The next big ‘Peter Lynch-style 10-bagger’ from Roadrunner Stocks

by Travis Johnson, Stock Gumshoe | May 5, 2014 1:43 pm

Which stock are they calling the heir to Intuitive Surgical?

Roadrunner Stocks is a newsletter run by Jim Fink at Investing Daily, and I think I’ve only covered his teaser pitches once before — that was back in October, and the four stocks he touted at the time are more or less a wash over that time period, half better performers than the market and half worse.  This latest pitch from him is a bit more interesting, though, because it’s a fairly well-reasoned argument for a single stock … and it’s in a sector that I agree is worth checking out.

Whether or not that means his idea works out is an open question, of course, but the great Gumshoe faithful want answers … so let’s go get ’em.

The idea he’s touting he calls “Operation 10X” — an opportunity to make ten times your money, the fabled Peter Lynch “10-bagger” that every investor lusts after. And it’s an orthopedics company.

And, of course, as with all good medical device stocks it gets held up to the mirror to see if it might bear a passing resemblance to Intuitive Surgical, the skyrocketing maker of the minimally invasive da Vinci surgical system (and yes, every time I see this I get a little grumpy — I sold my ISRG shares back in 2008, after a nice run but still more than $200 ago… I guess it’s some consolation that I haven’t had to sit through their rollercoaster run of $500-300-$500-$300 over the last year). Here’s what Fink says:

“Individual investors who recognized Intuitive Surgical and rode the powerful mega-trend for a few years got rich. And I mean really, really rich!

“Am I suggesting you buy Intuitive Surgical stock now? No. Absolutely not. That opportunity is over. It’s done.

“You may have missed Intuitive Surgical rocketing 2,624% higher. (Don’t feel bad, so did I!)

“But you are NOT going to miss this next one!

“And how do I know this?

“Because I’m going to make darn sure you recognize the next mega-trend on Wall Street that’s happening right now!”

I’m not so sure ISRG is “done”, though as a $14 billion company it’s already grown into its business quite a bit — it is, at least, more reasonably valued now than it has been in a long time, and I think many investors probably understate the value of having a ten-year head start on other robotic surgery systems and a large base of trained doctors who use your tools… but we’re not talking about ISRG today. What is the company they’re teasing for Roadrunner Stocks? Here are some more clues:

“My next 10-bagger was born when an orthopedic surgeon at the Mayo Clinic had a vision. The doctor had worked with several orthopedic companies and thought he saw some things the industry could do differently, and better.

“This surgeon believed in the Mayo Clinic mission that the needs of the patient come first. He wanted to make a difference in the quality of care provided to his patients suffering pain and loss of mobility from joint diseases.

“After leaving the Mayo Clinic, the surgeon started his own orthopedic company and then took it public. He is determined to provide innovative joint-replacement products designed by surgeons for their patients.

“The firm is now one of the world’s fastest-growing orthopedic companies. Sales exploded and they carved out a significant share of the $40 billion orthopedic implant market….

“My top-secret recommendation develops, manufactures and sells orthopedic implant devices, related surgical instrumentation and biologic services to hospitals around the world.”

The orthopedic market is pretty concentrated at the top, at least in the big areas like hip and knee replacements, with Johnson and Johnson (JNJ), Stryker (SYK) and Zimmer Holdings (ZMH) sharing dominance in most areas, but there are a surprisingly large number of smaller players who bring innovation and niche expertise… I guess there will always be entrepreneurial surgeons who think they can make a better shoulder socket, and many of the startup companies end up being bought out by the large firms or merging with each other, just like in pharmaceutical development.

So this isn’t a tease for one of those biggies — they are all pretty solid companies, and Zimmer is actually looking pretty interesting again (I suggested that one back in 2009 as the cheapest of the knee-and-hip crowd, but dropped it when it narrowed the valuation gap — it has since done very well, and I really like their deal to buy Biomet and almost double their size), but Fink is suggesting a far smaller company… you can’t make a “10 bagger” claim with a straight face when your stock starts at a $15-20 billion market capitalization.

