Dr. Geller provides a detailed review of the implant design and conveys why the design of the instruments and implants make it ideal for partial knee procedures.
Uh And thank you for having me on today's webinar. Um Thrilled to talk about some of these different products. Uh and a passion of mine is partial knee replacements. And we're gonna talk a little bit about the journey unicompartmental knee system today. Uh talking about the uh the new joke two system. All right. So we're gonna go to my talk, right? So, as you can see, I'm Jeff Geller from Columbia Presbyterian, New York Presbyterian at the epicenter these days in New York City. Why? Partial knee replacement? Why? Because every patient deserves a knee that feels quite normal. Uh As we know, partial knee replacements are a smaller procedure that really targets the diseased portion of the knee. Uh whether that's the medial compartment in the system or the lateral compartment and really enables patients to keep the healthy aspects of their knee uh including your AC L, your PC L uh and really enables patients to stay that much more active and maintain a little bit more normal proprioception about the knee. We know that partial knee replacements compared to total knee replacements, generally have a higher patient satisfaction rate. Um And the journey to uni is built on the heritage of some of the most clinically successful partial knees out there these days. Why? Partials, as I mentioned, uh generally a much faster recovery. It's a less invasive procedure. So there's there's less morbidity rates, lower risk of blood transfusion, lower pain medication intakes, um and a faster return to life, improved function by maintaining the AC L and the PC L. Uh we have a better chance of maintaining the more normal knee kinematics. Uh As a result, we've seen higher patient satisfaction rates with better forgotten uh joint scores, knee society scores. Uh and certainly a a decreased economic burden on the health care system. Most of these patients can be done as the same day type procedure sent home same day from an ambulatory surgery center. Uh and um really uh less of an economic burden and that they return to life faster, they return to work faster. Why the journey to uni uh because of the unmatched clinical performance. So the journey to UNI was, was really built upon some of the most successful partial knee replacement systems out there. The journey uni itself as well as the Genesis uh uh and the Zook have been um incredibly popular and successful over the years. In addition, we've paired that with a cutting edge platform. So all of the um instruments have been redesigned, they've been streamlined for very efficient surgery with an extraordinarily reproducible technique. This is by far the most important aspect of a partial knee replacement system. Uh We know that partial knee replacements can be daunting to, to some surgeons. So as a result, um we've really tried to improve the instrumentation to make it as foolproof as possible and a trusted design history. The journey to uni is a combination of the best design platforms, as mentioned and we've really consolidated all of that into one really optimal system. The thermal component design has been um modified somewhat from the prior versions. Why uh mostly to allow most efficient sizing and and uh avoidance of impingement. So, the femoral component is slightly asymmetric to follow the femoral con dials. There's a little bit of an anterior bend, a recession of of the edges all to help uh ease any sort of uh component impingement. There's 10 different sizes. So, so there's really quite a bit of a versatility from that standpoint, you can find a size that fits any patient. Um The lug holes are slightly divergent. Why is this important? Well, it helps with the overall fixation. Again, some of the the uh pitfalls of partial knee replacement have been early loosening. So, anything that we can do to improve the fixation including grit blasting, the femoral component, divergent lug holes, uh all of which help with our overall stability. And finally, um listen, the, you know, we're we're not infallible. Uh We may need to switch sizes and switch trials during during uh uh the trialing process. If, if sizing and balance isn't uh perfect, what we've done in this system is grouped the thermal components into uh small, medium and large groupings where the log holes are interchangeable between different sizes. So between sizes 1 to 3, you can interchange the different components and they'll all fit into the same log holes similarly with sizes 4 to 7 and eight through 10, all of which improves the overall versatility of the thermal components. Uh On the femoral side, in terms of the femoral trials, uh an important part of the overall tracking and sizing uh is again, some of the design of the, the uh femoral trials, particularly one of the femoral trials, which has a spiked rail on the trial itself. So you can uh completely optimize tracking and the femoral component on the tibial component. So this allows medial lateral sliding the thermal component. And once you've optimized uh the tracking of the femur on the tibia, you can then pin that guide into place and drill your log holes again to, to ensure the uh overall uh perfection of, of tracking any mal tracking again can be a reason for early failure. Uh The shoulder guys talk about the, the rocking horse sort of mechanism with the Glenoid on the uh the, the humoral head on the glenoid. It's a similar type mechanism with the um thermal component on the tibial component. If you have any degree of malt tracking. Uh There's some improved femoral trial holders uh and an impactor, all of which improved the ease of the technique. This is an example of an Oxford uni which again demonstrates really malposition of the thermal component which has led to the uh uh malt tracking on the tibia. You can see the tilt of the poly and the Oxford system. Uh all of which have led to early failure. This is a knee that was done uh about 1.5 to 2 years ago and is um on deck for an early revision. On the tibial side, we've really tried hard to improve and uh make the tibial cutting guides that much more efficient and, and um streamlined. So you'll see the picture on the left shows a typical ex extra medullary tibial guide. Uh All of which most people are familiar with using. However, we've adapted the cutting portion of the guide to be uh to allow significantly much more fine tuning. Once you do your tibial cut, once you've, you've uh set up your jig, so that your, your five degrees of post to your slope on the tibial cut and maximizing your overall coverage, uh we then move on to the spacer blocks. And if there's any tightness in your femoral gap, which is what you'll check first. After doing this step, the easily removable and replaceable cutting guide at the very top can just be removed. So you can check your gap put back on and resect a little bit more bone in terms of millimeters, if necessary, this is an incredibly powerful step so that you can