Does The Manufacturer Matter In Hardware Selection?

There used to be a time when fixation options were limited to what was available in a few sets manufactured by Synthes and maybe one or two other companies. From first MPJ fusion to hindfoot and ankle fractures/fusions and everything in between, the options could be found in those sets (or rather, had to be, as there were no other options!). Fortunately, the last 20 years have seen an explosion in fixation options for distal extremity surgery. As a result, fixation options are more plentiful, making the surgeon’s job easier, and likely improving surgical outcomes for patients, as well. To take it a step further, we now see the emergence of not only anatomic-specific implants, but also patient-specific implants, pre-designed and manufactured for an individual’s anatomy, taking into account subtle, unique anatomical differences. All these advancements surely help surgeons treat their patients and will continue to do so.

But with all the options we now have in terms of fixation, a question that arises is; does it matter whose hardware we use? There are now many companies offering similar options for the same problems, all making an argument for why their solution is the best for any given problem. As you may expect, and in my experience, rarely does their solid data objectively compare hardware constructs clearly identifying one manufacturer over another as superior. Furthermore, I’ve observed that different companies may manufacture a single product utilizing the same materials, and the end product only differs in its color or diameter by a millimeter or two. All this makes for lots of options that can be overwhelming. So how do we decide? We often have this discussion with my residents, and I usually mention three ways to decide on a specific manufacturer for a given case.

First, you obviously want to make sure that the company and product have approval for use in your facility. Many institutions have contracts in place that only allow surgeons to choose from one or two companies' products. Unless you can provide a reason (i.e. the companies approved don’t offer a solution to the problem you are trying to address) then you need to go with what's approved. While sometimes not ideal, this is a simple answer to the question, albeit you likely don't have much of a say in the selection.

Assuming you do have a choice, identify a company that has options for many of the pathologies you anticipate treating. While many companies exist related to to distal extremity surgery, in my experience, almost none have a portfolio that allows you to address every problem, but a few come close. My suggestion would be to go with one of those companies. This allows you to work with the local representative for that company more often and for them to better understand your specific preferences. This in turn allows for cases to go more smoothly when the rep knows what you like and how you like things done. This also allows you to keep the number of reps needed for a case down to a minimum if they have options for many problems (i.e soft tissue and bone).

Third, find a company whose reps you feel the most comfortable with and whose expertise you feel is best. While surgical decision making is up to the surgeon and years of training go into obtaining this expertise, many times a good rep can draw from their own experiences working with many different docs in the community and offer useful pearls for difficult situations. Having another set of eyes who can give a good suggestion based on someone else’s experience can be invaluable!

At the end of the day, it's all about patient care and offering the best options at every point of the health care delivery process. Implant selection is an important part of this process which requires you as the surgeon to give thought and consideration towards that goal. Ultimately, there are many options available to us to help our patients and there is usually more than one right answer when it comes to implant selection and the respective manufacturer. While it can seem daunting, especially to the new graduate, it’s great to have options. I, for one, would not want to go back to when the options were more limited.

Dr. Ali Rahnama is a fellowship-trained foot and ankle surgeon and an Assistant Professor at the Georgetown University School of Medicine in Washington, D.C. You can follow him on Instagram @DrAliRahnama for interesting cases and educational material.