Issue link: https://beckershealthcare.uberflip.com/i/520575
Save the date! CEO Roundtable + CFO/CIO Roundtable — November 18-19, 2015 — Chicago. Please call 800-417-2035 to register. Question: How long have you been doing revision knee surgeries? What is the most challenging part about the procedure? Dr. C. Lowry Barnes: I have been doing revisions for 23 years, and revisions consistently represent about 30 percent of my hip and knee practice. The most challenging part of the procedure is manag- ing stability, joint line and bone loss. Dr. James Browne: I finished my adult recon- struction fellowship almost five years ago and have been doing a significant volume of revi- sion knee arthroplasty procedures since that time. There are a variety of reasons why knee replacements are revised and the challenges often depend upon the cause of failure. Com- promised soft tissues, deficient ligaments and bone loss are all challenging issues. Peripros- thetic joint infection may be the greatest chal- lenge in terms of long-term outcome. Dr. Michael J. Taunton: I have been perform- ing revision knee procedures for eight years. Every revision knee is different, which keeps our job interesting and challenging. The most challenging portion of revision total knee sur- gery is insuring stability of the knee ligaments throughout range of motion. Q: How do primary knee surgeries differ from revision knee surgeries? CLB: Primaries are much more predictable re- garding intraoperative findings and subsequent challenges. Revisions often have multi-factorial problems leading to revision. The patient may have flexion instability in association with com- ponent malrotation, for instance. JB: Many primary knee replacement surgeries follow a straightforward series of surgical steps. Revision surgery tends to be more complex and less predictable. Revision surgery typically takes longer and is associated with a higher rate of complications. MT: In primary surgery, the behavior of the bone and soft tissues above the knee is fairly pre- dictable. In the setting of revision, the surgeon must identify then address why the prior total knee failed. Through correct identification, the surgeon may have a full understanding of how to fix the problem. Then, the surgeon must use the remaining bone and soft tissue, usually in a compromised state, to reconstruct the knee joint. Q: When you first started doing revision knee surgeries, what sort of procedure- specific tools and products were available to you? CLB: Most orthopedic implant companies have revision knee systems with many bells and whistles from both an implant system and in- strumentation system. Over time, experienced revision knee surgeons use fewer and fewer instruments and more and more constraint be- tween components. JB: Bone loss and ligament deficiency are com- mon problems that need to be addressed with revision knee surgery. The specialized implants used for revision knee surgery include aug- ments, stems and additional prosthetic con- straint to address these issues. Specialized revi- sion implants have been available for decades, although each system has its limitations. Modern knee revision implants have also gotten very ex- pensive and have contributed to the increasing financial burden of revision knee surgery. MT: Overtime, the availability of complex systems has increased, but surgeons continue to use the basic principles of ligament balancing and pros- thetic constraint to manage complex situations. Q: Over time, how has the procedure and its associated tools and products changed? CLB: Revision total knee replacement has be- come highly instrumented and systems have many modular approaches to implant custom- ization. Unfortunately, these changes have been coupled with significant increases in cost to the hospital and, therefore, the healthcare system. Many revision knee implants have "discounted" implant costs of more than $15,000. JB: Revision knee replacement systems and their associated instruments have gotten in- creasingly complex and expensive over time. Current systems have numerous parts and typi- cally require several pans of instruments. Many revision knee surgeons agree that the number and complexity of steps has gotten excessive. This has had the effect of reducing operating efficiency and increasing costs. The high cost of revision knee implants is a big portion of the overall resource consumption in revision surgery. MT: The instrumentation and implants have become increasingly complex, and expensive, consuming more resources for each procedure. Q: What inspired you to try designing and developing your own revision knee surgery system, and how did you start that process? CLB: I am a true believer in a value-based ap- proach to orthopedics. I realized many of my revision knee procedures used very similar augments of the distal and posterior femur and was convinced many revision knees could be addressed with "pre-augmented" implants at a much better value to the healthcare system. JB: Healthcare has entered a new era of val- ue. Value is defined as the health outcomes achieved for patients relative to the costs of achieving them. We realized there was a tre- mendous opportunity in the revision knee mar- ket to eliminate some of the unnecessary com- plexity and increase efficiency in the operating room while still delivering proven modern tech- nology. DJO Surgical assembled a like-minded group of high-volume revision knee surgeons and engineers to tackle this project and provid- ed us with the resources necessary to innovate. MT: Currently, most revision systems contain multiple modular augments for managing bone loss. This leads to instrumentation that is com- plex, and housed in as many if not more than eight pans. The implants also are complex, with multiple modular components. For many revi- sion knee surgeries, the extensive sets of aug- ments and instrumentation are not needed. We sought to design a revision knee system that incorporated many of the buildups and features we needed in a majority of revision cases, with a focus on efficiency and simplicity. Q: What exactly sets the Exprt Revision Knee System apart from others? CLB: The Exprt Revision Knee System is an implant system that can probably treat 75 to 80 percent of revision knees in the hands of an experienced knee surgeon and offers the value proposition of decreasing implant procedural costs by about $10,000 per case. JB: I see the Exprt Revision Knee System as being a disruptive innovation in the revision knee market. This system provides a high- quality implant with a streamlined efficiency, all at a dramatically lower cost. A simple yet sophisticated two-tray system has replaced the traditional eight-tray system. The implants have built in augments to compensate for bone loss, a single radius design, appropriately cross- linked vitamin E polyethylene and the degree of constraint necessary to address the majority of revision scenarios. The cost reductions are unprecedented with 40 to 70 percent savings over comparable revision systems. In today's value-driven healthcare market, this knee sys- tem provides a high-value, cost-effective option for a majority of knee revision patients. MT: The Exprt Revision Knee System seeks to manage a majority of revision total knee cases with an efficient, simple system that drives value. The instrumentation is streamlined, straightfor- ward and user-friendly. The implants incorporate augmentation into the distal and posterior femur, as well as the tibial plateau. The constraint and stem selection is designed to meet the bone and soft tissue defects found in most revision situa- tions. Combined, the instruments and implants provide a valuable toolbox for the revision knee surgeon, with increased efficiency. n 93 DJO Surgical is a division of DJO Global and provides orthopedic surgeons with high-end, patient fo- cused solutions for total joint arthroplasty, partial joint arthroplasty and revision surgeries. DJO Surgical partners with key consulting surgeons to provide focused innovative and proprietary patent devices, such as the EXPRT™ Precision System for revision knee, 3DKnee™ Total Knee System and Reverse® Shoulder Prosthesis. As an industry leader in differentiated technology and upper extremity solutions, DJO Surgical gives surgeons and their patients a full range of primary and revision implants for hip, knee and shoulder reconstructive joint surgery. DJO Surgical's Advanced Technologies department is dedi- cated to exploring and developing new, cutting edge technologies. Successes include the Match Point System™ patient specific instrument, e+™ polyethylene cross-linked material and p2 proprietary Titani- um Porous coating. For more information, please visit: http://www.djoglobal.com/our-brands/djo-surgical