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Sponsored by: One Patient. One Implant. Delivering Satisfaction & Lowering Costs — How Customized Total Knee Implants are Changing the TKR Experience P atients do not conform to a one-size-fits-all implant model, especially when it comes to knee replacements. Off-the-shelf implants often leave room for improvement in terms of fit and comfort because although many total knee replacement patients experience reduced pain following surgery, about 20 percent are not fully satisfied. Billerica, Mass.-based ConforMIS is personalizing the TKR experience by offering patients one-of-a-kind implants. ConforMIS leverages iFit Image-to-Implant technology to create its Customized Implants that are individually sized and shaped to a patient's unique anatomy. In May 2017, Arthroplasty Today published a retrospective study comparing customized implants to standard off-the-shelf implants for adverse events rates and cost of care for total knee arthroplasty. Patients treated with customized implants reported lower adverse event and transfusion rates; were less likely to be discharged to a rehabilitation facility; and had lower average total episode-of-care costs. Orthopedic surgeons Greg Martin, MD, a hip and knee specialist in Boynton Beach, Fla.; Derek Johnson, MD, of Centura Orthopedics Meridian in Parker, Colo.; and Barry Waldman, MD, of OrthoMaryland in Baltimore, share how ConforMIS Customized Implants have boosted patient satisfaction at their practices. Note: The following responses were slightly edited for length and clarity. Question: Why do you use ConforMIS Customized Implants for total knee replacements? Dr. Greg Martin: I began using ConforMIS implants because I needed to find a better way to help my patients that required knee replacement. We know that using traditional off-the-shelf implants, approximately one in five patients are not satisfied with their outcome. As a surgeon, this is frustrating because you can do a great job with the procedure and end up with an unhappy patient. It made intuitive sense to me that if we make an implant that is sized and shaped like the patient's own knee, they are more likely to be happy with how it feels. I think this is the major benefit of these implants. Unlike any other implant available, the ConforMIS knees are customized to the size and shape of the patient's own knee. Dr. Derek Johnson: I started using [ConforMIS Customized Implants] in the fall of 2014, because there's 20 to 30 percent of people who don't have significant pain but they aren't happy with their knee replacements. It's a challenge for joint replacement specialists, because you think everything looks great, but the patient is not satisfied. We think this may be because we're not restoring normal anatomy and geometry to the knee. It made sense conceptually if we're recreating a patient's unique anatomy; it's about restoring the normal joint line and normal joint geometry. A knee is very asymmetric; the off-the-shelf implants are pretty symmetric and uniform. Every single implant looks different than the one before with ConforMIS [Customized Implants]. Dr. Barry Waldman: ConforMIS uses a CT scan of a knee which allows them to make a knee that fits almost perfectly [with] the patients' actual anatomy. The system looks at hip and the ankle to get everything aligned correctly. We started using [the customized implants] in a few patients and I found that my patients had much more natural motion and could bend their knees more easily early on. Q: Were you surprised by the results from the retrospective study published in Arthroplasty Today, comparing adverse events rates and cost of care for total knee arthroplasty patients treated with customized individually made implants versus standard off-the-shelf implants? DJ: I don't think I was surprised; I think it does make sense. If a patient has a more normal, stable feeling knee, they are going to ambulate sooner, which will potentially allow them to discharge sooner. The lower blood transfusion rates also make sense. With the ConforMIS implants, you're covering the cut surfaces of the bone. Off-the-shelf implants leave 20 to 30 percent of the bone uncovered. BW: That's the exact experience that we've had. One of the advantages to the hospital is we just have one box with all the parts in it — there is no inventory to deal with. Not only are the implants customized, but the actual cutting guides are made of plastic and we are able to simply dispose of them when the case is over. 59 Executive Roundtable

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