His pitch relies on the increasingly demand for joint replacement, with arthritis hitting the baby boomers hard and with the market only improving as Medicaid covers more and more patients (people who previously would never have been able to afford a new hip).

Here are some more clues:

“… they have cutting-edge, industry-leading orthopedic products protected by over 100 crucial patents….

“… inked a long-term deal with Premier Healthcare Alliance. The contracts are for bone cement and total joint replacements including hip, knee and shoulder implants. Premier is one of the largest healthcare specific purchasing alliances in the United States….

“… quietly acquired two key competitors. These targeted acquisitions allowed the company to expand vertically into the rapidly growing spinal surgery area….

“… strong top-line and bottom-line growth, free cash flow and a pristine, debt-free balance sheet….

“The CEO and Prominent Wall Street Fund Managers Effectively Control the Public Float of Stock.

“The company only has 13 million shares outstanding. But the former Mayo Clinic surgeon who founded the company and is now the Chairman and CEO owns over three million of those shares, so the actual public float is about 9 million shares….

“… other major holders are BlackRock, Gabelli Funds, Vanguard, Wells Fargo Private Wealth Management, Goldman Sachs and Kennedy Capital Management.”

Ring a bell for anyone? No? OK, we’ll feed the clues into the gaping maw of the Mighty, Mighty Thinkolator — which boasts a nice new undercoating after our harsh New England winter. We get our answer pretty quickly for a Monday morning, this is: Exactech (EXAC)

Which is indeed a small orthopedic implant company, with a market cap around $300 million. And it’s been public for almost 20 years, so it’s actually a little bit surprising that it’s still independent — though the large insider ownership may have something to do with that (the founder and his family are still running the show, and along with other insiders they control about 40% of the stock). They primarily sell systems for hip, knee and shoulder partial and complete replacement, but also offer a variety of implant and cement products for orthopedists and do have a growing spinal business that they built through acquisition.

Doctors love investing, so hopefully we’ve got a few orthopedists out there who can opine as to where Exactech’s products fall in the spectrum — I don’t know what their competitive position is, just that they are dramatically smaller than Stryker and Zimmer and they are presumably at a sales disadvantage when going up against the massive sales forces at those larger firms. Orthopedic devices typically have high gross margins (meaning, the cost to build a knee implant is far less than they can charge for it), so when you’re small a new product or a little bit of growth can have a bigger impact, but it also means you’re less efficient (profit margins are considerably smaller than the big guys) — which is why big companies can show a nice return by swallowing up small ones and getting rid of extra overhead.

The lead products for EXAC are really knee replacement, including a medical device they’re selling called the GPS system for placing and aligning knees, and extremities, including their fastest-growing product, the Equinoxe shoulder system. They are growing their spine business, too, though it’s still quite a bit smaller than knee, hip and extremities — and they’re seeing some slack in their biologics business (bone implant material, particularly). If you think the analysts are on target and the company is going to grow earnings at an average of 10-15%, then it’s certainly a reasonable buy here — but for this year the company is guiding to only about 8% earnings growth, so that makes it a little bit tighter (analysts see them popping up to better than 10% growth in 2015).

They have beaten earnings estimates for several quarters in a row, but they haven’t been “blowout” beats — just a few percent each time. And they do, as teased, have some excellent small cap fund managers from Royce and Gabelli holding shares, large insider ownership, a fairly quiet (maybe not intentionally) push into growing their spine business and improving their salesforce — including a push into selling their GPS knee system, which they hope will spur more knee implant sales. They’re also continuing a transition of leadership, though that’s clearly been in the works for a long time (David Petty is taking over as CEO from his father, founder William Petty). Looks like an interesting stock, but that’s all I know about ’em so far — if you have an opinion on EXAC or other orthopedic implant companies, feel free to let it out to breathe… just use the friendly little comment box below.

