daa-tha: no technology needed
TRANSCRIPT
DAA-THAmdashNO TECHNOLOGY NEEDED
ANTHONY S UNGER MD
WASHINGTON DC
ANTHONY S UNGER MD
DISCLOSURES
INNOMEDmdashROYALTIES
BIOMETndash ROYALTIESCONSULTANT
STRYKERmdashCONSULTANT SPEAKER
CDD-STOCK HOLDER ROYALTIES
J OF ARTHROPLASTY-EDITORIAL BOARD
THA-TECHNOLOGY
DORR 2011
ldquoROBOTIC GUIDANCE IN THATHE SHAPE OF THINGS TO COMErdquo
DR DORRrsquoS ROBOTS
TECHNOLOGY(DEFINE)
GUIDANCE SYSTEMS
ROBOTS
NOT IMPLANT DESIGN OR MATERIALS
THA
ldquoTHE MOST SUCCESSFUL OPERATION OF THE 21ST
CENTURYrdquo 2013 ORTHOPAEDIC SURGEON
THAmdashWHY DO THEY FAIL
INFECTION
INSTABILITY
LOOSENING
LL DISCREPANCY
THA-PROBLEMS THAT TECHNOLOGY ADDRESSES
INFECTION---NO
INSTABILITYmdashMAYBE
LOOSENINGmdashNO
LL DISCREPANCY--MAYBE
THA-INSTABILITY
DISLOCATION RATE AVG 39(US MEDICARE POPULATION)
225 OF REVISION SURGERY IS FOR INSTABILITY
BOZIC JBJS 2009
THA-INSTABILITY
LEWINNEK JBJS 1978
CLASSIC CUP POSITION 30-50 ABD 5-25 ANTEVERSION
15 DISLOCATION RATE IN SAFE ZONE VERSUS 61 OUTSIDE ZONE
50 HIPS NOT IN SAFE ZONE
The John Charnley Award Risk Factors for Cup Malpositioning Quality Improvement Through a Joint Registry at a Tertiary Hospital
Mark C Callanan MA Bryan Jarrett BS Charles R Bragdon PhD David Zurakowski PhD Harry E Rubash MD Andrew A Freiberg MD Henrik Malchau MD PhD
THA-INSTABILITY
DIGIOIA 1998
ldquoIMPROVEMENTS IN ACETABULAR CUP ORIENTATION WILL IMPROVE OUCOMES AND REDUCE COSTSrdquo
IMPROVED CUP POSITION----LESS INSTABILITY---LESS REVISON---LESS COSTS
HAS THIS BEEN PROVEN
MORE ACCURATE WITH NAV
Total Hip Arthroplasty Using Imageless Computer-Assisted Hip Navigation A Prospective Randomized Study
Richard Lass MDa Bernd Kubista MDa Boris Olischar MDa Sophie Frantalb Reinhard Windhager MDa Alexander Giurea MDa
However in our prospective randomized study we could not detect a significant difference in clinical results and revision rates comparing the navigation and conventional implantation-technique at a short-term follow-up period (range 015ndash35 years) This is the major limitation of our study
ROBOTS IMPROVE ACCURACY
A comparison between robotic-assisted and manual implantation of cementlesstotal hip arthroplasty (Article)
Nakamura Na Sugano Nb Nishii Tb Kakimoto Aa Miki Hb
ROBOTS IMPROVE ACCURACY
Comparison of robotic-assisted and conventional acetabular cup placement in THA A matched-pair controlled study hip (Article)
Domb BGabc El Bitar YFa Sadik AYa Stake CEab Botser IBa
THA INSTABILITY
BULLE J OF ARTHROPLASTY 2012
PATIENT SPECIFIC INSTRUMENTATION(PSI)
PSI HAD SIGNIFICANT IMPROVEMENT IN PLANNED POSITION VERSUS FREEHAND
POSTERIOR APPROACH
NO DIFF IN OUTCOMES
PSI IMPROVES ACCURACY
Comparison of Acetabular Shell Position Using Patient Specific Instruments vs Standard Surgical Instruments A Randomized Clinical Trial
Travis Small DO Viktor Krebs MD Robert Molloy MD Jason Bryan MS Alison K Klika MS Wael K Barsoum MD
THA-INSTABILITY
ALL THE TECHNOLOGIES IMPROVE ACCURACY
NO IMPROVEMENT OF OUTCOMES
WHY
THA-INTABILITY
POSITION OF PROSTHESIS IS A STATICMEASUREMENT
INSTABILITY IS INFLUENCED BY SOFT TISSUE TENSION
INSTABILITY MAY BE DYNAMICmdashIMPINGEMENT
TECHNOLOGY DOES NOT EVALUATE THIS
CAN YOUR ROBOTNAV DO THIS
DAA(w Xray) VS NAV(POST)
Acetabular Component Positioning in Primary THA via an Anterior Posterolateral or Posterolateral-navigated Surgical Technique
Denis Nam MD Peter K Sculco MD Edwin P Su MD Michael M Alexiades MD Mark P Figgie MD David J Mayman MD
NAV(POST) better than DAA(w xray)
DAA did not have as much anteversion as NAV
Matta et al---061
Siguier et al----096
Unger 2006-2014 03 none in last 500 cases
DAA- LESS DISLOCATION
THA-NO TECHNOLOGY NEEDED
PAGANO 2009
RECENT META-ANALYSISIMPROVED CUP POSITION BUT NO IMPROVEMENT IN OUTCOMES
ldquoIN 2008 THE OBJECTIVE DATA FOR COMPUTER NAV IS LACKING THE CONSENSUS IS ALSO LACKING AS FEW SURGEONS ACTUALLY USE NAV FOR THArdquo
THA-NO TECHNOLOGY NEEDED
ldquoWE ARE NOW ENTERING THE 2ND DECADE OF CLINICAL USE OF THE NAV SYSTEMS AND WE STILL HAVE NOT FOUND THE EVIDENCE OF A CLINICAL BENEFITrdquo
ldquoNAV ALSO DEMONSTRATES A NUMBER OF UNFAVORABLE ISSUES INCREASED SURG TIME(INFECTION) HIGHER COSTS SPECIFIC COMPLICATIONSrdquo
THA-LL
ldquoPARAMONT GOAL OF THA IS IMPLANT FIXATION AND HIP STABILITYrdquo
BUT AVOID LL DISCREPANCY
THA--LL
LL DISCREP COMMON AFTER THA
MINIMIZE LL DISCREPANCY CRUCIAL TO THA SUCCESS
LL DISCREP IS 2ND MOST COMMON SOURCE OF LITIGATION
THAmdashLL
MOST PTS WITH LL DISCREP IMPROVE WITH TIME
PT AND CHIROPRACTORS DRAW ATTENTION AND NEED TO BE EDUCATED
HIP SOCIETY STUDY 05 TO 7 LL PERSIST
TX SHOE LIFT(UP TO 95MM) PT AND IN SEVERE CASES REVISION
THA--LL
frac34 OF PREOP PTS HAVE SHORTEN LIMB
THA LENGTHENS LIMB AVG 25-62 MM
GENERALLY lt 1CM LL DISCREP IS ACCEPTABLE
CAN TECHNOLOGY IMPROVE LL DISCREPANCY AFTER THA
THA--LL
CAN TECHNOLGY HELP
LL DISCREPANCY DIVIDED INTO TWO CATAGORIES
A STRUCTURAL
B FUNCTIONAL
THA-LL
STRUCTURAL ACTUAL DIFFERENCE IN OSSEOUS STRUCTURES
FUNCTIONAL POSTORAL ASSYMETRY RESULTING FROM SOFT TISSUE CONTRACTURES----PELVIC OBLIQUITY
THA--LL
TECHNOLOGY
MAY IMPROVE STRUCURAL ASPECT OF LL
IT WILL NOT ASSESS FUNCTIONAL ASPECTS OF LL
THAmdashLL
INTRAOPERATIVE ASSESSMENTS
STRUCTURAL(TECHNOLOGY) IMAGING COMPUTERS ROBOTS
FUNCTIONAL(NO TECHNOLOGY NEEDED) SHUCK TEST DROPKICK TEST LEG TO LEG COMPARISION
DAA REDUCES LL DISCREPANCY
PT is SUPINEmdashrdquoFEEL THE MALLEOLI ldquo
LL CAN BE EASILY ASSESSED
FUNCTIONAL ASSESSMENT EASY
XRAY CONFIRMATION IF NECESSARY
THA-NO TECHNOLOGY NEEDED
IAN LEARMONTH ldquoTHA AND THE LAW OF DIMINISHING RETURNSrdquo JBJS 2006
THA ADVANCESFIXATIONBEARINGSMIS
LAW OF DIMINISHING RETURNS APPLIES AS PRODUCT IMPROVES A EXPONENTIALLY GREATER INVESTMENT IS NEEDED TO IMPROVE TECHNOLOGY
THAmdashNO TECHNOLOGY NEEDED
LEARMONTH 2006
ldquoCAN WE AFFORD A SUBSTANCIAL INVESTMENT FOR AN ALREADY VERY SUCCESSFUL PROCEDURErdquo
ldquoA GREATER BENEFIT MAY ACCRUE FROM RESEARCH IN ORTHOBIOLOGIS TISSUE ENGINEERING AND GENE THERAPYrdquo
THA-NO TECHNOLOGY NEEDED
PROFESSION IS BEING PUSHED BY OUTSIDE FORCES
MEDIA
PATIENTS
INDUSTRY
SURGEON DESIGNERS
THAmdashNO TECHNOLOGY NEEDED
CONCLUSIONS
NEW TECHNOLOGY HAS NOT PROVEN ITSELF TO IMPROVE OUTCOMES FURTHER INVESTMENT MUST BE ANALYSED IN LIEU OF THIS FACT AS WELL AS THE OPPORTUNITY TO ENHANCE OUTCOMES THROUGH OTHER MEANS
NEW TECHONOLGY SHOULD BE ADVOCATED CAREFULLY AT THIS TIME
THANK YOU
ANTHONY S UNGER MD
DISCLOSURES
INNOMEDmdashROYALTIES
BIOMETndash ROYALTIESCONSULTANT
STRYKERmdashCONSULTANT SPEAKER
CDD-STOCK HOLDER ROYALTIES
J OF ARTHROPLASTY-EDITORIAL BOARD
THA-TECHNOLOGY
DORR 2011
ldquoROBOTIC GUIDANCE IN THATHE SHAPE OF THINGS TO COMErdquo
DR DORRrsquoS ROBOTS
TECHNOLOGY(DEFINE)
GUIDANCE SYSTEMS
ROBOTS
NOT IMPLANT DESIGN OR MATERIALS
THA
ldquoTHE MOST SUCCESSFUL OPERATION OF THE 21ST
CENTURYrdquo 2013 ORTHOPAEDIC SURGEON
THAmdashWHY DO THEY FAIL
INFECTION
INSTABILITY
LOOSENING
LL DISCREPANCY
THA-PROBLEMS THAT TECHNOLOGY ADDRESSES
INFECTION---NO
INSTABILITYmdashMAYBE
LOOSENINGmdashNO
LL DISCREPANCY--MAYBE
THA-INSTABILITY
DISLOCATION RATE AVG 39(US MEDICARE POPULATION)
225 OF REVISION SURGERY IS FOR INSTABILITY
BOZIC JBJS 2009
THA-INSTABILITY
LEWINNEK JBJS 1978
CLASSIC CUP POSITION 30-50 ABD 5-25 ANTEVERSION
15 DISLOCATION RATE IN SAFE ZONE VERSUS 61 OUTSIDE ZONE
50 HIPS NOT IN SAFE ZONE
The John Charnley Award Risk Factors for Cup Malpositioning Quality Improvement Through a Joint Registry at a Tertiary Hospital
Mark C Callanan MA Bryan Jarrett BS Charles R Bragdon PhD David Zurakowski PhD Harry E Rubash MD Andrew A Freiberg MD Henrik Malchau MD PhD
THA-INSTABILITY
DIGIOIA 1998
ldquoIMPROVEMENTS IN ACETABULAR CUP ORIENTATION WILL IMPROVE OUCOMES AND REDUCE COSTSrdquo
IMPROVED CUP POSITION----LESS INSTABILITY---LESS REVISON---LESS COSTS
HAS THIS BEEN PROVEN
MORE ACCURATE WITH NAV
Total Hip Arthroplasty Using Imageless Computer-Assisted Hip Navigation A Prospective Randomized Study
Richard Lass MDa Bernd Kubista MDa Boris Olischar MDa Sophie Frantalb Reinhard Windhager MDa Alexander Giurea MDa
However in our prospective randomized study we could not detect a significant difference in clinical results and revision rates comparing the navigation and conventional implantation-technique at a short-term follow-up period (range 015ndash35 years) This is the major limitation of our study
ROBOTS IMPROVE ACCURACY
A comparison between robotic-assisted and manual implantation of cementlesstotal hip arthroplasty (Article)
Nakamura Na Sugano Nb Nishii Tb Kakimoto Aa Miki Hb
ROBOTS IMPROVE ACCURACY
Comparison of robotic-assisted and conventional acetabular cup placement in THA A matched-pair controlled study hip (Article)
Domb BGabc El Bitar YFa Sadik AYa Stake CEab Botser IBa
THA INSTABILITY
BULLE J OF ARTHROPLASTY 2012
PATIENT SPECIFIC INSTRUMENTATION(PSI)
PSI HAD SIGNIFICANT IMPROVEMENT IN PLANNED POSITION VERSUS FREEHAND
POSTERIOR APPROACH
NO DIFF IN OUTCOMES
PSI IMPROVES ACCURACY
Comparison of Acetabular Shell Position Using Patient Specific Instruments vs Standard Surgical Instruments A Randomized Clinical Trial
Travis Small DO Viktor Krebs MD Robert Molloy MD Jason Bryan MS Alison K Klika MS Wael K Barsoum MD
THA-INSTABILITY
ALL THE TECHNOLOGIES IMPROVE ACCURACY
NO IMPROVEMENT OF OUTCOMES
WHY
THA-INTABILITY
POSITION OF PROSTHESIS IS A STATICMEASUREMENT
INSTABILITY IS INFLUENCED BY SOFT TISSUE TENSION
INSTABILITY MAY BE DYNAMICmdashIMPINGEMENT
TECHNOLOGY DOES NOT EVALUATE THIS
CAN YOUR ROBOTNAV DO THIS
DAA(w Xray) VS NAV(POST)
Acetabular Component Positioning in Primary THA via an Anterior Posterolateral or Posterolateral-navigated Surgical Technique
Denis Nam MD Peter K Sculco MD Edwin P Su MD Michael M Alexiades MD Mark P Figgie MD David J Mayman MD
NAV(POST) better than DAA(w xray)
DAA did not have as much anteversion as NAV
Matta et al---061
Siguier et al----096
Unger 2006-2014 03 none in last 500 cases
DAA- LESS DISLOCATION
THA-NO TECHNOLOGY NEEDED
PAGANO 2009
RECENT META-ANALYSISIMPROVED CUP POSITION BUT NO IMPROVEMENT IN OUTCOMES
ldquoIN 2008 THE OBJECTIVE DATA FOR COMPUTER NAV IS LACKING THE CONSENSUS IS ALSO LACKING AS FEW SURGEONS ACTUALLY USE NAV FOR THArdquo
THA-NO TECHNOLOGY NEEDED
ldquoWE ARE NOW ENTERING THE 2ND DECADE OF CLINICAL USE OF THE NAV SYSTEMS AND WE STILL HAVE NOT FOUND THE EVIDENCE OF A CLINICAL BENEFITrdquo
ldquoNAV ALSO DEMONSTRATES A NUMBER OF UNFAVORABLE ISSUES INCREASED SURG TIME(INFECTION) HIGHER COSTS SPECIFIC COMPLICATIONSrdquo
THA-LL
ldquoPARAMONT GOAL OF THA IS IMPLANT FIXATION AND HIP STABILITYrdquo
BUT AVOID LL DISCREPANCY
THA--LL
LL DISCREP COMMON AFTER THA
MINIMIZE LL DISCREPANCY CRUCIAL TO THA SUCCESS
LL DISCREP IS 2ND MOST COMMON SOURCE OF LITIGATION
THAmdashLL
MOST PTS WITH LL DISCREP IMPROVE WITH TIME
PT AND CHIROPRACTORS DRAW ATTENTION AND NEED TO BE EDUCATED
HIP SOCIETY STUDY 05 TO 7 LL PERSIST
TX SHOE LIFT(UP TO 95MM) PT AND IN SEVERE CASES REVISION
THA--LL
frac34 OF PREOP PTS HAVE SHORTEN LIMB
THA LENGTHENS LIMB AVG 25-62 MM
GENERALLY lt 1CM LL DISCREP IS ACCEPTABLE
CAN TECHNOLOGY IMPROVE LL DISCREPANCY AFTER THA
THA--LL
CAN TECHNOLGY HELP
LL DISCREPANCY DIVIDED INTO TWO CATAGORIES
A STRUCTURAL
B FUNCTIONAL
THA-LL
STRUCTURAL ACTUAL DIFFERENCE IN OSSEOUS STRUCTURES
FUNCTIONAL POSTORAL ASSYMETRY RESULTING FROM SOFT TISSUE CONTRACTURES----PELVIC OBLIQUITY
THA--LL
TECHNOLOGY
MAY IMPROVE STRUCURAL ASPECT OF LL
IT WILL NOT ASSESS FUNCTIONAL ASPECTS OF LL
THAmdashLL
INTRAOPERATIVE ASSESSMENTS
STRUCTURAL(TECHNOLOGY) IMAGING COMPUTERS ROBOTS
FUNCTIONAL(NO TECHNOLOGY NEEDED) SHUCK TEST DROPKICK TEST LEG TO LEG COMPARISION
DAA REDUCES LL DISCREPANCY
PT is SUPINEmdashrdquoFEEL THE MALLEOLI ldquo
LL CAN BE EASILY ASSESSED
FUNCTIONAL ASSESSMENT EASY
XRAY CONFIRMATION IF NECESSARY
THA-NO TECHNOLOGY NEEDED
IAN LEARMONTH ldquoTHA AND THE LAW OF DIMINISHING RETURNSrdquo JBJS 2006
THA ADVANCESFIXATIONBEARINGSMIS
LAW OF DIMINISHING RETURNS APPLIES AS PRODUCT IMPROVES A EXPONENTIALLY GREATER INVESTMENT IS NEEDED TO IMPROVE TECHNOLOGY
THAmdashNO TECHNOLOGY NEEDED
LEARMONTH 2006
ldquoCAN WE AFFORD A SUBSTANCIAL INVESTMENT FOR AN ALREADY VERY SUCCESSFUL PROCEDURErdquo
ldquoA GREATER BENEFIT MAY ACCRUE FROM RESEARCH IN ORTHOBIOLOGIS TISSUE ENGINEERING AND GENE THERAPYrdquo
THA-NO TECHNOLOGY NEEDED
PROFESSION IS BEING PUSHED BY OUTSIDE FORCES
MEDIA
PATIENTS
INDUSTRY
SURGEON DESIGNERS
THAmdashNO TECHNOLOGY NEEDED
CONCLUSIONS
NEW TECHNOLOGY HAS NOT PROVEN ITSELF TO IMPROVE OUTCOMES FURTHER INVESTMENT MUST BE ANALYSED IN LIEU OF THIS FACT AS WELL AS THE OPPORTUNITY TO ENHANCE OUTCOMES THROUGH OTHER MEANS
NEW TECHONOLGY SHOULD BE ADVOCATED CAREFULLY AT THIS TIME
THANK YOU
THA-TECHNOLOGY
DORR 2011
ldquoROBOTIC GUIDANCE IN THATHE SHAPE OF THINGS TO COMErdquo
DR DORRrsquoS ROBOTS
TECHNOLOGY(DEFINE)
GUIDANCE SYSTEMS
ROBOTS
NOT IMPLANT DESIGN OR MATERIALS
THA
ldquoTHE MOST SUCCESSFUL OPERATION OF THE 21ST
CENTURYrdquo 2013 ORTHOPAEDIC SURGEON
THAmdashWHY DO THEY FAIL
INFECTION
INSTABILITY
LOOSENING
LL DISCREPANCY
THA-PROBLEMS THAT TECHNOLOGY ADDRESSES
INFECTION---NO
INSTABILITYmdashMAYBE
LOOSENINGmdashNO
LL DISCREPANCY--MAYBE
THA-INSTABILITY
DISLOCATION RATE AVG 39(US MEDICARE POPULATION)
225 OF REVISION SURGERY IS FOR INSTABILITY
BOZIC JBJS 2009
THA-INSTABILITY
LEWINNEK JBJS 1978
CLASSIC CUP POSITION 30-50 ABD 5-25 ANTEVERSION
15 DISLOCATION RATE IN SAFE ZONE VERSUS 61 OUTSIDE ZONE
50 HIPS NOT IN SAFE ZONE
The John Charnley Award Risk Factors for Cup Malpositioning Quality Improvement Through a Joint Registry at a Tertiary Hospital
Mark C Callanan MA Bryan Jarrett BS Charles R Bragdon PhD David Zurakowski PhD Harry E Rubash MD Andrew A Freiberg MD Henrik Malchau MD PhD
THA-INSTABILITY
DIGIOIA 1998
ldquoIMPROVEMENTS IN ACETABULAR CUP ORIENTATION WILL IMPROVE OUCOMES AND REDUCE COSTSrdquo
IMPROVED CUP POSITION----LESS INSTABILITY---LESS REVISON---LESS COSTS
HAS THIS BEEN PROVEN
MORE ACCURATE WITH NAV
Total Hip Arthroplasty Using Imageless Computer-Assisted Hip Navigation A Prospective Randomized Study
