Oxford. Partial Knee

Transcription

1 Oxford Partial Knee

2 Oxford Partial Knee A Definitive Implant The Oxford Partial Knee is the most widely used 38 and clinically proven 22 partial knee replacement (PKR) system in the world, offering industry leading approaches to patient care for increased OR efficiencies and reproducible results. Replacing just the affected medial compartment allows a more natural fit, 23 improved range of motion 1 and is a more bone conserving operation than total knee arthroplasty (TKA). Oxford PKR patients have also been found to be more satisfied with their ability to perform activities of daily living compared to TKA patients. 31 The Oxford Partial Knee System is available in the following variety of combinations; cemented, cementless, medial, lateral, and TiNbN components for the treatment of your patients. Tibial Component Anatomical shape for optimal bone coverage 2

3 Cementless Fixation Femoral Component Conforming, spherical design minimizes contact stress throughout entire range of motion 39 Curved inner geometry for minimal bone removal 39 The Oxford Partial Knee for medial compartment replacement is now available with Porous Plasma Spray (PPS) & Hydroxyapatite (HA) coating for cementless fixation. Offers twin-peg femoral design to allow for additional rotational stability Plasma sprayed porous titanium coating provides mechanical interlock with the substrate 4 Provides improved fixation 5 Reduces the incidence of radiolucencies seen under the tibial components on screened radiographs 5 Eliminates possible known failure mechanisms caused by poor cementing technique Reduces operating time as it eliminates cement preparation and curing time Mobile Meniscal Bearing Mobile bearing designed to remain fully congruent with femoral component throughout entire range of motion 1 Proven wear resistance with ArCom Direct Compression Molded polyethylene 2,3 Available in 5 femoral component sizes for optimised patient fit 1

4 Oxford Partial Knee Microplasty Partial Knee Instrumentation The Oxford Partial Knee System continues to advance partial knee arthroplasty with Microplasty Instrumentation. This instrumentation platform is designed to provide surgeons with innovative tools to help with ease of use, precision, efficiency and reproducibility for each patient: Minimal incision to avoid quadriceps disruption Size specific femoral instrumentation for precise 1 mm incremental bone removal Supports patient demand with accurate reproducible results Spherical mill and spigots provide a simplified approach to balancing the flexion and extension gaps

5 Oxford Partial Knee and Today s Fixed Bearing Partial Knee Replacements The Oxford Partial Knee has demonstrated 91% survivorship at 20 years. 29 Due to its congruent, forgiving design, the Oxford has demonstrated ultra low polyethylene wear in multiple retrieval studies No significant correlation exists between preoperative evidence of PFJ and poor outcomes with the Oxford PKR 36,37 Short term clinical outcomes found the Oxford Partial Knee restores joint kinematics better than today s fixed bearing partial knee replacements due to: Larger and incremental increase in tibial internal rotation 30 More consistent AP translation of the medial femoral condyle 30 More consistent AP translation of contact point 30

