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The Forever Active Forum held in Melbourne Australia 15 – 17 June, 2018 was an exceptional gathering of international experts in total knee replacement surgery. The forum focussed on a remarkable improvement in patient outcomes being observed with the introduction of the world’s only fully dedicated medially stabilised total knee replacement system.
Headline topics included:
- Recognition for the MatOrtho® program of safe introduction for new technology;
- The positive experiences of individual surgeons who have changed their practice and now use the SAIPH® knee;
- The sharing of tips and tricks for surgeons considering changing to the different philosophy of the medially stabilised TKR;
- Results of the SAIPH® Knee Multicentre study ongoing in Australia.
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Jon Baré, convenor and chair of the forum, opened with a statement of recognition to MatOrtho® for their commitment to a safe introduction program for the SAIPH® knee. The Forever Active Forum had been agreed as the mechanism to announce results of the multicentre study that started in Australia, led by Jon Baré, in 2015.
The highly focussed 2-day program included a range of topics in total knee replacement, from history to current concepts and controversies, through to some blue-sky and practical thoughts on the future of TKR.
The highly regarded faculty included an array of national key opinion leaders from Sydney, Melbourne and further afield. International names included Thomas Schmalzried from the US, Kelly Vince from New Zealand and Fares Haddad and Adrian Fairbank from UK. From an engineering perspective Mike Tuke was available to share his views and experience on the podium and was thrilled to be there!
Safe introduction of a new technology
Andrew Shimmin presented on the early stage of introduction with the results of the fluoroscopic study of his first 14 SAIPH® procedures which confirmed the design characteristics of the SAIPH® knee achieve normal knee medial AP stability, lateral freedom to move, and without compromise to a full range of motion. He also described the initial ‘designer series’ outcomes study of 100 patients which reported 2-year and more recently 5-year outcomes, which showed better PROMs outcomes and higher levels of satisfaction than previously published results of existing knee systems.
Results of a multicentre study
Jon Baré presented on the next stage of the safe introduction program, limited release to non-designer surgeons and a 2-year tightly controlled study, including surgeons’ learning curves. From 504 patients enrolled by 13 surgeons, data was available for 287 patients from 8 surgeons at 1-year follow-up and a limited number at 2 years. Results show an acceptable rate of revisions and complications and a high level of patient satisfaction. The results compare favourably with the designer series.
What do the registries say about medial ball and socket concept?
One of the next stages of the safe introduction program is continued monitoring of registry data and David Wood provided a review of the Australian registry data. He observed a trend in declining use of posterior stabilised and minimally stabilised (cruciate retaining) knees but a rise in use of medially stabilised knees since 2012, when the SAIPH® was made available for use in Australia. By the end of 2016 medially stabilised knees accounted for 7% of the Australian TKRs.
Of the medially stabilised knees, Dr Wood noted that the SAIPH® has the lowest cumulative rate of revision, although only at 3 years – and suggested delegates ‘watch this space’! It was also noted that the MRK™ had incorrectly been placed in the cruciate retaining group by the registry and that it had the lowest cumulative revision rate of all!
Is changing device or even philosophy a risk?
Lyndon Bradley presented a wide range of factors and measurables reported in the past on whether changing device or tools can compromise a good track record. He concluded that a learning curve is likely over 15-30 cases and a slight (<5min) increase in surgical time can be expected while becoming accustomed to a new device, however there is no evidence that changing implants effects outcomes or harms patients.
Indeed, for the SAIPH® knee better outcomes were consistently reported throughout the forum. Andrew Shimmin’s fluoroscopic study was performed on his first consecutive 14 patients, including his learning curve and outcomes were excellent. Roger Brighton described his study of consecutive randomised knees comparing SAIPH® to his prior standard TKR and found a surprising outcome: every single PROMs score delivered an improvement for the SAIPH® knee. The statistical significance of improvement in the forgotten joint score, where for almost every activity the SAIPH® Knee was more likely to be forgotten, created the greatest interest of all.
A very open and honest tips and tricks session however highlighted that the faculty had perceived occasional occurrences of a stiff knee, even with satisfied patients. Following a comprehensive discussion, the consensus was that these early experiences were resolved with the short learning curve and that all could benefit from such a study and resulting discussions. A particular takeaway message for the surgeons who had changed from a cruciate retaining knee philosophy was appreciating the benefit of leaving a ‘normal knee’ degree of flexion laxity for the SAIPH® ball and socket knee design.
Do patients with stable knees report better outcomes?
Normal knees are fully stable in extension and allow slight separation under tension in flexion, yet they are always stable. Roger Brighton demonstrated the importance of achieving stability following TKR with results of a stability study using the KT-1000 force-displacement measuring device. This study found a very strong correlation between stable knees and better PROMs, especially pain, sports and daily living. Stable knees were also more likely to be associated with high level of patient satisfaction.
Which type of knee replacement provides more stable knees?
A topic of interest of course is whether the SAIPH® knee provides a normal stable joint, particularly given the recommendation for more flexion laxity than many surgeons are accustomed to. Bill Walter also presented outcomes from a sagittal stability study including patients from three independent surgeons and 4 different knee designs (medially stabilised, cruciate retaining, posterior stabilised and deep-dish). The study concluded that patients with a SAIPH® knee were more likely to have a stable knee.
What is coming next?
A wealth of high quality information was presented at the meeting, which we will convey through a series of articles over the coming weeks. Overall the faculty acknowledging the safe introduction program implemented by MatOrtho® concluded that the SAIPH® knee is ready to proceed to the final stage of stepwise introduction: general release with ongoing joint registry follow-up.
A huge amount of useful and insightful information was delivered at this meeting and we aim to circulate this via our news feed in due course. You can also find us on LinkedIn.