And, of course, if you’ve tried Roadrunner Stocks we want to know what you think of ’em, just click here and you can review that letter[1] for your fellow investors (we sometimes forget to ask, but we’re always happy to hear about letters our readers have subscribed to — you can click here to see the alphabetical list of all the letters our readers have reviewed[2], or to add your own thoughts).


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Endnotes:
  1. click here and you can review that letter: http://www.stockgumshoe.com/reviews/roadrunner-stocks/
  2. click here to see the alphabetical list of all the letters our readers have reviewed: http://www.stockgumshoe.com/reviews-alphabetically/

Source URL: https://www.stockgumshoe.com/reviews/roadrunner-stocks/the-next-big-peter-lynch-style-10-bagger-from-roadrunner-stocks/


  1. Leo S
    May 5 2014, 03:38:25 pm

    I have had two knee replacements. The first one a Stryker Duracon. The second a Stryker Triathalon. Both were installed by the same doctor without telling me of the change in prosthesis. The second one needed a revision (thicker plate) three years later and is still problematical. In studying problems with different prosthesis on the web it appears that the Smith and Nephew products are much more reliable. At least their labeling is more error free. In getting the operative record on either operation from the hospital it was pretty cryptic and of no help, I assume to protect the surgeon, surprise surprise. Ask lots of questions BEFORE the operation.

  2. White Rabbit
    May 5 2014, 07:34:02 pm

    I pulled up a 10 year chart to see if I could draw any conclusions on EXAC’s price movements.
    It reached a high of about 31 3/4 during July of 2008, and then fell to a low of about 10 1/4 during March of 2009. This rise and fall were on heavy volumes compared to subsequent trading volumes. From that low, it rallied to a high of 22.34 during the week of April 26, 2010. It never broke that high until October 24, 2013. That was part of a move to 25.14 on Jan 7, 2014. followed by a fall to 21.02 on Feb 3, 2014. A trading range between these values ensued, but since April 25th it closed lower every day until today, May 5th, when it finally closed up $0.14 from a low of 21.36, which is close to the previous low of 21.02.
    I feel that EXAC bears watching from a technical viewpoint, but a significant break below 21 would require that a new base be formed before I would be interested in buying it. I am not an expert chartist, but I don’t see anything here that indicates that a 10 bagger will occur anytime soon!

    • Dr Bonz
      Dr Bonz
      May 5 2014, 08:47:36 pm

      As my name implies, I am an orthopedic surgeon. While I have heard of this company (medically, not investment wise) it is FAR from a big player in the implant world. Zimmer, Stryker, Biomet (which was just purchased by Zimmer), Depuy (which is owned by J&J), and Smith and Nephew are the main players. All are huge companies with many divisions. EVERY orthopedic surgeon has seen ads from all of these companies. I can honestly say I have never seen an Exactech ad. Implant sales are frequently directed by hospitals. They are the ones who pay for the implant (and of course they then bill the patient for it at a markup). Since the hospital buys the implant, they are very instrumental in what implants are used in their operating rooms. And in a world where more and more doctors are employed by the hospitals in which they work, those hospitals are gaining even more control over the decision of implant that is used. Unless this company can compete with the big boys, I don’t see it gaining much traction nor do I see a “ten bagger” here.

      As far as the GPS navigation they apparently sell, these systems have been out there in one form or another for about 10 years. They are VERY expensive. As I said, the almighty dollar reigns supreme when it comes to sales in a hospital. With government reimbursement to hospitals plummeting, the CEOs are looking to LOWER the cost of replacing patient’s joints. The hospital charges the patient a global fee dictated by the government. In other words, they get X amount of dollars for a joint replacement. That X amount is the same whether the patient stays in for 3 days or 10 days. It is the same if the implant costs them 1/2 X or 1/3 X. So they try to keep their cost down and therefore there intact as high as possible. Every year hospitals get paid less for doing the same things. If they use a more expensive implant and/or a navigation system in the OR, it takes a bigger chunk out of the X. Hospitals cannot survive this way.

