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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">How Has COVID-19 affected Our Orthopaedic Implant Industry Partners? Implications for the Surgeon-Industry Relationship in 2020 and Beyond</title><author><name sortKey="Warth, Lucian C" sort="Warth, Lucian C" uniqKey="Warth L" first="Lucian C." last="Warth">Lucian C. Warth</name><affiliation><nlm:aff id="aff1">Indiana University School of Medicine, Department of Orthopaedic Surgery, Indianapolis, IN</nlm:aff></affiliation><affiliation><nlm:aff id="aff2">IU Health Saxony Hospital, IU Health Hip & Knee Center, Fishers, IN</nlm:aff></affiliation></author><author><name sortKey="Noiseux, Nicolas O" sort="Noiseux, Nicolas O" uniqKey="Noiseux N" first="Nicolas O." last="Noiseux">Nicolas O. Noiseux</name><affiliation><nlm:aff id="aff3">University of Iowa Department of Orthopaedics and Rehabilitation, Iowa City, IA</nlm:aff></affiliation></author><author><name sortKey="Duncan, Stephen T" sort="Duncan, Stephen T" uniqKey="Duncan S" first="Stephen T." last="Duncan">Stephen T. Duncan</name><affiliation><nlm:aff id="aff4">University of Kentucky Department of Orthopaedic Surgery & Sports Medicine, Lexington, KY</nlm:aff></affiliation></author><author><name sortKey="Bradley Daines, S" sort="Bradley Daines, S" uniqKey="Bradley Daines S" first="S." last="Bradley Daines">S. Bradley Daines</name><affiliation><nlm:aff id="aff5">Saint Alphonsus Boise, Joint Preservation & Reconstruction, Boise, ID</nlm:aff></affiliation></author><author><name sortKey="Mahoney, Craig R" sort="Mahoney, Craig R" uniqKey="Mahoney C" first="Craig R." last="Mahoney">Craig R. Mahoney</name><affiliation><nlm:aff id="aff6">The Iowa Clinic, Des Moines, IA</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmc">7187849</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7187849</idno><idno type="RBID">PMC:7187849</idno><idno type="doi">10.1016/j.arth.2020.04.063</idno><idno type="pmid">NONE</idno><date when="2020">2020</date><idno type="wicri:Area/Pmc/Corpus">000709</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000709</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">How Has COVID-19 affected Our Orthopaedic Implant Industry Partners? Implications for the Surgeon-Industry Relationship in 2020 and Beyond</title><author><name sortKey="Warth, Lucian C" sort="Warth, Lucian C" uniqKey="Warth L" first="Lucian C." last="Warth">Lucian C. Warth</name><affiliation><nlm:aff id="aff1">Indiana University School of Medicine, Department of Orthopaedic Surgery, Indianapolis, IN</nlm:aff></affiliation><affiliation><nlm:aff id="aff2">IU Health Saxony Hospital, IU Health Hip & Knee Center, Fishers, IN</nlm:aff></affiliation></author><author><name sortKey="Noiseux, Nicolas O" sort="Noiseux, Nicolas O" uniqKey="Noiseux N" first="Nicolas O." last="Noiseux">Nicolas O. Noiseux</name><affiliation><nlm:aff id="aff3">University of Iowa Department of Orthopaedics and Rehabilitation, Iowa City, IA</nlm:aff></affiliation></author><author><name sortKey="Duncan, Stephen T" sort="Duncan, Stephen T" uniqKey="Duncan S" first="Stephen T." last="Duncan">Stephen T. Duncan</name><affiliation><nlm:aff id="aff4">University of Kentucky Department of Orthopaedic Surgery & Sports Medicine, Lexington, KY</nlm:aff></affiliation></author><author><name sortKey="Bradley Daines, S" sort="Bradley Daines, S" uniqKey="Bradley Daines S" first="S." last="Bradley Daines">S. Bradley Daines</name><affiliation><nlm:aff id="aff5">Saint Alphonsus Boise, Joint Preservation & Reconstruction, Boise, ID</nlm:aff></affiliation></author><author><name sortKey="Mahoney, Craig R" sort="Mahoney, Craig R" uniqKey="Mahoney C" first="Craig R." last="Mahoney">Craig R. Mahoney</name><affiliation><nlm:aff id="aff6">The Iowa Clinic, Des Moines, IA</nlm:aff></affiliation></author></analytic><series><title level="j">The Journal of Arthroplasty</title><idno type="ISSN">0883-5403</idno><idno type="eISSN">1532-8406</idno><imprint><date when="2020">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Introduction</title><p>The COVID-19 pandemic has had far-reaching societal and financial consequences. The purpose of this study was to evaluate how COVID-19 has affected AAHKS Industry Partners and the Surgeon-Industry relationship, emphasizing education, resource allocation, and strategic direction for the 2<sup>nd</sup> half of 2020.