Over the last 10 years, shoulder surgery has been gaining interest among both surgeons and the medtech manufacturers. The suite of products available has expanded to include several new technologies, including shoulder resurfacing and reverse shoulder implants, which have provided surgeons with a toolkit to treat patients who would have been previously ineligible for surgery. As product options and patient demand expands, the total procedure volume for shoulder arthroplasty surgery has expanded to about 110,000 annual surgeries in the US in 2012.
Compared to more mature reconstruction markets, such as hip and knee arthroplasty, shoulder reconstruction is still developing as a specialty, and shoulder surgeons are still struggling to develop best practices for dealing with difficult patient cases and surgical complications.
In the 8 Common Pitfalls of Total Shoulder Arthroplasty symposium presented at the 2013 American Academy of Orthopaedic Surgeons (AAOS) meeting in Chicago, key opinion leaders in shoulder arthroplasty discussed common concerns and potential solutions from their practice.
The common pitfalls included:
  1. Glenoid cup placement
  2. Shoulder arthroplasty surgical site infection
  3. Prosthetic instability
  4. Post-operative rotator cuff failure
  5. Intraoperative nerve failure
  6. Post-humeral subluxation and glenoid erosion
  7. Peri-prosthetic fractures
  8. Implant loosening and migration
So, what can medtech companies take away from this discussion?
First, strong market growth is still to be expected in this specialty for the next 10 years. The number of patients will continue to expand in both established and emerging markets.
Second, there is ample opportunity for innovation as surgeons look for solutions to increasingly complex cases. Improved fixation and stability and improved techniques for placement were specifically cited as areas for improvement.
Third, interest in reverse shoulder arthroplasty will continue to be strong. Several symposium presenters mentioned the use of reverse shoulder arthroplasty as a bailout to salvage otherwise failed anatomic arthroplasty procedures.
Fourth, revision procedure volumes will also likely expand. Ongoing improvements in shoulder reconstruction technologies will reduce post-operative failure rates (e.g., due to loosening and migration), and thus somewhat limit the need for revision. However, patients will continue to outlive their initial primary total shoulder arthroplasty (TSA) implants, and expand the demand for revision technologies. Therefore, shoulder implant manufacturers will have similar innovation opportunities as those currently facing hip and knee implant makers. These include modifications to primary TSA implants to facilitate easier implant removal (such as cementless or shorter stem designs), or allograft augments to bulk up areas of bone deficiency to allow revision component placement.
Fifth, there will be increased opportunity for 2-stage revision procedures. Surgical site infections are one of the leading causes of implant failure, and they are costly to correct. Therefore, there is an opportunity for antibiotic cements and spacers (which are used in the first stage of a 2-stage revision).
It's definitely going to be an area everyone will continue to watch with interest, especially as growth in the more mature knee and hip implant markets remains slow.
Stay tuned for more from AAOS 2013.

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