Richard Lass MDa Bernd Kubista MDa Boris Olischar MDa Sophie Frantalb Reinhard Windhager MDa Alexander Giurea MDa
However in our prospective randomized study we could not detect a significant difference in clinical results and revision rates comparing the navigation and conventional implantation-technique at a short-term follow-up period (range 015ndash35 years) This is the major limitation of our study
ROBOTS IMPROVE ACCURACY
A comparison between robotic-assisted and manual implantation of cementlesstotal hip arthroplasty (Article)
Nakamura Na Sugano Nb Nishii Tb Kakimoto Aa Miki Hb
ROBOTS IMPROVE ACCURACY
Comparison of robotic-assisted and conventional acetabular cup placement in THA A matched-pair controlled study hip (Article)
Domb BGabc El Bitar YFa Sadik AYa Stake CEab Botser IBa
THA INSTABILITY
BULLE J OF ARTHROPLASTY 2012
PATIENT SPECIFIC INSTRUMENTATION(PSI)
PSI HAD SIGNIFICANT IMPROVEMENT IN PLANNED POSITION VERSUS FREEHAND
POSTERIOR APPROACH
NO DIFF IN OUTCOMES
PSI IMPROVES ACCURACY
Comparison of Acetabular Shell Position Using Patient Specific Instruments vs Standard Surgical Instruments A Randomized Clinical Trial
Travis Small DO Viktor Krebs MD Robert Molloy MD Jason Bryan MS Alison K Klika MS Wael K Barsoum MD
THA-INSTABILITY
ALL THE TECHNOLOGIES IMPROVE ACCURACY
NO IMPROVEMENT OF OUTCOMES
WHY
THA-INTABILITY
POSITION OF PROSTHESIS IS A STATICMEASUREMENT
INSTABILITY IS INFLUENCED BY SOFT TISSUE TENSION
INSTABILITY MAY BE DYNAMICmdashIMPINGEMENT
TECHNOLOGY DOES NOT EVALUATE THIS
CAN YOUR ROBOTNAV DO THIS
DAA(w Xray) VS NAV(POST)
Acetabular Component Positioning in Primary THA via an Anterior Posterolateral or Posterolateral-navigated Surgical Technique
Denis Nam MD Peter K Sculco MD Edwin P Su MD Michael M Alexiades MD Mark P Figgie MD David J Mayman MD
NAV(POST) better than DAA(w xray)
DAA did not have as much anteversion as NAV
Matta et al---061
Siguier et al----096
Unger 2006-2014 03 none in last 500 cases
DAA- LESS DISLOCATION
THA-NO TECHNOLOGY NEEDED
PAGANO 2009
RECENT META-ANALYSISIMPROVED CUP POSITION BUT NO IMPROVEMENT IN OUTCOMES
ldquoIN 2008 THE OBJECTIVE DATA FOR COMPUTER NAV IS LACKING THE CONSENSUS IS ALSO LACKING AS FEW SURGEONS ACTUALLY USE NAV FOR THArdquo
THA-NO TECHNOLOGY NEEDED
ldquoWE ARE NOW ENTERING THE 2ND DECADE OF CLINICAL USE OF THE NAV SYSTEMS AND WE STILL HAVE NOT FOUND THE EVIDENCE OF A CLINICAL BENEFITrdquo
ldquoNAV ALSO DEMONSTRATES A NUMBER OF UNFAVORABLE ISSUES INCREASED SURG TIME(INFECTION) HIGHER COSTS SPECIFIC COMPLICATIONSrdquo
THA-LL
ldquoPARAMONT GOAL OF THA IS IMPLANT FIXATION AND HIP STABILITYrdquo
BUT AVOID LL DISCREPANCY
THA--LL
LL DISCREP COMMON AFTER THA
MINIMIZE LL DISCREPANCY CRUCIAL TO THA SUCCESS
LL DISCREP IS 2ND MOST COMMON SOURCE OF LITIGATION
THAmdashLL
MOST PTS WITH LL DISCREP IMPROVE WITH TIME
PT AND CHIROPRACTORS DRAW ATTENTION AND NEED TO BE EDUCATED
HIP SOCIETY STUDY 05 TO 7 LL PERSIST
TX SHOE LIFT(UP TO 95MM) PT AND IN SEVERE CASES REVISION
THA--LL
frac34 OF PREOP PTS HAVE SHORTEN LIMB
THA LENGTHENS LIMB AVG 25-62 MM
GENERALLY lt 1CM LL DISCREP IS ACCEPTABLE
CAN TECHNOLOGY IMPROVE LL DISCREPANCY AFTER THA
THA--LL
CAN TECHNOLGY HELP
LL DISCREPANCY DIVIDED INTO TWO CATAGORIES
A STRUCTURAL
B FUNCTIONAL
THA-LL
STRUCTURAL ACTUAL DIFFERENCE IN OSSEOUS STRUCTURES
FUNCTIONAL POSTORAL ASSYMETRY RESULTING FROM SOFT TISSUE CONTRACTURES----PELVIC OBLIQUITY
THA--LL
TECHNOLOGY
MAY IMPROVE STRUCURAL ASPECT OF LL
IT WILL NOT ASSESS FUNCTIONAL ASPECTS OF LL
THAmdashLL
INTRAOPERATIVE ASSESSMENTS
STRUCTURAL(TECHNOLOGY) IMAGING COMPUTERS ROBOTS
FUNCTIONAL(NO TECHNOLOGY NEEDED) SHUCK TEST DROPKICK TEST LEG TO LEG COMPARISION
DAA REDUCES LL DISCREPANCY
PT is SUPINEmdashrdquoFEEL THE MALLEOLI ldquo
LL CAN BE EASILY ASSESSED
FUNCTIONAL ASSESSMENT EASY
XRAY CONFIRMATION IF NECESSARY
THA-NO TECHNOLOGY NEEDED
IAN LEARMONTH ldquoTHA AND THE LAW OF DIMINISHING RETURNSrdquo JBJS 2006
THA ADVANCESFIXATIONBEARINGSMIS
LAW OF DIMINISHING RETURNS APPLIES AS PRODUCT IMPROVES A EXPONENTIALLY GREATER INVESTMENT IS NEEDED TO IMPROVE TECHNOLOGY
THAmdashNO TECHNOLOGY NEEDED
LEARMONTH 2006
ldquoCAN WE AFFORD A SUBSTANCIAL INVESTMENT FOR AN ALREADY VERY SUCCESSFUL PROCEDURErdquo
ldquoA GREATER BENEFIT MAY ACCRUE FROM RESEARCH IN ORTHOBIOLOGIS TISSUE ENGINEERING AND GENE THERAPYrdquo
THA-NO TECHNOLOGY NEEDED
PROFESSION IS BEING PUSHED BY OUTSIDE FORCES
MEDIA
PATIENTS
INDUSTRY
SURGEON DESIGNERS
THAmdashNO TECHNOLOGY NEEDED
CONCLUSIONS
NEW TECHNOLOGY HAS NOT PROVEN ITSELF TO IMPROVE OUTCOMES FURTHER INVESTMENT MUST BE ANALYSED IN LIEU OF THIS FACT AS WELL AS THE OPPORTUNITY TO ENHANCE OUTCOMES THROUGH OTHER MEANS
NEW TECHONOLGY SHOULD BE ADVOCATED CAREFULLY AT THIS TIME
THANK YOU
DR DORRrsquoS ROBOTS
TECHNOLOGY(DEFINE)
GUIDANCE SYSTEMS
ROBOTS
NOT IMPLANT DESIGN OR MATERIALS
THA
ldquoTHE MOST SUCCESSFUL OPERATION OF THE 21ST
CENTURYrdquo 2013 ORTHOPAEDIC SURGEON
THAmdashWHY DO THEY FAIL
INFECTION
INSTABILITY
LOOSENING
LL DISCREPANCY
THA-PROBLEMS THAT TECHNOLOGY ADDRESSES
INFECTION---NO
INSTABILITYmdashMAYBE
LOOSENINGmdashNO
LL DISCREPANCY--MAYBE
THA-INSTABILITY
DISLOCATION RATE AVG 39(US MEDICARE POPULATION)
225 OF REVISION SURGERY IS FOR INSTABILITY
BOZIC JBJS 2009
THA-INSTABILITY
LEWINNEK JBJS 1978
CLASSIC CUP POSITION 30-50 ABD 5-25 ANTEVERSION
15 DISLOCATION RATE IN SAFE ZONE VERSUS 61 OUTSIDE ZONE
50 HIPS NOT IN SAFE ZONE
The John Charnley Award Risk Factors for Cup Malpositioning Quality Improvement Through a Joint Registry at a Tertiary Hospital
Mark C Callanan MA Bryan Jarrett BS Charles R Bragdon PhD David Zurakowski PhD Harry E Rubash MD Andrew A Freiberg MD Henrik Malchau MD PhD
THA-INSTABILITY
DIGIOIA 1998
ldquoIMPROVEMENTS IN ACETABULAR CUP ORIENTATION WILL IMPROVE OUCOMES AND REDUCE COSTSrdquo
IMPROVED CUP POSITION----LESS INSTABILITY---LESS REVISON---LESS COSTS
HAS THIS BEEN PROVEN
MORE ACCURATE WITH NAV
Total Hip Arthroplasty Using Imageless Computer-Assisted Hip Navigation A Prospective Randomized Study
Richard Lass MDa Bernd Kubista MDa Boris Olischar MDa Sophie Frantalb Reinhard Windhager MDa Alexander Giurea MDa
However in our prospective randomized study we could not detect a significant difference in clinical results and revision rates comparing the navigation and conventional implantation-technique at a short-term follow-up period (range 015ndash35 years) This is the major limitation of our study
ROBOTS IMPROVE ACCURACY
A comparison between robotic-assisted and manual implantation of cementlesstotal hip arthroplasty (Article)
Nakamura Na Sugano Nb Nishii Tb Kakimoto Aa Miki Hb
ROBOTS IMPROVE ACCURACY
Comparison of robotic-assisted and conventional acetabular cup placement in THA A matched-pair controlled study hip (Article)
Domb BGabc El Bitar YFa Sadik AYa Stake CEab Botser IBa
THA INSTABILITY
BULLE J OF ARTHROPLASTY 2012
PATIENT SPECIFIC INSTRUMENTATION(PSI)
PSI HAD SIGNIFICANT IMPROVEMENT IN PLANNED POSITION VERSUS FREEHAND
POSTERIOR APPROACH
NO DIFF IN OUTCOMES
PSI IMPROVES ACCURACY
Comparison of Acetabular Shell Position Using Patient Specific Instruments vs Standard Surgical Instruments A Randomized Clinical Trial
Travis Small DO Viktor Krebs MD Robert Molloy MD Jason Bryan MS Alison K Klika MS Wael K Barsoum MD
THA-INSTABILITY
ALL THE TECHNOLOGIES IMPROVE ACCURACY
NO IMPROVEMENT OF OUTCOMES
WHY
THA-INTABILITY
POSITION OF PROSTHESIS IS A STATICMEASUREMENT
INSTABILITY IS INFLUENCED BY SOFT TISSUE TENSION
INSTABILITY MAY BE DYNAMICmdashIMPINGEMENT
TECHNOLOGY DOES NOT EVALUATE THIS
CAN YOUR ROBOTNAV DO THIS
DAA(w Xray) VS NAV(POST)
Acetabular Component Positioning in Primary THA via an Anterior Posterolateral or Posterolateral-navigated Surgical Technique
Denis Nam MD Peter K Sculco MD Edwin P Su MD Michael M Alexiades MD Mark P Figgie MD David J Mayman MD
NAV(POST) better than DAA(w xray)
DAA did not have as much anteversion as NAV
Matta et al---061
Siguier et al----096
Unger 2006-2014 03 none in last 500 cases
DAA- LESS DISLOCATION
THA-NO TECHNOLOGY NEEDED
PAGANO 2009
RECENT META-ANALYSISIMPROVED CUP POSITION BUT NO IMPROVEMENT IN OUTCOMES
ldquoIN 2008 THE OBJECTIVE DATA FOR COMPUTER NAV IS LACKING THE CONSENSUS IS ALSO LACKING AS FEW SURGEONS ACTUALLY USE NAV FOR THArdquo
THA-NO TECHNOLOGY NEEDED
ldquoWE ARE NOW ENTERING THE 2ND DECADE OF CLINICAL USE OF THE NAV SYSTEMS AND WE STILL HAVE NOT FOUND THE EVIDENCE OF A CLINICAL BENEFITrdquo
ldquoNAV ALSO DEMONSTRATES A NUMBER OF UNFAVORABLE ISSUES INCREASED SURG TIME(INFECTION) HIGHER COSTS SPECIFIC COMPLICATIONSrdquo
THA-LL
ldquoPARAMONT GOAL OF THA IS IMPLANT FIXATION AND HIP STABILITYrdquo
BUT AVOID LL DISCREPANCY
THA--LL
LL DISCREP COMMON AFTER THA
MINIMIZE LL DISCREPANCY CRUCIAL TO THA SUCCESS
LL DISCREP IS 2ND MOST COMMON SOURCE OF LITIGATION
THAmdashLL
MOST PTS WITH LL DISCREP IMPROVE WITH TIME
PT AND CHIROPRACTORS DRAW ATTENTION AND NEED TO BE EDUCATED
HIP SOCIETY STUDY 05 TO 7 LL PERSIST
TX SHOE LIFT(UP TO 95MM) PT AND IN SEVERE CASES REVISION
THA--LL
frac34 OF PREOP PTS HAVE SHORTEN LIMB
THA LENGTHENS LIMB AVG 25-62 MM
GENERALLY lt 1CM LL DISCREP IS ACCEPTABLE
CAN TECHNOLOGY IMPROVE LL DISCREPANCY AFTER THA
THA--LL
CAN TECHNOLGY HELP
LL DISCREPANCY DIVIDED INTO TWO CATAGORIES
A STRUCTURAL
B FUNCTIONAL
THA-LL
STRUCTURAL ACTUAL DIFFERENCE IN OSSEOUS STRUCTURES
FUNCTIONAL POSTORAL ASSYMETRY RESULTING FROM SOFT TISSUE CONTRACTURES----PELVIC OBLIQUITY
THA--LL
TECHNOLOGY
MAY IMPROVE STRUCURAL ASPECT OF LL
IT WILL NOT ASSESS FUNCTIONAL ASPECTS OF LL
THAmdashLL
INTRAOPERATIVE ASSESSMENTS
STRUCTURAL(TECHNOLOGY) IMAGING COMPUTERS ROBOTS
FUNCTIONAL(NO TECHNOLOGY NEEDED) SHUCK TEST DROPKICK TEST LEG TO LEG COMPARISION
DAA REDUCES LL DISCREPANCY
PT is SUPINEmdashrdquoFEEL THE MALLEOLI ldquo
LL CAN BE EASILY ASSESSED
FUNCTIONAL ASSESSMENT EASY
XRAY CONFIRMATION IF NECESSARY
THA-NO TECHNOLOGY NEEDED
IAN LEARMONTH ldquoTHA AND THE LAW OF DIMINISHING RETURNSrdquo JBJS 2006
THA ADVANCESFIXATIONBEARINGSMIS
LAW OF DIMINISHING RETURNS APPLIES AS PRODUCT IMPROVES A EXPONENTIALLY GREATER INVESTMENT IS NEEDED TO IMPROVE TECHNOLOGY
THAmdashNO TECHNOLOGY NEEDED
LEARMONTH 2006
ldquoCAN WE AFFORD A SUBSTANCIAL INVESTMENT FOR AN ALREADY VERY SUCCESSFUL PROCEDURErdquo
ldquoA GREATER BENEFIT MAY ACCRUE FROM RESEARCH IN ORTHOBIOLOGIS TISSUE ENGINEERING AND GENE THERAPYrdquo
THA-NO TECHNOLOGY NEEDED
PROFESSION IS BEING PUSHED BY OUTSIDE FORCES
MEDIA
PATIENTS
INDUSTRY
SURGEON DESIGNERS
THAmdashNO TECHNOLOGY NEEDED
CONCLUSIONS
NEW TECHNOLOGY HAS NOT PROVEN ITSELF TO IMPROVE OUTCOMES FURTHER INVESTMENT MUST BE ANALYSED IN LIEU OF THIS FACT AS WELL AS THE OPPORTUNITY TO ENHANCE OUTCOMES THROUGH OTHER MEANS
NEW TECHONOLGY SHOULD BE ADVOCATED CAREFULLY AT THIS TIME
THANK YOU
TECHNOLOGY(DEFINE)
GUIDANCE SYSTEMS
ROBOTS
NOT IMPLANT DESIGN OR MATERIALS
THA
ldquoTHE MOST SUCCESSFUL OPERATION OF THE 21ST
CENTURYrdquo 2013 ORTHOPAEDIC SURGEON
THAmdashWHY DO THEY FAIL
INFECTION
INSTABILITY
LOOSENING
LL DISCREPANCY
THA-PROBLEMS THAT TECHNOLOGY ADDRESSES
INFECTION---NO
INSTABILITYmdashMAYBE
LOOSENINGmdashNO
LL DISCREPANCY--MAYBE
THA-INSTABILITY
DISLOCATION RATE AVG 39(US MEDICARE POPULATION)
225 OF REVISION SURGERY IS FOR INSTABILITY
BOZIC JBJS 2009
THA-INSTABILITY
LEWINNEK JBJS 1978
CLASSIC CUP POSITION 30-50 ABD 5-25 ANTEVERSION
15 DISLOCATION RATE IN SAFE ZONE VERSUS 61 OUTSIDE ZONE
50 HIPS NOT IN SAFE ZONE
The John Charnley Award Risk Factors for Cup Malpositioning Quality Improvement Through a Joint Registry at a Tertiary Hospital
Mark C Callanan MA Bryan Jarrett BS Charles R Bragdon PhD David Zurakowski PhD Harry E Rubash MD Andrew A Freiberg MD Henrik Malchau MD PhD
THA-INSTABILITY
DIGIOIA 1998
ldquoIMPROVEMENTS IN ACETABULAR CUP ORIENTATION WILL IMPROVE OUCOMES AND REDUCE COSTSrdquo
IMPROVED CUP POSITION----LESS INSTABILITY---LESS REVISON---LESS COSTS
HAS THIS BEEN PROVEN
MORE ACCURATE WITH NAV
Total Hip Arthroplasty Using Imageless Computer-Assisted Hip Navigation A Prospective Randomized Study
Richard Lass MDa Bernd Kubista MDa Boris Olischar MDa Sophie Frantalb Reinhard Windhager MDa Alexander Giurea MDa
However in our prospective randomized study we could not detect a significant difference in clinical results and revision rates comparing the navigation and conventional implantation-technique at a short-term follow-up period (range 015ndash35 years) This is the major limitation of our study
ROBOTS IMPROVE ACCURACY
A comparison between robotic-assisted and manual implantation of cementlesstotal hip arthroplasty (Article)
Nakamura Na Sugano Nb Nishii Tb Kakimoto Aa Miki Hb
ROBOTS IMPROVE ACCURACY
Comparison of robotic-assisted and conventional acetabular cup placement in THA A matched-pair controlled study hip (Article)
Domb BGabc El Bitar YFa Sadik AYa Stake CEab Botser IBa
THA INSTABILITY
BULLE J OF ARTHROPLASTY 2012
PATIENT SPECIFIC INSTRUMENTATION(PSI)
PSI HAD SIGNIFICANT IMPROVEMENT IN PLANNED POSITION VERSUS FREEHAND
POSTERIOR APPROACH
NO DIFF IN OUTCOMES
PSI IMPROVES ACCURACY
Comparison of Acetabular Shell Position Using Patient Specific Instruments vs Standard Surgical Instruments A Randomized Clinical Trial
Travis Small DO Viktor Krebs MD Robert Molloy MD Jason Bryan MS Alison K Klika MS Wael K Barsoum MD
THA-INSTABILITY
ALL THE TECHNOLOGIES IMPROVE ACCURACY
NO IMPROVEMENT OF OUTCOMES
WHY
THA-INTABILITY
POSITION OF PROSTHESIS IS A STATICMEASUREMENT
INSTABILITY IS INFLUENCED BY SOFT TISSUE TENSION
INSTABILITY MAY BE DYNAMICmdashIMPINGEMENT
TECHNOLOGY DOES NOT EVALUATE THIS
CAN YOUR ROBOTNAV DO THIS
DAA(w Xray) VS NAV(POST)
Acetabular Component Positioning in Primary THA via an Anterior Posterolateral or Posterolateral-navigated Surgical Technique
Denis Nam MD Peter K Sculco MD Edwin P Su MD Michael M Alexiades MD Mark P Figgie MD David J Mayman MD
NAV(POST) better than DAA(w xray)
DAA did not have as much anteversion as NAV
Matta et al---061
Siguier et al----096
