1. ORTHOPAEDIC INTRO.

Common musculoskeletal disorders include:

Carpal Tunnel Syndrome & Tendonitis

diadactics:

- is a theory of teaching, and in a wider sense, a theory and practical application of teaching and learning. In demarcation from "mathetics" (the science of learning (focuses on the learner and the process of learning), - didactics refers only to the science of teaching.

10 largest companies:

1. DePuy synthes 2. Zimmer biomet 3. Stryker 4. Smith and nephew 5. Medtronic 6. Arthrex 7. NuVasive 8. Wright medical 9. Aesculap 10. Globus medical

Two main objectives to completing this pre-study module:

1. Review your course documents, syllabus, classroom policies, and schedule. 2. Familiarize yourself with basic Orthopaedic terminology, skeletal anatomy, anatomical planes, and clinical literature prior to the course beginning.

Development of Orthopaedics 1829:

1829: H.S. Levert - implant materials

When did Orthopaedic development explode?

1960's

Spine now covers:

> Degenerative > Deformity > Tumor/Trauma technologies · Different approaches are available · Explosion in biologics > Grafting is HUGE in spinal surgeries · Minimally invasive Spine surgery booms

Biologic drug (Biologics):

A biologic drug (biologics): - is a product that is produced from living organisms or contain components of living organisms. - Biologic drugs include a wide variety of products derived from human, animal, or microorganisms by using biotechnology

Musculoskeletal disorders or MSD's:

are injuries and disorders that affect the human body's movement or musculoskeletal system (i.e. muscles, tendons, ligaments, nerves, discs, blood vessels, etc.).

Orthobiologics definition:

are substances that orthopaedic surgeons use to help injuries heal more quickly. - They are used to improve the healing of broken bones and injured muscles, tendons,and ligaments. - These products are made from substances that are naturally found in your body.

arthroplasty:

the surgical reconstruction or placement of a joint arthr(o): joint plasty: surgical repair or restoration

The Renaissance period:

was a fervent (having or displaying a passionate intensity) period of European cultural, artistic, political and economic "rebirth" following the Middle Ages. - Generally described as taking place from the 14th century to the 17th century, the Renaissance promoted the rediscovery of classical philosophy, literature and art.

Development of Orthopaedics 1741:

· 1741 Nicholas Andre published a book and coined the term "orthopaedics" (Orthos Paedeia)

Development of Orthopaedics 1840's:

· 1840's: Development of anesthesia > Ether > Nitrous Oxide > Refined pain meds

Orthopaedic progress 1880's:

· 1880's: Development of steel plates and screws - first use of internal fixation internal fixation: is an operation in orthopedics that involves the surgical implementation of implants for the purpose of repairing a bone

Orthopaedic progress 1887:

· 1887: American Orthopaedic Association

Orthopaedic progress 1890:

· 1890: German Surgeon Congress - outlined general concepts for joint replacement

Orthopaedic progress 1895:

· 1895: Wilhelm Roentgen - X-rays - now can diagnose and follow treatment progression

More Orthopaedic progress 1928:

· 1928: Sir Thomas Fleming - introduces antibiotics (penicillin) > made orthopaedic procedures safer · Germans progress with internal fixation - pins and nails

More Orthopaedic progress 1935:

· 1935: American Board of Orthopaedic Surgery

More Orthopaedic progress 1940's:

· 1940's: Development of metal alloys and plastics (Alloys: combination of metals or metals combined with other elements)

Spine history 1940's:

· 1940's: Dr. Harrington designed a rod construct to try and straighten out the spine because of the Polio epidemic

More Orthopaedic progress 1950's and 1960's:

· 1950's and 1960's: First titanium based alloys (lighter, stronger, Nickel-free) · Fracture care advanced rapidly · Advances were made in deformity and degenerative conditions and designs were advancing in joint replacement

Ortho. conferences:

· AAOS annual meeting (American Academy of Orthopaedic Surgeons) · COMPANIES LAUNCH THEIR NEWEST TECHNOLOGY (robotics, navigation, 3d printing, custom implants) pg.25