      Again, I know nothing about this company really. It may be a great stock to buy. I’m just posting my opinion on the way things work in the hospital world of joint replacement.

  3. Outlawjoseywales
    May 5 2014, 08:47:29 pm

    What’s this box noise? I have no clue what you are talking about. Are you friends with that Frank Archambeau guy?

    • 158 |
      Gill Neilsen
      May 6 2014, 07:38:45 am

      Yeah! Been on this forum for a while and the BOX thing eludes me also. But then a lot of things fall in that category.

      • 9374 |
        Travis Johnson, Stock Gumshoe
        Travis Johnson, Stock Gumshoe
        May 6 2014, 09:29:19 am

        I think folks are just commenting a second time because they forgot to check the “notify” box under the comment box to get email alerts for followup comments or responses. We’re hoping to have a system in place soon to subscribe to followup comments without having to leave a comment, we’ll see if it works.

        • 9374 |
          Travis Johnson, Stock Gumshoe
          Travis Johnson, Stock Gumshoe
          May 7 2014, 11:40:35 am

          New system for comment/discussion alert emails is now being tested — instead of the check box you can now choose to subscribe to all comments on that thread or just to replies to your comment, and you can also subscribe without commenting.

          If you’re logged in, you should also be given a link to manage your subscriptions so you can delete them or change them for any posts where you’ve subscribed to the discussion. Hope this helps to manage your email flow — let us know if it’s not working or you have other suggestions.

          • the Blind Day Trader
            May 7 2014, 04:24:57 pm

            Ah, this is looking good (I received comments through the testing phase, so saw the incremental changes:)). Have yet to test the new options, but a welcome update indeed.

            I am thankful for the new options, but I will point out a couple slight observations about the emails:

            The “[Stock Gumshoe]” label has disappeared from email subjects. That was very helpful for quick mail sorting. In other words, previously a subject would look like:

            [Stock Gumshoe] New Comment On: Microblog: Options, understandings and tactics

            Now it looks like:

            There is a new comment to The next big ‘Peter Lynch-style 10-bagger’ from Roadrunner Stocks

            The description of the article is better (looks like article plus associated newsletter), but the old preamble was, in my opinion, better for quicklypulling these emails out of the hundreds I receive daily.

            May I suggest:

            [Stock Gumshoe] new comment on The next big ‘Peter Lynch-style 10-bagger’ from Roadrunner Stocks

            As a hybrid format?
            (Oh yeah, I changed “comment to” back to “comment on”, which seemed more grammatically appropriate)

            Again, thanks for this update!

  4. Enginer
    May 5 2014, 09:14:16 pm

    I just noticed that the stock plummeted from 23 to 21.5 on the release of last quarter’s lackadaisical results, SEC Form 10-Q,
    Knees 2014 over 2013 up 0.3%
    Extremities (?) up 25.4%
    Hip up 3.5%
    Biologics & Spine DOWN 3.9%
    Other, Down 3.4%
    Overall, Up only 6.7% all on the strength in Extremities.
    Expenses look like they are climbing, relative. Maybe good for a pop, but I cannot see 1000%…

    • 9374 |
      Travis Johnson, Stock Gumshoe
      Travis Johnson, Stock Gumshoe
      May 5 2014, 09:39:43 pm

      Yep — Extremities is mostly the shoulder implant, not sure why they lump it in with other stuff.

  5. Gyula Soos
    May 5 2014, 10:50:20 pm

    I like this. First “This surgeon believed in the Mayo Clinic mission…”. Then ” After leaving the Mayo Clinic…”

    • Tom M
      May 10 2014, 09:34:03 pm

      Yep, head to India for that hip replacement. I mean, what could go wrong with that?
      Pro #1 : Docs earn considerably less, and the nurses work for $65 per month.
      Pro #2 : No medical liability insurance costs. … health care providers are a protected industry.
      Pro #3: They didn’t practice on animals in med school (unless they went here).
      Con #1 : Docs earn considerably less, and the nurses work for $65 per month.
      Con #2 : No medical liability insurance costs. … health care providers are a protected industry.
      Con #3: They didn’t practice on animals in med school.