Unger 2006-2014 03 none in last 500 cases
DAA- LESS DISLOCATION
THA-NO TECHNOLOGY NEEDED
PAGANO 2009
RECENT META-ANALYSISIMPROVED CUP POSITION BUT NO IMPROVEMENT IN OUTCOMES
ldquoIN 2008 THE OBJECTIVE DATA FOR COMPUTER NAV IS LACKING THE CONSENSUS IS ALSO LACKING AS FEW SURGEONS ACTUALLY USE NAV FOR THArdquo
THA-NO TECHNOLOGY NEEDED
ldquoWE ARE NOW ENTERING THE 2ND DECADE OF CLINICAL USE OF THE NAV SYSTEMS AND WE STILL HAVE NOT FOUND THE EVIDENCE OF A CLINICAL BENEFITrdquo
ldquoNAV ALSO DEMONSTRATES A NUMBER OF UNFAVORABLE ISSUES INCREASED SURG TIME(INFECTION) HIGHER COSTS SPECIFIC COMPLICATIONSrdquo
THA-LL
ldquoPARAMONT GOAL OF THA IS IMPLANT FIXATION AND HIP STABILITYrdquo
BUT AVOID LL DISCREPANCY
THA--LL
LL DISCREP COMMON AFTER THA
MINIMIZE LL DISCREPANCY CRUCIAL TO THA SUCCESS
LL DISCREP IS 2ND MOST COMMON SOURCE OF LITIGATION
THAmdashLL
MOST PTS WITH LL DISCREP IMPROVE WITH TIME
PT AND CHIROPRACTORS DRAW ATTENTION AND NEED TO BE EDUCATED
HIP SOCIETY STUDY 05 TO 7 LL PERSIST
TX SHOE LIFT(UP TO 95MM) PT AND IN SEVERE CASES REVISION
THA--LL
frac34 OF PREOP PTS HAVE SHORTEN LIMB
THA LENGTHENS LIMB AVG 25-62 MM
GENERALLY lt 1CM LL DISCREP IS ACCEPTABLE
CAN TECHNOLOGY IMPROVE LL DISCREPANCY AFTER THA
THA--LL
CAN TECHNOLGY HELP
LL DISCREPANCY DIVIDED INTO TWO CATAGORIES
A STRUCTURAL
B FUNCTIONAL
THA-LL
STRUCTURAL ACTUAL DIFFERENCE IN OSSEOUS STRUCTURES
FUNCTIONAL POSTORAL ASSYMETRY RESULTING FROM SOFT TISSUE CONTRACTURES----PELVIC OBLIQUITY
THA--LL
TECHNOLOGY
MAY IMPROVE STRUCURAL ASPECT OF LL
IT WILL NOT ASSESS FUNCTIONAL ASPECTS OF LL
THAmdashLL
INTRAOPERATIVE ASSESSMENTS
STRUCTURAL(TECHNOLOGY) IMAGING COMPUTERS ROBOTS
FUNCTIONAL(NO TECHNOLOGY NEEDED) SHUCK TEST DROPKICK TEST LEG TO LEG COMPARISION
DAA REDUCES LL DISCREPANCY
PT is SUPINEmdashrdquoFEEL THE MALLEOLI ldquo
LL CAN BE EASILY ASSESSED
FUNCTIONAL ASSESSMENT EASY
XRAY CONFIRMATION IF NECESSARY
THA-NO TECHNOLOGY NEEDED
IAN LEARMONTH ldquoTHA AND THE LAW OF DIMINISHING RETURNSrdquo JBJS 2006
THA ADVANCESFIXATIONBEARINGSMIS
LAW OF DIMINISHING RETURNS APPLIES AS PRODUCT IMPROVES A EXPONENTIALLY GREATER INVESTMENT IS NEEDED TO IMPROVE TECHNOLOGY
THAmdashNO TECHNOLOGY NEEDED
LEARMONTH 2006
ldquoCAN WE AFFORD A SUBSTANCIAL INVESTMENT FOR AN ALREADY VERY SUCCESSFUL PROCEDURErdquo
ldquoA GREATER BENEFIT MAY ACCRUE FROM RESEARCH IN ORTHOBIOLOGIS TISSUE ENGINEERING AND GENE THERAPYrdquo
THA-NO TECHNOLOGY NEEDED
PROFESSION IS BEING PUSHED BY OUTSIDE FORCES
MEDIA
PATIENTS
INDUSTRY
SURGEON DESIGNERS
THAmdashNO TECHNOLOGY NEEDED
CONCLUSIONS
NEW TECHNOLOGY HAS NOT PROVEN ITSELF TO IMPROVE OUTCOMES FURTHER INVESTMENT MUST BE ANALYSED IN LIEU OF THIS FACT AS WELL AS THE OPPORTUNITY TO ENHANCE OUTCOMES THROUGH OTHER MEANS
NEW TECHONOLGY SHOULD BE ADVOCATED CAREFULLY AT THIS TIME
THANK YOU
THA
ldquoTHE MOST SUCCESSFUL OPERATION OF THE 21ST
CENTURYrdquo 2013 ORTHOPAEDIC SURGEON
THAmdashWHY DO THEY FAIL
INFECTION
INSTABILITY
LOOSENING
LL DISCREPANCY
THA-PROBLEMS THAT TECHNOLOGY ADDRESSES
INFECTION---NO
INSTABILITYmdashMAYBE
LOOSENINGmdashNO
LL DISCREPANCY--MAYBE
THA-INSTABILITY
DISLOCATION RATE AVG 39(US MEDICARE POPULATION)
225 OF REVISION SURGERY IS FOR INSTABILITY
BOZIC JBJS 2009
THA-INSTABILITY
LEWINNEK JBJS 1978
CLASSIC CUP POSITION 30-50 ABD 5-25 ANTEVERSION
15 DISLOCATION RATE IN SAFE ZONE VERSUS 61 OUTSIDE ZONE
50 HIPS NOT IN SAFE ZONE
The John Charnley Award Risk Factors for Cup Malpositioning Quality Improvement Through a Joint Registry at a Tertiary Hospital
Mark C Callanan MA Bryan Jarrett BS Charles R Bragdon PhD David Zurakowski PhD Harry E Rubash MD Andrew A Freiberg MD Henrik Malchau MD PhD
THA-INSTABILITY
DIGIOIA 1998
ldquoIMPROVEMENTS IN ACETABULAR CUP ORIENTATION WILL IMPROVE OUCOMES AND REDUCE COSTSrdquo
IMPROVED CUP POSITION----LESS INSTABILITY---LESS REVISON---LESS COSTS
HAS THIS BEEN PROVEN
MORE ACCURATE WITH NAV
Total Hip Arthroplasty Using Imageless Computer-Assisted Hip Navigation A Prospective Randomized Study
Richard Lass MDa Bernd Kubista MDa Boris Olischar MDa Sophie Frantalb Reinhard Windhager MDa Alexander Giurea MDa
However in our prospective randomized study we could not detect a significant difference in clinical results and revision rates comparing the navigation and conventional implantation-technique at a short-term follow-up period (range 015ndash35 years) This is the major limitation of our study
ROBOTS IMPROVE ACCURACY
A comparison between robotic-assisted and manual implantation of cementlesstotal hip arthroplasty (Article)
Nakamura Na Sugano Nb Nishii Tb Kakimoto Aa Miki Hb
ROBOTS IMPROVE ACCURACY
Comparison of robotic-assisted and conventional acetabular cup placement in THA A matched-pair controlled study hip (Article)
Domb BGabc El Bitar YFa Sadik AYa Stake CEab Botser IBa
THA INSTABILITY
BULLE J OF ARTHROPLASTY 2012
PATIENT SPECIFIC INSTRUMENTATION(PSI)
PSI HAD SIGNIFICANT IMPROVEMENT IN PLANNED POSITION VERSUS FREEHAND
POSTERIOR APPROACH
NO DIFF IN OUTCOMES
PSI IMPROVES ACCURACY
Comparison of Acetabular Shell Position Using Patient Specific Instruments vs Standard Surgical Instruments A Randomized Clinical Trial
Travis Small DO Viktor Krebs MD Robert Molloy MD Jason Bryan MS Alison K Klika MS Wael K Barsoum MD
THA-INSTABILITY
ALL THE TECHNOLOGIES IMPROVE ACCURACY
NO IMPROVEMENT OF OUTCOMES
WHY
THA-INTABILITY
POSITION OF PROSTHESIS IS A STATICMEASUREMENT
INSTABILITY IS INFLUENCED BY SOFT TISSUE TENSION
INSTABILITY MAY BE DYNAMICmdashIMPINGEMENT
TECHNOLOGY DOES NOT EVALUATE THIS
CAN YOUR ROBOTNAV DO THIS
DAA(w Xray) VS NAV(POST)
Acetabular Component Positioning in Primary THA via an Anterior Posterolateral or Posterolateral-navigated Surgical Technique
Denis Nam MD Peter K Sculco MD Edwin P Su MD Michael M Alexiades MD Mark P Figgie MD David J Mayman MD
NAV(POST) better than DAA(w xray)
DAA did not have as much anteversion as NAV
Matta et al---061
Siguier et al----096
Unger 2006-2014 03 none in last 500 cases
DAA- LESS DISLOCATION
THA-NO TECHNOLOGY NEEDED
PAGANO 2009
RECENT META-ANALYSISIMPROVED CUP POSITION BUT NO IMPROVEMENT IN OUTCOMES
ldquoIN 2008 THE OBJECTIVE DATA FOR COMPUTER NAV IS LACKING THE CONSENSUS IS ALSO LACKING AS FEW SURGEONS ACTUALLY USE NAV FOR THArdquo
THA-NO TECHNOLOGY NEEDED
ldquoWE ARE NOW ENTERING THE 2ND DECADE OF CLINICAL USE OF THE NAV SYSTEMS AND WE STILL HAVE NOT FOUND THE EVIDENCE OF A CLINICAL BENEFITrdquo
ldquoNAV ALSO DEMONSTRATES A NUMBER OF UNFAVORABLE ISSUES INCREASED SURG TIME(INFECTION) HIGHER COSTS SPECIFIC COMPLICATIONSrdquo
THA-LL
ldquoPARAMONT GOAL OF THA IS IMPLANT FIXATION AND HIP STABILITYrdquo
BUT AVOID LL DISCREPANCY
THA--LL
LL DISCREP COMMON AFTER THA
MINIMIZE LL DISCREPANCY CRUCIAL TO THA SUCCESS
LL DISCREP IS 2ND MOST COMMON SOURCE OF LITIGATION
THAmdashLL
MOST PTS WITH LL DISCREP IMPROVE WITH TIME
PT AND CHIROPRACTORS DRAW ATTENTION AND NEED TO BE EDUCATED
HIP SOCIETY STUDY 05 TO 7 LL PERSIST
TX SHOE LIFT(UP TO 95MM) PT AND IN SEVERE CASES REVISION
THA--LL
frac34 OF PREOP PTS HAVE SHORTEN LIMB
THA LENGTHENS LIMB AVG 25-62 MM
GENERALLY lt 1CM LL DISCREP IS ACCEPTABLE
CAN TECHNOLOGY IMPROVE LL DISCREPANCY AFTER THA
THA--LL
CAN TECHNOLGY HELP
LL DISCREPANCY DIVIDED INTO TWO CATAGORIES
A STRUCTURAL
B FUNCTIONAL
THA-LL
STRUCTURAL ACTUAL DIFFERENCE IN OSSEOUS STRUCTURES
FUNCTIONAL POSTORAL ASSYMETRY RESULTING FROM SOFT TISSUE CONTRACTURES----PELVIC OBLIQUITY
THA--LL
TECHNOLOGY
MAY IMPROVE STRUCURAL ASPECT OF LL
IT WILL NOT ASSESS FUNCTIONAL ASPECTS OF LL
THAmdashLL
INTRAOPERATIVE ASSESSMENTS
STRUCTURAL(TECHNOLOGY) IMAGING COMPUTERS ROBOTS
FUNCTIONAL(NO TECHNOLOGY NEEDED) SHUCK TEST DROPKICK TEST LEG TO LEG COMPARISION
DAA REDUCES LL DISCREPANCY
PT is SUPINEmdashrdquoFEEL THE MALLEOLI ldquo
LL CAN BE EASILY ASSESSED
FUNCTIONAL ASSESSMENT EASY
XRAY CONFIRMATION IF NECESSARY
THA-NO TECHNOLOGY NEEDED
IAN LEARMONTH ldquoTHA AND THE LAW OF DIMINISHING RETURNSrdquo JBJS 2006
THA ADVANCESFIXATIONBEARINGSMIS
LAW OF DIMINISHING RETURNS APPLIES AS PRODUCT IMPROVES A EXPONENTIALLY GREATER INVESTMENT IS NEEDED TO IMPROVE TECHNOLOGY
THAmdashNO TECHNOLOGY NEEDED
LEARMONTH 2006
ldquoCAN WE AFFORD A SUBSTANCIAL INVESTMENT FOR AN ALREADY VERY SUCCESSFUL PROCEDURErdquo
ldquoA GREATER BENEFIT MAY ACCRUE FROM RESEARCH IN ORTHOBIOLOGIS TISSUE ENGINEERING AND GENE THERAPYrdquo
THA-NO TECHNOLOGY NEEDED
PROFESSION IS BEING PUSHED BY OUTSIDE FORCES
MEDIA
PATIENTS
INDUSTRY
SURGEON DESIGNERS
THAmdashNO TECHNOLOGY NEEDED
CONCLUSIONS
NEW TECHNOLOGY HAS NOT PROVEN ITSELF TO IMPROVE OUTCOMES FURTHER INVESTMENT MUST BE ANALYSED IN LIEU OF THIS FACT AS WELL AS THE OPPORTUNITY TO ENHANCE OUTCOMES THROUGH OTHER MEANS
NEW TECHONOLGY SHOULD BE ADVOCATED CAREFULLY AT THIS TIME
THANK YOU
THAmdashWHY DO THEY FAIL
INFECTION
INSTABILITY
LOOSENING
LL DISCREPANCY
THA-PROBLEMS THAT TECHNOLOGY ADDRESSES
INFECTION---NO
INSTABILITYmdashMAYBE
LOOSENINGmdashNO
LL DISCREPANCY--MAYBE
THA-INSTABILITY
DISLOCATION RATE AVG 39(US MEDICARE POPULATION)
225 OF REVISION SURGERY IS FOR INSTABILITY
BOZIC JBJS 2009
THA-INSTABILITY
LEWINNEK JBJS 1978
CLASSIC CUP POSITION 30-50 ABD 5-25 ANTEVERSION
15 DISLOCATION RATE IN SAFE ZONE VERSUS 61 OUTSIDE ZONE
50 HIPS NOT IN SAFE ZONE
The John Charnley Award Risk Factors for Cup Malpositioning Quality Improvement Through a Joint Registry at a Tertiary Hospital
Mark C Callanan MA Bryan Jarrett BS Charles R Bragdon PhD David Zurakowski PhD Harry E Rubash MD Andrew A Freiberg MD Henrik Malchau MD PhD
THA-INSTABILITY
DIGIOIA 1998
ldquoIMPROVEMENTS IN ACETABULAR CUP ORIENTATION WILL IMPROVE OUCOMES AND REDUCE COSTSrdquo
IMPROVED CUP POSITION----LESS INSTABILITY---LESS REVISON---LESS COSTS
HAS THIS BEEN PROVEN
MORE ACCURATE WITH NAV
Total Hip Arthroplasty Using Imageless Computer-Assisted Hip Navigation A Prospective Randomized Study
Richard Lass MDa Bernd Kubista MDa Boris Olischar MDa Sophie Frantalb Reinhard Windhager MDa Alexander Giurea MDa
However in our prospective randomized study we could not detect a significant difference in clinical results and revision rates comparing the navigation and conventional implantation-technique at a short-term follow-up period (range 015ndash35 years) This is the major limitation of our study
ROBOTS IMPROVE ACCURACY
A comparison between robotic-assisted and manual implantation of cementlesstotal hip arthroplasty (Article)
Nakamura Na Sugano Nb Nishii Tb Kakimoto Aa Miki Hb
ROBOTS IMPROVE ACCURACY
Comparison of robotic-assisted and conventional acetabular cup placement in THA A matched-pair controlled study hip (Article)
Domb BGabc El Bitar YFa Sadik AYa Stake CEab Botser IBa
THA INSTABILITY
BULLE J OF ARTHROPLASTY 2012
PATIENT SPECIFIC INSTRUMENTATION(PSI)
PSI HAD SIGNIFICANT IMPROVEMENT IN PLANNED POSITION VERSUS FREEHAND
POSTERIOR APPROACH
NO DIFF IN OUTCOMES
PSI IMPROVES ACCURACY
Comparison of Acetabular Shell Position Using Patient Specific Instruments vs Standard Surgical Instruments A Randomized Clinical Trial
Travis Small DO Viktor Krebs MD Robert Molloy MD Jason Bryan MS Alison K Klika MS Wael K Barsoum MD
THA-INSTABILITY
ALL THE TECHNOLOGIES IMPROVE ACCURACY
NO IMPROVEMENT OF OUTCOMES
WHY
THA-INTABILITY
POSITION OF PROSTHESIS IS A STATICMEASUREMENT
INSTABILITY IS INFLUENCED BY SOFT TISSUE TENSION
INSTABILITY MAY BE DYNAMICmdashIMPINGEMENT
TECHNOLOGY DOES NOT EVALUATE THIS
CAN YOUR ROBOTNAV DO THIS
DAA(w Xray) VS NAV(POST)
Acetabular Component Positioning in Primary THA via an Anterior Posterolateral or Posterolateral-navigated Surgical Technique
Denis Nam MD Peter K Sculco MD Edwin P Su MD Michael M Alexiades MD Mark P Figgie MD David J Mayman MD
NAV(POST) better than DAA(w xray)
DAA did not have as much anteversion as NAV
Matta et al---061
Siguier et al----096
Unger 2006-2014 03 none in last 500 cases
DAA- LESS DISLOCATION
THA-NO TECHNOLOGY NEEDED
PAGANO 2009
RECENT META-ANALYSISIMPROVED CUP POSITION BUT NO IMPROVEMENT IN OUTCOMES
ldquoIN 2008 THE OBJECTIVE DATA FOR COMPUTER NAV IS LACKING THE CONSENSUS IS ALSO LACKING AS FEW SURGEONS ACTUALLY USE NAV FOR THArdquo
THA-NO TECHNOLOGY NEEDED
ldquoWE ARE NOW ENTERING THE 2ND DECADE OF CLINICAL USE OF THE NAV SYSTEMS AND WE STILL HAVE NOT FOUND THE EVIDENCE OF A CLINICAL BENEFITrdquo
ldquoNAV ALSO DEMONSTRATES A NUMBER OF UNFAVORABLE ISSUES INCREASED SURG TIME(INFECTION) HIGHER COSTS SPECIFIC COMPLICATIONSrdquo
THA-LL
ldquoPARAMONT GOAL OF THA IS IMPLANT FIXATION AND HIP STABILITYrdquo
BUT AVOID LL DISCREPANCY
THA--LL
LL DISCREP COMMON AFTER THA
MINIMIZE LL DISCREPANCY CRUCIAL TO THA SUCCESS
LL DISCREP IS 2ND MOST COMMON SOURCE OF LITIGATION
THAmdashLL
MOST PTS WITH LL DISCREP IMPROVE WITH TIME
PT AND CHIROPRACTORS DRAW ATTENTION AND NEED TO BE EDUCATED
HIP SOCIETY STUDY 05 TO 7 LL PERSIST
TX SHOE LIFT(UP TO 95MM) PT AND IN SEVERE CASES REVISION
THA--LL
frac34 OF PREOP PTS HAVE SHORTEN LIMB
THA LENGTHENS LIMB AVG 25-62 MM
GENERALLY lt 1CM LL DISCREP IS ACCEPTABLE
CAN TECHNOLOGY IMPROVE LL DISCREPANCY AFTER THA
THA--LL
CAN TECHNOLGY HELP
LL DISCREPANCY DIVIDED INTO TWO CATAGORIES
A STRUCTURAL
B FUNCTIONAL
THA-LL
STRUCTURAL ACTUAL DIFFERENCE IN OSSEOUS STRUCTURES
FUNCTIONAL POSTORAL ASSYMETRY RESULTING FROM SOFT TISSUE CONTRACTURES----PELVIC OBLIQUITY
THA--LL
TECHNOLOGY
MAY IMPROVE STRUCURAL ASPECT OF LL
IT WILL NOT ASSESS FUNCTIONAL ASPECTS OF LL
THAmdashLL
INTRAOPERATIVE ASSESSMENTS
STRUCTURAL(TECHNOLOGY) IMAGING COMPUTERS ROBOTS
FUNCTIONAL(NO TECHNOLOGY NEEDED) SHUCK TEST DROPKICK TEST LEG TO LEG COMPARISION
DAA REDUCES LL DISCREPANCY
PT is SUPINEmdashrdquoFEEL THE MALLEOLI ldquo
LL CAN BE EASILY ASSESSED
FUNCTIONAL ASSESSMENT EASY
XRAY CONFIRMATION IF NECESSARY
THA-NO TECHNOLOGY NEEDED
IAN LEARMONTH ldquoTHA AND THE LAW OF DIMINISHING RETURNSrdquo JBJS 2006
THA ADVANCESFIXATIONBEARINGSMIS
LAW OF DIMINISHING RETURNS APPLIES AS PRODUCT IMPROVES A EXPONENTIALLY GREATER INVESTMENT IS NEEDED TO IMPROVE TECHNOLOGY
THAmdashNO TECHNOLOGY NEEDED
LEARMONTH 2006
