Zimmer AAOS Daily Highlights - February 14, 2007
Rebuilding the Revision Knee
Feb 14, 2007 04:34 PM
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Wolfgang Klauser, M.D. and
Kelly Vince, M.D. presented facts and tips on revision knee surgery to a
large crowd of surgeons at the Zimmer Theater. According to Dr. Klauser,
the knee revision rate will increase 8.5% in Europe and as much as 12%
in the United States over the next few years. Dr. Klauser examined
patient expectations and mechanisms of failure, and determined that the
most common reason for failure in TKA is component instability with
ligament instability. He then suggested that the ideal revision implant
system should include a variety of constraint options, use traditional
alignment techniques, and provide augmentation and stability options
such as offset stems.. |
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The most important point that surgeons must remember, according to Dr. Klauser, is to correct the factors that caused the initial failure. Dr. Vince reiterated those concerns, stressing the importance of properly diagnosing the cause of failure. He also urged surgeons to be comprehensive in their approach to a revision knee, never leaving out the important steps. According to Dr. Vince, there are three important steps in any revision knee procedure: 1) establish the tibial platform, 2) stabilize the joint in flexion, and 3) stabilize the knee in extension. Dr. Vince concluded with a discussion of Trabecular Metal Technology and its importance in revision knee surgery
THA Articulations Are Not All Created Equal
Feb 14, 2007 04:03
PM
Particle disease has been a major limitation in the life of a total hip
prosthesis, according to Claude Rieker, Ph. D. In conjunction with
Harry Rubash, M.D. and Clive Duncan, M.D., Dr. Rieker presented an
overview of the current state of articulations in total hip arthroplasty at
the Zimmer Theater.
Dr. Rieker explained the relationship among
acetabular component wear, osteolysis, and component loosening, while Dr.
Rubash explained the etiology of particulate debris and how bone resorption
occurs. He then examined methods to decrease lysis.
Current
technologies were reviewed, including crosslinked polyethylenes. Dr. Rieker
explained various methods of crosslinking and how the resulting materials
are different in terms of free radical concentrations and resistance to
oxidation.
Dr. Rieker also discussed metal-on-metal articulations and
the advantages of forged high-carbon cobalt-chromium alloys in
metal-on-metal applications. Dr. Duncan provided an overview of the clinical
applications of various metal technologies, covering large-diameter heads
and metal-on-metal. He explained that wear reduction in metal-on-metal
articulations is determined by surface finish, lubrication method, and the
self-polishing nature of the materials. Dr. Duncan addressed the issues of
serum ions, hypersensitivity, and long-term complications.
Dr. Winquist on Zimmer Periarticular Plating System
Feb 14,
2007 03:17 PM
| Dr. Robert Winquist here speaks on the Zimmer Periarticular Locking Plate System today in the Zimmer Institute at the Zimmer AAOS exhibit booth. Dr. Winquist presented a number of clinical cast studies to illustrate indications for using locking plate technology. He then addressed a number of surgical issues, such as proper plate placement and his preference for the use of fixed angle screw placement as opposed to variable angle. The presentation included a sawbones demonstration. |
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Periprosthetic Fractures: The Next Epidemic?
Feb 14, 2007 02:59 PM
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Paul Duwelius, M.D. and Bharat Desai, M.D. discussed the current state of
periprosthetic fractures Wednesday at the Zimmer Theater. Dr. Duwelius
said that such fractures are becoming more common and more complex in
terms of both mechanical and biological problems. |
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He determined that periprosthetic fractures occur in 1% to 5% of primary arthroplasty patients, and up to 20% of revision arthroplasty patients. In determining the appropriate treatment, according to Dr. Duwelius, the key is to answer the question: "Is the implant interface stable or unstable?" A recent treatment for a fracture with a stable interface is precontoured periarticular plating, as this may provide a means to help avoid creating stress raisers.
Dr. Desai elaborated on methods to provide adequate stability around the
implant. He said that one important concern is the need to address the
underlying osteopenia. He then discussed treatment using the NCB Plate,
which is a noncontact, bridging plate. Dr. Desai highlighted cases using the
plate.
