Getting Hip to the Boomers

Stryker's new orthopedic technology gives aging patients an alternative to full joint replacement

The hips and knees of 77 million baby boomers are rapidly wearing out, but the people to whom those joints belong aren't retreating to their beds and sofas. They plan to keep right on skiing, surfing, and running, and they want replacement parts that can keep up with them. That demand has sparked a marketing war among device-makers Stryker (SYK ), Zimmer (ZMH ), and Smith & Nephew, which have introduced all manner of customizable joints, from knees designed for women to hips that are more flexible than the one Grandpa got.

The latest land grab in the market for replacement joints comes courtesy of Stryker. The Kalamazoo (Mich.) device maker is now entering the nascent U.S. market for hip resurfacing, a procedure in which the top of the femur is reshaped and capped, preserving most of the patient's own bone. The idea is not new: Hip resurfacing was invented in the 1970s but fell out of favor when the plastic parts used in the devices wore out quickly. Today's systems are made of durable metal and are aimed at patients who want maximum mobility.


Despite the technological improvements, Stryker is fighting residual skepticism from the '70s flops. It's also playing catch-up with rival Smith & Nephew, which introduced its hip resurfacing system in the U.S. a year ago. Smith & Nephew is averaging a 20% rise in sales growth each month, reports Robert Cripe, vice-president for such products. Stryker's entry could benefit patients by driving prices down, but could also sow confusion as the two companies joust over fine points such as the quality of the data each presented to the Food & Drug Administration.

Hip resurfacing is just one example of how device makers are targeting their wares at thinner and thinner slices of the boomer market. Because the procedure is safe only for patients who have relatively large bones, it's mostly being marketed to men in their 40s and up who are physically active. But women also get special attention. Zimmer, based in Warsaw, Ind., was a pioneer, in 2006, with its Gender Solutions knee for women. Now it's working on a female hip. And earlier this year, the FDA gave Smith & Nephew a green light to market three of its knees to women, including one it says is ideal for athletes.

Stryker resisted gender branding, but it did recently showcase its smallest knee as ideal for women. Smart move: Its sales of orthopedic implants rose 14% in the first nine months of 2007, to $2.6 billion, thanks largely to knees. Analysts see total sales growing at least 10% this year, to $5.9 billion, and profits could rise 25%, to $976 million.

Some experts gripe that all this growth is more about marketing than medical need. There is no evidence gender-specific knees lessen pain or improve mobility, says Dr. Thomas C. Barber, a board member for the American Academy of Orthopaedic Surgeons from Oakland, Calif. And the new technology costs more: Female knees go for around $7,000, Barber estimates, as opposed to $5,000 for regular knees. Hip resurfacing systems cost up to $10,000--twice as much as total hip replacements. Barber predicts that without data to show these devices improve outcomes, health insurers might stop paying for them. "Whenever you have expensive technologies that are not proven, you get problems," he says.

Some companies, including Stryker, have launched registries to track patients over the long run. As for the continuing segmentation of the aging boomer market, they make no apologies. Says Mike Mogul, president of Stryker's orthopedic division: "We think of this as personalizing surgery."


An article in the October issue of the Journal of Arthroplasty warns that patients who have their arthritic hips resurfaced are likely to need further surgery down the road. That's because the patients tend to be relatively young and active, and they feel so much better afterward that they often return to high activity levels at work and at play.

By Arlene Weintraub

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