Download Knee replacement - DePuy Community Education Seminars

Welcome!
DePuy Orthopaedics Community
Education Seminar
Thank you for joining us! We hope today’s information
will help you on a path to reducing your pain and gaining mobility.
This informational presentation about knee pain
and treatment options will be followed by a
question-and-answer session.
Today’s presentation is sponsored by
DePuy Orthopaedics, Inc.
Agenda
1. How your knee works
& why it hurts
Thigh bone
(femur)
2. Knee replacement
basics
3. What patients have
to say
4. Your questions
2
Cartilage
Kneecap
(patella)
Shin bone
(tibia)
• Dr. [insert name]
• [insert practice name]
3
• Insert surgeon speaker’s bio
4
How your knee works
Anatomy of the knee
• Largest joint in body
• Referred to as a hinge joint because it allows the knee to flex &
extend; while hinges can only bend and straighten, the knee has
the ability to rotate (turn) & translate (glide)
• 3 bones
• Shin bone (tibia)
• Thigh bone (femur)
• Kneecap (patella)
5
What’s causing your pain?
It’s estimated 70 million people in the U.S. have some form
of arthritis.1 Osteoarthritis is one of the most common types.
• Osteoarthritis
• Wear and tear that deteriorates the “cushion” in your joints
• A degenerative condition—it won’t get better and may get worse
• Rheumatoid arthritis
• An autoimmune disease that attacks the lining of joints, causing
swelling, possibly throbbing pain and deformity
1. Landers, S. Another reason to exercise for those with arthritis. American Medical Association website.
<http://www.ama-assn.org/amednews/2005/05/02/hlsc0502.htm>, 2005.
6
What’s causing your pain?
Healthy knee
The end of each bone in the joint is
covered with cartilage, acting as a
cushion so the joint functions
without pain
Diseased knee (osteoarthritis)
Wear and tear deteriorates natural
cushion, leading to bone-on-bone
contact, soreness and swelling
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Assessing your pain
• Does your knee hurt one or more days per week?
• Does the pain interfere with your sleep?
• Is it painful for you to walk more than a block?
• Are pain medications no longer working?
• Is knee pain limiting your participation in activities
(e.g. family vacations or other functions)?
• Has inactivity from knee pain caused you to gain weight?
8
Assessing your pain
• Rate your pain on a scale of 1 to 5
• For most people, the tipping point is about 4 or 5—
that’s when the pain becomes too difficult and they
turn to a surgeon for relief1
Little or
no pain
1. 2007 DePuy Orthopaedics, Inc. Knee Attitudes & Usage Study.
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Excruciating,
debilitating pain
Assessing your pain
Check your mobility
If you have difficulty performing any of the movements below,
it may be time to talk to your doctor about next steps
Walk
10
Bend at the
hips and knees
Pretend to drive:
push the gas/brake
Pretend to golf:
swing a club
How can your pain be treated?
• Water therapy
• Soaking, ice packs,
hot packs
• Medications
• Exercise &
physical therapy
• Also good for weight
loss
• Injections
• Analgesics
• Corticosteroids
ORTHOVISC® is a trademark of Anika Research, Inc.
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• Corticosteroids,
hyaluronic acid
(e.g., ORTHOVISC®)
Knee replacement
• Implants replace damaged surfaces
• Helps relieve pain and restore mobility
• Approximately 580,000 knee
replacements are performed each year
in the U.S.1
• One study has shown that ten years after
surgery, 99.6% of patients still depend
on their SIGMA® Knees with fixed
bearing option in their daily lives2
1. American Association of Orthopaedic Surgeons. Total Knee Replacement – Your Orthopaedic Connection.
http://orthoinfo.aaos.org/topic.cfm?topic=a00389 Accessed April, 2011.
2. Dalury et al. Midterm results with the P.F.C. SIGMA Total Knee Arthroplasty System. The Journal of Arthroplasty
Vol.23, No.2, 2008: 175-181.
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What is knee replacement?
A surgical procedure that
removes and replaces
diseased joint surfaces
with implants
Femoral
component
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Tibial
component
How does it work?
• Diseased areas at top of shin bone
(tibia) and bottom of thigh bone (femur)
are removed and reshaped
• Femoral component covers the
thigh bone (femur)
• Tibial component covers the
shin bone (tibia)
• Polyethylene insert placed between
femoral and tibial components
• Patellar component replaces the
kneecap (patella)
14
Femoral
component
Polyethylene
insert
Patellar
component
Tibial
component
How does it work?
