Table of Contents

1. OVERVIEW OF MUSCULOSKELETAL DISORDERS………………………….. 1-1
1.1 Arthritis …………………………………………………………………………………. 1-1
1.2 Carpal Tunnel Syndrome…………………………………………………………. 1-5
1.3 Meniscal and Ligament/Tendon Injuries…………………………………….. 1-6
1.4 Muscular Dystrophy………………………………………………………………… 1-6
1.5 Osteoporosis …………………………………………………………………………. 1-6
1.6 Fractures ………………………………………………………………………………. 1-7
1.7 Joint Disorders and Hip, Knee, and Shoulder Replacement………….. 1-8
1.8 Knee Arthroscopy: Anterior Cruciate Ligament Repair,
Cartilage and Meniscal Repair, and Lavage and Debridement ……. 1-10
1.9 Rotator Cuff Repair……………………………………………………………….. 1-11
1.10 Spinal Disorders and Spine Surgery………………………………………… 1-12
Exhibit 1-1: Italy, Musculoskeletal Surgery, Procedure Volumes Forecast,
by Type, 2010-2016………………………………………………………………… 1-2
Exhibit 1-2: Italy, Musculoskeletal Disorders, Incidence and Prevalence ……….. 1-15
2. MUSCULOSKELETAL DISORDERS…………………………………………………. 2-1
2.1 Arthritis …………………………………………………………………………………. 2-1
2.1.1 Etiology…………………………………………………………………… 2-4
2.1.2 Epidemiology…………………………………………………………… 2-5
2.2 Carpal Tunnel Syndrome……………………………………………………….. 2-10
2.2.1 Etiology…………………………………………………………………. 2-10
2.2.2 Epidemiology…………………………………………………………. 2-12
2.3 Meniscal and Ligament/Tendon Injuries…………………………………… 2-13
2.3.1 Etiology…………………………………………………………………. 2-15
2.3.2 Epidemiology…………………………………………………………. 2-15
2.4 Duchenne Muscular Dystrophy……………………………………………….. 2-16
2.4.1 Etiology…………………………………………………………………. 2-18
2.4.2 Epidemiology…………………………………………………………. 2-19
2.5 Osteoporosis ……………………………………………………………………….. 2-19
2.5.1 Etiology…………………………………………………………………. 2-21
2.5.2 Epidemiology…………………………………………………………. 2-21
Exhibit 2-1: 2010, Italy and Europe, Rheumatoid Arthritis,
Comparative Incidence and Prevalence…………………………………….. 2-7
Exhibit 2-2: 2010, Italy and Europe, Osteoarthritis of the Knee,
Comparative Incidence and Prevalence…………………………………….. 2-9
Exhibit 2-3: 2010, Italy and Europe, Osteoarthritis of the Hip,
Comparative Incidence and Prevalence…………………………………… 2-11
Exhibit 2-4: 2010, Italy and Europe, Carpal Tunnel Syndrome,
Comparative Incidence and Prevalence…………………………………… 2-14
Exhibit 2-5: 2010, Italy and Europe, Meniscal and Ligament/Tendon
Injuries of the Knee, Comparative Incidence and Prevalence ……… 2-17
Exhibit 2-6: 2010, Italy and Europe, Duchenne Muscular Dystrophy,
Comparative Incidence and Prevalence…………………………………… 2-20
Exhibit 2-7: 2010, Italy and Europe, Osteoporosis,
Comparative Incidence and Prevalence…………………………………… 2-23
3. MUSCULOSKELETAL SURGICAL PROCEDURES ……………………………. 3-1
3.1 Fractures and Fracture Management ………………………………………… 3-1
3.1.1 Types of Fractures …………………………………………………… 3-3
3.1.2 Arthritis and Fractures ………………………………………………. 3-4
3.1.3 Internal Fixation of Fractures……………………………………… 3-6
3.1.4 External Fixation of Fractures…………………………………….. 3-8