</p></sec><sec><title>Methods</title><p>AAHKS Industry Partners were contacted to participate in a blinded survey and optional interview with the AAHKS Industry Relations Committee. Based on the results, a group of AAHKS Member Surgeons with disparate practice types were asked to postulate on how the COVID-19 pandemic has and will affect their practice and relationship with Industry.</p></sec><sec><title>Results</title><p>AAHKS Industry Partner responses indicated decreased resource allocation for Regional, ‘Other National,’ and AAHKS Annual meetings (67%, 55%, and 30% respectively). Web-based educational content was expected to increase in 2020 and will likely remain a point of emphasis in 2021 (100% and 70% of responders). For Q3/Q4 2020, a significant emphasis was placed on Site of Service/Outpatient TJA and Covid-19 related Safety Measures (70% and 90% of responders), as well as increased availability of instrumentation and implants (40%, 60% respectively).</p></sec><sec><title>Discussion</title><p>The COVID-19 Pandemic has altered the orthopaedic landscape for the foreseeable future. Survey responses by AAHKS Industry Partners demonstrate a continued commitment to surgeon education with and increasing shift to a web-based platform. Increased resource allocation for outpatient TJA and COVID-19 related safety measures were significant. Articulating optimal mechanisms to aid Industry in supporting surgeons with different practice models to meet demand during the second half of fiscal year 2020 will be critical.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Arthroplasty</journal-id><journal-id journal-id-type="iso-abbrev">J Arthroplasty</journal-id><journal-title-group><journal-title>The Journal of Arthroplasty</journal-title></journal-title-group><issn pub-type="ppub">0883-5403</issn><issn pub-type="epub">1532-8406</issn><publisher><publisher-name>Elsevier Inc.</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmc">7187849</article-id><article-id pub-id-type="publisher-id">S0883-5403(20)30451-4</article-id><article-id pub-id-type="doi">10.1016/j.arth.2020.04.063</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>How Has COVID-19 affected Our Orthopaedic Implant Industry Partners? Implications for the Surgeon-Industry Relationship in 2020 and Beyond</article-title></title-group><contrib-group><contrib contrib-type="author" id="au1"><name><surname>Warth</surname><given-names>Lucian C.</given-names></name><degrees>MD</degrees><email>lwarth@iuhealth.org</email><xref rid="aff1" ref-type="aff">1</xref><xref rid="aff2" ref-type="aff">2</xref><xref rid="cor1" ref-type="corresp">∗</xref></contrib><contrib contrib-type="author" id="au2"><name><surname>Noiseux</surname><given-names>Nicolas O.</given-names></name><degrees>MD</degrees><xref rid="aff3" ref-type="aff">3</xref></contrib><contrib contrib-type="author" id="au3"><name><surname>Duncan</surname><given-names>Stephen T.</given-names></name><degrees>MD</degrees><xref rid="aff4" ref-type="aff">4</xref></contrib><contrib contrib-type="author" id="au4"><name><surname>Bradley Daines</surname><given-names>S.</given-names></name><degrees>MD</degrees><xref rid="aff5" ref-type="aff">5</xref></contrib><contrib contrib-type="author" id="au5"><name><surname>Mahoney</surname><given-names>Craig R.</given-names></name><degrees>MD</degrees><xref rid="aff6" ref-type="aff">6</xref></contrib><aff id="aff1"><label>1</label>Indiana University School of Medicine, Department of Orthopaedic Surgery, Indianapolis, IN</aff><aff id="aff2"><label>2</label>IU Health Saxony Hospital, IU Health Hip & Knee Center, Fishers, IN</aff><aff id="aff3"><label>3</label>University of Iowa Department of Orthopaedics and Rehabilitation, Iowa City, IA</aff><aff id="aff4"><label>4</label>University of Kentucky Department of Orthopaedic Surgery & Sports Medicine, Lexington, KY</aff><aff id="aff5"><label>5</label>Saint Alphonsus Boise, Joint Preservation & Reconstruction, Boise, ID</aff><aff id="aff6"><label>6</label>The Iowa Clinic, Des Moines, IA</aff></contrib-group><author-notes><corresp id="cor1"><label>∗</label>Corresponding Author: Lucian C. Warth, MD Indiana University Health Physicians Orthopedics and Sports Medicine Indiana University School of Medicine, Department of Orthopaedic Surgery 13100 East 136th Street Suite 2000 Fishers, IN, USA 46037 Phone: 317-688-5980 <email>lwarth@iuhealth.org</email></corresp></author-notes><pub-date pub-type="pmc-release"><day>28</day><month>4</month><year>2020</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on .</pmc-comment>