ldquoCAN WE AFFORD A SUBSTANCIAL INVESTMENT FOR AN ALREADY VERY SUCCESSFUL PROCEDURErdquo
ldquoA GREATER BENEFIT MAY ACCRUE FROM RESEARCH IN ORTHOBIOLOGIS TISSUE ENGINEERING AND GENE THERAPYrdquo
THA-NO TECHNOLOGY NEEDED
PROFESSION IS BEING PUSHED BY OUTSIDE FORCES
MEDIA
PATIENTS
INDUSTRY
SURGEON DESIGNERS
THAmdashNO TECHNOLOGY NEEDED
CONCLUSIONS
NEW TECHNOLOGY HAS NOT PROVEN ITSELF TO IMPROVE OUTCOMES FURTHER INVESTMENT MUST BE ANALYSED IN LIEU OF THIS FACT AS WELL AS THE OPPORTUNITY TO ENHANCE OUTCOMES THROUGH OTHER MEANS
NEW TECHONOLGY SHOULD BE ADVOCATED CAREFULLY AT THIS TIME
THANK YOU
THA-PROBLEMS THAT TECHNOLOGY ADDRESSES
INFECTION---NO
INSTABILITYmdashMAYBE
LOOSENINGmdashNO
LL DISCREPANCY--MAYBE
THA-INSTABILITY
DISLOCATION RATE AVG 39(US MEDICARE POPULATION)
225 OF REVISION SURGERY IS FOR INSTABILITY
BOZIC JBJS 2009
THA-INSTABILITY
LEWINNEK JBJS 1978
CLASSIC CUP POSITION 30-50 ABD 5-25 ANTEVERSION
15 DISLOCATION RATE IN SAFE ZONE VERSUS 61 OUTSIDE ZONE
50 HIPS NOT IN SAFE ZONE
The John Charnley Award Risk Factors for Cup Malpositioning Quality Improvement Through a Joint Registry at a Tertiary Hospital
Mark C Callanan MA Bryan Jarrett BS Charles R Bragdon PhD David Zurakowski PhD Harry E Rubash MD Andrew A Freiberg MD Henrik Malchau MD PhD
THA-INSTABILITY
DIGIOIA 1998
ldquoIMPROVEMENTS IN ACETABULAR CUP ORIENTATION WILL IMPROVE OUCOMES AND REDUCE COSTSrdquo
IMPROVED CUP POSITION----LESS INSTABILITY---LESS REVISON---LESS COSTS
HAS THIS BEEN PROVEN
MORE ACCURATE WITH NAV
Total Hip Arthroplasty Using Imageless Computer-Assisted Hip Navigation A Prospective Randomized Study
Richard Lass MDa Bernd Kubista MDa Boris Olischar MDa Sophie Frantalb Reinhard Windhager MDa Alexander Giurea MDa
However in our prospective randomized study we could not detect a significant difference in clinical results and revision rates comparing the navigation and conventional implantation-technique at a short-term follow-up period (range 015ndash35 years) This is the major limitation of our study
ROBOTS IMPROVE ACCURACY
A comparison between robotic-assisted and manual implantation of cementlesstotal hip arthroplasty (Article)
Nakamura Na Sugano Nb Nishii Tb Kakimoto Aa Miki Hb
ROBOTS IMPROVE ACCURACY
Comparison of robotic-assisted and conventional acetabular cup placement in THA A matched-pair controlled study hip (Article)
Domb BGabc El Bitar YFa Sadik AYa Stake CEab Botser IBa
THA INSTABILITY
BULLE J OF ARTHROPLASTY 2012
PATIENT SPECIFIC INSTRUMENTATION(PSI)
PSI HAD SIGNIFICANT IMPROVEMENT IN PLANNED POSITION VERSUS FREEHAND
POSTERIOR APPROACH
NO DIFF IN OUTCOMES
PSI IMPROVES ACCURACY
Comparison of Acetabular Shell Position Using Patient Specific Instruments vs Standard Surgical Instruments A Randomized Clinical Trial
Travis Small DO Viktor Krebs MD Robert Molloy MD Jason Bryan MS Alison K Klika MS Wael K Barsoum MD
THA-INSTABILITY
ALL THE TECHNOLOGIES IMPROVE ACCURACY
NO IMPROVEMENT OF OUTCOMES
WHY
THA-INTABILITY
POSITION OF PROSTHESIS IS A STATICMEASUREMENT
INSTABILITY IS INFLUENCED BY SOFT TISSUE TENSION
INSTABILITY MAY BE DYNAMICmdashIMPINGEMENT
TECHNOLOGY DOES NOT EVALUATE THIS
CAN YOUR ROBOTNAV DO THIS
DAA(w Xray) VS NAV(POST)
Acetabular Component Positioning in Primary THA via an Anterior Posterolateral or Posterolateral-navigated Surgical Technique
Denis Nam MD Peter K Sculco MD Edwin P Su MD Michael M Alexiades MD Mark P Figgie MD David J Mayman MD
NAV(POST) better than DAA(w xray)
DAA did not have as much anteversion as NAV
Matta et al---061
Siguier et al----096
Unger 2006-2014 03 none in last 500 cases
DAA- LESS DISLOCATION
THA-NO TECHNOLOGY NEEDED
PAGANO 2009
RECENT META-ANALYSISIMPROVED CUP POSITION BUT NO IMPROVEMENT IN OUTCOMES
ldquoIN 2008 THE OBJECTIVE DATA FOR COMPUTER NAV IS LACKING THE CONSENSUS IS ALSO LACKING AS FEW SURGEONS ACTUALLY USE NAV FOR THArdquo
THA-NO TECHNOLOGY NEEDED
ldquoWE ARE NOW ENTERING THE 2ND DECADE OF CLINICAL USE OF THE NAV SYSTEMS AND WE STILL HAVE NOT FOUND THE EVIDENCE OF A CLINICAL BENEFITrdquo
ldquoNAV ALSO DEMONSTRATES A NUMBER OF UNFAVORABLE ISSUES INCREASED SURG TIME(INFECTION) HIGHER COSTS SPECIFIC COMPLICATIONSrdquo
THA-LL
ldquoPARAMONT GOAL OF THA IS IMPLANT FIXATION AND HIP STABILITYrdquo
BUT AVOID LL DISCREPANCY
THA--LL
LL DISCREP COMMON AFTER THA
MINIMIZE LL DISCREPANCY CRUCIAL TO THA SUCCESS
LL DISCREP IS 2ND MOST COMMON SOURCE OF LITIGATION
THAmdashLL
MOST PTS WITH LL DISCREP IMPROVE WITH TIME
PT AND CHIROPRACTORS DRAW ATTENTION AND NEED TO BE EDUCATED
HIP SOCIETY STUDY 05 TO 7 LL PERSIST
TX SHOE LIFT(UP TO 95MM) PT AND IN SEVERE CASES REVISION
THA--LL
frac34 OF PREOP PTS HAVE SHORTEN LIMB
THA LENGTHENS LIMB AVG 25-62 MM
GENERALLY lt 1CM LL DISCREP IS ACCEPTABLE
CAN TECHNOLOGY IMPROVE LL DISCREPANCY AFTER THA
THA--LL
CAN TECHNOLGY HELP
LL DISCREPANCY DIVIDED INTO TWO CATAGORIES
A STRUCTURAL
B FUNCTIONAL
THA-LL
STRUCTURAL ACTUAL DIFFERENCE IN OSSEOUS STRUCTURES
FUNCTIONAL POSTORAL ASSYMETRY RESULTING FROM SOFT TISSUE CONTRACTURES----PELVIC OBLIQUITY
THA--LL
TECHNOLOGY
MAY IMPROVE STRUCURAL ASPECT OF LL
IT WILL NOT ASSESS FUNCTIONAL ASPECTS OF LL
THAmdashLL
INTRAOPERATIVE ASSESSMENTS
STRUCTURAL(TECHNOLOGY) IMAGING COMPUTERS ROBOTS
FUNCTIONAL(NO TECHNOLOGY NEEDED) SHUCK TEST DROPKICK TEST LEG TO LEG COMPARISION
DAA REDUCES LL DISCREPANCY
PT is SUPINEmdashrdquoFEEL THE MALLEOLI ldquo
LL CAN BE EASILY ASSESSED
FUNCTIONAL ASSESSMENT EASY
XRAY CONFIRMATION IF NECESSARY
THA-NO TECHNOLOGY NEEDED
IAN LEARMONTH ldquoTHA AND THE LAW OF DIMINISHING RETURNSrdquo JBJS 2006
THA ADVANCESFIXATIONBEARINGSMIS
LAW OF DIMINISHING RETURNS APPLIES AS PRODUCT IMPROVES A EXPONENTIALLY GREATER INVESTMENT IS NEEDED TO IMPROVE TECHNOLOGY
THAmdashNO TECHNOLOGY NEEDED
LEARMONTH 2006
ldquoCAN WE AFFORD A SUBSTANCIAL INVESTMENT FOR AN ALREADY VERY SUCCESSFUL PROCEDURErdquo
ldquoA GREATER BENEFIT MAY ACCRUE FROM RESEARCH IN ORTHOBIOLOGIS TISSUE ENGINEERING AND GENE THERAPYrdquo
THA-NO TECHNOLOGY NEEDED
PROFESSION IS BEING PUSHED BY OUTSIDE FORCES
MEDIA
PATIENTS
INDUSTRY
SURGEON DESIGNERS
THAmdashNO TECHNOLOGY NEEDED
CONCLUSIONS
NEW TECHNOLOGY HAS NOT PROVEN ITSELF TO IMPROVE OUTCOMES FURTHER INVESTMENT MUST BE ANALYSED IN LIEU OF THIS FACT AS WELL AS THE OPPORTUNITY TO ENHANCE OUTCOMES THROUGH OTHER MEANS
NEW TECHONOLGY SHOULD BE ADVOCATED CAREFULLY AT THIS TIME
THANK YOU
THA-INSTABILITY
DISLOCATION RATE AVG 39(US MEDICARE POPULATION)
225 OF REVISION SURGERY IS FOR INSTABILITY
BOZIC JBJS 2009
THA-INSTABILITY
LEWINNEK JBJS 1978
CLASSIC CUP POSITION 30-50 ABD 5-25 ANTEVERSION
15 DISLOCATION RATE IN SAFE ZONE VERSUS 61 OUTSIDE ZONE
50 HIPS NOT IN SAFE ZONE
The John Charnley Award Risk Factors for Cup Malpositioning Quality Improvement Through a Joint Registry at a Tertiary Hospital
Mark C Callanan MA Bryan Jarrett BS Charles R Bragdon PhD David Zurakowski PhD Harry E Rubash MD Andrew A Freiberg MD Henrik Malchau MD PhD
THA-INSTABILITY
DIGIOIA 1998
ldquoIMPROVEMENTS IN ACETABULAR CUP ORIENTATION WILL IMPROVE OUCOMES AND REDUCE COSTSrdquo
IMPROVED CUP POSITION----LESS INSTABILITY---LESS REVISON---LESS COSTS
HAS THIS BEEN PROVEN
MORE ACCURATE WITH NAV
Total Hip Arthroplasty Using Imageless Computer-Assisted Hip Navigation A Prospective Randomized Study
Richard Lass MDa Bernd Kubista MDa Boris Olischar MDa Sophie Frantalb Reinhard Windhager MDa Alexander Giurea MDa
However in our prospective randomized study we could not detect a significant difference in clinical results and revision rates comparing the navigation and conventional implantation-technique at a short-term follow-up period (range 015ndash35 years) This is the major limitation of our study
ROBOTS IMPROVE ACCURACY
A comparison between robotic-assisted and manual implantation of cementlesstotal hip arthroplasty (Article)
Nakamura Na Sugano Nb Nishii Tb Kakimoto Aa Miki Hb
ROBOTS IMPROVE ACCURACY
Comparison of robotic-assisted and conventional acetabular cup placement in THA A matched-pair controlled study hip (Article)
Domb BGabc El Bitar YFa Sadik AYa Stake CEab Botser IBa
THA INSTABILITY
BULLE J OF ARTHROPLASTY 2012
PATIENT SPECIFIC INSTRUMENTATION(PSI)
PSI HAD SIGNIFICANT IMPROVEMENT IN PLANNED POSITION VERSUS FREEHAND
POSTERIOR APPROACH
NO DIFF IN OUTCOMES
PSI IMPROVES ACCURACY
Comparison of Acetabular Shell Position Using Patient Specific Instruments vs Standard Surgical Instruments A Randomized Clinical Trial
Travis Small DO Viktor Krebs MD Robert Molloy MD Jason Bryan MS Alison K Klika MS Wael K Barsoum MD
THA-INSTABILITY
ALL THE TECHNOLOGIES IMPROVE ACCURACY
NO IMPROVEMENT OF OUTCOMES
WHY
THA-INTABILITY
POSITION OF PROSTHESIS IS A STATICMEASUREMENT
INSTABILITY IS INFLUENCED BY SOFT TISSUE TENSION
INSTABILITY MAY BE DYNAMICmdashIMPINGEMENT
TECHNOLOGY DOES NOT EVALUATE THIS
CAN YOUR ROBOTNAV DO THIS
DAA(w Xray) VS NAV(POST)
Acetabular Component Positioning in Primary THA via an Anterior Posterolateral or Posterolateral-navigated Surgical Technique
Denis Nam MD Peter K Sculco MD Edwin P Su MD Michael M Alexiades MD Mark P Figgie MD David J Mayman MD
NAV(POST) better than DAA(w xray)
DAA did not have as much anteversion as NAV
Matta et al---061
Siguier et al----096
Unger 2006-2014 03 none in last 500 cases
DAA- LESS DISLOCATION
THA-NO TECHNOLOGY NEEDED
PAGANO 2009
RECENT META-ANALYSISIMPROVED CUP POSITION BUT NO IMPROVEMENT IN OUTCOMES
ldquoIN 2008 THE OBJECTIVE DATA FOR COMPUTER NAV IS LACKING THE CONSENSUS IS ALSO LACKING AS FEW SURGEONS ACTUALLY USE NAV FOR THArdquo
THA-NO TECHNOLOGY NEEDED
ldquoWE ARE NOW ENTERING THE 2ND DECADE OF CLINICAL USE OF THE NAV SYSTEMS AND WE STILL HAVE NOT FOUND THE EVIDENCE OF A CLINICAL BENEFITrdquo
ldquoNAV ALSO DEMONSTRATES A NUMBER OF UNFAVORABLE ISSUES INCREASED SURG TIME(INFECTION) HIGHER COSTS SPECIFIC COMPLICATIONSrdquo
THA-LL
ldquoPARAMONT GOAL OF THA IS IMPLANT FIXATION AND HIP STABILITYrdquo
BUT AVOID LL DISCREPANCY
THA--LL
LL DISCREP COMMON AFTER THA
MINIMIZE LL DISCREPANCY CRUCIAL TO THA SUCCESS
LL DISCREP IS 2ND MOST COMMON SOURCE OF LITIGATION
THAmdashLL
MOST PTS WITH LL DISCREP IMPROVE WITH TIME
PT AND CHIROPRACTORS DRAW ATTENTION AND NEED TO BE EDUCATED
HIP SOCIETY STUDY 05 TO 7 LL PERSIST
TX SHOE LIFT(UP TO 95MM) PT AND IN SEVERE CASES REVISION
THA--LL
frac34 OF PREOP PTS HAVE SHORTEN LIMB
THA LENGTHENS LIMB AVG 25-62 MM
GENERALLY lt 1CM LL DISCREP IS ACCEPTABLE
CAN TECHNOLOGY IMPROVE LL DISCREPANCY AFTER THA
THA--LL
CAN TECHNOLGY HELP
LL DISCREPANCY DIVIDED INTO TWO CATAGORIES
A STRUCTURAL
B FUNCTIONAL
THA-LL
STRUCTURAL ACTUAL DIFFERENCE IN OSSEOUS STRUCTURES
FUNCTIONAL POSTORAL ASSYMETRY RESULTING FROM SOFT TISSUE CONTRACTURES----PELVIC OBLIQUITY
THA--LL
TECHNOLOGY
MAY IMPROVE STRUCURAL ASPECT OF LL
IT WILL NOT ASSESS FUNCTIONAL ASPECTS OF LL
THAmdashLL
INTRAOPERATIVE ASSESSMENTS
STRUCTURAL(TECHNOLOGY) IMAGING COMPUTERS ROBOTS
FUNCTIONAL(NO TECHNOLOGY NEEDED) SHUCK TEST DROPKICK TEST LEG TO LEG COMPARISION
DAA REDUCES LL DISCREPANCY
PT is SUPINEmdashrdquoFEEL THE MALLEOLI ldquo
LL CAN BE EASILY ASSESSED
FUNCTIONAL ASSESSMENT EASY
XRAY CONFIRMATION IF NECESSARY
THA-NO TECHNOLOGY NEEDED
IAN LEARMONTH ldquoTHA AND THE LAW OF DIMINISHING RETURNSrdquo JBJS 2006
THA ADVANCESFIXATIONBEARINGSMIS
LAW OF DIMINISHING RETURNS APPLIES AS PRODUCT IMPROVES A EXPONENTIALLY GREATER INVESTMENT IS NEEDED TO IMPROVE TECHNOLOGY
THAmdashNO TECHNOLOGY NEEDED
LEARMONTH 2006
ldquoCAN WE AFFORD A SUBSTANCIAL INVESTMENT FOR AN ALREADY VERY SUCCESSFUL PROCEDURErdquo
ldquoA GREATER BENEFIT MAY ACCRUE FROM RESEARCH IN ORTHOBIOLOGIS TISSUE ENGINEERING AND GENE THERAPYrdquo
THA-NO TECHNOLOGY NEEDED
PROFESSION IS BEING PUSHED BY OUTSIDE FORCES
MEDIA
PATIENTS
INDUSTRY
SURGEON DESIGNERS
THAmdashNO TECHNOLOGY NEEDED
CONCLUSIONS
NEW TECHNOLOGY HAS NOT PROVEN ITSELF TO IMPROVE OUTCOMES FURTHER INVESTMENT MUST BE ANALYSED IN LIEU OF THIS FACT AS WELL AS THE OPPORTUNITY TO ENHANCE OUTCOMES THROUGH OTHER MEANS
NEW TECHONOLGY SHOULD BE ADVOCATED CAREFULLY AT THIS TIME
THANK YOU
THA-INSTABILITY
LEWINNEK JBJS 1978
CLASSIC CUP POSITION 30-50 ABD 5-25 ANTEVERSION
15 DISLOCATION RATE IN SAFE ZONE VERSUS 61 OUTSIDE ZONE
50 HIPS NOT IN SAFE ZONE
The John Charnley Award Risk Factors for Cup Malpositioning Quality Improvement Through a Joint Registry at a Tertiary Hospital
Mark C Callanan MA Bryan Jarrett BS Charles R Bragdon PhD David Zurakowski PhD Harry E Rubash MD Andrew A Freiberg MD Henrik Malchau MD PhD
THA-INSTABILITY
DIGIOIA 1998
ldquoIMPROVEMENTS IN ACETABULAR CUP ORIENTATION WILL IMPROVE OUCOMES AND REDUCE COSTSrdquo
IMPROVED CUP POSITION----LESS INSTABILITY---LESS REVISON---LESS COSTS
HAS THIS BEEN PROVEN
MORE ACCURATE WITH NAV
Total Hip Arthroplasty Using Imageless Computer-Assisted Hip Navigation A Prospective Randomized Study
Richard Lass MDa Bernd Kubista MDa Boris Olischar MDa Sophie Frantalb Reinhard Windhager MDa Alexander Giurea MDa
However in our prospective randomized study we could not detect a significant difference in clinical results and revision rates comparing the navigation and conventional implantation-technique at a short-term follow-up period (range 015ndash35 years) This is the major limitation of our study
ROBOTS IMPROVE ACCURACY
A comparison between robotic-assisted and manual implantation of cementlesstotal hip arthroplasty (Article)
Nakamura Na Sugano Nb Nishii Tb Kakimoto Aa Miki Hb
ROBOTS IMPROVE ACCURACY
Comparison of robotic-assisted and conventional acetabular cup placement in THA A matched-pair controlled study hip (Article)
Domb BGabc El Bitar YFa Sadik AYa Stake CEab Botser IBa
THA INSTABILITY
BULLE J OF ARTHROPLASTY 2012
PATIENT SPECIFIC INSTRUMENTATION(PSI)
PSI HAD SIGNIFICANT IMPROVEMENT IN PLANNED POSITION VERSUS FREEHAND
POSTERIOR APPROACH
NO DIFF IN OUTCOMES
PSI IMPROVES ACCURACY
Comparison of Acetabular Shell Position Using Patient Specific Instruments vs Standard Surgical Instruments A Randomized Clinical Trial
Travis Small DO Viktor Krebs MD Robert Molloy MD Jason Bryan MS Alison K Klika MS Wael K Barsoum MD
