Orthopaedic industry revenue reached $49.3 billion worldwide in 2017 and grew at 3.7%, $1.7 billion over 2016, according to our estimates to be published in THE ORTHOPAEDIC INDUSTRY ANNUAL REPORT. In 2017, the 20 largest orthopaedic device companies-those with revenue above $200 million-posted growth. That's a statement we haven't made for at least the last three years, and one we think indicates positive momentum in orthopaedics. What fueled this growth? New product launches, acquisitions and international expansion were the most-cited contributors by company executives.

Source: The orthopaedic industry report, SEB Source: Zimmer Biomet annual report 2018 The orthopaedic market The global orthopaedic market was valued at USD 51bn as of 2018, with a growth rate of 3.5% y/y according to the orthopaedic industry annual report 2019. Joint replacements (including knees, hips and extremities) contribute to.

Although the deferred and non-prosecution agreements entered into by five of the leading orthopaedic implant companies have caused our profession to re-examine the surgeon-industry partnerships that have helped advance the field, the legal and ethical considerations in that relationship have not changed. Libro aprendizaje y memoria un enfoque integral pdf to word converter. Moving forward, the surgeon must recognize that a truly valuable exchange must be demonstrated and delivered in that relationship for compensation to be warranted. This paper summarizes the value proposition in the orthopaedic surgeon-industry partnership.

The Deferred Prosecution Agreements entered into by four orthopaedic manufacturing companies and the Non-Prosecution Agreement entered into by an additional orthopaedic company, through the U.S. Attorney's office in New Jersey, has brought into question, “What is the True Value of the Orthopaedic Surgeon's relationship with Industry?” In this regard there are two definitions of value which warrant exploration: “Value” defined as a fair or proper equivalent exchange of commodities and “Value” defined as social principles, goals or standards held or accepted by an individual class or society. It is these two definitions which will be addressed in the context of the relationship of the orthopaedic surgeon with industry. The discussion will further focus only on the value of the orthopaedic surgeon-industry partnership in regard to product development. The discussion will try to apply context to the requirement for compensation and what constitutes appropriate compensation in this age of increasing accountability for increasingly limited resources of society where healthcare has become a major expenditure of these resources.The second definition of value which relates to social principles, goals and standards is very germane to this discussion.

Medicine in general, and surgery specifically, is considered one of the learned professions. With professionalism comes both privilege and responsibility. The public cedes the learned professions certain privileges because these professional occupations require specialized knowledge, training and experience which provide important and valuable services to the public.,The public is paramount in the value proposition of the surgeon designer-industry relationship. The public in terms of the patient will be discussed later. However, there is another aspect of the public in regard to the value proposition. Industry has a responsibility to its public, the shareholders, to optimize its returns and optimize the use of its resources. The surgeon designer must understand that he or she has a responsibility to his or her public, his or her professional field.

This includes full disclosure of all potential conflicts of interest which in this day and age includes a complete understanding of the effects these conflicts can have on decision making in the practice of medicine and in the interpretation and reporting of scientific results.Self regulation is one of those privileges which we as a profession should cherish, respect and promote every day of our professional lives. Self regulation has given our profession relatively exclusive authority to set the standards for the degree of expertise needed for licensure and certification as well as recertifica-tion. As surgeons, it has granted us the right to make judgments about the need for surgery and the need to perform operative procedures on our patients which can have unintended consequences including severe complications, even death. In addition to enforcing levels of technical competence, self regulation as well as professionalism require us to enforce certain levels of ethical performance. We are expected to have a dominant commitment to serving others, rather than to personal gain.

Privileges ceded to the medical profession require a perception by the public that physicians are truly dedicated to the welfare of their patients over their own self-interest. The basis for “Medicine's Contract with Society” as articulated by Linda Emanuel is that our ethical responsibility as medical professionals “is primarily about the expert protection of vulnerable people and vulnerable values, in this case patients and the values of health care, respectively.”,It is for these reasons that the orthopaedic surgeon who chooses to partner with industry must understand that because of his or her statute as a medical professional he or she cannot engage in the type of partnerships with industry that other leaders in their fields are able to engage. Eldrick Tont (Tiger) Woods can partner with industry by endorsing products of which he has no involvement in design. Michael William (Coach K) Kryzewski can partner with industry by endorsing a device he has had or procedure he has undergone. The differences between the perceptions and realities of these industry partnerships and between those of a medical professional, including an orthopaedic surgeon and industry, lies in this understanding of the privileges and responsibilities awarded by society to our medical and orthopaedic profession. This differentiation most recently arose in the case of Robert Koffler Jarvik, MD, developer of the Jarvik-7 artificial heart, when he endorsed Lipitor for Pfizer even though he had never completed an internship or residency and had never been licensed to practice medicine.

Pfizer eventually withdrew the advertisements after public and congressional outcry questioning the propriety of a medical professional partnering and profiting with industry through endorsements.It is within this professional and ethical environment that an orthopaedic surgeon who enters into a product development partnership with industry today must function. The principle beneficiary of the partnership between the orthopaedic surgeon and industry should and must be the patient., The value of the orthopaedic surgeon in the partnerships with industry during the infancy of the orthopaedic surgery discipline was easily defined. Homer Stryker of Kalamazoo, Michigan founded his own company, John Charnley developed his own hip and brought it to Thackery for commercialization and the Association for the Study of Internal Fixation, (AO/ASIF) (Martin Allgower, Maurice Muller, Robert Schneider and Hans Walleneggor) developed a series of implants which they licensed for manufacture to the Straumann Institute, (Waldenburg, Switzerland) and which were widely distributed under the Synthes trademark. These implants were small in scope and were used by relatively few surgeons. Regulation of the commercial manufacture and distribution of orthopaedic implants in the 1950's and 1960's were rudimentary. DISCUSSIONThe Orthopaedic Surgeon and Industry value proposition in regard to design partnerships must follow many of the principles utilized for decades by our legal colleagues. Value can only be assigned when based on time, effort and personal contributions to the project.

Fortunately it has now become accepted that know how is as important as patents in regards to intellectual property transfer. It is only with this surgeon know how, with or without patented technology, that engineers of an implant company can produce instruments and products that address clinical problems and can provide predictable outcomes for patients.