<pub-date pub-type="epub"><day>28</day><month>4</month><year>2020</year></pub-date><history><date date-type="received"><day>16</day><month>4</month><year>2020</year></date><date date-type="rev-recd"><day>19</day><month>4</month><year>2020</year></date><date date-type="accepted"><day>19</day><month>4</month><year>2020</year></date></history><permissions><copyright-statement>© 2020 Elsevier Inc. All rights reserved.</copyright-statement><copyright-year>2020</copyright-year><copyright-holder>Elsevier Inc.</copyright-holder><license><license-p>Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.</license-p></license></permissions><abstract id="abs0010"><sec><title>Introduction</title><p>The COVID-19 pandemic has had far-reaching societal and financial consequences. The purpose of this study was to evaluate how COVID-19 has affected AAHKS Industry Partners and the Surgeon-Industry relationship, emphasizing education, resource allocation, and strategic direction for the 2<sup>nd</sup> half of 2020.</p></sec><sec><title>Methods</title><p>AAHKS Industry Partners were contacted to participate in a blinded survey and optional interview with the AAHKS Industry Relations Committee. Based on the results, a group of AAHKS Member Surgeons with disparate practice types were asked to postulate on how the COVID-19 pandemic has and will affect their practice and relationship with Industry.</p></sec><sec><title>Results</title><p>AAHKS Industry Partner responses indicated decreased resource allocation for Regional, ‘Other National,’ and AAHKS Annual meetings (67%, 55%, and 30% respectively). Web-based educational content was expected to increase in 2020 and will likely remain a point of emphasis in 2021 (100% and 70% of responders). For Q3/Q4 2020, a significant emphasis was placed on Site of Service/Outpatient TJA and Covid-19 related Safety Measures (70% and 90% of responders), as well as increased availability of instrumentation and implants (40%, 60% respectively).</p></sec><sec><title>Discussion</title><p>The COVID-19 Pandemic has altered the orthopaedic landscape for the foreseeable future. Survey responses by AAHKS Industry Partners demonstrate a continued commitment to surgeon education with and increasing shift to a web-based platform. Increased resource allocation for outpatient TJA and COVID-19 related safety measures were significant. Articulating optimal mechanisms to aid Industry in supporting surgeons with different practice models to meet demand during the second half of fiscal year 2020 will be critical.</p></sec></abstract></article-meta></front><body><sec id="sec1"><title>Introduction</title><p id="p0010">The orthopaedic practice of AAHKS members, like virtually every other industry in the United States, has been significantly burdened by the negative economic effects of the worldwide COVID-19 pandemic. Elective cases have been essentially eliminated. Fracture cases have slowed, and clinic visits have dropped by as much as 40-90 percent due to social distancing – all of which have contributed to significant strain on orthopaedic practices.</p><p id="p0015">The cessation of elective total hip and knee arthroplasty has also had a dramatic effect on AAHKS Industry Partners. Severe dips in 1<sup>st</sup> and 2<sup>nd</sup> quarter implant sales revenue have forced companies to take pro-active steps to conserve capital and maintain liquidity during these uncertain times. The significant financial resources AAHKS Industry Partners have historically committed to support national and regional orthopaedic meetings, surgeon education, clinical research, surgical/vendor OR support, and technological innovation have required re-distribution to varying degrees to maintain fiscal solvency.