Meet you at the joint
Had trouble scheduling an appointment with an orthopedist toward the end of February, did you? Guess you didn't hear that almost a third of the country's 23,500 bone doctors would spend the waning days of the month in the nation's capital at their specialty's annual meeting. Counting physicians from abroad, 11,083 doctors flowed like white blood cells through the channels and spaces of the Washington Convention Center, busily digesting medical presentations and bumping up happily against old colleagues. But they didn't come just for the studies and camaraderie. They came to shop.
The American Academy of Orthopaedic Surgeons' annual bash isn't close to the biggest medical meeting of the year--the radiologists run that one--but it is a lucrative venue for companies looking to drum up business. This year at least 300,000 Americans will have a hip joint entirely or partly replaced, running up nearly $11 billion in hospital charges, based on 2002 cost data. More than 400,000 will have a knee replaced, billed at another $11 billion. All orthopedic procedures require a tool of some kind, whether it is a surgical instrument, imaging system, or office management software. And the number of painful hips, knees, shoulders, and other joints and muscles is headed straight up as baby boomers age.
Everybody wins. As the bone doctors made their way to Washington, D.C., 12,365 sales representatives, engineers, and executives lay in wait on the exhibit floor. Some of their 458 booths were huge and sprawling, costing $1 million or more. The edifice from Stryker Orthopaedics, a Mahwah, N.J., manufacturer of a broad range of products and devices, took five days to set up. Others, occupied by niche-fillers and up-and-comers, were little more than a 10-foot table, a backdrop, and yards of hunter-green cloth drapings.
Such medical bazaars are a win-win-win. From this one, the orthopedists' group collected roughly $6 million in exhibitor fees, amounting to about 15 percent of its annual operating budget. Attendees--not just doctors but hospital and clinic administrators, too--could audition new toys and tools more efficiently than back home, where they would have to schedule many meetings to hear individual presentations. And the entrepreneurs got a chance to woo, dazzle, and deal. In the orthopedic community, this was, as variety show host Ed Sullivan used to say, a really big shew.
Wandering through this medical melding of Costco and the Sharper Image is great fun for a non-M.D. observer. An hour or so of strolling also suggests, of all things, a sculpture garden. There is real beauty in the elaborate curves of a surgical tool designed to manipulate hidden muscle tissue. The plastic hips and knees and spines at many booths, props for new kinds of joints or supports, are clearly meant not only to be functional but to catch the eye. A booth sponsored by a manufacturer of joint replacements displays a partial hip made of translucent acrylic, joined by an artificial ball and socket to a matching leg bone. The construction glitters like an anatomic ice sculpture.
Further meandering leads to a real sculptor's double booth near the back of the hall, where a constant stream of doctors admire and gently stroke Ron Wicks's striking bronzes. The former stockbroker, who calls himself Ronadro professionally (www.ronadro.com), has been depicting doctors plying their profession--gowned for surgery, wielding a scalpel--for more than 20 years. A 9-inch-tall physician with folded hands costs $975. A much larger, amazingly detailed snapshot in bronze of detached hands performing shoulder surgery with arthroscopic instruments is $5,450. There are dozens of them, all in limited editions. Some surgeons, Wicks says proudly, have purchased each bronze as it appears. He never gets tired of creating a new one.
Additional art-loving orthopedists are a few booths away. A crowd is snapping up fun $35 ties from eBone (www.eboneties.com) that bear depictions of bones, MRI images, instruments, and other themes appropriate to the specialty. The exhibitors are an orthopedist from Kenosha, Wis., who came up with the idea, and his wife. (An ophthalmologist in New York handles manufacturing.)
This random walk is fun, but a guide would be useful. Frank Pettrone, this year's exhibits committee chairman and a partner in a 31-physician orthopedic practice across the Potomac River in the Virginia suburbs, agrees to play Virgil.
Pettrone heads for the Aesculap booth and one of the hot products of the year, a computerized navigation system. That turns out to mean a way for orthopedists to line up the upper and lower leg bones prior to knee replacement surgery and replicate exactly the same configuration afterward. Misalignment, explains a representative, is the main reason replacement knees fail, and the $150,000 system can improve alignment by 2 to 3 degrees over the conventional approach. On the way to the next booth, Pettrone is asked whether such a system is worth the price. "It will be," he says--once the data show reduced knee failures because of the system. Meaning his practice isn't ready to spring for one.
Less is more. "Unicompartmental" knee replacements are also hot. At the DePuy Orthopaedics booth, Pettrone manipulates a model of the knee and points to its three sections, or compartments. All three don't always need replacing, he explains. In a unicompartmental replacement, only one is done--generally the medial compartment at the inside of the leg, which carries about 60 percent of the weight. The procedure permits a smaller incision because fewer of the ligaments that tie the knee together need to be cut. Recovery is faster, with less post-op pain. Is there a disadvantage? Not with the procedure itself, but it is still new enough that many orthopedists haven't done a large number. The observer is grateful his knees are sound.
Varieties of replacement hip joints are in abundant display. For elderly patients, a joint that lasts 10 or 15 years probably is fine, and the ball that goes into the artificial hip socket is made of plastic. Then there are balls made from metal or an advanced ceramic. Apparently both last just short of forever. After repeated prodding, one representative allows that metal balls shed metallic ions, tiny atomic scraps of chromium and cobalt. There is a question about whether the shed ions might make the bone react in some way that could lead to failure or might even promote cancer. But there have been no long-term investigations. Ceramic balls can--very rarely--fracture, "and when that happens, it's a real mess," says Pettrone. But few surgeons have had this happen. So, asks the observer, why choose one over the other? It sounds like a religious issue. Pettrone and the representative regard each other. Then the surgeon grins. "That's exactly what it is," he says.
A scattering of physicians, identifiable by their badge color, stand just outside the cavernous center puffing on cigarettes. There are only a few smokers--not nearly as many as at the American Heart Association meeting. Go figure.
This story appears in the March 14, 2005 print edition of U.S. News & World Report.