  6. Deb
    May 6 2014, 08:36:05 am

    So, if I need an implant I should seriously look to travel outside this country. I have heard hips are better replaced in India. Not sure where to go for knees. And with the direction medicine is taking here in the US, I think any investing in the medical arena involves an extra dose of risk and requires research above and beyond a level of reasonableness. My brother had the same experience with his two hip replacements as the guy with two new knees. First one worked out pretty well. Second one, just a couple years later, not so much.

    • Klaus Schonfeld
      May 11 2014, 01:53:32 am

      I live in the Philippines. I have met Westerners here who had successful and less expensive knee replacements. I have had satisfactory medical treatment here, including a brilliant 2-hour session during which my kidney stone was removed ultrasonically at a total cost of $1,500. If you chose the right time of year, the surgery could be combined with a nice holiday.

  7. John Harris
    May 6 2014, 12:10:37 pm

    I have no idea how much spine related business they do but I would not bet on that growing. Fusion cages, spinal fusion, and disc replacement surgeries are under heavy fire for lack of evidence they are any more effective than conservative care and insurers are more and more refusing to pay for much of what was a rapidly ballooning spinal surgery boom that is now being questioned – too often based on profits to doctors and surgical centers (often owned by the surgeons) not patient outcomes with “honorariums” going to doctors who use the most products from the device companies. Check out some back issues of the Backletter published by Lippincott Williams & Wilkins – scary reading.

  8. 59 |
    Thomas Paolini
    May 6 2014, 07:26:59 pm

    Great info: I have seen this stock touted by other newsletters as well. I have a much better perspective now.
    Thank you Travis and Dr. Bonz

  9. 457 |
    Dr Bonz
    Dr Bonz
    May 6 2014, 11:29:54 pm

    Guys, first of all, I can’t imagine you would get better care, or a better result with your total joint arthroplasty in India then you would here is the US. Cheaper maybe, but not better. As for the two posters who are comparing right and left joints and the fact that one apparently did well and the other didn’t, just let me say that you simply cannot compare one surgery to the other in this way. This is why I insist on never having two of my patients who I just did total joints on, in the same room post op. Inevitably, they will end up comparing notes and no matter what, ONE of them is going to be doing “better” than the other one in some way. This has nothing to do with one surgery (or implant) being “better” than the other. Every patient is different as is every knee or hip, even when they are inside the same patient.

    And Leo, I’m not sure why you believe Smith and Nephew has the best implants. Please don’t rely on the infamous internet research which I’m sure you know is laced with bias. You almost can’t tell the difference between an actual scientific article and a “under the table” advertisement anymore. The big 5 implant companies are all pretty good at making these things. They have been doing it for a long time and for the most part ALL of them have the R and D, the science, the design, the engineering, and the manufacturing down pretty well. I don’t see you going wrong with ANY of these companies. I myself use Stryker hips and Biomet knees. IN MY HANDS those are the “best” implants because I know how to implant them. I know all the tips and tricks and nuances of THESE implants. One of my partners uses Smith and Nephew hips and knees. In HIS hands, those are the best implants for the same reasons.

    Whenever a patient comes in after doing their “internet research” and tells me that they want a Zimmer knee, I tell them that would be fine. I can certainly do that for you. However, yours will be the FIRST Zimmer knee I put in. OR, I can do a Biomet knee for you. It will be the 500th one I’ve done. So which one do you want again? 🙂

    Maybe this is good stock investing advice too. Very few surgeons are going to have much experience with the Exactech implants.