</p><p id="p0020">Forecasts for when US elective procedures may resume suggest that inpatient procedures could potentially restart in some states by mid-May, and most if not all states by the end of June 2020<xref rid="bib1" ref-type="bibr"><sup>1</sup></xref>. Hospitals, orthopaedic groups, and industry must create strategies to address the anticipated increases in demand expected upon a return to ‘normalcy’. In the near term, it will be critical to meet volumetric demands, support the orthopaedic workforce, and create more efficient business relationships to maintain continuity in a rapidly changing milieu. Orthopaedic practice models of AAHKS members differ significantly and will be affected to varying extents moving forward; the ability to increase production during the 2<sup>nd</sup> half of the fiscal year for the private practice, academic, and hospital employed surgeon must be considered both separately and as a collective; needs in terms of optimal industry support will be heterogeneous. Due to the rapidly changing environment and risk of a resurgent COVID-19 virus, long-term strategies must also be articulated to safely prevent another catastrophic full-scale shutdown of elective cases.</p></sec><sec id="sec2"><title>Methods</title><p id="p0025">Executive leadership of AAHKS Industry Partners with a significant footprint in elective hip and knee arthroplasty were contacted to participate in a brief blinded survey (<xref rid="tbl1" ref-type="table">Table 1</xref>) and optional phone or Zoom interview with a member of the AAHKS Industry Relations Committee (IRC). The survey consisted of questions covering 5 topics to gauge changes in industry support resource allocation and work force including: Resources designated for orthopaedic meetings, Resources designated for surgeon education, Resources designated for strategic points of emphasis, Effect on industry work-force, and Measures taken to meet increased 3<sup>rd</sup> and 4<sup>th</sup> quarter demand.<table-wrap position="float" id="tbl1"><label>Table 1</label><caption><p>Insustry Survey</p></caption><table frame="hsides" rules="groups"><tbody><tr><td colspan="3">AAHKS Industry Partner Survey: COVID-19 Response</td></tr><tr><td colspan="3">In Response to the COVID-19 Pandemic and shutdown of elective Hip & Knee Arthroplasty in the United States, how has you company modified the following?</td></tr><tr><td colspan="3">Resources Designated for Orthopaedic Meetings (Increase, Decrease, No Change, Uncertain</td></tr><tr><td></td><td>Q3/Q4 2020</td><td>2021</td></tr><tr><td>AAHKS Annual Meeting</td><td></td><td></td></tr><tr><td>AAHKS Spring Meeting</td><td></td><td></td></tr><tr><td>Other National Meetings</td><td></td><td></td></tr><tr><td>Regional Meetings</td><td></td><td></td></tr><tr><td colspan="3"><bold>Resources Designated for Surgeon Education (Increase, Decrease, No Change, Uncertain)</bold></td></tr><tr><td></td><td>Q3/Q4 2020</td><td>2021</td></tr><tr><td>Resident</td><td></td><td></td></tr><tr><td>Fellow</td><td></td><td></td></tr><tr><td>Surgeon</td><td></td><td></td></tr><tr><td>Hands on Cadaveric</td><td></td><td></td></tr><tr><td>Web-Based RECORDED Video Education/Teaching</td><td></td><td></td></tr><tr><td>Web-Based LIVE Video Education/Training</td><td></td><td></td></tr><tr><td colspan="3">Resources Designated for Strategic Points of Emphasis (Increase, Decrease, No Change, Uncertain)</td></tr><tr><td></td><td>Q3/Q4 2020</td><td>2021</td></tr><tr><td>Technology (Robotics, Navigation, etc)</td><td></td><td></td></tr><tr><td>Product R&D</td><td></td><td></td></tr><tr><td>Marketing</td><td></td><td></td></tr><tr><td>Outpatient Joint Replacement</td><td></td><td></td></tr><tr><td>COVID-19 Related Operative Safety Measures</td><td></td><td></td></tr><tr><td colspan="3"><bold>How has the shutdown of elective arthroplasty cases affected your Work-Force? (Some have been let go, Some have been furloughed, Hours have been cut, More than one of the above, No change)</bold></td></tr><tr><td>Implant Production Employees</td><td></td><td></td></tr><tr><td>Sales Represetative Employees</td><td></td><td></td></tr><tr><td>R&D Employees</td><td></td><td></td></tr><tr><td>Marketing Employees</td><td></td><td></td></tr><tr><td colspan="3"><bold>There is an anticpated surge of elective arthroplasty surgical volume in Q3/Q4 2020; What if any measures are being taken to meet the potential increased demand of resources? (Increase, Decrease, No Change, Uncertain)</bold></td></tr><tr><td>Instrumentation/Pans</td><td></td><td></td></tr><tr><td>Implant Production</td><td></td><td></td></tr><tr><td>Sales Workforce</td><td></td><td></td></tr></tbody></table></table-wrap></p><p id="p0030">Results were tabulated and distributed a cohort of AAHKS Member Surgeons with disparate practice models including, Private practice, ‘Academic’ practice, and Hospital employed practice. Surgeons were asked to consider these results and postulate on how the COVID-19 pandemic has and will affect their specific practice type and relationship with Industry in 2020 and beyond.