newer technology in arthroplasty-hat’s the evidence
TRANSCRIPT
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H Gopalan
Editor, www.orthopaedicprinciples.com
Expert Advisor, www.myorthoevidence.com
SICOT India ICL Course Director
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Patient Specific Instrumentation
• Customisedinstruments for every patient
•Need for CT/MRI earlier
• Reduces inventory
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Level 2 Meta analysis•7 RCT
• Higher incidence of tibial component malaligment in PSI
Thienpont E et al..BJJ Aug 2014
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Computer Navigation in TKA
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Navigation: 21 RCTsMechanical Axis Deviation, Femoral and
Tibial Component Alignment: < 3 degree
CAS : <3 degrees
CAS took longer time
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Lutzner J et al.. 2013
• Superior Alignment < 3 degree: Can it affect revision rates?
•Cost effectiveness
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High Flexion in TKA
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•Choi WC JBJS Am 2010•Kim JBJS Am 2009
•Nieuwenhuijse JBJS Am 2013 RSA- Implant migration.
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NO DIFFERENCE
• Knee Society scores• HSS Knee Score• WOMAC • SF- 36 scores
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Oxinium
• Surface coating of Oxinium
•Coating is oxidised Zirconium, superior wear properties
•? Wear rates
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Kim WH 2012
KSS, WOMAC, ROM, UCLA score for post op mobility
Osteolysis, Patellar tilt, Subluxation,
Wear particle analysis: Aspiration
NO DIFFERENCE
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Cementless TKA
• Younger patients
• Circumvent Asceptic Loosening
•Prosthesis survival
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Cementless TKA
• 93 patients
• 9 year survival
• 93.7 % in cementless Vs 90 % cemented group
Lizuar Utrill A et al.. 2014
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CoC Vs CoP
•Reduced wear rates compared to metal on polyethylene
• CoC- squeaking incidence 2- 7%
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CoC Vs CoP: Kim YH 2011
• 200 patients
•Harris hip score, UCLA, WOMAC
• Similar Function and Radiological Outcome
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Trabecular Metal
•Cementless TKA
• 145 patients
•Trabecular Metal Vs Standard cemented TKA
•KSS, WOMAC better in trabecularmetal cemetless group
Fernandez- Fairer M et al.. 2013
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Uncemented Stem THA
• Uncemented Vs Cemented Hemiarthroplasty
• Expensive
•? Better function, Easier Revision
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Cemented Vs Uncemented HA•115 patients in each
• Uncemented group: better Harris hip scores at 5 years
• Periprosthetic fracture: 7.4% in uncementedgroup Vs 0.9% in the cemented group
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Accelerometer- Portable Device•100 patients
• No difference tibialcomponent alignment
• Higher time for tibial resection
•Better restoration of mechanical axis
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Five Innovations Gender Specific Knee Replacement
Modular necks in THA
High flexion Knee Replacement
Ceramic on Ceramic
Uncemented Monoblock cups
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Expose large number of patients to Unknown Implants
Introduction into commercial market
Adverse effect profile
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MoMs
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Evidence Based Reviews
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Evidence Based Practice
Don’t be the first to use new Technology and don’t be the last to ditch it.