Healthy knee
15
Knee replacement
®
DePuy SIGMA Knees
• SIGMA Knees come in a wide range of shapes,
sizes and materials
• Your surgeon may be able to fit you with a SIGMA
Knee designed to provide a natural feel and
movement
• The SIGMA Knee is an example of a proven design
that continues to evolve to meet the demands of
today’s patients
16
®
SIGMA Fixed Bearing Knees
• Most widely used type of knee
replacement in the U.S. today1
• Designed to enhance stability
of the joint
• New designs and advanced
materials
- Helps reduce wear
1. IMS Health
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®
SIGMA Fixed Bearing Knees
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®
SIGMA Rotating Platform Knees
Designed to rotate as it bends, imitating your
natural knee movement
• The surfaces of the knee joint roll
and glide against each other as
you bend. In other words, your knee
naturally rotates as it bends
• Designed for patients who want to
remain active since it minimizes
implant wear, compared to traditional
knee replacements1
• One study has shown after 20 years, 97% of
patients still depend on their rotating platform knees
in their daily lives2
1. McNulty, D. et al. “In Vitro Wear Rates of Fixed-bearing and Rotating Platform Knees (Rev. 2).” 2003.
2. Buechel F., et al. “Twenty Year Evaluation of Meniscal Bearing and Rotating Platform Knee Replacements.”
Clinical Orthopaedics and Related Research July 2001: 41-50.
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Should you wait to replace your knee?
Assess your pain and ability to function
• Do you feel severe pain in your knee?
• Has the pain and loss of function affected your quality of life?
• Do you have difficulty sleeping or performing basic functions
(walking, driving, climbing stairs)?
• Does medication no longer provide relief?
Consult your physician
Early diagnosis and treatment are important1
• Delaying may lower your quality of life2
Osteoarthritis is degenerative—it won’t get
better and may get worse
1. Fortin PR, et al. Outcomes of Total Hip and Knee Replacement. Arthritis & Rheumatism. 1999;42:1722-1728.
2. Fortin PR, et al. Timing of Total Joint Replacement Affects Clinical Outcomes Among Patients With Osteoarthritis
of the Hip or Knee. Arthritis & Rheumatism. 2002;46:3327-3330.
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Important safety information
• As with any medical treatment, individual results may vary
• The performance of joint replacements depends on your age,
weight, activity level and other factors
• There are potential risks, and recovery takes time
• People with conditions limiting rehabilitation should not have
this surgery
• Only an orthopaedic surgeon can tell if knee replacement is
right for you
21
Summary
• The leading cause of knee pain is osteoarthritis
• Osteoarthritis is degenerative – it won’t get better and may get worse
• Early diagnosis and treatment for total knee replacement are important1
• An Arthritis Foundation® study shows knee replacement has a
90-95% rate of patient satisfaction2
• SIGMA Knees come in a wide range of shapes, sizes and materials,
so your surgeon can recommend the implant that is right for you.
Arthritis Foundation® is a trademark of The Arthritis Foundation, Inc.
1. Fortin, Paul R., et al. Outcomes of Total Hip and Knee Replacement. Arthritis & Rheumatism 42 (1999): 1722-1728
2. The Arthritis Foundation. <http://arthitis.org/research/Bulletin/vol5no11/Printable.htm>, 2006.
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Before we take questions . . .
• Please fill out:
• Seminar Questionnaire
• Return at end of
seminar
• “For More Information”
Form
• Request additional
information be sent to
your home
23
Questions?
• Insert surgeon speaker’s contact info
24
Thank you!
To find out more about knee pain and
the treatment options available, visit:
www.kneereplacement.com
www.aaos.org
© DePuy Orthopaedics, Inc., 2011.
The third party trademarks used herein are trademarks
of their respective owners.
11/2011
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Additional slides
The following 2 slides are the SIGMA®
Rotating Platform Flexion Knees and SIGMA®
High Performance Partial Knees module.
If desired, please select the appropriate
slides to include within this presentation.
REMOVE THIS SLIDE
26
SIGMA® Rotating Platform Flexion Knees
Rotating Platform Flexion Knee
High Flex implant that enables deep
knee flexion
• May help with everyday activities
like sitting cross-legged, kneeling
and squatting
• Shown to reduce implant wear by
94% over traditional knee
implants1,2
1. McNulty, D. et al. “The effect of crosslinking UHMWPE on in vitro
wear rates of fixed and mobile bearing knees. ASTM STO 1445.”
2. Gsell, R. et al. American Society for Testing and Materials, West
Conshohocken, PA. <http://www.astm.org>, 2004.
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SIGMA® High Performance Partial Knees
High Performance Partial Knees
Can replace any of the three areas of your knee; replacing only
the damaged area maintains more of your natural knee
• May be an option for more active patients who require a
high degree of flexion but not total knee replacement
• Accommodates deep knee flexion, the movement needed
for kneeling, squatting or sitting cross-legged
• Less invasive with potential for faster recovery than total
knee replacement
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Additional slides
The following 3 slides are the TRUMATCH®
Personalized Solutions module.
If desired, please select the appropriate
slides to include within this presentation.
REMOVE THIS SLIDE
29
TRUMATCH® Personalized Solutions
What is TRUMATCH?
