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CHICAGO – You know the world is changing when you attend an orthopedic investor conference and feel like you’re more in the realm of biotechnology.

“Technology convergence” – or the combination of biotech, pharmaceuticals and devices in various forms – was clearly a key theme at the recent Small-Cap Orthopedics Conference in Chicago, which was put on by William Plovanic and his team at First Albany Capital.

Another term for these convergent medical technologies is bio-device combinations, which include drug-device combinations, implantable drug-delivery systems, medical nanotechnology and a host of other futuristic systems. All in all, the conference featured 30 company presentations along with plenary sessions by orthopedic surgeons to provide insights into the future of orthopedics.

Professor Gunnar Andersson, chairman of orthopedic surgery at Rush-Presbyterian-St. Luke’s Medical Center, discussed trends in spinal surgery. He pointed out how the recent resolution of patent disputes (mostly surrounding pedicle screw technology) has unleashed new innovation. As a result, newer indications (such as facet joint and cervical spine surgery) are experiencing an influx of orthopedic device innovations.

The most important trend, however, has been toward ensuring greater mobility among patients that would have otherwise received mobility-restrictive spinal fusion surgery. While the evidence supporting mobility-preserving approaches is not yet out (long-term data spanning five to 10 years is required), the current trends strongly support further development of the artificial disc and related technologies.

In line with the trend toward convergent technologies, however, the most disruptive spine-based technologies are in the area of orthobiologics, which are under continuous development along with their various delivery mechanisms.

Brian Cole, associate professor of orthopedics at Rush and team physician for a number of Chicago-based professional sports teams, discussed trends in cartilage repair in an area that looks less like classical orthopedics than space-age biotechnology. Future possibilities relating to stem cell transplantation were also addressed.

Of the 30 companies presenting, nearly half featured this rapidly growing area of convergent medical technologies. These companies included CeraPedics, Confluent Surgical, FzioMed, IsoTis Orthobiologics, LifeCell, OrthoLogic, Orthovita, OsteoBiologics, Pegasus Biologics and TissueLink Medical. Of this group, there were several companies (listed below) that especially embodied this trend toward convergence:

1. Cerapedics has developed a novel growth factor product based on the small peptide P-15^™, which mimics the cell-binding domain of Type-I collagen (the primary organic component of autograft bone).

2. Confluent Surgical has applied its proprietary in-situ polymerized biomaterials to numerous surgical applications including adhesion prevention, tissue sealing, tissue hemostasis and drug delivery.

3. Pegasus Biologics uses biotechnologies to manufacture and sterilize bioimplants for use in soft tissue reinforcement specifically for orthopedics, sports medicine, neurosurgical and spine applications.

4. TissueLink Medical has developed a radio-frequency technology for tissue closure allowing surgeons to simplify complex surgical tasks and improve clinical outcomes for patients. While not convergent in the sense of biotech and devices, TissueLink represents a new trend toward integrating various electromagnetic radiative systems as part of medical and surgical devices. Technology convergence takes on many forms.

What about the significance of these convergent technologies with respect to the larger scheme of things? Personalized medicine, for example, has been a buzzword in the medical field for the past decade. The vision that seems to be evolving is that a combination of pharmaceuticals (including biotechnology) and surgical devices represents one major manifestation of this important trend.

In a sense, this is just a natural progression of the concept of surgery already being a highly personalized form of therapeutic intervention. For example, an implanted smart device that delivers a certain amount of drug specific to the individual patient’s requirements is about as “personalized” as personalized medicine can be.

As technology further breaks down sector boundaries, there are additional implications for other constituencies in the health-care world. These include reforms to the drug and device FDA approval process. This is a bureaucracy already stressed by multiple controversies (Vioxx, Guidant, etc.) that’s only beginning to address the additional challenges of technology convergence and personalized medicine.

Also, traditional “silos” have facilitated and defined sales, marketing and distribution efforts. There are “drug reps” and “device reps” and we know their respective places. Drug reps scour the private offices while device reps make their presence known in the operating room. Where should “drug-device combination reps” (if they indeed should exist) plant themselves?

Instead of the “rep model,” will there be innovations in sales, marketing and distribution to complement the blurring of technology boundaries?

What also was made clear during the conference was the increasing disconnect between approval and reimbursement. In the past, FDA approval was pretty much equivalent to achieving Medicare and private payer reimbursement. This equation is no longer necessarily true. How this will impact innovation or even spur innovation is an open question.