start to get your balance absolutely perfect. Before proceeding to the next step, you can keep this jig on for uh two thirds of the case. So if at any point you need to go back and adjust your tibial cut, you have the versatility to do. So this is really one of the main advancements which I think uh sets this system apart from any other system. In addition to this um uh updated extra medullary uh cutting guide for the tibia. An alternate technique as well is um similar to what many Oxford users have seen. Uh the shim and the uh spoon technique which allows you to overall gauge your, your deficiency and your gaps uh and your soft tissue laxity with different size shims and set it up with your tibial guide to enable your your tibial cut using that technique as well. Uh It's a tried and true proven type of technique that's also available in this system. Uh And shows just about how versatile the instrumentation and the thought process has been de design behind the design team as well. Once you've cut your tibial God, we move on to cutting the femoral side. There is a series of cutting blocks which again help balancing uh your extension gap to match your flexion gap. Once your gaps are balanced. The rest of the surgery is really quite uh simple and quite direct. If we can balance our gaps early on in the technique, it will absolutely uh ensure long term success. One of the cornerstones of a long term successful uni is adequate cuts, uh um adequate balancing, uh good alignment and overall technique which this system uh really tries to, to encourage. And we've designed the system as such on the tibial side, the component will uh look quite familiar. It's uh built upon previous uh successful long-term, successful designs. Um There is a different medial and lateral tibial component. Uh Both of which optimize coverage uh in their respective sides. There's a little bit of uh relief in the enter aspect of the tibial component to avoid both overhang as well as soft tissue impingement. And as you've seen in, in uh the previous generations of this uh partial knee system, the three point fixation of the two pegs and the rail uh have been tried and true in terms of the uh long term success on the medial side, there's 10 different sizes once again to optimize your overall uh coverage. Uh And similarly, on the lateral side, we've got eight different sizes. Uh We've seen that the geometry of the lateral side is indeed different. It's a little wider on the lateral side. Uh And this helps optimize coverage and prevent subsidence. We know the great uh uh tibial fixation relies upon cortical um coverage by the the tibial component. And if we can extend that tibial component, so it covers around the uh uh cortical rim. Again, it's another thing to improve success, prevent subsidence uh and make a more successful system. Uh The polyethylene liners come in one millimeter increments as well. Again, to help with fine tuning of balance. Uh Here's a typical case uh this is uh uh a uh 55 year old uh male uh with the highly advanced medial compartment disease. You can see on the lateral, there may be a hint of Patel femoral disease, but we got an MRI to confirm. Uh and you can see on this axial view of the MRI, the patellofemoral joint looks uh looks quite intact. Uh So we went ahead and, and uh did a media uni on him. Uh He's about three months out right now and, and back to work and, and uh really quite happy with his results thus far. Um And you can see optimal coverage, great alignment um excellent overall um uh tracking of the thermal component on the tibia. And that's what this system allows. Similarly. Um on the lateral side. Uh again, we've got separate lateral com uh tibial components to improve with overall coverage. Uh This is a 75 year old woman who uh had predominantly lateral compartment disease. Uh Once again, we went ahead and did a partial knee replacement on her. She was asymptomatic in her medial compartment as well as her patellofemoral joint. And again, you can see that that the instrumentation in this system really helps allow excellent lateral compartment, uh balance tracking, uh and overall position you can see on the A P view, we've got great coverage on the uh coronal plane. On the lateral view, you can see nice alignment and coverage there as well with great tracking and the thermal component on the tibial component. So as we start to wrap up a couple of uh keystones of of successful technique, uh part one is your overall alignment. I feel that this tibial uh cutting guide really enables the surgeon to get excellent uh tibial alignment with properer uh coronal uh variability. Uh nice poster slope, aiming for about five degrees of poster slope on the medial side, maybe about six or seven degrees of poster slope on the lateral side, which is an atomic. Uh There's some nice um guides in here to ensure your overall uh chrome alignment with a block and a drop rod much as you might do in a total knee replacement as well as looking at your post, your slope, the balancing system in the middle set of pictures uh also enables great long term function. Why? Because we know that proper balancing and if we can do this early on in the technique, uh really uh makes the rest of the procedure significantly easier. Uh getting our soft tissue balance is is such an important part of partial knee replacements. And this system is designed to help the surgeon do this early on so that you're not trying to chase your tail uh later on the procedures by, by uh uh trying different size poly uh trials. Uh But early on it, it keeps you ahead of the game so that you feel quite secure by the end that your balance is really optimized. Uh And then personally uh towards the end of the procedure, uh cement technique is critically important. Uh I try to tell all my trainees uh really concentrate on surgical and cement technique of partial knee replacements. The bone on your uh affected side is always highly dense and sclerotic. I always drill uh smaller little drill holes to augment my cementation. I really concentrate on cement penetration into the bone. Uh and um and, and really and fastidious about my cement technique, which is critically important to the survivorship of the partial knee replacement. Uh As mentioned earlier, this system is uh perfect for an ambulatory surgery center type. Uh Setting all of the instruments have been condensed into two trays which really allows for easy portability, uh easy turnover, uh and significantly more efficient um uh room set up for your, your scrub tech uh and is a much more condensed system. So overall, uh this is uh uh a summary of our journey to UK system. Uh It can be done with real intelligence. Um We have been using it in limited market release thus far with significant uh success and satisfaction. And we look forward to tracking our techniques over the long term and making sure that uh this version of the partial knee replacement continues to be built upon the platform of previous versions with an extraordinarily high, a degree of success. Thank you.