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Surgeons to perform more navigated TKA, arthroscopic uni-knee surgeries by 2015
Surgeons likely will need high-tech assistance in order to satisfy the wants of patients, insurers.
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FLORENCE — Orthopaedic surgeons meeting here to discuss the future of total knee arthroplasty predicted that they will be performing many more knee replacements by 2015.
They also said that 8 years from now, surgeons will rely far more on some form of high-tech assistance like navigation or computer-assisted surgery (CAS) to enhance their accuracy.
The participants also predicted that such technology will prove invaluable for total knee arthroplasty (TKA) cases performed using a minimally invasive surgery (MIS) approach.
Orthopaedists from Italy, France, Belgium and Germany shared insights into the TKA of tomorrow in a symposium at the 2007 International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine Congress.
Jan Victor, MD, of Brugge, Belgium, presented statistics projecting increased numbers of TKAs being performed through 2020.
“It is expected that far more patients will seek help for knee arthritis,” he wrote in his abstract. Factors contributing to that were longer life expectancies and demands for greater function postoperatively. Epidemic proportions of obesity will also mean greater numbers of TKA patients.
“Results can be improved by better health care organization, the training of the ‘comprehensive knee surgeon,’ and technological advances,” Victor wrote.
Navigation benefits
Already patients are benefitting from some of these advances. For example, a few surgical navigation systems now help with better component alignment, according to Rolf K. Miehlke, MD, of Sedenhorst, Germany.
“The big step forward for us in 2002 was inclusion of gap and soft tissue balancing,” a very desirable feature, Miehlke said. “This is half the procedure.”
Miehlke notes that he and colleagues conducted a study of 821 knees undergoing TKA that were randomized to surgery with or without navigation. Of five parameters that corresponded to successful outcomes, navigation was positively associated with four of them.
For example, 92% of patients whose mobile-bearing prostheses were implanted using navigation attained successful outcomes vs. 73% who had success without it, a difference that was statistically significant, Miehlke added.
Looking ahead 10 years, navigation will play an increased role in revision TKA, he said. “I would foresee we’ll have more [of it].”
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Images: Zaffagnini S |
Technology factor
Paolo Aglietti, MD, member of the Orthopaedics Today International Editorial Board, discussed the advantages that optical vs. electromagnetic navigation systems will bring to TKA procedures. The best systems must be intuitive, consistent and exact, he said.
Moderator Philippe Neyret, MD, Lyon, France, explained how increased accuracy of bone cuts and ligament balancing will be critical going forward. Better instrumentation, fluoroscopy and CAS will help surgeons achieve those goals, he noted.
Meanwhile, Stefano Zaffagnini, MD, of Bologna, Italy, believes that although tools like navigation will contribute to successful postoperative outcomes in more selective cases, CAS and MIS will not dominate the field.
“Patients will ask for MIS and more precise and reliable procedures like navigated procedures,” he told Orthopaedics Today International. “Navigation allows you to be more reliable and to avoid major errors. The insurance companies will probably also ask for this.”
Ultimately, navigation helps surgeons document — and reproduce — what they do, Zaffagnini said.
Arthroscopic TKA
In his presentation, Zaffagnini discussed the steps he and his colleagues at the Institute Ortopedici Rizzoli are making to refine arthroscopic unicompartmental TKA.
“We’re very close to standardizing the procedure,” Zaffagnini said of his project, which uses slightly smaller components.
He uses standard arthroscopic portals and then slightly enlarges the incision for the medial portal when he fixes the components. The incision size using his MIS approach is larger than that of an arthroscopy but smaller than that of a mini-arthrotomy, he said.
Third-generation hydroxyapatite placed in special plugs on the bone side of both components helps stabilize the implants and fix them to host bone. “It will become a biological prosthesis” more akin to a resurfacing procedure, he said.
He said Arthrex Inc., of Naples, U.S.A., has reached a similar point in developing its own arthroscopic uni-TKA and instruments.
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Images: Victor J |
For more information:References:
- Paolo Aglietti, MD, can be reached at I Clinical Orthopaedics CTO. Largo Palagi, 1, Florence, Italy 50139; +39-55-416901; e-mail: ortosec@unifi.it. He is a consultant to Zimmer.
- Rolf K. Miehlke, MD, can be reached at the Dept. of Arthritis Surgery, Northwestern German Centre of Rheumatology, St. Josef Stift, Sedenhorst, Germany D-48324; +49-2526-300-1571: e-mail: rkmiehlke@st-josef.stift.de. He receives royalties from B. Braun/Aesculap.
- Philippe Neyret, MD, can be reached at Hopital de la Croix Rousse, 8 Rue de Margnolles, Lyon, France 69300; +33-472-071989; e-mail: Philippe.neyret@chu-lyon.fr. He receives royalties from and is a consultant to Tornier.
- Jan Victor, MD, can be reached at Beukenlaan 23, Brugge, Belgium 8310; +32-503-74423; e-mail: j.victor@skynet.be. He has no financial conflicts to disclose.
- Stefano Zaffagnini, MD, can be reached at Institute Ortopedici Rizzoli, Biomechanics Lab, via di Barbiano, Bologna, Italy, 40136; +39-51-6366506; e-mail: s.zaffagnini@biomec.ior.it. He has no financial conflicts to disclose.
- Aglietti P, Miehlke EK, Neyret P, et al. Symposium: The future in TKA: 2007 vs. 2015: Will it all be MIS and CAS Presented at the 2007 International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine Congress. May 27-31, 2007. Florence.