THA/MIS Panel Discussion
Feb 14, 2007 02:38 PM
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In a panel discussion today at the Zimmer Theatre,
Dr. Lawrence Dorr moderated a panel of noted surgeons, including
Dr. Richard Berger,
Dr. Russell Cohen,
Dr. Mark Hartzband and
Dr. Steven Myers on the benefits of using MIS procedures for THA.The group
concurred that MIS isn't just about the incision size, it's about
minimizing the trauma of surgery, improving pain management and
expediting rehab. Dr. Berger acknowledged that all three criteria can be
done individually and individually will lead to better outcomes. Yet
combined, the outcomes could be even better. |
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Patients are driving the increase in MIS THAs. The Internet has made
patients more educated. They want smaller incisions and they want to return
to normal activities faster. MIS patients are provided with thorough pre-op
education and they can anticipate their recovery milestones. This
preparation - and knowledge that they were an active participant in the
decision-making process - could be the single biggest factor towards a
successful recovery.
The panel addressed the safety of MIS, for which
there is no long term results, yet, the short term results are compelling
and predictable. Dr. Hartzband commented that when looking at traditional
vs. MIS THA, it's the same operation with less cutting, so it's intuitive
that you'll get a better result with the MIS procedure. The group also
concurred that there isn't a single best procedure. The best for you is the
one you're good at or the one you are most comfortable with. And most
importantly, there are some people who are not candidates for MIS. Remember,
it's OK to make a larger incision if it's the best thing for the patient.
The Knee Everyone's Talking About
Feb 14, 2007 01:32 PM
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The gender knee concept continued to draw strong interest at the Zimmer
Theater as a standing-room-only crowd heard Robert Booth M.D., Richard
Komistek, Ph. D., and Aaron Hofman, M.D. discuss the latest knowledge
about the differences between male and female knees. Dr. Booth began the
presentation by explaining that he believes female patients have been
underserved in TKA. He credited Dr. John Insall as the first to
recognize gender differences many years ago; however, at the time, there
were more important issues to address. |
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Dr. Booth and Dr. Hofman pointed out that the key differences include the
height of the anterior condyles, the Q angle, and the A/P-to-M/L aspect
ratio. Traditional attempts to accommodate these differences have led to
outcomes that may not be optimized. While female patients matched the
kinematics of male patients after TKA, they did not match before TKA, so
natural female kinematics are not always restored. Dr. Booth predicted a
"new era of mass customization," suggesting that gender knee implants are
only the beginning. Dr. Hofman said that gender design features, similar to
those introduced last year inNexGen® Complete Knee Solution Implants,
will soon be introduced into the Zimmer Natural-Knee® II System*.
Dr. Komistek presented data on the differences and also demonstrated these
differences visually, using video to show the gait of male and female
patients as they walked or jogged on a treadmill. He pointed out how joint
stresses differ between genders because of these differences in gait. Dr.
Komistek also showed animations to demonstrate kinematic differences such as
rollback and axial rotation.
Another presentation on Gender Solutions™
Implants is scheduled for 1:00 p.m., Thursday in the Zimmer Theater.
*510(k) pending - device not available for commercial distribution in the
U.S.
Dr. Rosenberg on MIS Total Knee Procedures in Zimmer Institute
Feb 14, 2007 01:16 PM
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Dr. Aaron Rosenberg this morning gave a special presentation on Minimally Invasive Solutions™ Total Knee arthroplasty. The presentation was part of the Zimmer education program at the Zimmer Institute in the Zimmer AAOS exhibit. Dr. Rosenberg covered key surgical highlights, from the importance of knowing instrumentation to how to identify key land marks for incisions through options for subvastus or midvastus surgical approaches. |
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Knee Surgeon Book Signing
Feb 14, 2007 01:06 PM
| "Insights," a 32-page booklet of case studies and other surgical insights on total knee arthroplasty from leading orthopaedic surgeons, is being distributed exclusively at the Zimmer AAOS exhibit this year. The publication includes three main case studies from Dr. Robert Booth, Dr. Kim Bertin and Dr. Giles Scuderi. All case studies are on the Zimmer® Gender Solutions™ Knee. Other surgeons also contributed comments and tips on various surgical issues, such as incision placement, fat distribution, and correcting valgus deformities. Three book signings, such as this one today, will be offered through Friday in the Zimmer AAOS exhibit next to the Zimmer Gender Solutions knee product area. |
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Blue Ladies
Feb 14, 2007 12:30 PM
| Zimmer has launched a concerted direct-to-consumer campaign - the first of its kind in company history - to support the launch of the Zimmer® Gender Solutions™ Knee. The central characters in the campaign are the "Blue Ladies," created in association with renowned illustrator R.O. Blechman. He is best known for his cover art on The New Yorker magazine. At this year's AAOS meeting, the Blue Ladies have truly come to life in the Zimmer exhibit to help promote the innovative Zimmer Gender Solutions Technology. The Blue Ladies direct-to-consumer campaign will substantially expand this year. As part of the campaign, a dedicated web site, www.GenderKnee.com, is now available to disseminate patient information about the Zimmer Gender Solutions Knee. |
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Reimbursement: The Dollars and Sense of Running a Practice
Feb
14, 2007 11:45 AM
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How can your efforts help to make sure you are getting paid what you
deserve?" asked Dr. Carlos Lavernia in his presentation this morning at
the Zimmer Theatre Get involved, pay attention and don't get distracted.