</p></sec><sec id="sec3"><title>Results</title><p id="p0035">Executive leadership of AAHKS Industry Partners with a significant footprint in primary elective total hip and total knee arthroplasty were contacted to participate in the survey. Ten responses were received, while 2 declined to participate (83%). Full survey results are listed in <xref rid="appsec1" ref-type="sec">Figure 1</xref>.</p><sec id="sec3.1"><title>Resources Designated for Orthopaedic Meeting Participation</title><p id="p0040">Industry partners noted an expected shift in 2020 toward decreased resources designated for Orthopaedic Meeting Participation across the board; with responding companies noting decreased support for Regional Meetings (67%), as well as ‘Other National Meetings’ (55%), and to a lesser extent the AAHKS Annul Meeting (30%). Uncertainty with respect to orthopaedic meeting resource allocation persisted amongst a small but significant percentage of responders for 2021 (20-33%), while most responders anticipated a return to standard levels of support (50-78%). Of responders, 30% anticipated increased resource allocation for the AAHKS Annual meeting in 2021.</p></sec><sec id="sec3.2"><title>Resources Designated for Surgeon Education:</title><p id="p0045">Twenty percent of responding companies anticipated decreased budgeting for resident, fellow, and surgeon specific educational activities in 2020; this was tempered by an across the board increase in Web-Based Recorded and Live Video educational content (100%). Industry support with educational resources in 2021 can be expected to rebound for resident (40%), fellow (40%) and surgeon (50%) education based on survey responses. Support for Web-Based Live and Recorded content was also expected to again increase in 2021 (70%).</p></sec><sec id="sec3.3"><title>Resources Designated for Strategic Points of Emphasis:</title><p id="p0050">The most significant trends identified for resources designated for strategic points of emphasis included a decrease in Marketing allocation (60% in 2020), and increased allocation for Site of Service/Outpatient Joint Replacement and COVID-19 Related Operative Safety Measures (70% and 90% of responders in 2020, 70% and 50% in 2021)</p></sec><sec id="sec3.4"><title>Measures Taken to Meet Increased 3<sup>rd</sup> and 4<sup>th</sup> Quarter Demand:</title><p id="p0055">In anticipation of a Q3/Q4 2020 surge in elective joint arthroplasty, 90% of responding Industry Partners anticipated no significant decrease in their sales workforce. Resources designated to increase available instrumentation and support implant production was expected to increase (40%, 50% respectively) or remain unchanged (60%, 40% respectively). No Industry Partner anticipated decreases in instrumentation, implant production, or sales workforce during fiscal year 2020.</p></sec></sec><sec id="sec4"><title>Discussion</title><p id="p0060">Industry support for AAHKS membership has played a critical role driving success of orthopaedics in general, and elective hip and knee arthroplasty in specific. Resources directed towards the training of residents, fellows and surgeons have improved educational offerings. Industry vendor support in the operative room and through implant development have enhanced operative efficiency and improved patient outcomes. The Surgeon-Industry relationship has become symbiotic to the point where both sides contribute to financial success and viability of a healthcare system which provides access to quality orthopedic care for the American public. An improved understanding of how the COVID-19 pandemic has affected AAHKS Industry Partners and enhanced communication will help optimize our combined response as a profession to uncharted waters ahead. The survey and interview responses provided by AAHKS Industry Partners varied considerably, however strong common themes of continued commitment to education, as well as the expectation for elevated levels of vendor/surgical support in the 2<sup>nd</sup> half of 2020 emerged.