Stryker says weight loss drugs could help obese patients slim down for knee and hip replacements. (Pictured is Stryker’s Triathlon Cementless knee.) [Image courtesy of Stryker]
Executives at Stryker, the world’s largest orthopedic device manufacturer, say they’re not afraid that GLP-1 weight loss drugs could hurt demand for joint replacement implants.
Instead, they see GLP-1 drugs — including Ozempic and Wegovy — as a neutral factor or perhaps even a slight positive. That’s because the drugs could help obese and near-obese patients slim down to qualify for knee and hip replacement surgery.
“We don’t anticipate the weight loss drug having a negative impact,” Lisa Kloes, the GM and VP of Stryker’s knee business, said in an interview with Medical Design & Outsourcing. “Actually, we think it’s going to help with implant volumes. There’s quite a large percentage of the candidates for total joint replacement that are too high of [body mass index, or BMI] to have surgery.”
“If you have arthritis, you have arthritis,” she later continued. “And so then it’s: Are you a good candidate for the surgery or not a good candidate for the surgery?”
Stryker VP and Knee GM Lisa Kloes [Photo courtesy of Stryker]
More from our interview with Kloes: How 3D printing and surgical robotics enable Stryker’s cementless knee implants
It’s too early to quantify the impact of weight loss drugs on orthopedic procedure volumes, Stryker CFO Glenn Boehnlein said in September at the Wells Fargo 2023 Healthcare Conference. But he said most orthopedic surgeons are telling Stryker that they’re turning away patients due to body weight, and that those doctors believe the weight loss drugs could help the patients slim down to qualify for the procedures.
“Most docs think that it potentially brings more patients into the procedure pipeline,” Boehnlein said. “… Our belief in working with our [key opinion leaders] is that this is a net neutral to a slight positive in terms of the impact that it could have. But I think we’ll see more data that will come out.”
Another factor is that osteoarthritis is a degenerative disease, and higher activity levels might accelerate the need for a joint replacement.
“To the extent that there are patients that lose weight and become more active that already have the indications for this disease, it might make them candidates sooner rather than later in the process,” Boehnlein said.
And for now, the drugs might be too expensive for patients to keep the weight off — though that could change if the drugmakers can demonstrate long-term cost savings to health insurers and government payors from a reduction in heart attacks, strokes and other obesity-related conditions.
“If you just look at how the drug is used, how it’s priced, and what that impact could be, you don’t have a lot of patients that can afford $17,000 a year in drug bills,” Boehnlein said. “We are seeing that most patients are coming off of the drug in 24 months, and that the weight is coming back on. So I do think, you know, that’s a factor too, in terms of where these patients may end up.”
Most recently, Stryker CEO Kevin Lobo addressed GLP-1 drugs on the company’s Q3 earnings call Nov. 2.
“Studies saying that there’s going to be a reduction, I think, are nonsense,” he said. … “We spent the morning talking to multiple surgeons at massively credible teaching hospitals — world-renowned teaching hospitals — who have pored through the research and feel that there is no need for us to worry whatsoever about any slowdown in our knee procedures.”
How heavy is too heavy for joint replacement surgery?
BMI is calculated as a patient’s weight in kilograms divided by the square of their height in meters. A BMI between 18.5 and 24.9 is considered healthy, while 25 to 29.9 is overweight and 30 and above is obese.
Heavier people are more likely to require hip or knee replacements due to the weight they put on their joints, according to the American Academy of Orthopaedic Surgeons. But obesity is also associated with complications during or after surgery, so patients with BMIs above 35 are often told they need to lose weight to qualify for joint replacements.
And with so many ortho procedures that were delayed by the COVID-19 pandemic, many orthopedic surgeons are turning away patients who are merely overweight rather than obese.
Stryker CFO Glenn Boehnlein [Photo courtesy of Stryker]
“If you think about the backlog of patients that most of these docs have, they’re not looking to take on the high-risk patients,” Boehnlein said. “Those patients that probably have BMI of 27 or higher are getting turned away in this environment.”
BMI overlap in GLP-1 patients and total knee recipients
Obesity’s connection to joint pain and deterioration is well established, BTIG analysts said in a recent note to investors.
“It’s common knowledge that every pound of body weight places four to six pounds of pressure on the knees and obese patients are 20 [times] more likely to need knee replacements. We want investors to consider that it is not necessarily a two-way street though,” BTIG analysts Ryan Zimmerman and Iseult McMahon wrote. “As patients elect to take a GLP-1 and lose weight this doesn’t equate to an equal removal of patients from the ‘funnel’ across all BMI classes as weight is shed. We base this view on studies published on the risk of osteoarthritis and the relationship with obesity.”
They also cited patient demographics from the 2022 American Joint Replacement Registry Annual Report and from them estimated that the average total knee arthroplasty patient from 2012 to 2022 had a BMI of 32.5.
That’s relevant because Wegovy pivotal STEP 1 trial patients lost 15% of their body weight on average, dropping the study population’s average BMI from 37.9 to 32.7.
“There are other reasons we think that the impact may prove less than feared, i.e. knee cartilage doesn’t regenerate and osteoarthritis is degenerative and far more directly related to age,” the analysts wrote.
GLP-1 tailwinds for other device developers
Stryker’s not the first medtech company to face questions about whether these weight loss drugs could slim down their bottom line. In October, executives at surgical robotics developer Intuitive Surgical offered a similarly optimistic view when asked about slowing growth in bariatric procedures.
“I think in the short term, we will see patients who are considering or are in the pipeline for bariatric surgery going to try the drug,” Intuitive Chief Medical Officer Dr. Myriam Curet said. “However, given compliance issues, cost, side effects, we expect that many of them will not stay on the drugs for longer than a year or two, and at that time will consider bariatric surgery. So I think overall we’ll see an increased interest in bariatric surgery, but that will get delayed in the short term.”
And in September, Abbott and analysts pointed to real-world data indicating that GLP-1s could be a tailwind for Abbott’s FreeStyle Libre continuous glucose monitoring systems.
Studies on the effects of these weight loss drugs continue. They’ll be keenly watched by device developers and manufacturers whose products treat conditions where obesity is a contributing factor or where BMI plays into a patient’s eligibility for treatment.
Drug Discovery & Development: Will GLP-1 drugs transition from obesity and diabetes to diverse clinical indications?
This story was originally published on Nov. 2, 2023, and updated on Nov. 3 with remarks from Stryker CEO Kevin Lobo.