Start the adventure with MSC covering:

· ANATOMY · PATHOLOGY · BIOMECHANICS · MATERIALS · TREATMENT/PROCEDURE · INVESTIGATE IMPLANTS AND INSTRUMENTS · WORKSHOPS/LABS · ALL FOCUSED ON SALES DEVELOPMENT

Sports medicine:

· Arthroscopy · Surgical techniques · Implants · Grafting - Biologics is taking off!!! · Joint preservation technologies

Market Segments Arthroscopy:

· Arthroscopy/soft tissue benefits from a younger, educated population that seeks to return to an active lifestyle. - This market is dominated by 7 players that control more than 90% of the market. - These companies are actively launching new products for new indications, which ultimately leads to revenue

Spine 1940's Harrington rod:

· Caused Flatback syndrome because there was no curve in the rod like our spines naturally have · But we have to start somewhere!

Great past, great future...with challenges:

· Demand vs. Cost · Established Competition · Hospital employment vs. Private practice for surgeons · Payment models · Outpatient procedures · Volume challenges · Disruptive technology

Renaissance medicine:

· Despite efforts of brilliant people little was advanced during the dark ages · The treatments of the roman empire were mainly used. Not much advancement in musculoskeletal treatment · The Renaissance proved to be a new era. There was a much better understanding of Anatomy and some function · Musculoskeletal issues were better understood as the skeletal systems and bone was advanced and a better understanding of the reparative process

Development of Orthopaedics Early 1800's:

· Early 1800's Plaster of Paris (building material used for many centuries before it was used for casting) applied to cotton bandages

Spine history Early 1900's:

· Early 1900's: Tuberculosis caused degenerative discs · Surgeons would take bone from other places in the body, to fuse the two vertebrae together so that the patient didn't have pain in the previous disc space

Spine history First artificial disc:

· First artificial disc approved in 2004!!! MOTION PRESERVATION is introduced

Market Segments Trauma market:

· Growth in the trauma market is largely driven by patient demographics and need to heal broken bones. - New products in 2017 came from all sorts of companies: top-trauma players, those well-established in other segments and start-ups, as well, which drove market growth

World view:

· In 2017, the number of orthopaedic surgeries performed worldwide totaled approximately 22.3 million · The number of procedures per year is forecasted to grow at a 4.9% compound annual rate over the 2017-2022 interval, approaching 28.3 million by 2020 and making this one of the most rapidly growing surgical procedures category · Book: Orthopaedic global trends and opportunities

Market Segments Joint reconstruction and spine:

· Joint reconstruction and spine, the two largest segments by revenue, together account for 55% of market revenue. - Companies of all sizes within these segments, continue to vocalize that payors and hospitals are pushing back on implant prices and demanding proof that products will perform as marketed

Development of Orthopaedics Joseph Lister:

· Joseph Lister: aseptic surgical techniques

Father Ortho:

· Many people believe Hugh Owen Thomson was the first orthopedist · Practiced 1857-1890 · Focused on fractures, pictured in his normal "fracture setter" (pg.9) garb he wore everyday (garb: clothing or dress, especially distinctive in some way) · Eccentric and temperamental he practiced to the poor in Liverpool and smoked continuously · Developed many innovations: > Thomas test and exam > Thomas splint > Thomas wrench

Trauma: (once orthopaedic development exploded in the 1960's):

· New devices and advanced materials · Trauma specific options · Colored devices started being used for easy identification · Surgical techniques · Grafting

Market Segments Orthobiologics:

· Orthobiologics are used across all orthopaedic segments. - The faster-growing portions of the segment come from the use of arthroscopy/soft tissue or sports medicine. - Use of orthobiologics remains scrutinized for joint reconstruction and spine indications

Analysis and Reports:

· Orthopaedic industry revenue reached $49.3 billion in 2017 and grew at $3.7, - $1.7 billion over 2016 according to the Orthopaedic Industry Annual Report · The 20 largest orthopaedic device companies - those with revenue over $200 million - posted growth - this indicates positive momentum

Orthopaedic surgeons:

· Physicians eventually became surgeons · Originally there were no orthopaedic surgeons · Over time the specialty developed and eventually surgeons were dedicated to MUSCULOSKELETAL CARE · First came fracture management, but there was difficulty dealing with disease states

Orthopaedic revolution:

· Polymethyl methacrylate (PMMA) - bone cement · Innovative surgical techniques · 40 years = millions of patients treated · Sir John Charnley combined new materials and innovative surgical techniques that became the basis for modern total joints. > He was knighted by the Queen for his research (knighted: title given by a British king or queen for his achievements or his service to his country. > Man who has been given knighthood can put Sir in front of his name instead of Mr.)