</p><sec id="sec4.1"><title>Indirect Education Support: National and Regional Meetings</title><p id="p0065">Industry Partners expressed trepidation in their support of Regional Meetings in 2020 (67% decrease) and a level of uncertainty with regard to the 2020 AAHKS Annual Meeting (30% uncertain, 30% decreased resource allocation). Continued commitment to support for the AAHKS Annual Meeting in 2021, however was strong (50% no change, 30% increase). This critical continued resource allocation moving forward indirectly supports the educational mission of our largest arthroplasty society. The extent to which COVID-19 and associated societal scars lingers may very well affect the scope, scale, attendance, and importance of all in person regional and national orthopaedic meetings for the foreseeable future.</p></sec><sec id="sec4.2"><title>Direct Education Support:</title><p id="p0070">In terms of direct support to surgeon education, a small downtrend of support at each level of training was identified for 2020, however a unanimous increase in resources directed towards web-based educational platforms was seen which can potentially benefit all learners. This included 100% of responders directing more resources towards Web-Based Recorded and Live Video educational content in 2020. As physicians are forced to embrace and become comfortable with telemedicine secondary to COVID-19 induced social distancing, remote engagement and education supported by our Industry Partners may become a mainstay to reach a large number of individuals without geographic or temporal limitations in a cost and time efficient manner.</p></sec><sec id="sec4.3"><title>Surgical Support During 3rd and 4<sup>th</sup> Quarter 2020</title><p id="p0075">A common theme across survey responses and phone interviews was a significant commitment to enhanced surgeon support during the anticipated uptick of elective arthroplasty procedure in the second half of the fiscal year. While AAHKS Industry Partners nearly universally articulated an assurance to partner with surgeons to meet increased need, there is significant uncertainly on how to distribute limited resources and optimally support disparate surgeon practice models. Defining the needs of AAHKS members with different practice models and articulating an appropriate response will allow our Industry Partners to help smooth the transition back to the Operative Room for all arthroplasty surgeons. Industry Partners are working to prepare for the expected surge in demand and appear open to guidance. This is a potential action item for AAHKS and national leadership as we look to the future in 2020 and beyond.</p><p id="p0080">Of Industry responders 70% expected to allocate more resources to ‘Site of Service’ support such as outpatient joint arthroplasty in both 2020 and 2021. COVID-19 related operative safety measures were also a highly emphasized (90% and 50% in 2020 and 2021 respectively). As this first wave of COVID-19 tamponades, the expected surge of elective cases currently backlogged will likely entail maximally stressing the elective capabilities in certain centers; the needs will be varied and inherently dependent on surgeon practice model. Both sides of the aisle of our profession are currently bracing for the possibility of extended weekday schedules and/or weekend elective schedules where none existed prior. There will be increased emphasis on efficiency of the non-surgical aspects of cases: pre-op preparation, anesthesia time, turn-over times in the OR, etc. Surgical efficiency will also be stressed, yet hopefully maintaining its rightful place behind quality and safety. Our relationship with Industry and our implant vendors can play a critical role during this time.</p><p id="p0085">On the vendor side, there could be a significantly greater tug-of-war for implant reps to be present in multiple hospitals or surgery centers at once, even late into the evenings or on weekends. More instrument sets may be needed to do more of the same case per day, or on consecutive days. As such, central sterilization efforts will heavily be put to the test as well. Refill of implants will be demanded more quickly, and more individual units of the same size will be expected to be available at once, to work through the backlog. We expect that the hip and knee implant manufacturers will do their best to provide the supply required, as their sales will have been reduced for 3 months or more.