• Uses advancements in
technology to provide
surgeons with customized
instruments designed
specifically for your knee
anatomy
30
Benefits of TRUMATCH
• Helps your surgeon achieve
consistency in the placement and
positioning of your knee
replacement
• TRUMATCH instruments help your
surgeon to obtain a precise fit of the
implant. The implant helps reduce a
patient’s pain and restore their
mobility
• Reduces number of surgical steps
and operating time
31
TRUMATCH® Personalized Solutions
How does it work?
• A CT scan of your leg is taken
• A 3-D model of your knee is developed
• Personalized guides are created based
on your unique anatomy
• Your guides help your surgeon position
and place your new knee implant
• Guides are removed by your
surgeon prior to your new knee
being implanted
32
Additional slides
The following 3 slides are the SIGMA®
Partial Knee Alternative module.
If desired, please select the appropriate
slides to include within this presentation.
REMOVE THIS SLIDE
33
The Partial Knee Alternative
“Partial”
“Total”
34
Partial Knee Replacement
Removes only the
damaged area of the knee
Uses technologicallyadvanced metal and
plastic implants to replace
the damaged area, helping
to relieve pain and restore
natural movement.
35
Potential advantages of a Partial Knee
• Maintains more of the healthy
ligaments and bone, helping
to restore the natural
movement during activities
• Potential for faster recovery
• Minimally invasive procedure
to reduce blood loss
• Possible reduced scarring
36
Unicondylar
Patellofemoral
Additional slides
The following 3 slides are the
gender-specific module.
If desired, please select the appropriate
slides to include within this presentation.
REMOVE THIS SLIDE
37
Important considerations for women
• Osteoarthritis affects three times more women than
men1
• Women are more likely than men to be disabled
• The pain is more severe for women2
• Women’s knees rotate more than men’s, especially
during deep bending (kneeling)3
• Current knee replacements are designed to fit the
anatomies of both women and men
1. Hawker, Gillian A., et al. "Differences Between Men and Women in the Rate of Use of Hip and Knee Arthroplasty.“
The New England Journal of Medicine 342 (2000): 1016-1022
2. Harris Interactive research survey, April 2005
3. Hsu, Wei-Hsiu, et al. “Difference in Torsional Joint Stiffness of the Knee Between Genders.” The American Journal of Sports
Medicine Vol. 34, No. 5 (2006): 765-770.
38
Gender-specific implants
• All orthopaedic manufacturers have
knee implant systems with sizes
appropriate for both female and male
patients
• Surgeons know which knee will fit
each patient best, based on gender,
age, size, activity levels and
aspirations
• There is no clinical support of the need
for gender-specific implants
• It is too early for any clinical data; won’t
know results of gender-specific implant
clinical studies for 10-15 years
39
Gender-specific implants
• More than 60% of knee replacements have been
implanted in women1
• Current knee replacement patients have a 90 to 95%
satisfaction rate with the results of their surgery2
1. American Academy of Orthopaedic Surgeons
<http://www.aaos.org/wordhtml/research/stats/Hipkneefacts.htm>, 2006.
2. The Arthritis Foundation
<http://www.arthritis.org/research/Bulletin/vol51no11/Printable.htm>, 2006.
40
Additional slides
The following 4 slides are the minimally
invasive knee surgery module.
If desired, please select the appropriate
slides to include within this presentation.
REMOVE THIS SLIDE
41
Minimally invasive knee replacement surgery
• Minimally invasive surgery
(MIS) is still very new
• SIGMA® Knees can be
implanted using minimally
invasive surgery
• Alignment affects:
• How long your knee
replacement lasts
• Long-term success
42
Benefits of MIS
• Some early studies of MIS have shown some
potential benefits of the surgery (when
compared to traditional, “open” surgery), such
as:
• Less blood loss
• Potential for shorter
hospital stays
• Potential for faster
recovery
43
Complications of MIS
• Other studies, however, have shown several
complications with the surgery, (when
compared to traditional, “open” surgery),
including:
• Increased number of surgical complications
• Poor implant positioning
• No difference in the length of recovery
44
What really matters when it comes to MIS
• MIS is still relatively new
• It won’t be known for 10 to 15 years if the new
techniques affect the long-term function and durability
of the implant
• You should discuss with your surgeon whether MIS is
an appropriate surgical course of treatment for you
45
Additional slides
The following 2 slides are the
computer-assisted surgery module.
If desired, please select the appropriate
slides to include within this presentation.
REMOVE THIS SLIDE
46
Computer-assisted surgery
• What is computer-assisted
surgery (CAS)?
• A new approach to knee
replacement
• The patient’s anatomy is
simulated and displayed
on a computer
• Computer provides information
about where to place the
components
47
Potential benefits of CAS
• CAS guides surgeon in areas
that are difficult to visualize
• Relays specific measurements
not previously available to
surgeons, such as implant
alignment and angle of cuts
• Gives precise, accurate data
on your specific anatomy
• Allows surgeons to make decisions
about implant placement based on
detailed data from the computer
48