, further exacerbate the current crisis [4].

Surgeons are increasingly compelled to advocate for their patients, striving to secure the necessary resources and support. However, this responsibility should not fall solely on the shoulders of individual surgeons. Healthcare systems and institutions need to prioritize furnishing surgeons with the vital tools and resources essential for carrying out their responsibilities effectively.

By investing in the infrastructure and equipment crucial for delivering optimal patient care, healthcare organizations ensure surgeons can focus on their primary goal of restoring patients’ health and well-being without unnecessary obstacles or compromises. Efficient surgical interventions not only expedite patient recovery but also bolster economic productivity by facilitating early workforce reintegration. By prioritizing the provision of adequate resources and technology to surgeons, healthcare systems can facilitate faster recoveries, promote workforce participation, and drive innovation, thereby fostering a healthier population and a more prosperous economy.

Additionally, investing in advanced surgical equipment and technology, healthcare institutions empower surgeons to explore new approaches and refine existing methodologies, enhancing healthcare delivery as well as sustainability and economic competitiveness. Too often, expensive, niche products rally investor enthusiasm, while ORs languish without some of the most simple and cost-effective solutions. While AI and robotics hold promise for the future, immediate improvements in patient outcomes can be achieved by prioritizing access to user-friendly orthopaedic tools.

Prioritizing patient well-being and surgical excellence over short-term cost-cutting is therefore imperative for a resilient healthcare system. It’s time to shift our focus from expensive experimental technologies to practical solutions that can transform the lives of millions of patients in the short term, while fostering innovation and sector improvements in the long term.



[1] ReportLinker, Orthopaedics in Global Market Overview 2023-2027, August 2023

[2] Statista, Orthopedic Devices – United Kingdom Market Insights

[3] Royal College of Surgeons of England, NHS waiting list at record high of over 7.3 million

[4] Independent, Thousands of surgeons blame burnout as half consider leaving NHS -survey