FISCAL FITNESScontinued from page 25diverse places as South Korea and Valparaiso, Indiana. Exhibit 3 liststhese companies along with their newly-cleared products.Having traveled the more arduous IDE/PMA route to product clearancein the U.S., Synthes received FDA’s okay to market its ProDisc-Llumbar disc, while FDA’s Orthopedic and Rehabilitation Devices Panelrecommended for approval of Medtronic’s Prestige cervical disc andInfuse for craniomaxillofacial indications. Smith & Nephew’sBirmingham Hip Resurfacing System also received FDA clearance, asdid Aastrom Biosciences’ proprietary Tissue Repair Cells for use in treatmentof osteonecrosis, cleared through an Orphan Drug Designation. AnFDA panel will meet in first quarter 2007 to review Corin’s Cormetresurfacing hip for possible clearance in the U.S.ReGen Biologics failed in its attempts to gain FDA clearance for itscollagen scaffold and FDA cancelled a meeting in 2006 that may delayclearance for Stryker’s OP-1 putty. Millenium Biologix withdrew itsrequest for an IDE for Peptos bone graft product and OrthoLogic’s IDEfor Chrysalin was terminated due to lack of demonstrable benefits of theproduct in treatment of distal radius fractures.FDA’s Orthopaedic and Rehabilitation Devices Panel voted to opposereclassification (downclassification) of non-invasive bone growth stimulatorsand classified BioniCare’s pulsed electrical stimulator technologyas “Transcutaneous Electrical Stimulator for Arthritis,” as opposed to aExhibit 2.Strategic Alliances in Orthopaedics in 2006Company Providing Company Receiving Activityaap FAME MergerAastrom Biosciences Orthovita Agreement to develop orthopaedic products using Orthovita's Vitoss scaffolds + Aastrom's Tissue Repair CellsAffinergy Synthes Exclusive development/license agreement for coatings/medical devices in spinal, trauma and craniomaxillofacial areasAffinergy MTF Exclusive worldwide alliance for use of Affinergy's coating technology with MTF allograft productsAlloSource Osiris Provision of bone matrix for production of Osiris' bone regenerating productsAltiva Curasan Launch of Cerasorb M Ortho beta-tricalcium phosphate product for spinal indicationsArtimplant Arthrotek Distribution/launch in U.S. of Sportmesh rotator cuff patchBiorthexNitinol Device & Components (J&Jsubsidiary)Collaboration to develop Actipore-based (porous Nitinol) surface coating for orthopaedic implantsBlackstone Capital Encore Medical Merger (return to private status)Blackstone et al . private equity Biomet Acquisition (to close 10/07)Brasseler Zimmer U.S. distribution of Brasseler's large bone surgical power equipment system and other devicesCeraPedics BioD Collaborate on product development using CeraPedics' P-15 bone graft substitute technology and BioD's stem cell procurement procedureClearant Tissue Banks International Supply of Clearant Process sports medicine implantsCoolSystems VQ OrthoCare Distribution of Game Ready Accelerated Recovery System to podiatrists, pain management specialists and orthopaedic and spine surgeonsCorin Stryker Exclusive U.S. marketing/distribution of Corin's Uniglide mobile bearing unicondylar knee systemCorin Acrobot Acquisition of 7.5% stakeDePuy FMS, Hand Innovations AcquisitionEncelle Pioneer Surgical Technology Collaboration on product development (e.g. for bone graft extender in spine)Integra KMI, Miltex AcquisitionIntegra LifeSciences Miltex AcquisitionIntegra LifeSciences Kinetikos Medical AcquisitionIntelligent Orthopaedics BSN Medical Global rights to distribute STORM device (Staffordshire Orthopaedic Reduction Machine) for fracture reduction in tibia and distal femurIsoTis OrthoBiologics Alphatec Non-exclusive private label agreement for distribution of DynaGraft II DBMKyphon Disc-O-Tech, InnoSpine, St. Francis AcquisitionLifeNet Zimmer Rights and licenses to patents and intellectual property related to Allowash bone cleaning and sterilization technologyMedArtis Vertebron Worldwide distribution (U.S. exclusivity) of tricalcium phosphate and hydroxyapatite synthetic bone graft materialsMoog McKinley Acquisition of pain management businessOrthofix Blackstone AcquisitionOrthoLogic Quintiles Development/commercialization of synthetic peptide with potential application in fracture repairOssur Innovation Sports AcquisitionOsteobiologics Alphatec Exclusive U.S. marketing/distribution rights to PolyGraft for certain spine bone void filling applicationsOsteoMed Skeletal Kinetics AcquisitionOsteotech Bacterin Nonexclusive license to U.S. Patents. 