    • 154 |
      Leo S
      May 7 2014, 11:50:44 am

      Dr. Ed:
      Thanks for posting. I thought I was clear on the Smith and Nephew article that it was regarding labeling. Their labeling errors were less than 20% of anyone else. I think you would agree that it is nice to know how thick the spacer plate is that you are putting in.
      I was not told why my 2nd knee was bending in the wrong direction before the revision three years later, because the doctor is so non-communicative. I have consulted other orthopedists in the area, because of 2nd knee pain and all they say is “oh he is a good surgeon”. I believe he is. I also know he does more than one operation at the same time on two different people, in a teaching hospital. This also was unknown to me until after my second knee replacement.
      It is interesting to note that I was in a study comparing the duracon prosthesis to the triathlon prosthesis along with six other people using a fluoroscope observation of the knee as we stepped up a small step and kneeled. We were promised a copy of the study. I never received one, even after several requests.
      The 2nd knee has always been sore and swollen, with no reason or relief from the orthopedist. I feel that the surgeon should have told me about the prosthesis change and let me make the decision. I never buy a new car the first year they come out and I surely would not put anything untested or unproven in my body. Communication! Communication! Communication! Regards.

    • Gary W
      May 8 2014, 05:28:30 am

      Dr. Bonz, FYI, I’ve been a patient at Stanford University hospital and at Kailash Hospital in Noida, near Delhi, India. And my daughter is a second-year resident. I don’t know about better, but India was 10 times cheaper with substantially the same doctors’ skill level. But in India I felt definitely more human. American medicine treats patients like objects to be put through standardized processes, not as individuals with ideas and feelings. In India, doctors listened to me; nurses responded to my buzzer within 60 seconds; visiting hours were whatever I wanted; a friend or family member could sleep in my room, which felt good. As hospitals and doctors process 40% more patients in the same time, Americans will go abroad in droves. So I agree with your views on this stock. Thank you!

      • 154 |
        Leo S
        May 8 2014, 11:47:32 am

        Gary: Your statement: “American medicine treats patients like objects to be put through standardized processes, not as individuals with ideas and feelings.” I totally agree. Unfortunately this is the paradigm we are faced with. Someone on another thread begged for a “single payer system”. How quaint a suggestion. That is what I was raised on. A single payment to the doctor, no insurance company or government to get in the way, and we did just fine. We were also raised on welfare, which is a whole other story. We did not get a check to buy whatever frills suited us. We got flour, beans, rice, sugar, and other staples as well as some clothes. More government is not the answer. Government can provide a proper safety net. When they go further the politics, corporate greed, and voter gullibility/apathy take over. Congress is a social club. They won’t fix it. I am considering going to what is called concierge medicine. You pay a doctor a fixed amount per year (in my case $1500) and he takes care of you. They do not take medicare. It is too bad that some people cannot afford that. Sorry for the rant.

        • 3530 |
          KennyG
          May 8 2014, 01:49:45 pm

          Leo: regarding that concierge medicine. My doctor recently changed his practice to such a service. In his case it was thru “MDVIP”. The cost was about the same as you mentioned, $1500 per year. But the part about they do not take medicare is not so….at least with MDVIP. That cost of $1500 is basically a yearly membership cost that ‘permits’ me to continue seeing this particular doctor. On top of that I still get charged for services as prior to joining this program. The doctors practice continues submitting bills to Medicare and 3rd party insurers and all deductions and copays still apply. A benefit of this service is that the doctor actually spends time with you – up to an hour is common.

          In a earlier thread (forget which one it was) I had asked Dr.KSS if he heard of this new movement in concierge medicine and what his thoughts were. With all on his plate he probably never read that particular question of mine.

