Cellular allografts consist of allograft bone combined with adipose derived mesenchymal stem cells; or may refer to HCT/P (Human Cells, Tissues, and Cellular and Tissue-based Product) comprised of viable cells within a cortical cancellous bone matrix. The viable cell bone matrix (VCBM) is a cryopreserved cancellous bone combined with demineralized cortical bone matrix. Their key characteristic in regards to bone repair is that they provide osteogenic properties.
Cartilage is a connective tissue that lines the ends of bones. It provides shock absorption within the joint and prevents abrasion from occurring to the articular surfaces of bone. Cartilage, in its various forms, is found in intervertebral discs, as the articular lining for joint surfaces and in the meniscal pads of the knees. All types of cartilage are poorly vascularized and, as proper healing requires adequate blood flow, are some of the slowest healing tissues of the body.
Osteoarthritis is cumulative trauma that eventually wears away at cartilaginous surfaces, exposing the underlying bone to additional wear. There are few alternatives for osteobiologic cartilage repair. Damage to cartilage is difficult to treat because the tissue lacks blood supply and has limited capacity for self-repair.
The scope of the orthopedic cell therapy market in this report covers platelet-rich plasma and concentrated bone marrow aspirate.
The platelet and bone marrow concentration market consists of centrifuge equipment that separates and concentrates platelets and cells based on their various densities. The majority of companies participating in this market provide the centrifuges on loan and sell only the disposable components, such as the spin buckets. Typically, one bucket is required per procedure.
Growth factors are a group of small, soluble proteins that bind onto cell surface receptors, triggering a series of signals that regulate the bodys ability to grow, renew and heal. Due to the regenerative properties of growth factors, they have been exploited for bone healing in orthopedic applications. Since September 1, 2015, there are two main growth factor products offered in the U.S. market: INFUSE® by Medtronic and AUGMENT® by Wright Medical. Strykers OP-1 which had been sold to Olympus Biotech is no longer available as Olympus Biotech ceased sales May 31, 2014. Strykers OP-1 is a different form of bone morphogenic proteins (BMPs) that belong to a larger family of proteins called transforming growth factors.
Spinal fusion is a surgical procedure designed to combine two or more vertebrae together, eventually forming a fused bone. It is primarily used for eliminating or significantly reducing the pain caused by abnormal movement of the vertebrae by immobilizing them. Supplemental bone tissue, either autograft or allograft, is used for promoting bone growth. A union of two vertebral bodies is referred to as a single-level fusion. Fusion is accomplished by using either an instrumented or non-instrumented surgical approach. Instrumented fusions incorporate fixation devices to secure and stabilize the fusion site, and interbody devices are used for filling the intervertebral disc space to enhance and promote fusion. Non-instrumented fusions utilize bone tissue to promote growth, but do not incorporate any implant devices into the procedures.
Bone is naturally piezoelectric, which means that mechanical stress applied to bone alters its natural electric field. Conversely, an applied electric or ultrasound field will alter the mechanical stress within the bone, thereby stimulating bone growth. It is by this principle that bone growth stimulators work, artificially inducing stress to stimulate bone growth as an adaptive response. All bone stimulation devices are indicated for non-union fractures, which include difficult-to-heal or slowly healing fractures. All external devices can be worn over a cast.
Bone pins are manufactured in a wide range of diameters suitable for various types of applications. This report will cover bone pins with diameters ranging from 0.6 mm to 3.0 mm (Kirschner wires or K-wires) and from 3 mm to 6 mm (Steinmann pins). In general, these bone pins are used for either provisional fixation or definitive fixation.
For provisional fixation, their applications, taking place mainly during the fracture reduction stage, are followed by definitive fixation provided through plates and screws. Provisional fixation offers several advantages, including secure and firm fixation of plate to bone with minimal damage to periosteum, precision of plate positioning and adjustment prior to definitive fixation, reduced clamp use during screw placement and stabilization of fracture for intraoperative X rays.