5,284,655 and 5,290,558 relating to flowable DBM powder compositionsPortland Orthopaedics PLUS Orthopedics U.S. distribution of Portland's Revision Knee SystemRegeneration Technologies (RTI) Altiva Distribution of OsteoBridge line of DBM-based productsRegeneration Technologies (RTI) Pioneer Distribution of BioSet DBM pasteRTI Blackstone Manufacturing of BioCleanse-Sterilized Spinal AllograftsRTI Cryolife Exchange and service agreement for orthopaedic tissueSmith & Nephew Endoscopy Nexa Orthopedics Exclusive right to distribute certain PolyGraft products for forefoot surgerySummit Corporate Services Orthos Product importation, management of Orthos' distribution facility, inventory, billing, etc.Summit Corporate Services Accin Product support, inventory management, logistics, distribution, etc.TiGenix Hospital for Special Surgery Collaboration for further development of ChondroCelect cartilage repair productTranS1 ApaTech Exclusive U.K. and Ireland distribution of AxiaLIF lumbar fusion systemTutogen RTI Mutual sourcing agreements; RTI w/ 1st right of refusal to all soft tissue used in sports medicine surgeries recovered by Tutogen's partnersWarburg Pincus et al . Tornier Acquisition of majority interestcontinued on page 2726 Orthopaedic Product News • January/February 2007
FISCAL FITNESScontinued from page 26Exhibit 3.Newcomers to FDA 510(K) Clearances in 2006Accin Uni-Knee System (Accin)Acute Bone Screw (Acute Innovations)ActivaScrew and ActivaPin (Bioretec)Endoscopic Spine System (Arthro Kinetics)Pin Screw (BK Meditech)AperFix Femoral Implant with Inserter (Cayenne Medical)DSI Pins and Wires (Delta Surgical Instruments)Space CPSXL Bone Cement (DFine)Eberle Shaver System C2 and Shaver Blades (EberleFeinwerktechnische Systeme)Gss Pedicle Screw System (Gs Medical)STORM Operating Kit (Intelligent Orthopaedics)Cement Restrictor (Interbody Innovations)IFS Cannulated Bone Screw (Internal Fixation Systems)KFx Knotless Fixation System (KFx Medical)Koby Surgical Internal Fixation System (Koby Surgical)Distal Radius Locking Plating System (Newclip Technics)Hemi Toe (OrthoPro)Osteopore PCL Scaffold (Osteopore)Osteo-Link Bone Void Filler Pellets (Promed Advance Technology)Shaver Blades (Rema Medisintechnik)Mykres Spinal System (Showa Ika)SSP Pedicle Screw System (Specialty Spine Products)Atlas Spinal Cage, multiple models (Spinal Edge)Slimplicity Anterior Cervical Plate System and Spinal USACement Restrictor (Spinal USA)Osteopore TCP (Spinecraft)Adjust-Rite Fixation Devices (Valpo Orthopedic)TENS device. We’re still waiting for some disposition on a downclassificationof mobile bearing knees.The year brought the first implantation of xenograft (bovine) boneproducts in humans in the U.S. through RTI. Anika and Integra beganhuman clinicals for their anti-adhesion products for use after spine surgery(in the U.K. and U.S., respectively). Human clinicals began in 2006(most in the U.S.) for an all-polymer hip (Active Implants in Europe),GEM OS1 Bone Graft in foot/ankle fusion and unstable distal radiusfracture repair (BioMimetic Therapeutics), P-15 Putty (CeraPedics),Cartilage Autograft Implantation System (DePuy Mitek), cervical disc(DePuy Spine), Bidex spinal implant (Expandis in Israel), AnatomicFacet Replacement System (Facet Solutions), TOPS posterior motionpreservation system (Impliant), Mobi-C cervical artificial disc (LDR),DIAM posterior dynamic stabilization product (Medtronic), NFlexPosterior Dynamic Stabilization System (N Spine), NeoDisc cervicaldisc replacement device (NuVasive), coflex dynamic interspinousimplant (Paradigm Spine), PEEK-on-PEEK-based NUBAC IntradiscalArthroplasty System (Pioneer Surgical), Collagen Meniscus Implant forlateral meniscus injury (ReGen Biologics), NuCore