          • 154 |
            Leo S
            May 8 2014, 04:04:52 pm

            KennyG: Wow! thanks Kenny, I really appreciate the post. Maybe if enough of us do this we can eventually return to something resembling the good old days. Of course a big objection will be “what about the poor people”. We were poor, and lower than hammered whale doo doo and we got taken care of just fine. People looked out for each other then and they still do but the government gets in the way with a one size fits all. I am calling the concierge today. Take care

  10. Kenneth Green
    May 10 2014, 10:31:49 pm

    I just had to chime in with some info for all those baby boomers that are looking to get knee or hip replacements in the near future. my background is engineering.
    In 2005 I tore the cartilage in my right knee. A very able surgeon put me out of my misery by skillfully snipping and removing the torn piece, fabulous, pain free again. About three years later pains back. The same surgeon explains the reason, bone on bone where the torn cartilage was removed ( by the way, it is now possible to reattach the tear. I’ll explain later.
    The surgeons solution, knee replacement. Holy bleep, if I had known that snipping off the tear would result in my getting a knee replacement three years later, I may have looked for a better solution.
    Not wanting to make the same mistake twice, this time I did look for another solution and found it at “The Center for regenerative medicine in Miami Beach Florida” Dr Guss Fleechian.
    I flew down there from Toronto. He did Platelet Rich Plasma (PRP) and growth hormone injections directly into the knee over a ten day period, a days rest in between injections.
    This procedure is a breeze. the bone and cartilage is regenerated. I now understand that he has replaced the growth hormone with fat cells ( stem cells ) from the tummy with even better results.
    Bottom line folks, 2008 to 2014, 95% pain free, no rejection therefore no medications or their bleeping side effects. I have a golden retriever and walk him three times daily 40 minutes each time. I am 82 years old and whilst I no longer leap over tall buildings I believe I made the right choice instead getting all that metal installed that has a habit of deteriorating. For more info Google PRP injections. and Stem Cells, That’s the future for medicine, not replacement parts. Your body can repair itself if given half a chance. Cheers.

  11. Dr Bonz
    Dr Bonz
    May 11 2014, 01:39:47 pm

    Kenneth: In 2008, you were in your mid to late 70s. I doubt that a torn meniscus cartilage was the sole cause of your arthritis. You may not have had SYMPTOMS of arthritis before your meniscus tear, you most likely DID have it. Often, an event (such as yours, an injury, a tear) is essentially the “straw that breaks the camels back” and causes your previously asymptomatic arthritis to become symptomatic.

    As to your claim that we can “fix” a torn meniscus, this is only partially true. Meniscus cartilage is, for the most part, void of blood vessels (except for the extreme periphery of the meniscus). In other words, when you tear a meniscus, it doesn’t bleed. That is why we must simply remove the torn portion and leave as much normal meniscus behind. Patients ask me why we don’t just stitch it back together. It is this avascularity that prevents this. When you cut your skin, it bleeds like crazy due to an abundance of vessels. Sutures are used and these vessels bring healing factors to the site and you eventually heal and the sutures are removed. You can’t do that with meniscus. The sutures would eventually tear out since no healing would ever take place.

    As you implied, the meniscus is a “cushion” between the femur (thigh bone) and the tibia (shin bone) that make up your knee joint. It is true that removing some of this cushion can (eventually) lead to arthritis. But a torn meniscus is not only not doing you any good. It is actually “doing you bad”. It will flop around inside your knee leading to much worse arthritis if it is not removed. The extreme peripheral tears (which comprise probably less than 10% of all tears and where there actually ARE some viable blood vessels) can be repaired in the manner you mentioned but the vast majority of patients are not candidates due to the nature of their tears.
    As far as the treatments you mentioned (PRP injections) they most certainly DO NOT allow your bone and cartilage to “regenerate”. The jury is still out on this treatment that certainly is not proven and most definitely does not have the success rate of total joint replacement. Congratulations on your successful treatment though.

