Aging Population Driving Innovation, Growth in Europe’s Orthopedic Trauma Market

Finance and Development, estimates that by 2050, there will be a 77 percent increase in the number of people older than 65 living in Europe, with the population older than 85 years old doubling. Inevitably, government and public structures will be implementing changes and adaptations to accommodate the needs of this rapidly growing elderly population. In 2011, the total European market for orthopedic trauma devices was valued at more than 670 million euros, approximately $840 million at current exchange rates. The countries included in this analysis were Germany, France, U.K., Italy, Spain, Benelux (Belgium, Netherlands, Luxembourg), Scandinavia (Norway, Sweden, Finland, Denmark), Austria, Switzerland and Portugal. The healthcare system and medical industry will have to provide quick support and improved technologies suited for this new demographic scenario. As with all orthopedic markets, the orthopedic trauma device market is greatly driven by the increased rate of osteoporosis in the elderly population. In recent years, the European orthopedic trauma device market has been shifting towards new technologies and devices that are more beneficial and suited to an aging population. Trends such as an increase in the use of hip intramedullary (IM) nails over compression hip screws and a shift in preference from stainless steel to titanium technology are helping fuel innovation and market growth. The drivers behind these trends largely can be attributed to leading competitors supporting the switch to these technologies. DePuy Synthes has strongly been encouraging surgeons to use titanium devices, which are more biocompatible and lightweight, and therefore, better suit the needs of elderly patients.

The strongest driver of the orthopedic trauma device market is Europe’s rapidly expanding aging population. As the elderly population grows, so do the incidence rates of osteoporosis, and in accordance, the rate of trauma-related bone injuries. The rapid rates at which the European population is aging can be attributed to a variety of causes, one of which is a drop in the fertility rate. The combined European average is well below the natural replacement rate, which forces the standard pyramidal demographic spread to reverse and causes the oldest segments of the population outnumber the youngest. Another factor contributing to the rise of the continent’s elderly populous is a foreseeable increase in the life expectancy rate of all European countries. Estimates indicate that by 2050, there will be a rise of about six years to the average life expectancy rate of Europeans, bumping it to 86 years.

Although this increased elderly population will greatly increase demand in the market, it also creates a financial burden on governments. To deal with the stresses, many European countries are seeing an increase in the amount of hospital public tendering and the implementation of tighter reimbursement structures. Although these factors force competitors to lower their prices, the overall effect of the aging population will be positive and allow for the market to continue growing at a compound annual growth rate of 4.7 percent.

Hip IM Nails Replacing Compression Hip Screws
Over the past decade, an increasing number of surgeons have used hip IM nails in place of compression hip screws (a.k.a., dynamic hip screws) to treat proximal femoral fractures. The European hip IM nail market has seen an increase of nearly 9 percent compared with 2010, whereas the compression hip screw market experienced negative growth compared with 2010. Both rates are expected to stay relatively stable over the next five years, which will further widen the gap between their usage rates. This trend will lead to dominant use of IM nails to treat intertrochanteric fractures. Wider adoption of hip IM nails also will contribute to overall significant growth in the total orthopedic trauma device market due to the large price discrepancy between the two technologies where the average selling price of hip IM nails is about double that of compression hip screws.

Chart 1: Hip IM Nail vs. Compression Hip Screw Market Growth, 2008-2018 (U.S.$M)

Titanium Driving Trauma Market Growth
Over the past decade, stainless steel technology quickly has given way to titanium in all segments of the orthopedic trauma device market, including plate and screw systems, IM nails, hip IM nails, compression hip screws and cannulated screws. There are several advantages to using titanium, including greater biocompatibility, better stress distribution, higher flexibility and better X-ray and magnetic resonance imaging capabilities. In Germany, Switzerland, and Spain, a large majority of the IM nail market is comprised of titanium. Furthermore, in the Netherlands, the market virtually is dominated by titanium plate and screw systems.

However, in some countries such as the United Kingdom and France, there still is a wide use of stainless steel devices, particularly plates and screws. For instance, in Italy the vast majority of IM nails are titanium, but surgeons there have a tendency to revert back to using stainless steel technology. Experts believe this trend to be a consequence of the 2011 sovereign debt crisis—stainless steel devices are significantly cheaper than titanium ones; thus, many surgeons are attracted by their lower cost. Another factor contributing to the continued demand for stainless steel in Italy is the difficulty in removing titanium plates due to the cold-welding properties of the metal. Consequently, in Italy, where IM nail removal frequently is performed, demand will continue for stainless steel products.
Nonetheless, the growth of titanium devices will supersede stainless steel device growth in all segments of the orthopedic trauma device market and hence, fuel overall market growth.

New Technologies Pushed to the Forefront
In 2011, Synthes (before its acquisition by Johnson & Johnson) held a leading share in the total European orthopedic trauma market and cemented its position as the leading competitor in all trauma market segments except for the hip IM nail and external fixation markets. The company holds the most significant share in the plate and screw market followed by the cannulated screw market. Its position can be attributed to the advanced locking plate and screw systems the company first introduced in 2002. In addition to its pioneering efforts, which allowed the manufacturer to establish and maintain its position in the plate and screw market in Europe, Synthes actively has been promoting a switch to titanium over stainless steel systems, which also helped fuel market growth.

The growth seen in Synthes’ trauma division can be credited to new products that were introduced to the company’s portfolio during the second half of 2011. One example is the new Dynamic Locking Screw (DLS), which features an innovative design that facilitates dynamic motion and locking technology. Not only is this new technology ideal for use in fracture bridging, but it also contributes to the overall bone healing process, according to the company. Recently, the European Union approved of Johnson & Johnson’s $23.1 billion proposed acquisition of Synthes which resulted in a merger between the firm and J&J, resulting in a new entity, DePuy Synthes.

Dr. Kamran Zamanian, president and CEO of iData Research Inc., has spent more than 20 years working in the market research industry. He received his Bachelor of Science in engineering from the University of Dundee in Scotland, and later earned Master of Science and doctoral degrees in market research and technology from the University of Manchester in the United Kingdom. Lucie Semenec is a senior analyst, and Olivia Fellows is a research coordinator for iData Research. Information in this article is taken from a report published by iData Research titled, “European Markets for Orthopedic Trauma Devices.” For more information and a free synopsis of the above report, contact iData Research at [email protected]. iData Research is an international market research and consulting firm focused on providing market intelligence for the medical device, dental and pharmaceutical industries.