</p></sec><sec id="sec4.4"><title>Private Practice Perspective</title><p id="p0090">Amid the current shutdown of elective arthroplasty, private orthopedic groups, like any independent service provider, have been put at significant at risk. That said, with the assistance of Industry, private practice groups supporting Orthopaedic Hospitals and physician owned ambulatory surgery centers (ASCs) may have enhanced logistical mobility to ramp up elective case load at a greater rate than hospital employed or academic orthopaedic Surgeons. The ultimate sustainability of private orthopedic practices must come through a resumption of normal business practices. In the meantime, favorable financing structures for capital expenditures and volume based economic incentives are potential opportunities for Industry Partners to help ‘weather the storm’.</p><p id="p0095">There is also risk moving forward that further interruptions in business could be anticipated in the fourth quarter. Some epidemiologists and infectious disease experts have predicted that COVID-19 infections will drop precipitously over the summer, only to come roaring back in the late fall and winter<xref rid="bib2" ref-type="bibr"><sup>2</sup></xref>. Hospitals will inevitably shoulder the burden of treating infected patients, as they have currently. Site of care, including outpatient surgery centers and physicians owned hospitals will likely be the ‘clean’ hospitals moving forward. These sites which will see less viral burden can serve a public role without placing additional stress on hospital systems. In anticipation, industry could play a large role in helping orthopaedic surgeons maintain care pathways that ultimately reduce patient exposure to the Covid-19 virus.</p></sec><sec id="sec4.5"><title>Academic Practice Perspective</title><p id="p0100">The academic arthroplasty surgeon faces a different set of potential pifalls. The ‘red tape’ commonly associated with large tertiary referral centers may obviate the ability to increase weekday efforts or add weekend shifts. A push for efficiency may also have an extended impact on teaching at academic institutions, wanting to catch up on wait-lists and make up for lost revenue, as a priority over technical instruction.</p><p id="p0105">Vendor support may be limited due to more stringent access restrictions in tertiary hospitals where COVID-19 patients are still popping up even after the initial surge has abated. Furthermore, at many institutions there is no contract with one or two manufacturers, but rather a capitation model with a multitude of vendors used for primary and revision joint surgery. It is possible that due to the financial blow of COVID-19, the model currently in place is urged to change in order to produce more savings on implant costs. Finally, the confidence that there is no risk of coronavirus transmission will need to be instilled in the patients proceeding to elective surgery, which may be more difficult at a tertiary care center. Whether this involves increased testing, antibody testing or advanced PPE usage is uncertain.</p></sec><sec id="sec4.6"><title>Hospital Employed Practice Perspective</title><p id="p0110">Much like the position of an academic surgeon, the hospital employed orthopaedic surgeon may have to a degree had a buffer against the immediate economic ramifications of COVID-19 fallout. This group however will have highly variable Hospital/Administrative response in the coming months. Industry may be able to play a role in partnering with hospitals to strengthen a previously existing relationship or forge a new partnership. While the hospital employed practice is unlikely to be inundated with a surge of semi-urgent revision or infection cases compared to a tertiary referral center, control over when and how to increase production is variable and administration dependent.</p><p id="p0115">As surgical moratoriums are lifted, is likely that hospital systems will place an emphasis on the rapid resumption of highly profitable elective cases such as total joint arthroplasty to offset fiscal losses imposed by the COVID-19 shutdown<xref rid="bib3" ref-type="bibr"><sup>3</sup></xref>. Favorable financing structures for capital expenditures and volume based economic incentives are potential opportunities for Industry Partners to work with hospital systems to support the hospital employed orthopaedic surgeon.