Orthopaedics:

· Revolution of innovation in the last 45 years · Expanding patient population · $20+ billion industry · Dynamic career

Roman medicine:

· Romans very influenced by the Greeks · Main advancements were physician schools developed in Rome & its effort in public health. The main impact was the wide breadth of the empire · Many medical techniques and treatments spread through the empire, using certain salves (such as honey and vinegar) to treat wounds saved many · The legions (Roman army units) provided many musculoskeletal injuries, so the romans had much practice

Historical perspective:

· Since ancient man musculoskeletal injuries and deformities have been an issue · Few solutions except for nature to heal · Some primitive treatment (first or earliest of kind) for wounds suffered during musculoskeletal trauma became lethal, because of the ointments to treat wounds

Market Segments Hip, knee, & spine markets:

· The 2% year-over-year growth of the hip, knee and spine markets is partially attributed to this payor and hospital scrutiny

Didactics The wide and varied curriculum delivers:

· The wide and varied curriculum delivers industry quality updates via didactics, clinical research, case and technology presentation and a multidisciplinary team of Spine, Orthopaedic Reconstruction & Trauma instructors.

Spine today:

· Today, we have a better understanding of balance · We understand where to put the screws for improved fixation

Spine history Today:

· Today: Screw/Rod/Plate constructs are still being used to fuse

World war I:

· WORLD WAR 1: (the great war) was a global war that lasted from July 28th 1914 - November 11th 1918) · A lot of motivation to develop orthopedic approaches, techniques, instruments, devices etc. · Forced to be aggressive surgically · Demonstrated need for orthopaedic option

Analysis and Reports What fueled this growth?

· What fueled this growth? New product launches, acquisitions and international expansion (acquisition: an asset or object bought or obtained)

Orthopaedic perspective review:

· World market · Market segments · Companies/Sales · Population

Motivation:

· World war I expected to be a summer campaign, but lasted over 4 years through trench warfare - 9 million died, 21 million wounded - most with musculoskeletal injuries

Arthroscopy:

Arthroscopy (also called arthroscopic or keyhole surgery) - is a minimally invasive surgical procedure on a joint in which an examination and sometimes treatment of damage is performed using an arthroscope, an endoscope that is inserted into the joint through a small incision

Orthopaedics main descriptive words:

DYNAMIC INNOVATIVE GROWING COMPETITIVE CHALLENGING

The Dark Ages:

Dark ages: the middle ages (5th-15th century) that asserts that a demographic, cultural, and economic deterioration occurred in Western Europe following the decline of the Roman Empire

Father of Spine:

HIPPOCRATES: father of spine · Not only did he study other orthopaedics, he is also father of spine · Named many of the pathologies and structures of spinal bones · Labeled the curves of the spine and described tendons, muscles of the spine and anatomic vessels relative to spinal anatomy · The Hippocratic list included spinal pathologies we still use as diagnosis today

Ancient Greek medicine:

Hippocrates: established first school of medicine · Followed thinking that the Gods were not the cause of illness but nature · School examined disease through observation and deduction · Musculoskeletal issues were some of the most evident knowing man cannot walk on a crooked leg (stabilizing the extremity was apparent)

2018 ORTHOPAEDIC PRODUCT SALES BY MARKET SEGMENT:

SPINE: 18% KNEE: 18% HIP: 15% TRAUMA: 14% SPORTS MEDICINE: 11% ORTHOBIOLOGICS: 10% EXTREMITY: 4% OTHER: 10%