Imagine trying to sell this procedure to a brand new customer: It’s a hip replacement procedure, in which a doctor cuts open the patient’s leg, saws off the top of the femur, scoops out the inside of the ball joint, and replaces the bone with an artificial bone and ball joint arrangement.
The prospective customer may think it sounds crude, but the truth is that hip replacement procedures are quite advanced. Over the years, doctors have gotten so good at them that patients can leave the hospital the day of the procedure and be on their feet within days. But something else has happened over the years: The population most in need of replacement hips (and knees) are members of the baby boom generation, older but still skeptical and questioning. Marketing to them is a challenge, both for the doctors and the companies that make the devices.
Garry Clark, a marketing representative for Zimmer, an Indiana-based company that designs and manufactures orthopedic reconstructive devices, says that medical device marketing used to be aimed squarely at the doctors. But the regulatory environment changed, in part because of the potential conflicts for doctors who might be given an incentive to use a product that might not be the best one for the patient; and because the baby boomers want to make their own informed decisions.
Unlike some of its competitors Zimmer has stayed away from extensive advertising directed at prospective patients. “We don’t see as much value in those campaigns,” says Clark. “They irritate doctors,” who then have to explain to their patients sometimes exaggerated claims that are made.
Instead Zimmer does grass roots engagement, including partnering with the Arthritis Foundation, sponsoring the national senior games, and underwriting activities such as the Seldner brothers’ climb for its patient ambassador program. The Seldners, he says, are likely to appear at some educational forums for prospective patients and at Zimmer’s national employee meeting.
The doctor who was “peppered” by questions from baby boomer Joe Seldner was David Eingorn of Mercer-Bucks Orthopedics. He replaced Seldner’s hip in August, 2010, with a Zimmer trabecular metal spar. The replacement hips of yesteryear were solid pieces of metal. But the Zimmer models that Eingorn uses are a latticework that is 80 percent porous, which leaves room for real bone to grow.
“The bone actually grows right through the metal,” Eingorn says. “In six weeks, if you were to take a bandsaw and cut it in half, it would be 50 percent bone. By 12 weeks, it would be solid bone — the implant becomes part of the body almost biologically.”
The first hip replacement was done in Germany in 1881, with an ivory ball joint. For many years, replacements were only done on elderly people with limited mobility, to relieve them of pain caused by arthritis and joint damage. The first metal prosthetics were done in the United States shortly after World War II.
Everything about the world of hip replacements has improved drastically since Eingorn began 30 years ago. The future doctor grew up in Cheltenham, Pennsylvania, where his father was a builder. “I used to do woodworking all the time because of my father, and orthopedics was the only thing in medicine that made sense to me, working with saws and chisels and hammers. Everything I did with my father, I indirectly use on human legs,” he says.
Eingorn went to college at LaSalle and got his medical degree at Temple, and has been involved in joint replacement since the beginning of his practice. He has designed patented jig systems to help surgeons place hips more quickly and efficiently as they operate. He has also done research that advanced the understanding the geometry of prosthetics.
The field has advanced to the point where surgeries can be done in around 45 minutes. Partly that’s due to the improved understanding of anatomy, Eingorn says. Partly it’s due to the fact that surgeons are supported by better-trained surgical teams. “We’re not going to go in having a group of who don’t know exactly what they’re doing,” Eingorn says.”
New imaging technology also helps with the procedure. With computer images of Seldner’s leg taken from X-Rays, Eingorn was able to visualize how the entire procedure would go before making the first cut. The computer imaging allowed him to manipulate a virtual model of the replacement parts, scaled correctly so he could order a hip that was the perfect size.
That last bit is incredibly important, and it is one other area in which technology has made life better for hip patients. Imagine trying on a pair of shoes that just won’t quite fit — shoe sizes are a difference of millimeters, and cloth, canvas and leather all have much greater “give” than metal and bone. When Eingorn started out with replacements, different hip sizes were one and a half millimeters apart. Putting in a replacement that was too big could result in a femur cracking in half, Eingorn says, so that wasn’t really an option. Instead, he would have to grind down the bones to make the replacement part fit. Much better to have one that was the exact size needed.
Nowadays, part sizes are much more precise, and Eingorn can order the right one the first time.
Even the regulations surrounding surgeons and conflicts of interest have changed over the years. At one time, Eingorn did some research on behalf of Zimmer, for which he was paid. Now, taking any form of compensation from the manufacturer would be illegal, Eingorn says. Surgeons are supposed to choose parts based on their merits, rather than which company is paying them. Eingorn says he prefers Zimmer because of their tubecular metal technology.
“You get a hip that represents the best technology,” he says. “You pick stuff from different vendors. We’re talking about permanent hip replacements. You want a surface that is going to last a long time, and one that has long stability and a prosthesis that is going to hold up.”
Eingorn says he has not had any of the hip replacements he has installed within the last 10 years fail. However, hip replacements are not infallible. Zimmer recalled one of its components, called the “Durom Cup” in 2008 because some of them failed in the first two years after surgery.
Lastly, the patients themselves have improved. Most people are better educated about what the procedure entails and many even go through “pre-hab” exercises to improve their prospects at recovery. The 60-year-olds of today are in much better shape than those who Eingorn operated on in his days as an intern.
In the old days, Eingorn says, it would have been unthinkable for anyone with a hip replacement to climb Mount Kilimanjaro. “We were just happy if someone was getting up and walking around and not having any pain,” he says.