</p></sec></sec><sec id="sec5"><title>Conclusions</title><p id="p0120">In summary, the majority of AAHKS Industry Partner responses indicated a forward-thinking mindset in the face of COVID-19 induced uncertainty. In the short term, and emphasis on educational offerings has not been lost, but has been transitioned to a less hands on and more technologically driven ‘social-distancing’ friendly medium. This may very well become a significant aspect of our profession’s ‘new normal’. Support for ‘hands on’ training that is a stalwart of total joint arthroplasty education will likely rebound but may take time and patience.</p><p id="p0125">It is apparent that arthroplasty surgeons and Industry will have to maximize their efforts to work together safely, cohesively, respectfully and efficiently more than ever before, to weather the tidal wave of surgeries that is sure to come and forge a stronger working relationship and fortify our profession. Early and open communication will be paramount to smoothly adapting to changes in volume and disparate needs of surgeons and practices moving forward.</p><p id="p0130">Orthopaedic surgeons, hospitals, and most importantly patients across the United States have benefited greatly from symbiotic partnerships with manufacturers of orthopaedic products and implants. Although the current pandemic threatens massive upheaval across the industry, it also provides an opportunity to strengthen the Surgeon-Industry partnership in 2020 and beyond, enhancing our ability to achieve our ultimate goal – the assurance of access to quality orthopedic care for the American public.</p></sec></body><back><ref-list id="cebib0010"><title>References:</title><ref id="bib1"><label>1</label><mixed-citation publication-type="other" id="sref1">Well Fargo Equity Research; MedTech: Forecasting When US Elective Procedures Restart. April 5, 2020</mixed-citation></ref><ref id="bib2"><label>2</label><mixed-citation publication-type="other" id="sref2"><ext-link ext-link-type="uri" xlink:href="https://finance.yahoo.com/news/covid-19-could-make-a-us-resurgence-this-fall-depending-on-national-response-122231894.html" id="intref0010">https://finance.yahoo.com/news/covid-19-could-make-a-us-resurgence-this-fall-depending-on-national-response-122231894.html</ext-link></mixed-citation></ref><ref id="bib3"><label>3</label><mixed-citation publication-type="other" id="sref3">Canaccord Genuity Capital Markets Industry Update; Biomedical Devices and Services. What Med-Tech executives are saying – conclusions from our inaugural (anonymous) survery). April 13, 2020</mixed-citation></ref></ref-list><sec id="appsec1" sec-type="supplementary-material"><label>Appendix A</label><title>Supplementary data</title><p id="p0135"><supplementary-material content-type="local-data" id="mmc1"><caption><title>Warth COI</title></caption><media xlink:href="mmc1.pdf"></media></supplementary-material><supplementary-material content-type="local-data" id="mmc2"><caption><title>Duncan COI</title></caption><media xlink:href="mmc2.pdf"></media></supplementary-material><supplementary-material content-type="local-data" id="mmc3"><caption><title>Noiseux COI</title></caption><media xlink:href="mmc3.pdf"></media></supplementary-material><supplementary-material content-type="local-data" id="mmc4"><caption><title>Daines COI</title></caption><media xlink:href="mmc4.pdf"></media></supplementary-material><supplementary-material content-type="local-data" id="mmc5"><caption><title>Mahoney COI</title></caption><media xlink:href="mmc5.pdf"></media></supplementary-material></p></sec><sec id="appsec2"><title>Appendix</title><p id="p0140"><fig id="figs1"><label>Figure 1</label><caption><p>Final Survey Results</p></caption><graphic xlink:href="fx1a_lrg"></graphic><graphic xlink:href="fx1b_lrg"></graphic><graphic xlink:href="fx1c_lrg"></graphic><graphic xlink:href="fx1d_lrg"></graphic><graphic xlink:href="fx1e_lrg"></graphic><graphic xlink:href="fx1f_lrg"></graphic><graphic xlink:href="fx1g_lrg"></graphic><graphic xlink:href="fx1h_lrg"></graphic><graphic xlink:href="fx1i_lrg"></graphic><graphic xlink:href="fx1j_lrg"></graphic><graphic xlink:href="fx1k_lrg"></graphic><graphic xlink:href="fx1l_lrg"></graphic></fig></p></sec></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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