THA-INSTABILITY
ALL THE TECHNOLOGIES IMPROVE ACCURACY
NO IMPROVEMENT OF OUTCOMES
WHY
THA-INTABILITY
POSITION OF PROSTHESIS IS A STATICMEASUREMENT
INSTABILITY IS INFLUENCED BY SOFT TISSUE TENSION
INSTABILITY MAY BE DYNAMICmdashIMPINGEMENT
TECHNOLOGY DOES NOT EVALUATE THIS
CAN YOUR ROBOTNAV DO THIS
DAA(w Xray) VS NAV(POST)
Acetabular Component Positioning in Primary THA via an Anterior Posterolateral or Posterolateral-navigated Surgical Technique
Denis Nam MD Peter K Sculco MD Edwin P Su MD Michael M Alexiades MD Mark P Figgie MD David J Mayman MD
NAV(POST) better than DAA(w xray)
DAA did not have as much anteversion as NAV
Matta et al---061
Siguier et al----096
Unger 2006-2014 03 none in last 500 cases
DAA- LESS DISLOCATION
THA-NO TECHNOLOGY NEEDED
PAGANO 2009
RECENT META-ANALYSISIMPROVED CUP POSITION BUT NO IMPROVEMENT IN OUTCOMES
ldquoIN 2008 THE OBJECTIVE DATA FOR COMPUTER NAV IS LACKING THE CONSENSUS IS ALSO LACKING AS FEW SURGEONS ACTUALLY USE NAV FOR THArdquo
THA-NO TECHNOLOGY NEEDED
ldquoWE ARE NOW ENTERING THE 2ND DECADE OF CLINICAL USE OF THE NAV SYSTEMS AND WE STILL HAVE NOT FOUND THE EVIDENCE OF A CLINICAL BENEFITrdquo
ldquoNAV ALSO DEMONSTRATES A NUMBER OF UNFAVORABLE ISSUES INCREASED SURG TIME(INFECTION) HIGHER COSTS SPECIFIC COMPLICATIONSrdquo
THA-LL
ldquoPARAMONT GOAL OF THA IS IMPLANT FIXATION AND HIP STABILITYrdquo
BUT AVOID LL DISCREPANCY
THA--LL
LL DISCREP COMMON AFTER THA
MINIMIZE LL DISCREPANCY CRUCIAL TO THA SUCCESS
LL DISCREP IS 2ND MOST COMMON SOURCE OF LITIGATION
THAmdashLL
MOST PTS WITH LL DISCREP IMPROVE WITH TIME
PT AND CHIROPRACTORS DRAW ATTENTION AND NEED TO BE EDUCATED
HIP SOCIETY STUDY 05 TO 7 LL PERSIST
TX SHOE LIFT(UP TO 95MM) PT AND IN SEVERE CASES REVISION
THA--LL
frac34 OF PREOP PTS HAVE SHORTEN LIMB
THA LENGTHENS LIMB AVG 25-62 MM
GENERALLY lt 1CM LL DISCREP IS ACCEPTABLE
CAN TECHNOLOGY IMPROVE LL DISCREPANCY AFTER THA
THA--LL
CAN TECHNOLGY HELP
LL DISCREPANCY DIVIDED INTO TWO CATAGORIES
A STRUCTURAL
B FUNCTIONAL
THA-LL
STRUCTURAL ACTUAL DIFFERENCE IN OSSEOUS STRUCTURES
FUNCTIONAL POSTORAL ASSYMETRY RESULTING FROM SOFT TISSUE CONTRACTURES----PELVIC OBLIQUITY
THA--LL
TECHNOLOGY
MAY IMPROVE STRUCURAL ASPECT OF LL
IT WILL NOT ASSESS FUNCTIONAL ASPECTS OF LL
THAmdashLL
INTRAOPERATIVE ASSESSMENTS
STRUCTURAL(TECHNOLOGY) IMAGING COMPUTERS ROBOTS
FUNCTIONAL(NO TECHNOLOGY NEEDED) SHUCK TEST DROPKICK TEST LEG TO LEG COMPARISION
DAA REDUCES LL DISCREPANCY
PT is SUPINEmdashrdquoFEEL THE MALLEOLI ldquo
LL CAN BE EASILY ASSESSED
FUNCTIONAL ASSESSMENT EASY
XRAY CONFIRMATION IF NECESSARY
THA-NO TECHNOLOGY NEEDED
IAN LEARMONTH ldquoTHA AND THE LAW OF DIMINISHING RETURNSrdquo JBJS 2006
THA ADVANCESFIXATIONBEARINGSMIS
LAW OF DIMINISHING RETURNS APPLIES AS PRODUCT IMPROVES A EXPONENTIALLY GREATER INVESTMENT IS NEEDED TO IMPROVE TECHNOLOGY
THAmdashNO TECHNOLOGY NEEDED
LEARMONTH 2006
ldquoCAN WE AFFORD A SUBSTANCIAL INVESTMENT FOR AN ALREADY VERY SUCCESSFUL PROCEDURErdquo
ldquoA GREATER BENEFIT MAY ACCRUE FROM RESEARCH IN ORTHOBIOLOGIS TISSUE ENGINEERING AND GENE THERAPYrdquo
THA-NO TECHNOLOGY NEEDED
PROFESSION IS BEING PUSHED BY OUTSIDE FORCES
MEDIA
PATIENTS
INDUSTRY
SURGEON DESIGNERS
THAmdashNO TECHNOLOGY NEEDED
CONCLUSIONS
NEW TECHNOLOGY HAS NOT PROVEN ITSELF TO IMPROVE OUTCOMES FURTHER INVESTMENT MUST BE ANALYSED IN LIEU OF THIS FACT AS WELL AS THE OPPORTUNITY TO ENHANCE OUTCOMES THROUGH OTHER MEANS
NEW TECHONOLGY SHOULD BE ADVOCATED CAREFULLY AT THIS TIME
THANK YOU
50 HIPS NOT IN SAFE ZONE
The John Charnley Award Risk Factors for Cup Malpositioning Quality Improvement Through a Joint Registry at a Tertiary Hospital
Mark C Callanan MA Bryan Jarrett BS Charles R Bragdon PhD David Zurakowski PhD Harry E Rubash MD Andrew A Freiberg MD Henrik Malchau MD PhD
THA-INSTABILITY
DIGIOIA 1998
ldquoIMPROVEMENTS IN ACETABULAR CUP ORIENTATION WILL IMPROVE OUCOMES AND REDUCE COSTSrdquo
IMPROVED CUP POSITION----LESS INSTABILITY---LESS REVISON---LESS COSTS
HAS THIS BEEN PROVEN
MORE ACCURATE WITH NAV
Total Hip Arthroplasty Using Imageless Computer-Assisted Hip Navigation A Prospective Randomized Study
Richard Lass MDa Bernd Kubista MDa Boris Olischar MDa Sophie Frantalb Reinhard Windhager MDa Alexander Giurea MDa
However in our prospective randomized study we could not detect a significant difference in clinical results and revision rates comparing the navigation and conventional implantation-technique at a short-term follow-up period (range 015ndash35 years) This is the major limitation of our study
ROBOTS IMPROVE ACCURACY
A comparison between robotic-assisted and manual implantation of cementlesstotal hip arthroplasty (Article)
Nakamura Na Sugano Nb Nishii Tb Kakimoto Aa Miki Hb
ROBOTS IMPROVE ACCURACY
Comparison of robotic-assisted and conventional acetabular cup placement in THA A matched-pair controlled study hip (Article)
Domb BGabc El Bitar YFa Sadik AYa Stake CEab Botser IBa
THA INSTABILITY
BULLE J OF ARTHROPLASTY 2012
PATIENT SPECIFIC INSTRUMENTATION(PSI)
PSI HAD SIGNIFICANT IMPROVEMENT IN PLANNED POSITION VERSUS FREEHAND
POSTERIOR APPROACH
NO DIFF IN OUTCOMES
PSI IMPROVES ACCURACY
Comparison of Acetabular Shell Position Using Patient Specific Instruments vs Standard Surgical Instruments A Randomized Clinical Trial
Travis Small DO Viktor Krebs MD Robert Molloy MD Jason Bryan MS Alison K Klika MS Wael K Barsoum MD
THA-INSTABILITY
ALL THE TECHNOLOGIES IMPROVE ACCURACY
NO IMPROVEMENT OF OUTCOMES
WHY
THA-INTABILITY
POSITION OF PROSTHESIS IS A STATICMEASUREMENT
INSTABILITY IS INFLUENCED BY SOFT TISSUE TENSION
INSTABILITY MAY BE DYNAMICmdashIMPINGEMENT
TECHNOLOGY DOES NOT EVALUATE THIS
CAN YOUR ROBOTNAV DO THIS
DAA(w Xray) VS NAV(POST)
Acetabular Component Positioning in Primary THA via an Anterior Posterolateral or Posterolateral-navigated Surgical Technique
Denis Nam MD Peter K Sculco MD Edwin P Su MD Michael M Alexiades MD Mark P Figgie MD David J Mayman MD
NAV(POST) better than DAA(w xray)
DAA did not have as much anteversion as NAV
Matta et al---061
Siguier et al----096
Unger 2006-2014 03 none in last 500 cases
DAA- LESS DISLOCATION
THA-NO TECHNOLOGY NEEDED
PAGANO 2009
RECENT META-ANALYSISIMPROVED CUP POSITION BUT NO IMPROVEMENT IN OUTCOMES
ldquoIN 2008 THE OBJECTIVE DATA FOR COMPUTER NAV IS LACKING THE CONSENSUS IS ALSO LACKING AS FEW SURGEONS ACTUALLY USE NAV FOR THArdquo
THA-NO TECHNOLOGY NEEDED
ldquoWE ARE NOW ENTERING THE 2ND DECADE OF CLINICAL USE OF THE NAV SYSTEMS AND WE STILL HAVE NOT FOUND THE EVIDENCE OF A CLINICAL BENEFITrdquo
ldquoNAV ALSO DEMONSTRATES A NUMBER OF UNFAVORABLE ISSUES INCREASED SURG TIME(INFECTION) HIGHER COSTS SPECIFIC COMPLICATIONSrdquo
THA-LL
ldquoPARAMONT GOAL OF THA IS IMPLANT FIXATION AND HIP STABILITYrdquo
BUT AVOID LL DISCREPANCY
THA--LL
LL DISCREP COMMON AFTER THA
MINIMIZE LL DISCREPANCY CRUCIAL TO THA SUCCESS
LL DISCREP IS 2ND MOST COMMON SOURCE OF LITIGATION
THAmdashLL
MOST PTS WITH LL DISCREP IMPROVE WITH TIME
PT AND CHIROPRACTORS DRAW ATTENTION AND NEED TO BE EDUCATED
HIP SOCIETY STUDY 05 TO 7 LL PERSIST
TX SHOE LIFT(UP TO 95MM) PT AND IN SEVERE CASES REVISION
THA--LL
frac34 OF PREOP PTS HAVE SHORTEN LIMB
THA LENGTHENS LIMB AVG 25-62 MM
GENERALLY lt 1CM LL DISCREP IS ACCEPTABLE
CAN TECHNOLOGY IMPROVE LL DISCREPANCY AFTER THA
THA--LL
CAN TECHNOLGY HELP
LL DISCREPANCY DIVIDED INTO TWO CATAGORIES
A STRUCTURAL
B FUNCTIONAL
THA-LL
STRUCTURAL ACTUAL DIFFERENCE IN OSSEOUS STRUCTURES
FUNCTIONAL POSTORAL ASSYMETRY RESULTING FROM SOFT TISSUE CONTRACTURES----PELVIC OBLIQUITY
THA--LL
TECHNOLOGY
MAY IMPROVE STRUCURAL ASPECT OF LL
IT WILL NOT ASSESS FUNCTIONAL ASPECTS OF LL
THAmdashLL
INTRAOPERATIVE ASSESSMENTS
STRUCTURAL(TECHNOLOGY) IMAGING COMPUTERS ROBOTS
FUNCTIONAL(NO TECHNOLOGY NEEDED) SHUCK TEST DROPKICK TEST LEG TO LEG COMPARISION
DAA REDUCES LL DISCREPANCY
PT is SUPINEmdashrdquoFEEL THE MALLEOLI ldquo
LL CAN BE EASILY ASSESSED
FUNCTIONAL ASSESSMENT EASY
XRAY CONFIRMATION IF NECESSARY
THA-NO TECHNOLOGY NEEDED
IAN LEARMONTH ldquoTHA AND THE LAW OF DIMINISHING RETURNSrdquo JBJS 2006
THA ADVANCESFIXATIONBEARINGSMIS
LAW OF DIMINISHING RETURNS APPLIES AS PRODUCT IMPROVES A EXPONENTIALLY GREATER INVESTMENT IS NEEDED TO IMPROVE TECHNOLOGY
THAmdashNO TECHNOLOGY NEEDED
LEARMONTH 2006
ldquoCAN WE AFFORD A SUBSTANCIAL INVESTMENT FOR AN ALREADY VERY SUCCESSFUL PROCEDURErdquo
ldquoA GREATER BENEFIT MAY ACCRUE FROM RESEARCH IN ORTHOBIOLOGIS TISSUE ENGINEERING AND GENE THERAPYrdquo
THA-NO TECHNOLOGY NEEDED
PROFESSION IS BEING PUSHED BY OUTSIDE FORCES
MEDIA
PATIENTS
INDUSTRY
SURGEON DESIGNERS
THAmdashNO TECHNOLOGY NEEDED
CONCLUSIONS
NEW TECHNOLOGY HAS NOT PROVEN ITSELF TO IMPROVE OUTCOMES FURTHER INVESTMENT MUST BE ANALYSED IN LIEU OF THIS FACT AS WELL AS THE OPPORTUNITY TO ENHANCE OUTCOMES THROUGH OTHER MEANS
NEW TECHONOLGY SHOULD BE ADVOCATED CAREFULLY AT THIS TIME
THANK YOU
THA-INSTABILITY
DIGIOIA 1998
ldquoIMPROVEMENTS IN ACETABULAR CUP ORIENTATION WILL IMPROVE OUCOMES AND REDUCE COSTSrdquo
IMPROVED CUP POSITION----LESS INSTABILITY---LESS REVISON---LESS COSTS
HAS THIS BEEN PROVEN
MORE ACCURATE WITH NAV
Total Hip Arthroplasty Using Imageless Computer-Assisted Hip Navigation A Prospective Randomized Study
Richard Lass MDa Bernd Kubista MDa Boris Olischar MDa Sophie Frantalb Reinhard Windhager MDa Alexander Giurea MDa
However in our prospective randomized study we could not detect a significant difference in clinical results and revision rates comparing the navigation and conventional implantation-technique at a short-term follow-up period (range 015ndash35 years) This is the major limitation of our study
ROBOTS IMPROVE ACCURACY
A comparison between robotic-assisted and manual implantation of cementlesstotal hip arthroplasty (Article)
Nakamura Na Sugano Nb Nishii Tb Kakimoto Aa Miki Hb
ROBOTS IMPROVE ACCURACY
Comparison of robotic-assisted and conventional acetabular cup placement in THA A matched-pair controlled study hip (Article)
Domb BGabc El Bitar YFa Sadik AYa Stake CEab Botser IBa
THA INSTABILITY
BULLE J OF ARTHROPLASTY 2012
PATIENT SPECIFIC INSTRUMENTATION(PSI)
PSI HAD SIGNIFICANT IMPROVEMENT IN PLANNED POSITION VERSUS FREEHAND
POSTERIOR APPROACH
NO DIFF IN OUTCOMES
PSI IMPROVES ACCURACY
Comparison of Acetabular Shell Position Using Patient Specific Instruments vs Standard Surgical Instruments A Randomized Clinical Trial
Travis Small DO Viktor Krebs MD Robert Molloy MD Jason Bryan MS Alison K Klika MS Wael K Barsoum MD
THA-INSTABILITY
ALL THE TECHNOLOGIES IMPROVE ACCURACY
NO IMPROVEMENT OF OUTCOMES
WHY
THA-INTABILITY
POSITION OF PROSTHESIS IS A STATICMEASUREMENT
INSTABILITY IS INFLUENCED BY SOFT TISSUE TENSION
INSTABILITY MAY BE DYNAMICmdashIMPINGEMENT
TECHNOLOGY DOES NOT EVALUATE THIS
CAN YOUR ROBOTNAV DO THIS
DAA(w Xray) VS NAV(POST)
Acetabular Component Positioning in Primary THA via an Anterior Posterolateral or Posterolateral-navigated Surgical Technique
Denis Nam MD Peter K Sculco MD Edwin P Su MD Michael M Alexiades MD Mark P Figgie MD David J Mayman MD
NAV(POST) better than DAA(w xray)
DAA did not have as much anteversion as NAV
Matta et al---061
Siguier et al----096
Unger 2006-2014 03 none in last 500 cases
DAA- LESS DISLOCATION
THA-NO TECHNOLOGY NEEDED
PAGANO 2009
RECENT META-ANALYSISIMPROVED CUP POSITION BUT NO IMPROVEMENT IN OUTCOMES
ldquoIN 2008 THE OBJECTIVE DATA FOR COMPUTER NAV IS LACKING THE CONSENSUS IS ALSO LACKING AS FEW SURGEONS ACTUALLY USE NAV FOR THArdquo
THA-NO TECHNOLOGY NEEDED
ldquoWE ARE NOW ENTERING THE 2ND DECADE OF CLINICAL USE OF THE NAV SYSTEMS AND WE STILL HAVE NOT FOUND THE EVIDENCE OF A CLINICAL BENEFITrdquo
ldquoNAV ALSO DEMONSTRATES A NUMBER OF UNFAVORABLE ISSUES INCREASED SURG TIME(INFECTION) HIGHER COSTS SPECIFIC COMPLICATIONSrdquo
THA-LL
ldquoPARAMONT GOAL OF THA IS IMPLANT FIXATION AND HIP STABILITYrdquo
BUT AVOID LL DISCREPANCY
THA--LL
LL DISCREP COMMON AFTER THA
MINIMIZE LL DISCREPANCY CRUCIAL TO THA SUCCESS
LL DISCREP IS 2ND MOST COMMON SOURCE OF LITIGATION
THAmdashLL
MOST PTS WITH LL DISCREP IMPROVE WITH TIME
PT AND CHIROPRACTORS DRAW ATTENTION AND NEED TO BE EDUCATED
HIP SOCIETY STUDY 05 TO 7 LL PERSIST
TX SHOE LIFT(UP TO 95MM) PT AND IN SEVERE CASES REVISION
THA--LL
frac34 OF PREOP PTS HAVE SHORTEN LIMB
THA LENGTHENS LIMB AVG 25-62 MM
GENERALLY lt 1CM LL DISCREP IS ACCEPTABLE
CAN TECHNOLOGY IMPROVE LL DISCREPANCY AFTER THA
THA--LL
CAN TECHNOLGY HELP
LL DISCREPANCY DIVIDED INTO TWO CATAGORIES
A STRUCTURAL
B FUNCTIONAL
THA-LL
STRUCTURAL ACTUAL DIFFERENCE IN OSSEOUS STRUCTURES
FUNCTIONAL POSTORAL ASSYMETRY RESULTING FROM SOFT TISSUE CONTRACTURES----PELVIC OBLIQUITY
THA--LL
TECHNOLOGY
MAY IMPROVE STRUCURAL ASPECT OF LL
IT WILL NOT ASSESS FUNCTIONAL ASPECTS OF LL
THAmdashLL
INTRAOPERATIVE ASSESSMENTS
STRUCTURAL(TECHNOLOGY) IMAGING COMPUTERS ROBOTS
FUNCTIONAL(NO TECHNOLOGY NEEDED) SHUCK TEST DROPKICK TEST LEG TO LEG COMPARISION
DAA REDUCES LL DISCREPANCY
PT is SUPINEmdashrdquoFEEL THE MALLEOLI ldquo
LL CAN BE EASILY ASSESSED
FUNCTIONAL ASSESSMENT EASY
XRAY CONFIRMATION IF NECESSARY
THA-NO TECHNOLOGY NEEDED
IAN LEARMONTH ldquoTHA AND THE LAW OF DIMINISHING RETURNSrdquo JBJS 2006
THA ADVANCESFIXATIONBEARINGSMIS
LAW OF DIMINISHING RETURNS APPLIES AS PRODUCT IMPROVES A EXPONENTIALLY GREATER INVESTMENT IS NEEDED TO IMPROVE TECHNOLOGY
THAmdashNO TECHNOLOGY NEEDED
LEARMONTH 2006
ldquoCAN WE AFFORD A SUBSTANCIAL INVESTMENT FOR AN ALREADY VERY SUCCESSFUL PROCEDURErdquo
ldquoA GREATER BENEFIT MAY ACCRUE FROM RESEARCH IN ORTHOBIOLOGIS TISSUE ENGINEERING AND GENE THERAPYrdquo
THA-NO TECHNOLOGY NEEDED
PROFESSION IS BEING PUSHED BY OUTSIDE FORCES
MEDIA
PATIENTS
INDUSTRY
SURGEON DESIGNERS
THAmdashNO TECHNOLOGY NEEDED
CONCLUSIONS
NEW TECHNOLOGY HAS NOT PROVEN ITSELF TO IMPROVE OUTCOMES FURTHER INVESTMENT MUST BE ANALYSED IN LIEU OF THIS FACT AS WELL AS THE OPPORTUNITY TO ENHANCE OUTCOMES THROUGH OTHER MEANS
NEW TECHONOLGY SHOULD BE ADVOCATED CAREFULLY AT THIS TIME
THANK YOU
MORE ACCURATE WITH NAV
