Joint replacement of the hip and knee remain very satisfactory operations. They are, however, expensive. The actual manufacturing of the implant represents only 30% of the final cost, while sales and marketing represent 40%. Recently, the patents on many well established and successful implants have expired. Companies have started producing and distributing implants that purport to replicate existing implants with good long-term results.

The aims of this paper are to assess the legality, the monitoring and cost saving implications of such generic implants. We also assess how this might affect the traditional orthopaedic implant companies.

Cite this article: Bone Joint J 2016;98-B:892–900.

Introduction: The nature of orthopaedic surgery often demands a high level of physical activity that may be associated with a variety of musculoskeletal symptoms. We designed this study to identify the prevalence and variety of musculoskeletal symptoms affecting orthopaedic surgeons working in Britain.

Methods: A questionnaire was designed to explore relevant musculoskeletal symptoms. The case group included all fellows of the British Orthopaedic Association working in Britain (n=1300) and the control group was the primary anaesthetist working with that surgeon (n=1300). All questionnaires were anonymous and completed by post.

Results: The response rate was 47% (n=605) for orthopaedic surgeons and 20% for the control group (n=255). The prevalence of back pain was higher in the orthopaedic surgeons (50%) compared to controls (40%; p< 0.05) as was neck pain (28% vs 19%; p< 0.01), carpal tunnel syndrome (20% vs. 5%; p< 0.001), hand pain (20% vs 8%; p< 0.001) and shoulder pain (29% vs 19%; p< 0.005). Although orthopaedic surgeons reported more symptoms than controls, it was notable that significantly more controls used analgesics compared to surgeons (59% vs 35%; p< 0.001). The use of glucosamine was equal in both groups (3% vs 6%). There were two reports of injuries in surgeons that occurred whilst operating (meniscal tear and lumbar disc prolapse). Significantly more surgeons felt their symptoms would lead to early retirement compared to controls (15% vs 8%; p< 0.01).

Discussion: This study has shown that occupational musculoskeletal morbidity is higher in orthopaedic surgeons compared to a control group. The reasons for this are multifactoral. The cumulative nature of the symptoms may lead to early retirement in more orthopaedic surgeons compared to other specialities. This study highlights an important occupational health issue and raises the question of increased health and safety awareness from our managers when considering the demands placed on surgeons.