Newer technology in arthroplasty-hat’s the evidence

H Gopalan

Editor, www.orthopaedicprinciples.com

Expert Advisor, www.myorthoevidence.com

SICOT India ICL Course Director

Patient Specific Instrumentation

• Customisedinstruments for every patient

•Need for CT/MRI earlier

• Reduces inventory

Level 2 Meta analysis•7 RCT

• Higher incidence of tibial component malaligment in PSI

Thienpont E et al..BJJ Aug 2014

Computer Navigation in TKA

Navigation: 21 RCTsMechanical Axis Deviation, Femoral and

Tibial Component Alignment: < 3 degree

CAS : <3 degrees

CAS took longer time

Lutzner J et al.. 2013

• Superior Alignment < 3 degree: Can it affect revision rates?

•Cost effectiveness

High Flexion in TKA

•Choi WC JBJS Am 2010•Kim JBJS Am 2009

•Nieuwenhuijse JBJS Am 2013 RSA- Implant migration.

NO DIFFERENCE

• Knee Society scores• HSS Knee Score• WOMAC • SF- 36 scores

Oxinium

• Surface coating of Oxinium

•Coating is oxidised Zirconium, superior wear properties

•? Wear rates

Kim WH 2012

KSS, WOMAC, ROM, UCLA score for post op mobility

Osteolysis, Patellar tilt, Subluxation,

Wear particle analysis: Aspiration

NO DIFFERENCE

Cementless TKA

• Younger patients

• Circumvent Asceptic Loosening

•Prosthesis survival

Cementless TKA

• 93 patients

• 9 year survival

• 93.7 % in cementless Vs 90 % cemented group

Lizuar Utrill A et al.. 2014

CoC Vs CoP

•Reduced wear rates compared to metal on polyethylene

• CoC- squeaking incidence 2- 7%

CoC Vs CoP: Kim YH 2011

• 200 patients

•Harris hip score, UCLA, WOMAC

• Similar Function and Radiological Outcome

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

Uncemented Stem THA

• Uncemented Vs Cemented Hemiarthroplasty

• Expensive

•? Better function, Easier Revision

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

Accelerometer- Portable Device•100 patients

• No difference tibialcomponent alignment

• Higher time for tibial resection

•Better restoration of mechanical axis

Five Innovations Gender Specific Knee Replacement

Modular necks in THA

High flexion Knee Replacement

Ceramic on Ceramic

Uncemented Monoblock cups

Expose large number of patients to Unknown Implants

Introduction into commercial market

Adverse effect profile

MoMs

Evidence Based Reviews

Evidence Based Practice

Don’t be the first to use new Technology and don’t be the last to ditch it.