6 Oxford Partial Knee Published Clinical Results Overview of Oxford Unicompartmental Knee Arthroplasty Gaurav Khanna, MD; Bruce A. Levy, MD 6 Oxford Unicompartmental Knee Replacement: Literature Review. Orthopedics Supplement. 30(5): Authors Year n Age (years) Disease Knee Score Goodfellow et al Carr et al Murray et al (27 lateral) Vorlat et al (3 lateral) Svard et al Emerson et al Keys et al Rajasekhar et al (range: 54 86) 69 (range: 57 81) 71 (range: 35 91) 62 (range 46 84) 70 (range: 51 86) 63 (range: 38 85) 68 (range: 0 80) 71 (range: 53 88) Medial or lateral OA Follow-up (y) None Given 3 (2 5) 91.0 % Survivorship (y) Mode of Failure 9 revisions (5 component loosening, 3 bearing dislocation, 1 disease progression) Medial OA 40.1 (OKS) revision (component loosening) Anteromedial OA None Given 7.6 (6 14) 98.0 (10) Medial or lateral OA Anteromedial OA 87.0 (HSS) 5 (2 8) 93.0 None Given 12.5 ( ) 95.0 (10) Medial OA 92 (AKS) 6.8 (2 13) 93.0 (10) Medial OA None Given 7.5 (6 10) 100 (10) None Medial OA 92.2 (AKS) 5.8 (2 12) 94.0 (10) Langdown et al (46 85) AVN 38.0 (OKS) 5.2 (1 13) 100 (10) None Price et al Verdonk et al (10 lateral) Price et al Vorlat et al Kort et al Luscombe et al Pandit et al Price and Svard pts <60: 56 (range: 35 60) pts >60: 71 (range: 60 95) 61 (range: 46 84) 70 (range: 49 95) 66 (range: 46 89) 56 (range: 43 60) 63 (range: 41 79) 66 (range: 33 89) 69.7 (range: 48 94) Medial OA 94.0 (HSS) (10) Medial OA 86.0 (HSS) (10) Medial or lateral OA None Given 6.8 (2 14) 86.0 Medial OA 86.0 (HSS) (15) Medial OA None Given 5.5 (1 10) 84.0 (10) Medial OA 90.5 (AKS) (2 6) 96.0 Medial OA 38.3 (OKS) Anteromedial OA (667) AVN (21) Anteromedial OA, Secondary OA, Osteonecrosis 39.0 (OKS) None Given 5.9 (0.5 22) 98 (10) 91 (20) Abbreviations: AKS=American Knee Score, AVN=Avascular Necrosis, HSS=Hospital for Special Surgery, OA=Osteoarthritis, and OKS=Oxford Knee Score. 5 revisions (2 component loosening, 2 lateral OA, 1 unexplained pain) 3 revisions (2 lateral OA, 1 component malalignment) 6 revisions (3 bearing dislocation, 2 component loosening, 1 infection) 7 revisions (4 lateral OA, 1 bearing impingement, 1 inflammatory arthritis, 1 component loosening) 5 revisions (2 component loosening, 1 component loosening/bearing dislocation, 1 bearing dislocation, 1 unexplained pain) 4 revisions (2 lateral OA, 1 component loosening, 1 bearing fracture) 20 revisions (8 lateral OA, 5 component loosening, 3 deep infection, 3 bearing dislocation, 1 unexplained pain) 14 revisions (5 component loosening, 3 bearing dislocation, 3 lateral OA, 2 unexplained pain, 1 supracondylar femur fracture) 23 revisions (7 lateral OA, 5 component loosening, 5 bearing dislocation, 2 infection, 2 unexplained pain, 1 component loosening/bearing dislocation, 1 bearing fracture) 24 revisions (9 lateral OA, 6 component loosening, 4 bearing dislocation, 2 bearing fracture, 1 tibial subsidence, 1 instability, 1 unknown) 2 revisions (1 tibial loosening/ femoral malalignment, 1 femoral malalignment) 4 revisions (1 unexplained pain, 1 deep infection, 1 component loosening, 1 bearing dislocation) 9 revisions (4 deep infection, 3 bearing dislocation, 2 unexplained pain) 29 revisions (10 lateral arthrosis, 9 component loosening, 5 infection, 2 bearing dislocations, 3 unexplained pain)

7 Benefits of Partial Knees Include: The most widely used 38 and clinically proven 22 partial knee system in the world. Survivorship A multi-centre study 31 found that Oxford PKR patients were 2.7 times more satisfied with their ability to perform activities of daily living and 1.8 times more likely to report that their knee felt normal compared to TKA patients Improved range of motion compared to TKA Preserves more healthy bone than TKA 25 Better functionality 27 and more natural motion than TKA 25 Faster recovery and shorter hospital stay than TKA 23 Substantial cost savings over TKA (according to an independent study) % at 15 years % at 20 years 29