Total Hip Arthroplasty Using Imageless Computer-Assisted Hip Navigation A Prospective Randomized Study
Richard Lass MDa Bernd Kubista MDa Boris Olischar MDa Sophie Frantalb Reinhard Windhager MDa Alexander Giurea MDa
However in our prospective randomized study we could not detect a significant difference in clinical results and revision rates comparing the navigation and conventional implantation-technique at a short-term follow-up period (range 015ndash35 years) This is the major limitation of our study
ROBOTS IMPROVE ACCURACY
A comparison between robotic-assisted and manual implantation of cementlesstotal hip arthroplasty (Article)
Nakamura Na Sugano Nb Nishii Tb Kakimoto Aa Miki Hb
ROBOTS IMPROVE ACCURACY
Comparison of robotic-assisted and conventional acetabular cup placement in THA A matched-pair controlled study hip (Article)
Domb BGabc El Bitar YFa Sadik AYa Stake CEab Botser IBa
THA INSTABILITY
BULLE J OF ARTHROPLASTY 2012
PATIENT SPECIFIC INSTRUMENTATION(PSI)
PSI HAD SIGNIFICANT IMPROVEMENT IN PLANNED POSITION VERSUS FREEHAND
POSTERIOR APPROACH
NO DIFF IN OUTCOMES
PSI IMPROVES ACCURACY
Comparison of Acetabular Shell Position Using Patient Specific Instruments vs Standard Surgical Instruments A Randomized Clinical Trial
Travis Small DO Viktor Krebs MD Robert Molloy MD Jason Bryan MS Alison K Klika MS Wael K Barsoum MD
THA-INSTABILITY
ALL THE TECHNOLOGIES IMPROVE ACCURACY
NO IMPROVEMENT OF OUTCOMES
WHY
THA-INTABILITY
POSITION OF PROSTHESIS IS A STATICMEASUREMENT
INSTABILITY IS INFLUENCED BY SOFT TISSUE TENSION
INSTABILITY MAY BE DYNAMICmdashIMPINGEMENT
TECHNOLOGY DOES NOT EVALUATE THIS
CAN YOUR ROBOTNAV DO THIS
DAA(w Xray) VS NAV(POST)
Acetabular Component Positioning in Primary THA via an Anterior Posterolateral or Posterolateral-navigated Surgical Technique
Denis Nam MD Peter K Sculco MD Edwin P Su MD Michael M Alexiades MD Mark P Figgie MD David J Mayman MD
NAV(POST) better than DAA(w xray)
DAA did not have as much anteversion as NAV
Matta et al---061
Siguier et al----096
Unger 2006-2014 03 none in last 500 cases
DAA- LESS DISLOCATION
THA-NO TECHNOLOGY NEEDED
PAGANO 2009
RECENT META-ANALYSISIMPROVED CUP POSITION BUT NO IMPROVEMENT IN OUTCOMES
ldquoIN 2008 THE OBJECTIVE DATA FOR COMPUTER NAV IS LACKING THE CONSENSUS IS ALSO LACKING AS FEW SURGEONS ACTUALLY USE NAV FOR THArdquo
THA-NO TECHNOLOGY NEEDED
ldquoWE ARE NOW ENTERING THE 2ND DECADE OF CLINICAL USE OF THE NAV SYSTEMS AND WE STILL HAVE NOT FOUND THE EVIDENCE OF A CLINICAL BENEFITrdquo
ldquoNAV ALSO DEMONSTRATES A NUMBER OF UNFAVORABLE ISSUES INCREASED SURG TIME(INFECTION) HIGHER COSTS SPECIFIC COMPLICATIONSrdquo
THA-LL
ldquoPARAMONT GOAL OF THA IS IMPLANT FIXATION AND HIP STABILITYrdquo
BUT AVOID LL DISCREPANCY
THA--LL
LL DISCREP COMMON AFTER THA
MINIMIZE LL DISCREPANCY CRUCIAL TO THA SUCCESS
LL DISCREP IS 2ND MOST COMMON SOURCE OF LITIGATION
THAmdashLL
MOST PTS WITH LL DISCREP IMPROVE WITH TIME
PT AND CHIROPRACTORS DRAW ATTENTION AND NEED TO BE EDUCATED
HIP SOCIETY STUDY 05 TO 7 LL PERSIST
TX SHOE LIFT(UP TO 95MM) PT AND IN SEVERE CASES REVISION
THA--LL
frac34 OF PREOP PTS HAVE SHORTEN LIMB
THA LENGTHENS LIMB AVG 25-62 MM
GENERALLY lt 1CM LL DISCREP IS ACCEPTABLE
CAN TECHNOLOGY IMPROVE LL DISCREPANCY AFTER THA
THA--LL
CAN TECHNOLGY HELP
LL DISCREPANCY DIVIDED INTO TWO CATAGORIES
A STRUCTURAL
B FUNCTIONAL
THA-LL
STRUCTURAL ACTUAL DIFFERENCE IN OSSEOUS STRUCTURES
FUNCTIONAL POSTORAL ASSYMETRY RESULTING FROM SOFT TISSUE CONTRACTURES----PELVIC OBLIQUITY
THA--LL
TECHNOLOGY
MAY IMPROVE STRUCURAL ASPECT OF LL
IT WILL NOT ASSESS FUNCTIONAL ASPECTS OF LL
THAmdashLL
INTRAOPERATIVE ASSESSMENTS
STRUCTURAL(TECHNOLOGY) IMAGING COMPUTERS ROBOTS
FUNCTIONAL(NO TECHNOLOGY NEEDED) SHUCK TEST DROPKICK TEST LEG TO LEG COMPARISION
DAA REDUCES LL DISCREPANCY
PT is SUPINEmdashrdquoFEEL THE MALLEOLI ldquo
LL CAN BE EASILY ASSESSED
FUNCTIONAL ASSESSMENT EASY
XRAY CONFIRMATION IF NECESSARY
THA-NO TECHNOLOGY NEEDED
IAN LEARMONTH ldquoTHA AND THE LAW OF DIMINISHING RETURNSrdquo JBJS 2006
THA ADVANCESFIXATIONBEARINGSMIS
LAW OF DIMINISHING RETURNS APPLIES AS PRODUCT IMPROVES A EXPONENTIALLY GREATER INVESTMENT IS NEEDED TO IMPROVE TECHNOLOGY
THAmdashNO TECHNOLOGY NEEDED
LEARMONTH 2006
ldquoCAN WE AFFORD A SUBSTANCIAL INVESTMENT FOR AN ALREADY VERY SUCCESSFUL PROCEDURErdquo
ldquoA GREATER BENEFIT MAY ACCRUE FROM RESEARCH IN ORTHOBIOLOGIS TISSUE ENGINEERING AND GENE THERAPYrdquo
THA-NO TECHNOLOGY NEEDED
PROFESSION IS BEING PUSHED BY OUTSIDE FORCES
MEDIA
PATIENTS
INDUSTRY
SURGEON DESIGNERS
THAmdashNO TECHNOLOGY NEEDED
CONCLUSIONS
NEW TECHNOLOGY HAS NOT PROVEN ITSELF TO IMPROVE OUTCOMES FURTHER INVESTMENT MUST BE ANALYSED IN LIEU OF THIS FACT AS WELL AS THE OPPORTUNITY TO ENHANCE OUTCOMES THROUGH OTHER MEANS
NEW TECHONOLGY SHOULD BE ADVOCATED CAREFULLY AT THIS TIME
THANK YOU
However in our prospective randomized study we could not detect a significant difference in clinical results and revision rates comparing the navigation and conventional implantation-technique at a short-term follow-up period (range 015ndash35 years) This is the major limitation of our study
ROBOTS IMPROVE ACCURACY
A comparison between robotic-assisted and manual implantation of cementlesstotal hip arthroplasty (Article)
Nakamura Na Sugano Nb Nishii Tb Kakimoto Aa Miki Hb
ROBOTS IMPROVE ACCURACY
Comparison of robotic-assisted and conventional acetabular cup placement in THA A matched-pair controlled study hip (Article)
Domb BGabc El Bitar YFa Sadik AYa Stake CEab Botser IBa
THA INSTABILITY
BULLE J OF ARTHROPLASTY 2012
PATIENT SPECIFIC INSTRUMENTATION(PSI)
PSI HAD SIGNIFICANT IMPROVEMENT IN PLANNED POSITION VERSUS FREEHAND
POSTERIOR APPROACH
NO DIFF IN OUTCOMES
PSI IMPROVES ACCURACY
Comparison of Acetabular Shell Position Using Patient Specific Instruments vs Standard Surgical Instruments A Randomized Clinical Trial
Travis Small DO Viktor Krebs MD Robert Molloy MD Jason Bryan MS Alison K Klika MS Wael K Barsoum MD
THA-INSTABILITY
ALL THE TECHNOLOGIES IMPROVE ACCURACY
NO IMPROVEMENT OF OUTCOMES
WHY
THA-INTABILITY
POSITION OF PROSTHESIS IS A STATICMEASUREMENT
INSTABILITY IS INFLUENCED BY SOFT TISSUE TENSION
INSTABILITY MAY BE DYNAMICmdashIMPINGEMENT
TECHNOLOGY DOES NOT EVALUATE THIS
CAN YOUR ROBOTNAV DO THIS
DAA(w Xray) VS NAV(POST)
Acetabular Component Positioning in Primary THA via an Anterior Posterolateral or Posterolateral-navigated Surgical Technique
Denis Nam MD Peter K Sculco MD Edwin P Su MD Michael M Alexiades MD Mark P Figgie MD David J Mayman MD
NAV(POST) better than DAA(w xray)
DAA did not have as much anteversion as NAV
Matta et al---061
Siguier et al----096
Unger 2006-2014 03 none in last 500 cases
DAA- LESS DISLOCATION
THA-NO TECHNOLOGY NEEDED
PAGANO 2009
RECENT META-ANALYSISIMPROVED CUP POSITION BUT NO IMPROVEMENT IN OUTCOMES
ldquoIN 2008 THE OBJECTIVE DATA FOR COMPUTER NAV IS LACKING THE CONSENSUS IS ALSO LACKING AS FEW SURGEONS ACTUALLY USE NAV FOR THArdquo
THA-NO TECHNOLOGY NEEDED
ldquoWE ARE NOW ENTERING THE 2ND DECADE OF CLINICAL USE OF THE NAV SYSTEMS AND WE STILL HAVE NOT FOUND THE EVIDENCE OF A CLINICAL BENEFITrdquo
ldquoNAV ALSO DEMONSTRATES A NUMBER OF UNFAVORABLE ISSUES INCREASED SURG TIME(INFECTION) HIGHER COSTS SPECIFIC COMPLICATIONSrdquo
THA-LL
ldquoPARAMONT GOAL OF THA IS IMPLANT FIXATION AND HIP STABILITYrdquo
BUT AVOID LL DISCREPANCY
THA--LL
LL DISCREP COMMON AFTER THA
MINIMIZE LL DISCREPANCY CRUCIAL TO THA SUCCESS
LL DISCREP IS 2ND MOST COMMON SOURCE OF LITIGATION
THAmdashLL
MOST PTS WITH LL DISCREP IMPROVE WITH TIME
PT AND CHIROPRACTORS DRAW ATTENTION AND NEED TO BE EDUCATED
HIP SOCIETY STUDY 05 TO 7 LL PERSIST
TX SHOE LIFT(UP TO 95MM) PT AND IN SEVERE CASES REVISION
THA--LL
frac34 OF PREOP PTS HAVE SHORTEN LIMB
THA LENGTHENS LIMB AVG 25-62 MM
GENERALLY lt 1CM LL DISCREP IS ACCEPTABLE
CAN TECHNOLOGY IMPROVE LL DISCREPANCY AFTER THA
THA--LL
CAN TECHNOLGY HELP
LL DISCREPANCY DIVIDED INTO TWO CATAGORIES
A STRUCTURAL
B FUNCTIONAL
THA-LL
STRUCTURAL ACTUAL DIFFERENCE IN OSSEOUS STRUCTURES
FUNCTIONAL POSTORAL ASSYMETRY RESULTING FROM SOFT TISSUE CONTRACTURES----PELVIC OBLIQUITY
THA--LL
TECHNOLOGY
MAY IMPROVE STRUCURAL ASPECT OF LL
IT WILL NOT ASSESS FUNCTIONAL ASPECTS OF LL
THAmdashLL
INTRAOPERATIVE ASSESSMENTS
STRUCTURAL(TECHNOLOGY) IMAGING COMPUTERS ROBOTS
FUNCTIONAL(NO TECHNOLOGY NEEDED) SHUCK TEST DROPKICK TEST LEG TO LEG COMPARISION
DAA REDUCES LL DISCREPANCY
PT is SUPINEmdashrdquoFEEL THE MALLEOLI ldquo
LL CAN BE EASILY ASSESSED
FUNCTIONAL ASSESSMENT EASY
XRAY CONFIRMATION IF NECESSARY
THA-NO TECHNOLOGY NEEDED
IAN LEARMONTH ldquoTHA AND THE LAW OF DIMINISHING RETURNSrdquo JBJS 2006
THA ADVANCESFIXATIONBEARINGSMIS
LAW OF DIMINISHING RETURNS APPLIES AS PRODUCT IMPROVES A EXPONENTIALLY GREATER INVESTMENT IS NEEDED TO IMPROVE TECHNOLOGY
THAmdashNO TECHNOLOGY NEEDED
LEARMONTH 2006
ldquoCAN WE AFFORD A SUBSTANCIAL INVESTMENT FOR AN ALREADY VERY SUCCESSFUL PROCEDURErdquo
ldquoA GREATER BENEFIT MAY ACCRUE FROM RESEARCH IN ORTHOBIOLOGIS TISSUE ENGINEERING AND GENE THERAPYrdquo
THA-NO TECHNOLOGY NEEDED
PROFESSION IS BEING PUSHED BY OUTSIDE FORCES
MEDIA
PATIENTS
INDUSTRY
SURGEON DESIGNERS
THAmdashNO TECHNOLOGY NEEDED
CONCLUSIONS
NEW TECHNOLOGY HAS NOT PROVEN ITSELF TO IMPROVE OUTCOMES FURTHER INVESTMENT MUST BE ANALYSED IN LIEU OF THIS FACT AS WELL AS THE OPPORTUNITY TO ENHANCE OUTCOMES THROUGH OTHER MEANS
NEW TECHONOLGY SHOULD BE ADVOCATED CAREFULLY AT THIS TIME
THANK YOU
ROBOTS IMPROVE ACCURACY
A comparison between robotic-assisted and manual implantation of cementlesstotal hip arthroplasty (Article)
Nakamura Na Sugano Nb Nishii Tb Kakimoto Aa Miki Hb
ROBOTS IMPROVE ACCURACY
Comparison of robotic-assisted and conventional acetabular cup placement in THA A matched-pair controlled study hip (Article)
Domb BGabc El Bitar YFa Sadik AYa Stake CEab Botser IBa
THA INSTABILITY
BULLE J OF ARTHROPLASTY 2012
PATIENT SPECIFIC INSTRUMENTATION(PSI)
PSI HAD SIGNIFICANT IMPROVEMENT IN PLANNED POSITION VERSUS FREEHAND
POSTERIOR APPROACH
NO DIFF IN OUTCOMES
PSI IMPROVES ACCURACY
Comparison of Acetabular Shell Position Using Patient Specific Instruments vs Standard Surgical Instruments A Randomized Clinical Trial
Travis Small DO Viktor Krebs MD Robert Molloy MD Jason Bryan MS Alison K Klika MS Wael K Barsoum MD
THA-INSTABILITY
ALL THE TECHNOLOGIES IMPROVE ACCURACY
NO IMPROVEMENT OF OUTCOMES
WHY
THA-INTABILITY
POSITION OF PROSTHESIS IS A STATICMEASUREMENT
INSTABILITY IS INFLUENCED BY SOFT TISSUE TENSION
INSTABILITY MAY BE DYNAMICmdashIMPINGEMENT
TECHNOLOGY DOES NOT EVALUATE THIS
CAN YOUR ROBOTNAV DO THIS
DAA(w Xray) VS NAV(POST)
Acetabular Component Positioning in Primary THA via an Anterior Posterolateral or Posterolateral-navigated Surgical Technique
Denis Nam MD Peter K Sculco MD Edwin P Su MD Michael M Alexiades MD Mark P Figgie MD David J Mayman MD
NAV(POST) better than DAA(w xray)
DAA did not have as much anteversion as NAV
Matta et al---061
Siguier et al----096
Unger 2006-2014 03 none in last 500 cases
DAA- LESS DISLOCATION
THA-NO TECHNOLOGY NEEDED
PAGANO 2009
RECENT META-ANALYSISIMPROVED CUP POSITION BUT NO IMPROVEMENT IN OUTCOMES
ldquoIN 2008 THE OBJECTIVE DATA FOR COMPUTER NAV IS LACKING THE CONSENSUS IS ALSO LACKING AS FEW SURGEONS ACTUALLY USE NAV FOR THArdquo
THA-NO TECHNOLOGY NEEDED
ldquoWE ARE NOW ENTERING THE 2ND DECADE OF CLINICAL USE OF THE NAV SYSTEMS AND WE STILL HAVE NOT FOUND THE EVIDENCE OF A CLINICAL BENEFITrdquo
ldquoNAV ALSO DEMONSTRATES A NUMBER OF UNFAVORABLE ISSUES INCREASED SURG TIME(INFECTION) HIGHER COSTS SPECIFIC COMPLICATIONSrdquo
THA-LL
ldquoPARAMONT GOAL OF THA IS IMPLANT FIXATION AND HIP STABILITYrdquo
BUT AVOID LL DISCREPANCY
THA--LL
LL DISCREP COMMON AFTER THA
MINIMIZE LL DISCREPANCY CRUCIAL TO THA SUCCESS
LL DISCREP IS 2ND MOST COMMON SOURCE OF LITIGATION
THAmdashLL
MOST PTS WITH LL DISCREP IMPROVE WITH TIME
PT AND CHIROPRACTORS DRAW ATTENTION AND NEED TO BE EDUCATED
HIP SOCIETY STUDY 05 TO 7 LL PERSIST
TX SHOE LIFT(UP TO 95MM) PT AND IN SEVERE CASES REVISION
THA--LL
frac34 OF PREOP PTS HAVE SHORTEN LIMB
THA LENGTHENS LIMB AVG 25-62 MM
GENERALLY lt 1CM LL DISCREP IS ACCEPTABLE
CAN TECHNOLOGY IMPROVE LL DISCREPANCY AFTER THA
THA--LL
CAN TECHNOLGY HELP
LL DISCREPANCY DIVIDED INTO TWO CATAGORIES
A STRUCTURAL
B FUNCTIONAL
THA-LL
STRUCTURAL ACTUAL DIFFERENCE IN OSSEOUS STRUCTURES
FUNCTIONAL POSTORAL ASSYMETRY RESULTING FROM SOFT TISSUE CONTRACTURES----PELVIC OBLIQUITY
THA--LL
TECHNOLOGY
MAY IMPROVE STRUCURAL ASPECT OF LL
IT WILL NOT ASSESS FUNCTIONAL ASPECTS OF LL
THAmdashLL
INTRAOPERATIVE ASSESSMENTS
STRUCTURAL(TECHNOLOGY) IMAGING COMPUTERS ROBOTS
FUNCTIONAL(NO TECHNOLOGY NEEDED) SHUCK TEST DROPKICK TEST LEG TO LEG COMPARISION
DAA REDUCES LL DISCREPANCY
PT is SUPINEmdashrdquoFEEL THE MALLEOLI ldquo
LL CAN BE EASILY ASSESSED
FUNCTIONAL ASSESSMENT EASY
XRAY CONFIRMATION IF NECESSARY
THA-NO TECHNOLOGY NEEDED
IAN LEARMONTH ldquoTHA AND THE LAW OF DIMINISHING RETURNSrdquo JBJS 2006
THA ADVANCESFIXATIONBEARINGSMIS
LAW OF DIMINISHING RETURNS APPLIES AS PRODUCT IMPROVES A EXPONENTIALLY GREATER INVESTMENT IS NEEDED TO IMPROVE TECHNOLOGY
THAmdashNO TECHNOLOGY NEEDED
LEARMONTH 2006
ldquoCAN WE AFFORD A SUBSTANCIAL INVESTMENT FOR AN ALREADY VERY SUCCESSFUL PROCEDURErdquo
ldquoA GREATER BENEFIT MAY ACCRUE FROM RESEARCH IN ORTHOBIOLOGIS TISSUE ENGINEERING AND GENE THERAPYrdquo
THA-NO TECHNOLOGY NEEDED
PROFESSION IS BEING PUSHED BY OUTSIDE FORCES
MEDIA
PATIENTS
INDUSTRY
SURGEON DESIGNERS
THAmdashNO TECHNOLOGY NEEDED
CONCLUSIONS
NEW TECHNOLOGY HAS NOT PROVEN ITSELF TO IMPROVE OUTCOMES FURTHER INVESTMENT MUST BE ANALYSED IN LIEU OF THIS FACT AS WELL AS THE OPPORTUNITY TO ENHANCE OUTCOMES THROUGH OTHER MEANS
NEW TECHONOLGY SHOULD BE ADVOCATED CAREFULLY AT THIS TIME
THANK YOU
ROBOTS IMPROVE ACCURACY
Comparison of robotic-assisted and conventional acetabular cup placement in THA A matched-pair controlled study hip (Article)
Domb BGabc El Bitar YFa Sadik AYa Stake CEab Botser IBa
THA INSTABILITY