Write letters to professional organizations to encourage them to develop
better tools to evaluate our work. Push for balanced billing, there are
some wealthy Medicare patients who can pay more. And, support RUC-based
survey methodology. It works. Take time to read the survey, complete it
accurately, and turn it in. Don't underestimate your time in the OR and
take into consideration the time you spend with patients in rounds. You
can make a difference. |
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Louise Borda, Senior Manager of Coding Services for Massachusetts General
Hospital states that in the reimbursement battle, documentation is your best
defense. What are her tips?
- For multiple procedures, dictate new paragraphs for each procedure.
- Document anatomically where you are (how many levels of procedure).
- Document separate incisions.
- Document if you had to reposition the patient.
- For modifiers, dictate separate letters and state why the procedure is more complex, for example, morbid obesity, altered surgical field, etc.
- Track and know the productivity per FTE
- What are collections as a percentage of charges
- Claim denial rate - do you know your top 5 reasons for denial?
- Cost as a percentage of revenue.
Zimmer Theatre Opens with Shoulder Presentation
Feb 14, 2007
10:55 AM
| Evan Flatow, M.D. and Louis Bigliani, M.D. opened the Zimmer Theater today with a presentation about the use of Trabecular Metal™ Technology in total shoulder arthroplasty. More than 150 were in attendance, including about 75 surgeons, as Dr. Flatow began with a description of Trabecular Metal Material and its properties. He then discussed the significance of bone and soft tissue ingrowth to proper healing after shoulder arthroplasty. |
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Dr. Flatow cited anatomical and biomechanical studies that were used to design theBigliani/Flatow® Complete Shoulder Solution and its sizing scheme. He stressed the need for two inclination angles, 42° and 48°. He also discussed how the porous material may facilitate tuberosity healing, and showed video of a patient with excellent range of motion at 15 months postop.
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Dr. Bigliani followed with a discussion of the Inverse/Reverse Total
Shoulder and briefly reviewed the deltopectoral approach. He discussed
rotator cuff deficiency and how the system addresses the issue.
Referring to a case involving an 82-year-old woman who had approximately
30° elevation preoperatively, he showed the patient with 120° of
elevation at one year postop. |
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Exhibit Opening
Feb 14, 2007 09:01 AM
| The Zimmer corporate booth was a popular destination for surgeons as the exhibit schedule opened today at the 74th annual meeting of the American Academy of Orthopaedic Surgeons in San Diego. The Zimmer booth contains some 18 product pods to present Zimmer products across the complete orthopaedic portfolio as well as a specific area devoted to Zimmer Health Economics. |
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There are special Zimmer Institute laboratory areas, one for general products and one specifically for Computer Assisted Solutions, in which surgeons can receive a hands-on educational experience. The Zimmer exhibit this year also features a new theater-in-the-round with seating for about 100 people to view an extensive schedule of surgeon education presentations throughout the three exhibit days. The exhibit this year includes a wall that depicts Zimmer's long history and tradition of excellence in orthopaedics. Receptionists at both main entrances to the booth can help direct surgeons to the location in which they are most interested. Receptionists can also arrange translator services for many languages to assist surgeons as needed.
