Issue link: https://beckershealthcare.uberflip.com/i/956253
30 Executive Briefing Question: Was changing to MOTO a difficult transition? Dr. Mandume Kerina: No. Transitioning was easy because the principles of partial knee replacement are the foundation for the Moto surgical philosophy, a balanced aligned resection. Dr. Akbar Nawab: Not for me either. As a joint compartmentalist, I am looking to have the best long-term survivorship for my partial knee replacements and this means not only a durable and reliable arthroplasty but also preserving the contralateral compartment from failure. Alignment accuracy with Moto is beautifully refined with a combination of measured resection and gap balancing. Dr. Ryan Molli: The transition was easy as the instrumentation is similar to commonly performed knee arthroplasty. The surgical technique is very well thought out and the instrumentation versatility allows precise balancing in both flexion and extension Q: Did you have to change your patient positioning, draping and exposure? MK: No, same as I've always done. I like the DeMayo Knee Positioner® because I have great control over the leg and find it helps to leave my hands free when teaching surgeon visitors. AN: I use a leg holder too, no changes. And as an educator for ZUK for years, I agree with Dr. Kerina's remark. RM: I was trained on and used the Oxford® for years, and prefer the hanging leg technique, and have had no need to do anything different. Q: How are you using it in your practice? RM: I have a high-volume joint replacement practice. MOTO is very efficient in the hospital setting, and my staff loves the simplicity of only three trays. Q: What features make this UKA the best for your sports medicine/ outpatient practice? AN: As a knee surgeon who specializes in joint preservation as well as reconstruction, I tend to treat younger patients, and have transitioned most of my patients into my ASC, where this procedure is performed as an outpatient arthroplasty. It is efficient, and addresses any issues I might encounter, even in the ACL-deficient or reconstructed patients. Q: What excites you most about this new system in your hands? RM: I now feel like I'm in complete control of every step of the UKA, and perhaps most importantly, I now have a mechanism to minimize the tibial resection thickness by adjusting my posterior femoral condyle resection level. AN: I love the ability to decide, on every patient, exactly how I want to balance the flexion and extension gaps. And with my younger patients, I know that any future needs, such as a need for a lateral UKA or patellofemoral joint, that all the components were designed to be compatible. MK: It is nice to have a system in my hands where I can redo or revise any step at any point in the procedure. I am able to make adjustments in very short time and without sacrificing quality. Q: How has your facility adapted to the change to MOTO? AN: My ASC loved it! With only three trays, setup is a breeze, and my techs quickly adapted to the new instruments. Q: Tell us about a case that MOTO provided a solution, that wasn't possible until now? RM: I had a recent case when, after osteophyte debridement, my extension gap was 5 mm greater than my flexion gap! I was able to solve this by using the smaller distal femur resection guide and cutting 2 mm more from the posterior Akbar Nawab, MD J. Mandume Kerina, MD femoral condyle with Moto's unique pre-cutting guides, which placed the femoral component more distal. It led to perfect balance throughout the range of motion, with no further tibial resection. That is the beauty of the MOTO system, independent extension and flexion balancing, which is unlike any other system. Q: Despite a good preoperative exam, and stress films, are you ever surprised by the flexion- extension imbalance? Was MOTO able to address that? MK: Definitely. I believe in good alignment films as well as a valgus stress film to show me the potential correction. Even still, a large medial osteophyte tenting the MCL can mislead your assessment of laxity. Once removed, it is easy to check the laxity and alignment that drives your resection plan to balance the flexion and extension gaps, while not overcorrecting the alignment into valgus. Anthony Robins, MD, of Yarrow Point, Wash. sat down with his fellow MOTO design surgeons to find out how MOTO was already making a difference in their individual practices. Below is an excerpt from these discussions with Dr. Kerina, Akbar Nawab, MD, of Louisville, Ky.-based Ellis & Badenhausen Orthopaedics, and Ryan Molli, DO, of Whole Health Joint Replacement Institute in Meadville, Pa.