    • Tom O'Neill
      Jun 17 2014, 02:49:09 am

      Dr. Bonz,
      I read your reply dated May 11, 2014 in this thread regarding joint replacements and, in particular, about the removal of torn meniscus material in the knee joint. I had reconstructive surgery on my right knee in January 1977 when I was a mere lad of 33 years.
      The surgery was complicated by the loss of the blood supply to the joint from the tibia. My surgeon had to drill a dozen small holes down into the bone to bring the blood supply up. My torn meniscus was removed nearly completely, all but a small ring of cartilage which was left in place.
      I spent a month in a cast and on crutches, at the end of which time I was assured the meniscus had regrown completely. However, I was cautioned that the material would be softer and more easily worn by twisting and turning and bending motions. I hug up my skis for good and concentrated on walking without the need for an aid.
      As recently as January 2009 an MRI confirmed the presence of a (now) thinner layer of meniscus material. My surgeon has retired, but a local surgeon where I now live indicated it may be time to consider a knee joint replacement.
      There’s more to my story but I would prefer to exchange private email with you concerning the particulars. I wonder if you would be willing to hear me out and perhaps become be a 2nd or 3rd advisor?

  12. Frank Weinholt
    May 12 2014, 03:32:42 am

    I am not a lawyer, but I am aware of several people who have had to have revisions of problematic knee replacements who either sued successfully or whose costs were totally paid for. The one name I’m aware of that I can remember most easily is “Depuy.” I believe the law firm of “Zocolof (?sp)” is expanding their search for victims beyond bad drug side effects but for failed joint repairs. Are there some out there who keep track of the number of such suits (successful or not) involving orthopedic hardware. Given Hospital efforts to avoid suits, would they be more inclined to expand their product lines of such devices if there is a malpractice factor involved?

  13. Frank Weinholt
    May 12 2014, 03:44:37 am

    PS: for those not here in the Southern part of the US, the law firm of “Zocolof” (sp) sponsors advertising (going on for nearly 10 years) on an almost daily basis looking for: “have you or a loved one ever taken Zyprexa, Risperdal, …. or drug X… then you may be entitled to compensation…. etc.” I know they have expanded their reach to orthopedic devices, but have just not heard the commercials often enough to remember the companies involved. However, I do recall the mention of the DaVinci device as another target for law suits.

    • Dr Bonz
      Dr Bonz
      May 13 2014, 07:05:35 am

      The implants that you have seen the ambulance chaser….ahhhhh, I mean the “TV attorneys” (I make that distinction because I realize that there are many very good lawyers out there who truly do want to help people and then there are the hucksters you see on TV), are actually on HIP replacements. There were some “metal on metal” hip implants (instead of placing a polyethylene socket into the metal socket that goes into the hip socket, these implants used a metal ball going into a metal socket. Most of these worked OK but there were a few out there where the ball didn’t fit circumferentially perfect into the socket which cause problems. These are the ones you are seeing on TV ads. My problem with these types of suits is, as you know, the “injured party” gets “some” money while the TV attorney gets millions.

      • Dr Bonz
        Dr Bonz
        May 13 2014, 07:09:38 am

        Frank: You are correct about the commercials on the Davinci robot. It is often used in urological surgery (among others). But if you stick around long enough, you’ll see a commercial for pretty much ANY device or medication (or class of medication).

        As far as hospitals trying to avoid lawsuits, these suits are usually against the company and (thank goodness) not against the doctor or hospital (at least not yet).

  14. sgf
    Jun 16 2014, 10:23:32 am

    I am a “very” active 50 year old slender female who found herself needing a total hip replacement at a very early age. I have since been researching this area. I have had my very successful (anterior approach) replacement with a Smith and Nephew device. As Dr Bonz mentioned, I chose my surgeon,(sports medicine group) and due to his expertise with the Smith and Nephew product, he chose the prosthesis he preferred for my situation. All of the printed material the hospital and the group gave me, was printed by Smith and Nephew, I do not know if this is the only company the “hospital” uses.

    Since researching this area I have been acquainted with more and more people that are needing this treatment at an earlier age. I think the thesis for investing in a joint prosthesis manufacturer is a good one,…but the company in question in the gumshoe article,…not so sure. There is speculation in the market at this point, that Smith and Nephew is a take over target by the larger companies,…Medtronic,…etc. and it’s price has risen in response by about 20% in the last 6 weeks.

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