Biomet Gains Hinge on Old Standby

Money Game

For one thing, industry insiders say, revision implants cost even more than the originals.

Medicare pays a capped rate -- around $2,500 or so -- for primary implants, they say. But it establishes no such cap, they say, for revisions that often sell for at least $5,000 more.

"The companies make a lot more money on those," says a salesman for one of the major implant makers. "It's all money-driven."

Others go so far as to claim that most popular implants are almost designed to fail. When creating the devices, they say, most companies rely very little on the science -- known as biomechanics -- that would enable them to create an implant that actually matches a patient's true physiological condition. Instead, they say, the companies crank out devices that, if anything, work opposite of human joints.

Edmund Chao, director of the orthopedic biomechanics lab at Johns Hopkins University, has highlighted this very problem. He says that current implants are designed to place the "load" -- or the pressure of a patient's weight -- on the inside of the bone instead of the outside like normal anatomy. As a result, he says, the bone can remodel itself in an effort to adapt to the new arrangement -- eventually wearing away -- and cause the joint replacement to fail in the end.

Miller of Biomet says his company's products hold up extremely well. Indeed, he puts their long-term success rate in the "upper 90% range." He also says that Biomet has made a number of significant advances, ranging from improved bone cementing to enhanced surgical techniques, over the last few decades.

Still, few seem willing to discuss the science behind this apparent problem.

"You would think that orthopedic surgery would have biomechanics as a fundamental prerequisite, much like civil engineering is needed to design a bridge," Cipolletti says. "Yet many surgeons have little or no knowledge of the subject. This void could be filled by the implant companies, but instead they inundate the surgeons -- and, now, the patients -- with marketing hyperbole."