Biomet Gains Hinge on Old Standby

Ethics 101

To be sure, the big device makers have no problem selling their implants.

Increasingly, however, they have come under fire -- and government scrutiny -- for some of the tactics they use. Orthopedic surgeons themselves have actually raised concerns.

David Apple, a section editor at Orthopedics Today, worries about even some routine practices in the industry. Specifically, he sees ethical problems with certain contracts, inked by implant makers, that offer surgeons financial rewards or suggest that they use specific products.

Two years ago, Clinical Orthopedics and Related Research published an entire report about ethical problems in the industry. The journal complained that device makers offer surgeons generous gifts -- ranging from ski trips to stock options to outright cash -- that could sway them to use products that may not be in their patients' best interests.

The Justice Department has since begun examining cozy relationships inside the industry. And many insiders believe the government could eventually uncover plenty.

Different Angle

Some companies, like Cipolletti's, do emphasize product design -- specifically based on biomechanics -- more than marketing.

Cipolletti says that he and his colleagues, all engineers, often felt frustrated by the lack of focus on an implant's actual performance when they worked for Johnson & Johnson. So, he says, when Johnson & Johnson acquired DePuy -- and then moved the implant division to another city -- the trio decided against relocating and launched Apex Surgical in the late 1990s instead.

So far, Apex has yet to be in business the decade necessary to track the long-term success rate of its products. However, Cipolletti says, the company has seen its implants regularly escape a major problem -- dislocation -- that tends to surface early.