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WHO WILL PAY THE COSTS OF NEW TECHNOLOGIES IN ARTHROPLASTY Renaat Vermeulen Eucomed and EHTI Board Member, Belgium Paying for “New Technology” in arthroplasty is just one element of a broader challenge that Health Care faces today. The real question is how innovation will be funded when less means are available. Innovation runs in cycles, driven by a need. Competition between both researchers and companies may lead to an invention. The earliest applied versions of the invention are typically expensive. When the technology and manufacturing methods mature, the prices come down substantially and the technology becomes part of basic offering. New or incremental innovation is the next step in the cycle, which is illustrated with the case of PSI (Patient Specific Instruments) Medical Innovation however is under threat in Europe because of a large funding gap in Health Care systems around Europe. The question is raised whether innovation should be stopped and it is commented as to why that is not a desirable solution. Four things need to happen in a sustainable funding model. - Industry should behave socially responsible; several examples of Industry’s recent contributions to funding are illustrated - Early adopters should be supported and with their co-operation better clinical and economical evidence of innovative devices should be collected - A dramatic reduction of the inefficiencies in the Health Care system needs to happen. A few examples are given to illustrate the potential of efficiency gains - Funding of innovation with Community money is crucial to avoid cost of opportunity and to maintain Industry competitiveness with other world regions Conclusion: there is no straight-forward answer to the title question. There is a shared responsibility of all stakeholders, but as a Society we have an overwhelming duty to continue to fund innovation. 38
HOW TO IMPROVE PATELLO-FEMORAL TRACKING WITH CURRENT TKA DESIGN TROCHLEAR CONSTRAINT ROLE Andrew Amis Imperial College, London, United Kingdom Key points 1. Near knee extension, patellar tracking and stability are controlled mainly by the soft tissues – the quadriceps and retinacula – and not by the trochlear geometry. Therefore, good tracking in early knee flexion depends primarily on soft tissue balancing. 2. The natural trochlear groove has a prominent lateral facet which controls patellar lateral translation when the patella enters the groove around 20 degrees knee flexion. 3. In general, there will be a higher constraint to control the patellar tracking when the trochlear groove is deeper and has a steeper slope on the articular facets. 4. Patellar tracking follows the natural trochlear groove, which is aligned with the mechanical axis of the femur. 5. Modern prostheses with grooves which are lateral near extension and medial near deep flexion are not anatomical and do not offer more physiological tracking or medial-lateral stability than did the older designs. 6. Patellar tracking is also influenced by the position of the prosthetic femoral component: external rotation causes the patella to be carried laterally and to be tilted laterally. 7. We may conclude that patellofemoral joint function after TKA depends on accurate implant alignment and soft tissue balancing. These surgical factors may be more important than the geometry of the implant! 39
Page 1 and 2: The Osteoarthritic Knee Best Curren
Page 3 and 4: Patellofemoral + medial OA in a 60
Page 5 and 6: SESSION 8 INFECTION Chairmen: S. Ho
Page 7 and 8: LOAD ABSORPTION - A SOLUTION TO DEL
Page 9 and 10: THE ROLE OF HIGH TIBIAL OSTEOTOMY P
Page 11 and 12: PATIENTS EXPECTATIONS AND OUTCOME A
Page 13 and 14: CASE 1 OSTEOARTHRITIS GRAD II MEDIA
Page 15 and 16: CASE 1 GRADE II OA NEUTRAL ALIGNMEN
Page 17 and 18: CASE 2 GRADE II MEDIAL OA IN ACTIVE
Page 19: CASE 3 OSTEOARTHRITIS GRAD III MEDI
Page 22 and 23: CASE 3 GRADE III MEDIAL OA IN ACTIV
Page 24 and 25: CASE 4 GRADE III LATERAL OA IN ACTI
Page 26 and 27: CASE 5 PATELLOFEMORAL + MEDIAL OSTE
Page 28 and 29: CASE 5 PATELLOFEMORAL + MEDIAL OA I
Page 30 and 31: PLANNING + APPROACH Roland Becker D
Page 32 and 33: BONE CUTS +ROTATIONAL POSITION Norb
Page 34 and 35: SOFT TISSUE BALANCING + PATELLAR TR
Page 36 and 37: BLOOD MANAGEMENT + PAIN CONTROL & R
Page 40 and 41: HOW TO IMPROVE PATELLO-FEMORAL TRAC
Page 42 and 43: placement (in flexion and posterior
Page 44 and 45: PLANNING WITH CONVENTIONAL X-RAY OR
Page 46 and 47: MULTIMODAL APPROACHES FOR A SHORTER
Page 48 and 49: STAYING OUT OF TROUBLE AT PRIMARY T
Page 50 and 51: GAP BALANCING TECHNIQUE AND STABILI
Page 52 and 53: “ADAPTED” MEASURED RESECTION TE
Page 54 and 55: PATELLAR RESURFACING TECHNICAL TIPS
Page 56 and 57: TKA IN POST-TRAUMATIC OSTEOARTHRITI
Page 58 and 59: TKA IN THE STIFF KNEE Michel Bonnin
Page 60 and 61: HOW DO I MANAGE SEVERELY DEFORMED K
Page 62 and 63: which will create easier extension
Page 64 and 65: PLANNING AND CORRECTION OF EXTRA-AR
Page 66 and 67: Fig. 2. Case number 10, a 74-year-o
Page 68 and 69: INFECTION DIAGNOSIS - A EUROPEAN PE
Page 70 and 71: MANAGEMENT EARLY WOUND HEALING COMP
Page 72 and 73: DEBRIDEMENT AND POLYETHYLENE LINER
Page 74 and 75: 4. Barrack RL, Engh G, Rorabeck C,
Page 76 and 77: FAILURE ANALYSIS AND PATIENT SELECT
Page 78 and 79: APPROACH / IMPLANT REMOVAL + 3 STEP
Page 80 and 81: References 1. Meneghini RM, Lewalle
Page 82 and 83: LEVEL OF CONSTRAINT + EXTENSOR MECH
Page 84 and 85: WHICH IS THE BEST STEM EXTENSION FO
Page 86 and 87: WHICH IS THE BEST STEM EXTENSION FO
Page 88 and 89:
FILLING THE DEFECT. METAPHYSEAL SOL
Page 90 and 91:
THE BEST SPACER FOR THE INFECTED TK
Page 92 and 93:
EXPOSURE FOR REVISION TKA: HOW DO Y
Page 94 and 95:
USE OF HINGES IN REVISION TOTAL KNE
Page 96 and 97:
References 1. Lachiewicz PF. Tantal
Page 98 and 99:
DIAPHYSEAL PREPARATION AND FIXATION
Page 100 and 101:
HOW TO TREAT A DAMAGED PATELLA DURI
Page 102 and 103:
REVISION TKA WITH ASSOCIATED EXTRA-
Page 104:
CASE - BILATERAL INFECTED TKA: EVAL
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