Becker's Spine Review

6 SPINE Will Ozempic alter spine, orthopedic fields? By Laura Dyrda G LP-1 weight loss drugs like Ozempic and Wegovy are rising in popularity and evidence suggests their possible effectiveness for helping patients lose weight. e trend could alter projections for orthopedic surgery differently in the short and long term. A study presented at the American Academy of Orthopaedic Surgeons found orthopedic surgeons will need to either double their total joint arthroplasty caseload or the number of surgeons will need to increase by 10% every five years to meet the growing demand for surgery. GLP-1s could increase that number more quickly in the short term. Lisa Kloes, general manager and vice president of Stryker's knee business, told Medical Design & Outsourcing that weight loss drugs could make it possible for patients with BMI too high for surgery to lose weight. She told the publication GLP-1s could "help implant volumes." Ravi Bashyal, MD, an orthopedic surgeon with NorthShore Orthopedics in Chicago, has seen that in his practice as well. "I've seen more patients recently that are able to now have surgery because they've had additional help [losing weight]," said Dr. Bashyal during the 29th Annual ASC Meeting, Oct. 26-28 in Chicago. "Do I think there are any sort of medications that are going to cure arthritis and eliminate the need for joint replacement? I hope so, but I don't hope so, and I don't think so. I don't think those are on the neuro horizon, but I do think that addressing neuropathic pain and potentially providing adjuncts to traditional pain relief gel injections or gel injections into hips or knees is something that we're going to see more of." Glenn Boehnlein, CFO of Stryker, also addressed the issue during the Wells Fargo 2023 Healthcare Conference, noting he's seeing surgeons turn patients away from surgery because their BMI is too high. "Most docs think that it potentially brings more patients into the procedure pipeline," Mr. Boehnlein said. "Our belief in working with [key opinion leaders] is that this is net neutral to a slight positive in terms of the impact it could have. But I think we'll see more data that will come out." e Wegovy STEP 1 trial showed patients lost 15% of their body weight on average, and there has been a high demand for weight loss drugs by consumers. e drugs are expensive, and their long- term effectiveness hasn't been proven, so health plans are debating coverage policies for the next few years. Researchers are continuing to study the effect of GLP-1s on weight loss aer early positive results. "In people with weight and obesity, losing weight can improve knee osteoarthritis symptoms, and some evidence supports that it may also slow joint structural changes," Lisa King, MD, PhD, a rheumatologist and clinician scientist investigating GLP-1s, told Medscape. Zimmer Biomet released an assessment of the potential impact of GLP-1s in October, noting that osteoarthritis cannot be cured and it's estimated insdustrywide there are around 10% of patients who are too obese to undergo knee or hip procedures. It also showed obesity rates haven't slowed down in recent years despite bariatric surgery or weight loss drugs; the volume of joint replacement procedures continues to increase around 5% per year. But what about the long term? If people are able to effectively prevent obesity with weight loss drugs, or slow the advancement of osteoarthritis, volumes could drop in the future. A Reuters report addressed the potential impact on hip and knee surgeries. "Companies selling joint replacements such as Zimmer Biomet and Smith+Nephew could see their $25 billion and $11 billion values slimmed. ese two firms earn about two-thirds and 30% of their revenue, respectively, from hip and knee implants. One study estimated about a quarter of surgical cases involving knees could be avoided if patients weren't overweight," Reuters noted. Pharmaceutical companies are continuing to innovate in the space as well. Eli Lilly will soon launch a weight loss drug that was developed to tackle diabetes and during clinical trials patients lost an average of 50 pounds on the drug. n Do spine patients prefer hospitals or ASCs? By Claire Wallace T he number of spinal procedures performed in the ASC setting is on the rise, especially since the COVID-19 pandemic. According to 2022 data from Newport Beach, Calif.- based Hoag Orthopedics, more than 190 ASCs in the U.S. now offer minimally invasive spine surgery. During the COVID-19 pandemic, patients were hesitant to seek out treatment in hospitals for fear of contracting an infection. Spine patients shared this preference, with more opting to undergo procedures in the ASC setting during the pandemic's height, according to a study published by Cureus in 2022. The small study surveyed 58 patients who were candidates for elective lumbar and cervical spinal surgery between September 2021 and February 2022. The survey measured patients' age, gender, vaccination status, fear of contracting COVID-19 and preference of surgical location. Of the patients surveyed, 30 said they would prefer to undergo a spine operation in the ASC setting, while 28 said they would prefer to undergo surgery in a hospital setting. The patients who preferred to undergo surgery in the ASC setting also reported a higher fear of contracting COVID-19. Males were more likely to want to undergo a procedure in the hospital setting, but they also had lower fear rates of contracting COVID-19 and lower vaccination rates. n

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