BULLE J OF ARTHROPLASTY 2012
PATIENT SPECIFIC INSTRUMENTATION(PSI)
PSI HAD SIGNIFICANT IMPROVEMENT IN PLANNED POSITION VERSUS FREEHAND
POSTERIOR APPROACH
NO DIFF IN OUTCOMES
PSI IMPROVES ACCURACY
Comparison of Acetabular Shell Position Using Patient Specific Instruments vs Standard Surgical Instruments A Randomized Clinical Trial
Travis Small DO Viktor Krebs MD Robert Molloy MD Jason Bryan MS Alison K Klika MS Wael K Barsoum MD
THA-INSTABILITY
ALL THE TECHNOLOGIES IMPROVE ACCURACY
NO IMPROVEMENT OF OUTCOMES
WHY
THA-INTABILITY
POSITION OF PROSTHESIS IS A STATICMEASUREMENT
INSTABILITY IS INFLUENCED BY SOFT TISSUE TENSION
INSTABILITY MAY BE DYNAMICmdashIMPINGEMENT
TECHNOLOGY DOES NOT EVALUATE THIS
CAN YOUR ROBOTNAV DO THIS
DAA(w Xray) VS NAV(POST)
Acetabular Component Positioning in Primary THA via an Anterior Posterolateral or Posterolateral-navigated Surgical Technique
Denis Nam MD Peter K Sculco MD Edwin P Su MD Michael M Alexiades MD Mark P Figgie MD David J Mayman MD
NAV(POST) better than DAA(w xray)
DAA did not have as much anteversion as NAV
Matta et al---061
Siguier et al----096
Unger 2006-2014 03 none in last 500 cases
DAA- LESS DISLOCATION
THA-NO TECHNOLOGY NEEDED
PAGANO 2009
RECENT META-ANALYSISIMPROVED CUP POSITION BUT NO IMPROVEMENT IN OUTCOMES
ldquoIN 2008 THE OBJECTIVE DATA FOR COMPUTER NAV IS LACKING THE CONSENSUS IS ALSO LACKING AS FEW SURGEONS ACTUALLY USE NAV FOR THArdquo
THA-NO TECHNOLOGY NEEDED
ldquoWE ARE NOW ENTERING THE 2ND DECADE OF CLINICAL USE OF THE NAV SYSTEMS AND WE STILL HAVE NOT FOUND THE EVIDENCE OF A CLINICAL BENEFITrdquo
ldquoNAV ALSO DEMONSTRATES A NUMBER OF UNFAVORABLE ISSUES INCREASED SURG TIME(INFECTION) HIGHER COSTS SPECIFIC COMPLICATIONSrdquo
THA-LL
ldquoPARAMONT GOAL OF THA IS IMPLANT FIXATION AND HIP STABILITYrdquo
BUT AVOID LL DISCREPANCY
THA--LL
LL DISCREP COMMON AFTER THA
MINIMIZE LL DISCREPANCY CRUCIAL TO THA SUCCESS
LL DISCREP IS 2ND MOST COMMON SOURCE OF LITIGATION
THAmdashLL
MOST PTS WITH LL DISCREP IMPROVE WITH TIME
PT AND CHIROPRACTORS DRAW ATTENTION AND NEED TO BE EDUCATED
HIP SOCIETY STUDY 05 TO 7 LL PERSIST
TX SHOE LIFT(UP TO 95MM) PT AND IN SEVERE CASES REVISION
THA--LL
frac34 OF PREOP PTS HAVE SHORTEN LIMB
THA LENGTHENS LIMB AVG 25-62 MM
GENERALLY lt 1CM LL DISCREP IS ACCEPTABLE
CAN TECHNOLOGY IMPROVE LL DISCREPANCY AFTER THA
THA--LL
CAN TECHNOLGY HELP
LL DISCREPANCY DIVIDED INTO TWO CATAGORIES
A STRUCTURAL
B FUNCTIONAL
THA-LL
STRUCTURAL ACTUAL DIFFERENCE IN OSSEOUS STRUCTURES
FUNCTIONAL POSTORAL ASSYMETRY RESULTING FROM SOFT TISSUE CONTRACTURES----PELVIC OBLIQUITY
THA--LL
TECHNOLOGY
MAY IMPROVE STRUCURAL ASPECT OF LL
IT WILL NOT ASSESS FUNCTIONAL ASPECTS OF LL
THAmdashLL
INTRAOPERATIVE ASSESSMENTS
STRUCTURAL(TECHNOLOGY) IMAGING COMPUTERS ROBOTS
FUNCTIONAL(NO TECHNOLOGY NEEDED) SHUCK TEST DROPKICK TEST LEG TO LEG COMPARISION
DAA REDUCES LL DISCREPANCY
PT is SUPINEmdashrdquoFEEL THE MALLEOLI ldquo
LL CAN BE EASILY ASSESSED
FUNCTIONAL ASSESSMENT EASY
XRAY CONFIRMATION IF NECESSARY
THA-NO TECHNOLOGY NEEDED
IAN LEARMONTH ldquoTHA AND THE LAW OF DIMINISHING RETURNSrdquo JBJS 2006
THA ADVANCESFIXATIONBEARINGSMIS
LAW OF DIMINISHING RETURNS APPLIES AS PRODUCT IMPROVES A EXPONENTIALLY GREATER INVESTMENT IS NEEDED TO IMPROVE TECHNOLOGY
THAmdashNO TECHNOLOGY NEEDED
LEARMONTH 2006
ldquoCAN WE AFFORD A SUBSTANCIAL INVESTMENT FOR AN ALREADY VERY SUCCESSFUL PROCEDURErdquo
ldquoA GREATER BENEFIT MAY ACCRUE FROM RESEARCH IN ORTHOBIOLOGIS TISSUE ENGINEERING AND GENE THERAPYrdquo
THA-NO TECHNOLOGY NEEDED
PROFESSION IS BEING PUSHED BY OUTSIDE FORCES
MEDIA
PATIENTS
INDUSTRY
SURGEON DESIGNERS
THAmdashNO TECHNOLOGY NEEDED
CONCLUSIONS
NEW TECHNOLOGY HAS NOT PROVEN ITSELF TO IMPROVE OUTCOMES FURTHER INVESTMENT MUST BE ANALYSED IN LIEU OF THIS FACT AS WELL AS THE OPPORTUNITY TO ENHANCE OUTCOMES THROUGH OTHER MEANS
NEW TECHONOLGY SHOULD BE ADVOCATED CAREFULLY AT THIS TIME
THANK YOU
THA INSTABILITY
BULLE J OF ARTHROPLASTY 2012
PATIENT SPECIFIC INSTRUMENTATION(PSI)
PSI HAD SIGNIFICANT IMPROVEMENT IN PLANNED POSITION VERSUS FREEHAND
POSTERIOR APPROACH
NO DIFF IN OUTCOMES
PSI IMPROVES ACCURACY
Comparison of Acetabular Shell Position Using Patient Specific Instruments vs Standard Surgical Instruments A Randomized Clinical Trial
Travis Small DO Viktor Krebs MD Robert Molloy MD Jason Bryan MS Alison K Klika MS Wael K Barsoum MD
THA-INSTABILITY
ALL THE TECHNOLOGIES IMPROVE ACCURACY
NO IMPROVEMENT OF OUTCOMES
WHY
THA-INTABILITY
POSITION OF PROSTHESIS IS A STATICMEASUREMENT
INSTABILITY IS INFLUENCED BY SOFT TISSUE TENSION
INSTABILITY MAY BE DYNAMICmdashIMPINGEMENT
TECHNOLOGY DOES NOT EVALUATE THIS
CAN YOUR ROBOTNAV DO THIS
DAA(w Xray) VS NAV(POST)
Acetabular Component Positioning in Primary THA via an Anterior Posterolateral or Posterolateral-navigated Surgical Technique
Denis Nam MD Peter K Sculco MD Edwin P Su MD Michael M Alexiades MD Mark P Figgie MD David J Mayman MD
NAV(POST) better than DAA(w xray)
DAA did not have as much anteversion as NAV
Matta et al---061
Siguier et al----096
Unger 2006-2014 03 none in last 500 cases
DAA- LESS DISLOCATION
THA-NO TECHNOLOGY NEEDED
PAGANO 2009
RECENT META-ANALYSISIMPROVED CUP POSITION BUT NO IMPROVEMENT IN OUTCOMES
ldquoIN 2008 THE OBJECTIVE DATA FOR COMPUTER NAV IS LACKING THE CONSENSUS IS ALSO LACKING AS FEW SURGEONS ACTUALLY USE NAV FOR THArdquo
THA-NO TECHNOLOGY NEEDED
ldquoWE ARE NOW ENTERING THE 2ND DECADE OF CLINICAL USE OF THE NAV SYSTEMS AND WE STILL HAVE NOT FOUND THE EVIDENCE OF A CLINICAL BENEFITrdquo
ldquoNAV ALSO DEMONSTRATES A NUMBER OF UNFAVORABLE ISSUES INCREASED SURG TIME(INFECTION) HIGHER COSTS SPECIFIC COMPLICATIONSrdquo
THA-LL
ldquoPARAMONT GOAL OF THA IS IMPLANT FIXATION AND HIP STABILITYrdquo
BUT AVOID LL DISCREPANCY
THA--LL
LL DISCREP COMMON AFTER THA
MINIMIZE LL DISCREPANCY CRUCIAL TO THA SUCCESS
LL DISCREP IS 2ND MOST COMMON SOURCE OF LITIGATION
THAmdashLL
MOST PTS WITH LL DISCREP IMPROVE WITH TIME
PT AND CHIROPRACTORS DRAW ATTENTION AND NEED TO BE EDUCATED
HIP SOCIETY STUDY 05 TO 7 LL PERSIST
TX SHOE LIFT(UP TO 95MM) PT AND IN SEVERE CASES REVISION
THA--LL
frac34 OF PREOP PTS HAVE SHORTEN LIMB
THA LENGTHENS LIMB AVG 25-62 MM
GENERALLY lt 1CM LL DISCREP IS ACCEPTABLE
CAN TECHNOLOGY IMPROVE LL DISCREPANCY AFTER THA
THA--LL
CAN TECHNOLGY HELP
LL DISCREPANCY DIVIDED INTO TWO CATAGORIES
A STRUCTURAL
B FUNCTIONAL
THA-LL
STRUCTURAL ACTUAL DIFFERENCE IN OSSEOUS STRUCTURES
FUNCTIONAL POSTORAL ASSYMETRY RESULTING FROM SOFT TISSUE CONTRACTURES----PELVIC OBLIQUITY
THA--LL
TECHNOLOGY
MAY IMPROVE STRUCURAL ASPECT OF LL
IT WILL NOT ASSESS FUNCTIONAL ASPECTS OF LL
THAmdashLL
INTRAOPERATIVE ASSESSMENTS
STRUCTURAL(TECHNOLOGY) IMAGING COMPUTERS ROBOTS
FUNCTIONAL(NO TECHNOLOGY NEEDED) SHUCK TEST DROPKICK TEST LEG TO LEG COMPARISION
DAA REDUCES LL DISCREPANCY
PT is SUPINEmdashrdquoFEEL THE MALLEOLI ldquo
LL CAN BE EASILY ASSESSED
FUNCTIONAL ASSESSMENT EASY
XRAY CONFIRMATION IF NECESSARY
THA-NO TECHNOLOGY NEEDED
IAN LEARMONTH ldquoTHA AND THE LAW OF DIMINISHING RETURNSrdquo JBJS 2006
THA ADVANCESFIXATIONBEARINGSMIS
LAW OF DIMINISHING RETURNS APPLIES AS PRODUCT IMPROVES A EXPONENTIALLY GREATER INVESTMENT IS NEEDED TO IMPROVE TECHNOLOGY
THAmdashNO TECHNOLOGY NEEDED
LEARMONTH 2006
ldquoCAN WE AFFORD A SUBSTANCIAL INVESTMENT FOR AN ALREADY VERY SUCCESSFUL PROCEDURErdquo
ldquoA GREATER BENEFIT MAY ACCRUE FROM RESEARCH IN ORTHOBIOLOGIS TISSUE ENGINEERING AND GENE THERAPYrdquo
THA-NO TECHNOLOGY NEEDED
PROFESSION IS BEING PUSHED BY OUTSIDE FORCES
MEDIA
PATIENTS
INDUSTRY
SURGEON DESIGNERS
THAmdashNO TECHNOLOGY NEEDED
CONCLUSIONS
NEW TECHNOLOGY HAS NOT PROVEN ITSELF TO IMPROVE OUTCOMES FURTHER INVESTMENT MUST BE ANALYSED IN LIEU OF THIS FACT AS WELL AS THE OPPORTUNITY TO ENHANCE OUTCOMES THROUGH OTHER MEANS
NEW TECHONOLGY SHOULD BE ADVOCATED CAREFULLY AT THIS TIME
THANK YOU
PSI IMPROVES ACCURACY
Comparison of Acetabular Shell Position Using Patient Specific Instruments vs Standard Surgical Instruments A Randomized Clinical Trial
Travis Small DO Viktor Krebs MD Robert Molloy MD Jason Bryan MS Alison K Klika MS Wael K Barsoum MD
THA-INSTABILITY
ALL THE TECHNOLOGIES IMPROVE ACCURACY
NO IMPROVEMENT OF OUTCOMES
WHY
THA-INTABILITY
POSITION OF PROSTHESIS IS A STATICMEASUREMENT
INSTABILITY IS INFLUENCED BY SOFT TISSUE TENSION
INSTABILITY MAY BE DYNAMICmdashIMPINGEMENT
TECHNOLOGY DOES NOT EVALUATE THIS
CAN YOUR ROBOTNAV DO THIS
DAA(w Xray) VS NAV(POST)
Acetabular Component Positioning in Primary THA via an Anterior Posterolateral or Posterolateral-navigated Surgical Technique
Denis Nam MD Peter K Sculco MD Edwin P Su MD Michael M Alexiades MD Mark P Figgie MD David J Mayman MD
NAV(POST) better than DAA(w xray)
DAA did not have as much anteversion as NAV
Matta et al---061
Siguier et al----096
Unger 2006-2014 03 none in last 500 cases
DAA- LESS DISLOCATION
THA-NO TECHNOLOGY NEEDED
PAGANO 2009
RECENT META-ANALYSISIMPROVED CUP POSITION BUT NO IMPROVEMENT IN OUTCOMES
ldquoIN 2008 THE OBJECTIVE DATA FOR COMPUTER NAV IS LACKING THE CONSENSUS IS ALSO LACKING AS FEW SURGEONS ACTUALLY USE NAV FOR THArdquo
THA-NO TECHNOLOGY NEEDED
ldquoWE ARE NOW ENTERING THE 2ND DECADE OF CLINICAL USE OF THE NAV SYSTEMS AND WE STILL HAVE NOT FOUND THE EVIDENCE OF A CLINICAL BENEFITrdquo
ldquoNAV ALSO DEMONSTRATES A NUMBER OF UNFAVORABLE ISSUES INCREASED SURG TIME(INFECTION) HIGHER COSTS SPECIFIC COMPLICATIONSrdquo
THA-LL
ldquoPARAMONT GOAL OF THA IS IMPLANT FIXATION AND HIP STABILITYrdquo
BUT AVOID LL DISCREPANCY
THA--LL
LL DISCREP COMMON AFTER THA
MINIMIZE LL DISCREPANCY CRUCIAL TO THA SUCCESS
LL DISCREP IS 2ND MOST COMMON SOURCE OF LITIGATION
THAmdashLL
MOST PTS WITH LL DISCREP IMPROVE WITH TIME
PT AND CHIROPRACTORS DRAW ATTENTION AND NEED TO BE EDUCATED
HIP SOCIETY STUDY 05 TO 7 LL PERSIST
TX SHOE LIFT(UP TO 95MM) PT AND IN SEVERE CASES REVISION
THA--LL
frac34 OF PREOP PTS HAVE SHORTEN LIMB
THA LENGTHENS LIMB AVG 25-62 MM
GENERALLY lt 1CM LL DISCREP IS ACCEPTABLE
CAN TECHNOLOGY IMPROVE LL DISCREPANCY AFTER THA
THA--LL
CAN TECHNOLGY HELP
LL DISCREPANCY DIVIDED INTO TWO CATAGORIES
A STRUCTURAL
B FUNCTIONAL
THA-LL
STRUCTURAL ACTUAL DIFFERENCE IN OSSEOUS STRUCTURES
FUNCTIONAL POSTORAL ASSYMETRY RESULTING FROM SOFT TISSUE CONTRACTURES----PELVIC OBLIQUITY
THA--LL
TECHNOLOGY
MAY IMPROVE STRUCURAL ASPECT OF LL
IT WILL NOT ASSESS FUNCTIONAL ASPECTS OF LL
THAmdashLL
INTRAOPERATIVE ASSESSMENTS
STRUCTURAL(TECHNOLOGY) IMAGING COMPUTERS ROBOTS
FUNCTIONAL(NO TECHNOLOGY NEEDED) SHUCK TEST DROPKICK TEST LEG TO LEG COMPARISION
DAA REDUCES LL DISCREPANCY
PT is SUPINEmdashrdquoFEEL THE MALLEOLI ldquo
LL CAN BE EASILY ASSESSED
FUNCTIONAL ASSESSMENT EASY
XRAY CONFIRMATION IF NECESSARY
THA-NO TECHNOLOGY NEEDED
IAN LEARMONTH ldquoTHA AND THE LAW OF DIMINISHING RETURNSrdquo JBJS 2006
THA ADVANCESFIXATIONBEARINGSMIS
LAW OF DIMINISHING RETURNS APPLIES AS PRODUCT IMPROVES A EXPONENTIALLY GREATER INVESTMENT IS NEEDED TO IMPROVE TECHNOLOGY
THAmdashNO TECHNOLOGY NEEDED
LEARMONTH 2006
ldquoCAN WE AFFORD A SUBSTANCIAL INVESTMENT FOR AN ALREADY VERY SUCCESSFUL PROCEDURErdquo
ldquoA GREATER BENEFIT MAY ACCRUE FROM RESEARCH IN ORTHOBIOLOGIS TISSUE ENGINEERING AND GENE THERAPYrdquo
THA-NO TECHNOLOGY NEEDED
PROFESSION IS BEING PUSHED BY OUTSIDE FORCES
MEDIA
PATIENTS
INDUSTRY
SURGEON DESIGNERS
THAmdashNO TECHNOLOGY NEEDED
CONCLUSIONS
NEW TECHNOLOGY HAS NOT PROVEN ITSELF TO IMPROVE OUTCOMES FURTHER INVESTMENT MUST BE ANALYSED IN LIEU OF THIS FACT AS WELL AS THE OPPORTUNITY TO ENHANCE OUTCOMES THROUGH OTHER MEANS
NEW TECHONOLGY SHOULD BE ADVOCATED CAREFULLY AT THIS TIME
THANK YOU
THA-INSTABILITY
ALL THE TECHNOLOGIES IMPROVE ACCURACY
NO IMPROVEMENT OF OUTCOMES
WHY
THA-INTABILITY
POSITION OF PROSTHESIS IS A STATICMEASUREMENT
INSTABILITY IS INFLUENCED BY SOFT TISSUE TENSION
INSTABILITY MAY BE DYNAMICmdashIMPINGEMENT
TECHNOLOGY DOES NOT EVALUATE THIS
CAN YOUR ROBOTNAV DO THIS
DAA(w Xray) VS NAV(POST)
Acetabular Component Positioning in Primary THA via an Anterior Posterolateral or Posterolateral-navigated Surgical Technique
Denis Nam MD Peter K Sculco MD Edwin P Su MD Michael M Alexiades MD Mark P Figgie MD David J Mayman MD
NAV(POST) better than DAA(w xray)
DAA did not have as much anteversion as NAV
Matta et al---061
Siguier et al----096
Unger 2006-2014 03 none in last 500 cases
DAA- LESS DISLOCATION
THA-NO TECHNOLOGY NEEDED
PAGANO 2009
RECENT META-ANALYSISIMPROVED CUP POSITION BUT NO IMPROVEMENT IN OUTCOMES
ldquoIN 2008 THE OBJECTIVE DATA FOR COMPUTER NAV IS LACKING THE CONSENSUS IS ALSO LACKING AS FEW SURGEONS ACTUALLY USE NAV FOR THArdquo
THA-NO TECHNOLOGY NEEDED
ldquoWE ARE NOW ENTERING THE 2ND DECADE OF CLINICAL USE OF THE NAV SYSTEMS AND WE STILL HAVE NOT FOUND THE EVIDENCE OF A CLINICAL BENEFITrdquo
ldquoNAV ALSO DEMONSTRATES A NUMBER OF UNFAVORABLE ISSUES INCREASED SURG TIME(INFECTION) HIGHER COSTS SPECIFIC COMPLICATIONSrdquo
THA-LL
ldquoPARAMONT GOAL OF THA IS IMPLANT FIXATION AND HIP STABILITYrdquo
BUT AVOID LL DISCREPANCY
THA--LL
LL DISCREP COMMON AFTER THA
MINIMIZE LL DISCREPANCY CRUCIAL TO THA SUCCESS
LL DISCREP IS 2ND MOST COMMON SOURCE OF LITIGATION
THAmdashLL
MOST PTS WITH LL DISCREP IMPROVE WITH TIME
PT AND CHIROPRACTORS DRAW ATTENTION AND NEED TO BE EDUCATED
HIP SOCIETY STUDY 05 TO 7 LL PERSIST
TX SHOE LIFT(UP TO 95MM) PT AND IN SEVERE CASES REVISION
THA--LL
frac34 OF PREOP PTS HAVE SHORTEN LIMB
THA LENGTHENS LIMB AVG 25-62 MM
GENERALLY lt 1CM LL DISCREP IS ACCEPTABLE
CAN TECHNOLOGY IMPROVE LL DISCREPANCY AFTER THA
THA--LL
CAN TECHNOLGY HELP
LL DISCREPANCY DIVIDED INTO TWO CATAGORIES
A STRUCTURAL
B FUNCTIONAL
THA-LL
STRUCTURAL ACTUAL DIFFERENCE IN OSSEOUS STRUCTURES
FUNCTIONAL POSTORAL ASSYMETRY RESULTING FROM SOFT TISSUE CONTRACTURES----PELVIC OBLIQUITY
THA--LL
TECHNOLOGY
MAY IMPROVE STRUCURAL ASPECT OF LL
IT WILL NOT ASSESS FUNCTIONAL ASPECTS OF LL
THAmdashLL
INTRAOPERATIVE ASSESSMENTS
STRUCTURAL(TECHNOLOGY) IMAGING COMPUTERS ROBOTS
FUNCTIONAL(NO TECHNOLOGY NEEDED) SHUCK TEST DROPKICK TEST LEG TO LEG COMPARISION