In 1984, bioabsorbable internal fixation devices were used at Helsinki University for the first time as a treatment for fractures and osteotomies of the extremities. Metal plates and screws remain the standard for use in internal fixation, despite the associated risks, including increased infection rates due to bacterial colony formation on the plates, bone atrophy due to stress-shielding (particularly in long bones) and the introduction of growth problems in growing patients. Metal plates and screws must often be removed, requiring a second surgery and exposing patients to the risks of surgery for a second time.
Hip fracture is a common injury that is more frequent with age and has an immediate impact on the quality of life. The approximate one-year mortality rate after a hip fracture is between 20% and 30%. A 2007 study in the American Journal of Therapy showed that fractures repaired within 48 hours of the traumatic incident had better outcomes than those repaired later. The number of annual hip fractures within the senior population alone is estimated to be over 300,000 in the United States, which is equivalent to an incidence rate of almost one per every 1,000 people. Approximately three-quarters of people affected are women, and upwards of 90% of injuries are caused by falls.
Cannulated screws are used for many different types of trauma fixation procedures. The guidewire keeps the unstable bone fragments from moving during screw insertion and allows for continuous fixation. Cannulated screws are designed to fuse multiple bone fragments together. These screws are offered in diameters ranging from under 4 mm to over 7 mm and feature a variety of shaped heads, thread lengths and designs. The analysis herein presents cannulated screws segmented first by headed or headless style and then by size, with large screws having a diameter over 6 mm, medium between 4 mm and 6 mm and small less than 4 mm. Distinctions in screw design can offer better bone purchase and easier extraction.
External fixation is a type of osseous fixation commonly used to treat bone trauma cases and other orthopedic problems. This form of reduction requires drilling holes into unaffected regions of bone around the fracture and screwing bolts or wires into the holes. External fixation is a minimally invasive procedure that is performed by placing a scaffolding frame with associated wires, pins, or both wires and pins on the outside of the damaged extremity. Small pins and wires are then used to hold the bone in its intended position.
Installation of external fixators requires general anesthesia and is usually performed in an operating room. Because the pins pierce through the skin, constant cleaning of the wound is necessary. Removal of the external device can be performed during an office visit without anesthesia.
Intramedullary (IM) hip screws are hybrid devices, incorporating aspects of intramedullary nails and conventional hip screw design. They are inserted into the femur at an angle similar to that of hip screws, but instead of being anchored by a plate external to the shaft of the bone, IM hip screws are anchored inside the medullary cavity. The screws are designed for intertrochanteric or subtrochanteric fractures of the hip. IM hip screws are also known as dynamic hip screws (DHS).
Intramedullary nails, also known as IM nails, IM rods or dynamic intramedullary rods, are solid or cannulated metal rods that are used to align and stabilize fractures. IM nails are inserted into the medullary canal of long bones of the extremities such as the femur, tibia and humerus. The most significant advantage of IM rods over other methods is that they share the weight load with the bone, rather than entirely supporting it. This allows for a more rapid recovery.
Plating devices were pioneered by the Association for the Study of Internal Fixation (AO/ASIF) in Switzerland. Early sales and marketing was done by the Straumann Group, of which the companys osteosynthesis division eventually became Synthes, which was acquired by Johnson & Johnsons Depuy in 2012 to become DePuy Synthes.
Staple fixation devices are divided into two main categories depending on the mechanism by which the compressive forces are applied across the site of fracture. Conventionally, mechanical compression staples, manufactured from either stainless steel or titanium, have been a popular form of fixation for osteotomy and arthrodesis. However, studies have shown that this type of staple provides inconsistent compression and distraction and hence does not result in optimal bone healing. This is in contrast to the second type of staple device: shape memory staples.
This report analyzes the procedure volumes that relate to orthopedic procedures by anatomy within the US between 2013 and 2023. The segments analyzed include: Shoulder Gilder Procedures, Upper Arm and Elbow Procedures, Forearm Procedures, Wrist, Hand and Finger Procedures, Hip Procedures, Upper Leg Procedures, Knee Procedures, Lower Leg Procedures, Ankle Procedures and Foot and Toe Procedures.