8 References 1. Goodfellow, J. and O Connor, J. The Mechanics of the Knee and Prosthesis Design. Journal of Bone and Joint Surgery (Br). 60(3): , Psychoyios, V et al. Wear of Congruent Meniscal Bearings in Unicompartmental Knee Arthroplasty. JBJS Br. (1998) 80-B: Kendrick, B.J.L. et al. Unicompartmental Knee Replacement as a Definitive Implant: 20 year in-vivo wear results. Journal Bone and Joint Surgery Br vol. 93-B no. SUPP II Focus on Fixation: Porous Plasma Spray & OsteoCoat HA. Biomet brochure Form No. Y-BMT Pandit, H et al. Cemented and Cementless Fixation of Unicompartmental Knee Replacement: A Randomised Controlled Trial. 6. Goodfellow, J. et al. The Oxford Knee for Unicompartmental Osteoarthritis.The First 103 Cases. Journal of Bone and Joint Surgery. 70: Carr, A. et al. Medial Unicompartmental Arthroplasty: A Survival Study of the Oxford Meniscal Knee. Clinical Orthopedics and Related Research. 295: Murray, D. et al. The Oxford Medial Unicompartmental Arthroplasty. A Ten Year Survival Study. Journal of Bone and Joint Surgery. 80-B(6):983 89, Vorlat, P. et al. The Oxford Unicompartmental Knee Prosthesis: A 5-Year Follow-up. Knee Surgery Sports Traumatology Arthroscopy. 8: Svard, U. and Price, A. Oxford Medial Unicompartmental Knee Arthroplasty. A Survival Analysis of an Independent Series. Journal of Bone and Joint SurgeryBr. 83: Emerson, R. et al. Comparison of a Mobile with a Fixed-Bearing Unicompartmental Knee Implant. Clinical Orthopedics and Related Research. 404: Keys, G. et al. Analysis of First Forty Oxford Medial Unicompartmental Knee Replacements from a Small District Hospital in UK. Knee. 11: Rajasekhar, C. et al. Unicompartmental Knee Arthroplasty. 2- to 12-year Results in a Community Hospital. Journal of Bone and Joint Surgery Br. 86: Langdown, A. et al. Oxford Medial Unicompartmental Arthroplasty for Focal Spontaneous Osteonecrosis of the Knee. Acta Orthopaedica. 76: Price, A. et al. Oxford Medial Unicompartmental Knee Arthroplasty in PatientsYounger and Older Than 60 Years of Age. Journal of Bone and Joint Surgery Br. 87: Verdonk, R. et al. The Oxford Unicompartmental Knee Prosthesis: A 2-14 Year Follow-up. Knee Surgery Sports Traumatology Arthroscopy. 13: Price, A. et al. Long-term Clinical Results of the Medial Oxford Unicompartmental Knee Arthroplasty. Clinical Orthopedics and Related Research. 435: Vorlat, P. et al. The Oxford Unicompartmental Knee Prosthesis: An Independent 10-year Survival Analysis. Knee Surgery Sports Traumatology Arthroscopy. 14: Kort, N. et al. The Oxford Phase III Unicompartmental Knee Replacement in Patients Less than 60 Years of Age. Knee Surgery Sports Traumatology Arthroscopy Luscombe, K. et al. Minimally Invasive Oxford Medial Unicompartmental Knee Arthroplasty. A Note of Caution! International Orthopaedics Pandit, H. et al. The Oxford Medial Unicompartmental Knee Replacement Using a Minimally-invasive Approach. Journal of Bone and Joint Surgery. 88B:54 60, Price, A. and Svard, U. A Second Decade Lifetable Survival Analysis of the Oxford Unicompartmental Knee Arthroplasty. Clinical Orthopaedics and Related Research. Published Online 13 August Lombardi, A. et al. Is Recovery Faster for Mobile-bearing Unicompartmental than Total Knee Arthroplasty? Clinical Orthopedics and Related Research.467: Amin A, et al. Unicompartmental or Total Knee Replacement? A Direct Comparative Study of Survivorship and Clinical Outcome at Five Years. JBJS Br. 2006; 88-B; Suppl 1, 100. Published Online. gov/pubmed. 25. Deshmukh, RV, Scott, RD. Unicompartmental knee arthroplasty: long term results. Clinical Orthopedics and Related Research. 2001; 392: Cobb, JP, et al. Unicondylar knee arthroplasty in the UK National Health Service: An analysis of candidacy, outcome and cost efficacy. ScienceDirect. The Knee Brown, NM, et al. Total Knee Arthroplasty Has Higher Postoperative Morbidity Than Unicompartmental Knee Arthroplasty: A Multicenter Analysis. The Journal of Arthroplasty, Robertsson, O, et al. Use of unicompartmental instead of tricompartmental prostheses for unicompartmental arthrosis in the knee is a cost effective alternative. Acta Orthop Scand. (1999); 70(2): Lygre, SHL et al. Pain and Function in Patients After Primary Unicompartmental and Total Knee Arthroplasty. JBJS Am. 2010; 92: Ming, GL et al. Mobile vs. fixed bearing unicondylar knee arthroplasty: A randomized study on short term clinical outcomes and knee kinematics. The Knee: Study by researchers at Washington University in St. Louis, Missouri, US. Portions of study funded by Biomet. Determined based on adjusted odds ratio calculation. 32. Kendrick, B.J.L et al. Polyethylene wear in Oxford unicompartmental knee replacement. JBJS: 92(3): , Kendrick B.J.L et al. Polyethylene wear of mobile-bearing unicompartmental knee replacement at 20 years. JBJS(Br): 93(4), Price, A.J et al. 10 year in vivo wear measurement of a fully congruent mobile bearing unicompartmental knee arthroplasty. JBJS(Br) 87(11), Psychoyios, V et al. Wear of congruent meniscal bearings in unicompartmental knee arthroplasty. JBJS(Br). 80, Berend, K.R et al. Does Preoperative Patellofemoral Joint State Affect Medial Unicompartmental Arthroplasty Survival? Orthopedics, 34(9), Beard, D.J et al. The influence of the presence and severity of preexisting patellofemoral degenerative changes on the outcome of the Oxford medial unicompartmental knee replacement. JBJS(Br), 89(12), Data on file. Oxford PKR Marketshare Data on file. 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