Injectable Nucleus(Spine Wave) and Dynesys with hydroxyapatite-coated screws (Zimmerin Europe). ApaTech also launched a multicenter international study tocompare its Actifuse Synthetic Bone Graft with Medtronic’s Infuse ininstrumented posterolateral lumbar spinal fusion.Berne vs. Synthes; Biedermann Motech and DePuy Spine vs. a numberof companies (e.g. Acme Spine, Allez Spine, Alphatec, etc.); andMedtronic vs. Biomet, Blackstone Medical, EBI Spine, Globus Medicaland Kyphon. Many of the Medtronic suits relate to protecting IP the companypurchased from Gary K. Michelson, M.D.The year also brought more than one visit from the U.S. Departmentof Justice (DoJ). In mid-2006, Biomet, DePuy, Smith & Nephew, Strykerand Zimmer received subpoenas from the U.S. DoJ requesting documents(from 2001 to mid-2006) relating to possible violations of U.S.antitrust laws, as regard the manufacture and sale of orthopaedicimplants. DePuy also noted that search warrants had been executed inconnection with the investigation. The DoJ also dismissed two qui tamsuits pending against Medtronic relating to allegations of sales and marketingpractices in its spinal business. Resolution of the case included a$40 million civil settlement placed in escrow.The Federal Bureau of Investigation (FBI) and FDA also found themselvesin our world. FDA filed a complaint against Endotec for unapproveddistribution of certain medical devices and FBI arrested a neurosurgeon,charging him with taking kickbacks for medical equipment purchasedby Medicare and Medicaid. The surgeon was freed on $4.3 millionbond, ordered to wear an ankle bracelet and confined to his home. Ofnote, an FBI witness against the surgeon died mysteriously. The caseshould go to trial in 2007.Finally, in a serious lapse of judgment or perhaps in an attempt to wina Darwin Award, some knucklehead who used to distribute products foran orthopaedic company actually emailed his competitors to try to getthem to coordinate with him on implant pricing at one hospital. He didn’tget any takers.We ended the year with renewed optimism about orthopaedics fromWall Street and the investment community. Stocks appear to be on therebound and growth likely will be more robust than many of us predicted.Some research results from 2006 offer glimmers of hope, as well.Genetically engineered, muscle-derived stem cells helped in articularcartilage defect repair, cord blood stem cells could be used to create bonestructures for fracture and defect repair and enriching collagen gel withplatelets may help in soft tissue repair. We learned that too much fluoridemay be causing problems in the bone and teeth of Americans, that thestructures of ice and mollusk shells may serve as templates for developmentof stronger materials and that manufactured spider silk could haveapplication in the creation of artificial tendons and ligaments.Anti-smoking campaigns moved into the operating room, with somesurgeons suggesting that smokers either quit or forget about that new hip.Similar dicta have been proposed for those who are obese. Good news,though - pine tree bark extract once again showed that it can decreasepain and inflammation associated with osteoarthritis of the knee.I take solace in that fact. One day I will probably face the prospect ofOA and, when that day comes, if I am smoking or obese or an otherwiseat-risk patient, I will steer clear of the hospital and simply tap into one ofthe hundreds of thousands of loblolly pines that live with me in upstateSouth Carolina.Here’s to 2007. May you find yourself surrounded by your ownloblollies, whatever they may be.Shirley A. Engelhardt is President and Founder of KnowledgeEnterprises, Inc. a stategic services firm solely focused in orthopaedics.She can be reached at 440-247-9051 or shirley@orthoworld.com.IP Battles and Lack of IntellectThe typical spate of lawsuits continued throughout 2006 mostly in thearea of spine: Kyphon vs. Medtronic Sofamor Danek; University ofEnquiry No 40The author owns a small stake in all publicly traded orthopaedic companies as wellas several private ones.January/February 2007 • Orthopaedic Product News 27