3.2 The Spine and Spine Surgery/Spinal Instrumentation………………… 3-10
3.2.1 The Vertebral Column …………………………………………….. 3-10
3.2.1.1 Disorders of the Vertebral Column ……………… 3-12
3.2.1.1.1 Low Back Pain ……………………… 3-12
3.2.1.1.2 Scoliosis………………………………. 3-13
3.2.2 Anterior Cervical Plates…………………………………………… 3-14
3.2.3 Interbody Fusion Devices………………………………………… 3-15
3.2.4 Pedicle Screws………………………………………………………. 3-17
3.2.5 Laminectomy…………………………………………………………. 3-17
3.2.6 Microdiscectomy…………………………………………………….. 3-19
3.2.7 Balloon Kyphoplasty……………………………………………….. 3-19
3.2.8 Vertebroplasty ……………………………………………………….. 3-20
3.2.9 Spinal Fusion…………………………………………………………. 3-21
3.2.10 Prosthetic Intervertebral Disc Replacement ……………….. 3-23
3.2.11 Instrumented Spinal Deformity Correction………………….. 3-24
©2012 Elsevier Business Intelligence ii #A768
Italy, Musculoskeletal Market Opportunities: Disease Incidence
and Prevalence, and Surgical Procedure Volumes Table of Contents
3.3 The Joints and Associated Diseases/Disorders and Injuries ……….. 3-26
3.3.1 Fibrous/Immoveable Joints………………………………………. 3-31
3.3.2 Cartilaginous Joints ………………………………………………… 3-32
3.3.3 Synovial Joints ………………………………………………………. 3-32
3.3.4 Joint Replacement………………………………………………….. 3-36
3.3.4.1 Total Hip Replacement……………………………… 3-36
3.3.4.2 Total Knee Replacement…………………………… 3-40
3.3.4.3 Total Shoulder Replacement……………………… 3-41
3.3.4.3.1 Shoulder Hemiarthroplasty …….. 3-43
3.3.4.3.2 Revision Shoulder Arthroplasty.. 3-43
3.3.5 Arthroscopy …………………………………………………………… 3-44
3.3.5.1 Anterior Cruciate Ligament Repair ……………… 3-47
3.3.5.2 Carpal Tunnel Release……………………………… 3-48
3.3.5.3 Lavage and Debridement of the Knee…………. 3-50
3.3.5.4 Meniscal and Articular Cartilage Repair ………. 3-51
3.3.5.5 Rotator Cuff Repair ………………………………….. 3-52
Exhibit 3-1: Italy, Internal Fixation/Fracture Repair of the Femur
and Tibia/Fibula, Procedure Volumes Forecast,
by Type, 2010-2016………………………………………………………………… 3-9
Exhibit 3-2: Italy, External Fixation, Procedure Volumes Forecast,
by Type, 2010-2016………………………………………………………………. 3-11
Exhibit 3-3: Classification of Anterior Cervical Plates ………………………………….. 3-16
Exhibit 3-4: Italy, Spine Surgery, Procedure Volumes Forecast,
by Type, 2010-2016………………………………………………………………. 3-27
Exhibit 3-5: Types of Synovial Joints………………………………………………………… 3-34
Exhibit 3-6: Illustrated Schematic of Total Hip Replacement Using
a Monoblock or Modular Femoral Stem……………………………………. 3-38
Exhibit 3-7: Italy, Total Hip Replacement, Procedure Volumes Forecast,
by Type, 2010-2016………………………………………………………………. 3-39
Exhibit 3-8: Italy, Total and Unicompartmental Knee Replacement,
Procedure Volumes Forecast, by Type, 2010-2016 …………………… 3-42
Exhibit 3-9: Italy, Total Shoulder Replacement,
Procedure Volumes Forecast, by Type, 2010-2016 …………………… 3-45
Exhibit 3-10: Italy, Selected Arthroscopic Surgery,
Procedure Volumes Forecast, by Type, 2010-2016 …………………… 3-54