DAA REDUCES LL DISCREPANCY
PT is SUPINEmdashrdquoFEEL THE MALLEOLI ldquo
LL CAN BE EASILY ASSESSED
FUNCTIONAL ASSESSMENT EASY
XRAY CONFIRMATION IF NECESSARY
THA-NO TECHNOLOGY NEEDED
IAN LEARMONTH ldquoTHA AND THE LAW OF DIMINISHING RETURNSrdquo JBJS 2006
THA ADVANCESFIXATIONBEARINGSMIS
LAW OF DIMINISHING RETURNS APPLIES AS PRODUCT IMPROVES A EXPONENTIALLY GREATER INVESTMENT IS NEEDED TO IMPROVE TECHNOLOGY
THAmdashNO TECHNOLOGY NEEDED
LEARMONTH 2006
ldquoCAN WE AFFORD A SUBSTANCIAL INVESTMENT FOR AN ALREADY VERY SUCCESSFUL PROCEDURErdquo
ldquoA GREATER BENEFIT MAY ACCRUE FROM RESEARCH IN ORTHOBIOLOGIS TISSUE ENGINEERING AND GENE THERAPYrdquo
THA-NO TECHNOLOGY NEEDED
PROFESSION IS BEING PUSHED BY OUTSIDE FORCES
MEDIA
PATIENTS
INDUSTRY
SURGEON DESIGNERS
THAmdashNO TECHNOLOGY NEEDED
CONCLUSIONS
NEW TECHNOLOGY HAS NOT PROVEN ITSELF TO IMPROVE OUTCOMES FURTHER INVESTMENT MUST BE ANALYSED IN LIEU OF THIS FACT AS WELL AS THE OPPORTUNITY TO ENHANCE OUTCOMES THROUGH OTHER MEANS
NEW TECHONOLGY SHOULD BE ADVOCATED CAREFULLY AT THIS TIME
THANK YOU
THA-INTABILITY
POSITION OF PROSTHESIS IS A STATICMEASUREMENT
INSTABILITY IS INFLUENCED BY SOFT TISSUE TENSION
INSTABILITY MAY BE DYNAMICmdashIMPINGEMENT
TECHNOLOGY DOES NOT EVALUATE THIS
CAN YOUR ROBOTNAV DO THIS
DAA(w Xray) VS NAV(POST)
Acetabular Component Positioning in Primary THA via an Anterior Posterolateral or Posterolateral-navigated Surgical Technique
Denis Nam MD Peter K Sculco MD Edwin P Su MD Michael M Alexiades MD Mark P Figgie MD David J Mayman MD
NAV(POST) better than DAA(w xray)
DAA did not have as much anteversion as NAV
Matta et al---061
Siguier et al----096
Unger 2006-2014 03 none in last 500 cases
DAA- LESS DISLOCATION
THA-NO TECHNOLOGY NEEDED
PAGANO 2009
RECENT META-ANALYSISIMPROVED CUP POSITION BUT NO IMPROVEMENT IN OUTCOMES
ldquoIN 2008 THE OBJECTIVE DATA FOR COMPUTER NAV IS LACKING THE CONSENSUS IS ALSO LACKING AS FEW SURGEONS ACTUALLY USE NAV FOR THArdquo
THA-NO TECHNOLOGY NEEDED
ldquoWE ARE NOW ENTERING THE 2ND DECADE OF CLINICAL USE OF THE NAV SYSTEMS AND WE STILL HAVE NOT FOUND THE EVIDENCE OF A CLINICAL BENEFITrdquo
ldquoNAV ALSO DEMONSTRATES A NUMBER OF UNFAVORABLE ISSUES INCREASED SURG TIME(INFECTION) HIGHER COSTS SPECIFIC COMPLICATIONSrdquo
THA-LL
ldquoPARAMONT GOAL OF THA IS IMPLANT FIXATION AND HIP STABILITYrdquo
BUT AVOID LL DISCREPANCY
THA--LL
LL DISCREP COMMON AFTER THA
MINIMIZE LL DISCREPANCY CRUCIAL TO THA SUCCESS
LL DISCREP IS 2ND MOST COMMON SOURCE OF LITIGATION
THAmdashLL
MOST PTS WITH LL DISCREP IMPROVE WITH TIME
PT AND CHIROPRACTORS DRAW ATTENTION AND NEED TO BE EDUCATED
HIP SOCIETY STUDY 05 TO 7 LL PERSIST
TX SHOE LIFT(UP TO 95MM) PT AND IN SEVERE CASES REVISION
THA--LL
frac34 OF PREOP PTS HAVE SHORTEN LIMB
THA LENGTHENS LIMB AVG 25-62 MM
GENERALLY lt 1CM LL DISCREP IS ACCEPTABLE
CAN TECHNOLOGY IMPROVE LL DISCREPANCY AFTER THA
THA--LL
CAN TECHNOLGY HELP
LL DISCREPANCY DIVIDED INTO TWO CATAGORIES
A STRUCTURAL
B FUNCTIONAL
THA-LL
STRUCTURAL ACTUAL DIFFERENCE IN OSSEOUS STRUCTURES
FUNCTIONAL POSTORAL ASSYMETRY RESULTING FROM SOFT TISSUE CONTRACTURES----PELVIC OBLIQUITY
THA--LL
TECHNOLOGY
MAY IMPROVE STRUCURAL ASPECT OF LL
IT WILL NOT ASSESS FUNCTIONAL ASPECTS OF LL
THAmdashLL
INTRAOPERATIVE ASSESSMENTS
STRUCTURAL(TECHNOLOGY) IMAGING COMPUTERS ROBOTS
FUNCTIONAL(NO TECHNOLOGY NEEDED) SHUCK TEST DROPKICK TEST LEG TO LEG COMPARISION
DAA REDUCES LL DISCREPANCY
PT is SUPINEmdashrdquoFEEL THE MALLEOLI ldquo
LL CAN BE EASILY ASSESSED
FUNCTIONAL ASSESSMENT EASY
XRAY CONFIRMATION IF NECESSARY
THA-NO TECHNOLOGY NEEDED
IAN LEARMONTH ldquoTHA AND THE LAW OF DIMINISHING RETURNSrdquo JBJS 2006
THA ADVANCESFIXATIONBEARINGSMIS
LAW OF DIMINISHING RETURNS APPLIES AS PRODUCT IMPROVES A EXPONENTIALLY GREATER INVESTMENT IS NEEDED TO IMPROVE TECHNOLOGY
THAmdashNO TECHNOLOGY NEEDED
LEARMONTH 2006
ldquoCAN WE AFFORD A SUBSTANCIAL INVESTMENT FOR AN ALREADY VERY SUCCESSFUL PROCEDURErdquo
ldquoA GREATER BENEFIT MAY ACCRUE FROM RESEARCH IN ORTHOBIOLOGIS TISSUE ENGINEERING AND GENE THERAPYrdquo
THA-NO TECHNOLOGY NEEDED
PROFESSION IS BEING PUSHED BY OUTSIDE FORCES
MEDIA
PATIENTS
INDUSTRY
SURGEON DESIGNERS
THAmdashNO TECHNOLOGY NEEDED
CONCLUSIONS
NEW TECHNOLOGY HAS NOT PROVEN ITSELF TO IMPROVE OUTCOMES FURTHER INVESTMENT MUST BE ANALYSED IN LIEU OF THIS FACT AS WELL AS THE OPPORTUNITY TO ENHANCE OUTCOMES THROUGH OTHER MEANS
NEW TECHONOLGY SHOULD BE ADVOCATED CAREFULLY AT THIS TIME
THANK YOU
CAN YOUR ROBOTNAV DO THIS
DAA(w Xray) VS NAV(POST)
Acetabular Component Positioning in Primary THA via an Anterior Posterolateral or Posterolateral-navigated Surgical Technique
Denis Nam MD Peter K Sculco MD Edwin P Su MD Michael M Alexiades MD Mark P Figgie MD David J Mayman MD
NAV(POST) better than DAA(w xray)
DAA did not have as much anteversion as NAV
Matta et al---061
Siguier et al----096
Unger 2006-2014 03 none in last 500 cases
DAA- LESS DISLOCATION
THA-NO TECHNOLOGY NEEDED
PAGANO 2009
RECENT META-ANALYSISIMPROVED CUP POSITION BUT NO IMPROVEMENT IN OUTCOMES
ldquoIN 2008 THE OBJECTIVE DATA FOR COMPUTER NAV IS LACKING THE CONSENSUS IS ALSO LACKING AS FEW SURGEONS ACTUALLY USE NAV FOR THArdquo
THA-NO TECHNOLOGY NEEDED
ldquoWE ARE NOW ENTERING THE 2ND DECADE OF CLINICAL USE OF THE NAV SYSTEMS AND WE STILL HAVE NOT FOUND THE EVIDENCE OF A CLINICAL BENEFITrdquo
ldquoNAV ALSO DEMONSTRATES A NUMBER OF UNFAVORABLE ISSUES INCREASED SURG TIME(INFECTION) HIGHER COSTS SPECIFIC COMPLICATIONSrdquo
THA-LL
ldquoPARAMONT GOAL OF THA IS IMPLANT FIXATION AND HIP STABILITYrdquo
BUT AVOID LL DISCREPANCY
THA--LL
LL DISCREP COMMON AFTER THA
MINIMIZE LL DISCREPANCY CRUCIAL TO THA SUCCESS
LL DISCREP IS 2ND MOST COMMON SOURCE OF LITIGATION
THAmdashLL
MOST PTS WITH LL DISCREP IMPROVE WITH TIME
PT AND CHIROPRACTORS DRAW ATTENTION AND NEED TO BE EDUCATED
HIP SOCIETY STUDY 05 TO 7 LL PERSIST
TX SHOE LIFT(UP TO 95MM) PT AND IN SEVERE CASES REVISION
THA--LL
frac34 OF PREOP PTS HAVE SHORTEN LIMB
THA LENGTHENS LIMB AVG 25-62 MM
GENERALLY lt 1CM LL DISCREP IS ACCEPTABLE
CAN TECHNOLOGY IMPROVE LL DISCREPANCY AFTER THA
THA--LL
CAN TECHNOLGY HELP
LL DISCREPANCY DIVIDED INTO TWO CATAGORIES
A STRUCTURAL
B FUNCTIONAL
THA-LL
STRUCTURAL ACTUAL DIFFERENCE IN OSSEOUS STRUCTURES
FUNCTIONAL POSTORAL ASSYMETRY RESULTING FROM SOFT TISSUE CONTRACTURES----PELVIC OBLIQUITY
THA--LL
TECHNOLOGY
MAY IMPROVE STRUCURAL ASPECT OF LL
IT WILL NOT ASSESS FUNCTIONAL ASPECTS OF LL
THAmdashLL
INTRAOPERATIVE ASSESSMENTS
STRUCTURAL(TECHNOLOGY) IMAGING COMPUTERS ROBOTS
FUNCTIONAL(NO TECHNOLOGY NEEDED) SHUCK TEST DROPKICK TEST LEG TO LEG COMPARISION
DAA REDUCES LL DISCREPANCY
PT is SUPINEmdashrdquoFEEL THE MALLEOLI ldquo
LL CAN BE EASILY ASSESSED
FUNCTIONAL ASSESSMENT EASY
XRAY CONFIRMATION IF NECESSARY
THA-NO TECHNOLOGY NEEDED
IAN LEARMONTH ldquoTHA AND THE LAW OF DIMINISHING RETURNSrdquo JBJS 2006
THA ADVANCESFIXATIONBEARINGSMIS
LAW OF DIMINISHING RETURNS APPLIES AS PRODUCT IMPROVES A EXPONENTIALLY GREATER INVESTMENT IS NEEDED TO IMPROVE TECHNOLOGY
THAmdashNO TECHNOLOGY NEEDED
LEARMONTH 2006
ldquoCAN WE AFFORD A SUBSTANCIAL INVESTMENT FOR AN ALREADY VERY SUCCESSFUL PROCEDURErdquo
ldquoA GREATER BENEFIT MAY ACCRUE FROM RESEARCH IN ORTHOBIOLOGIS TISSUE ENGINEERING AND GENE THERAPYrdquo
THA-NO TECHNOLOGY NEEDED
PROFESSION IS BEING PUSHED BY OUTSIDE FORCES
MEDIA
PATIENTS
INDUSTRY
SURGEON DESIGNERS
THAmdashNO TECHNOLOGY NEEDED
CONCLUSIONS
NEW TECHNOLOGY HAS NOT PROVEN ITSELF TO IMPROVE OUTCOMES FURTHER INVESTMENT MUST BE ANALYSED IN LIEU OF THIS FACT AS WELL AS THE OPPORTUNITY TO ENHANCE OUTCOMES THROUGH OTHER MEANS
NEW TECHONOLGY SHOULD BE ADVOCATED CAREFULLY AT THIS TIME
THANK YOU
DAA(w Xray) VS NAV(POST)
Acetabular Component Positioning in Primary THA via an Anterior Posterolateral or Posterolateral-navigated Surgical Technique
Denis Nam MD Peter K Sculco MD Edwin P Su MD Michael M Alexiades MD Mark P Figgie MD David J Mayman MD
NAV(POST) better than DAA(w xray)
DAA did not have as much anteversion as NAV
Matta et al---061
Siguier et al----096
Unger 2006-2014 03 none in last 500 cases
DAA- LESS DISLOCATION
THA-NO TECHNOLOGY NEEDED
PAGANO 2009
RECENT META-ANALYSISIMPROVED CUP POSITION BUT NO IMPROVEMENT IN OUTCOMES
ldquoIN 2008 THE OBJECTIVE DATA FOR COMPUTER NAV IS LACKING THE CONSENSUS IS ALSO LACKING AS FEW SURGEONS ACTUALLY USE NAV FOR THArdquo
THA-NO TECHNOLOGY NEEDED
ldquoWE ARE NOW ENTERING THE 2ND DECADE OF CLINICAL USE OF THE NAV SYSTEMS AND WE STILL HAVE NOT FOUND THE EVIDENCE OF A CLINICAL BENEFITrdquo
ldquoNAV ALSO DEMONSTRATES A NUMBER OF UNFAVORABLE ISSUES INCREASED SURG TIME(INFECTION) HIGHER COSTS SPECIFIC COMPLICATIONSrdquo
THA-LL
ldquoPARAMONT GOAL OF THA IS IMPLANT FIXATION AND HIP STABILITYrdquo
BUT AVOID LL DISCREPANCY
THA--LL
LL DISCREP COMMON AFTER THA
MINIMIZE LL DISCREPANCY CRUCIAL TO THA SUCCESS
LL DISCREP IS 2ND MOST COMMON SOURCE OF LITIGATION
THAmdashLL
MOST PTS WITH LL DISCREP IMPROVE WITH TIME
PT AND CHIROPRACTORS DRAW ATTENTION AND NEED TO BE EDUCATED
HIP SOCIETY STUDY 05 TO 7 LL PERSIST
TX SHOE LIFT(UP TO 95MM) PT AND IN SEVERE CASES REVISION
THA--LL
frac34 OF PREOP PTS HAVE SHORTEN LIMB
THA LENGTHENS LIMB AVG 25-62 MM
GENERALLY lt 1CM LL DISCREP IS ACCEPTABLE
CAN TECHNOLOGY IMPROVE LL DISCREPANCY AFTER THA
THA--LL
CAN TECHNOLGY HELP
LL DISCREPANCY DIVIDED INTO TWO CATAGORIES
A STRUCTURAL
B FUNCTIONAL
THA-LL
STRUCTURAL ACTUAL DIFFERENCE IN OSSEOUS STRUCTURES
FUNCTIONAL POSTORAL ASSYMETRY RESULTING FROM SOFT TISSUE CONTRACTURES----PELVIC OBLIQUITY
THA--LL
TECHNOLOGY
MAY IMPROVE STRUCURAL ASPECT OF LL
IT WILL NOT ASSESS FUNCTIONAL ASPECTS OF LL
THAmdashLL
INTRAOPERATIVE ASSESSMENTS
STRUCTURAL(TECHNOLOGY) IMAGING COMPUTERS ROBOTS
FUNCTIONAL(NO TECHNOLOGY NEEDED) SHUCK TEST DROPKICK TEST LEG TO LEG COMPARISION
DAA REDUCES LL DISCREPANCY
PT is SUPINEmdashrdquoFEEL THE MALLEOLI ldquo
LL CAN BE EASILY ASSESSED
FUNCTIONAL ASSESSMENT EASY
XRAY CONFIRMATION IF NECESSARY
THA-NO TECHNOLOGY NEEDED
IAN LEARMONTH ldquoTHA AND THE LAW OF DIMINISHING RETURNSrdquo JBJS 2006
THA ADVANCESFIXATIONBEARINGSMIS
LAW OF DIMINISHING RETURNS APPLIES AS PRODUCT IMPROVES A EXPONENTIALLY GREATER INVESTMENT IS NEEDED TO IMPROVE TECHNOLOGY
THAmdashNO TECHNOLOGY NEEDED
LEARMONTH 2006
ldquoCAN WE AFFORD A SUBSTANCIAL INVESTMENT FOR AN ALREADY VERY SUCCESSFUL PROCEDURErdquo
ldquoA GREATER BENEFIT MAY ACCRUE FROM RESEARCH IN ORTHOBIOLOGIS TISSUE ENGINEERING AND GENE THERAPYrdquo
THA-NO TECHNOLOGY NEEDED
PROFESSION IS BEING PUSHED BY OUTSIDE FORCES
MEDIA
PATIENTS
INDUSTRY
SURGEON DESIGNERS
THAmdashNO TECHNOLOGY NEEDED
CONCLUSIONS
NEW TECHNOLOGY HAS NOT PROVEN ITSELF TO IMPROVE OUTCOMES FURTHER INVESTMENT MUST BE ANALYSED IN LIEU OF THIS FACT AS WELL AS THE OPPORTUNITY TO ENHANCE OUTCOMES THROUGH OTHER MEANS
NEW TECHONOLGY SHOULD BE ADVOCATED CAREFULLY AT THIS TIME
THANK YOU
Matta et al---061
Siguier et al----096
Unger 2006-2014 03 none in last 500 cases
DAA- LESS DISLOCATION
THA-NO TECHNOLOGY NEEDED
PAGANO 2009
RECENT META-ANALYSISIMPROVED CUP POSITION BUT NO IMPROVEMENT IN OUTCOMES
ldquoIN 2008 THE OBJECTIVE DATA FOR COMPUTER NAV IS LACKING THE CONSENSUS IS ALSO LACKING AS FEW SURGEONS ACTUALLY USE NAV FOR THArdquo
THA-NO TECHNOLOGY NEEDED
ldquoWE ARE NOW ENTERING THE 2ND DECADE OF CLINICAL USE OF THE NAV SYSTEMS AND WE STILL HAVE NOT FOUND THE EVIDENCE OF A CLINICAL BENEFITrdquo
ldquoNAV ALSO DEMONSTRATES A NUMBER OF UNFAVORABLE ISSUES INCREASED SURG TIME(INFECTION) HIGHER COSTS SPECIFIC COMPLICATIONSrdquo
THA-LL
ldquoPARAMONT GOAL OF THA IS IMPLANT FIXATION AND HIP STABILITYrdquo
BUT AVOID LL DISCREPANCY
THA--LL
LL DISCREP COMMON AFTER THA
MINIMIZE LL DISCREPANCY CRUCIAL TO THA SUCCESS
LL DISCREP IS 2ND MOST COMMON SOURCE OF LITIGATION
THAmdashLL
MOST PTS WITH LL DISCREP IMPROVE WITH TIME
PT AND CHIROPRACTORS DRAW ATTENTION AND NEED TO BE EDUCATED
HIP SOCIETY STUDY 05 TO 7 LL PERSIST
TX SHOE LIFT(UP TO 95MM) PT AND IN SEVERE CASES REVISION
THA--LL
frac34 OF PREOP PTS HAVE SHORTEN LIMB
THA LENGTHENS LIMB AVG 25-62 MM
GENERALLY lt 1CM LL DISCREP IS ACCEPTABLE
CAN TECHNOLOGY IMPROVE LL DISCREPANCY AFTER THA
THA--LL
CAN TECHNOLGY HELP
LL DISCREPANCY DIVIDED INTO TWO CATAGORIES
A STRUCTURAL
B FUNCTIONAL
THA-LL
STRUCTURAL ACTUAL DIFFERENCE IN OSSEOUS STRUCTURES
FUNCTIONAL POSTORAL ASSYMETRY RESULTING FROM SOFT TISSUE CONTRACTURES----PELVIC OBLIQUITY
THA--LL
TECHNOLOGY
MAY IMPROVE STRUCURAL ASPECT OF LL
IT WILL NOT ASSESS FUNCTIONAL ASPECTS OF LL
THAmdashLL
INTRAOPERATIVE ASSESSMENTS
STRUCTURAL(TECHNOLOGY) IMAGING COMPUTERS ROBOTS
FUNCTIONAL(NO TECHNOLOGY NEEDED) SHUCK TEST DROPKICK TEST LEG TO LEG COMPARISION
DAA REDUCES LL DISCREPANCY
PT is SUPINEmdashrdquoFEEL THE MALLEOLI ldquo
LL CAN BE EASILY ASSESSED
FUNCTIONAL ASSESSMENT EASY
XRAY CONFIRMATION IF NECESSARY
THA-NO TECHNOLOGY NEEDED
IAN LEARMONTH ldquoTHA AND THE LAW OF DIMINISHING RETURNSrdquo JBJS 2006
THA ADVANCESFIXATIONBEARINGSMIS
LAW OF DIMINISHING RETURNS APPLIES AS PRODUCT IMPROVES A EXPONENTIALLY GREATER INVESTMENT IS NEEDED TO IMPROVE TECHNOLOGY
THAmdashNO TECHNOLOGY NEEDED
LEARMONTH 2006
ldquoCAN WE AFFORD A SUBSTANCIAL INVESTMENT FOR AN ALREADY VERY SUCCESSFUL PROCEDURErdquo
ldquoA GREATER BENEFIT MAY ACCRUE FROM RESEARCH IN ORTHOBIOLOGIS TISSUE ENGINEERING AND GENE THERAPYrdquo
THA-NO TECHNOLOGY NEEDED
PROFESSION IS BEING PUSHED BY OUTSIDE FORCES
MEDIA
PATIENTS
INDUSTRY
SURGEON DESIGNERS
THAmdashNO TECHNOLOGY NEEDED
CONCLUSIONS
NEW TECHNOLOGY HAS NOT PROVEN ITSELF TO IMPROVE OUTCOMES FURTHER INVESTMENT MUST BE ANALYSED IN LIEU OF THIS FACT AS WELL AS THE OPPORTUNITY TO ENHANCE OUTCOMES THROUGH OTHER MEANS
NEW TECHONOLGY SHOULD BE ADVOCATED CAREFULLY AT THIS TIME
THANK YOU
THA-NO TECHNOLOGY NEEDED
PAGANO 2009
RECENT META-ANALYSISIMPROVED CUP POSITION BUT NO IMPROVEMENT IN OUTCOMES
ldquoIN 2008 THE OBJECTIVE DATA FOR COMPUTER NAV IS LACKING THE CONSENSUS IS ALSO LACKING AS FEW SURGEONS ACTUALLY USE NAV FOR THArdquo
THA-NO TECHNOLOGY NEEDED
ldquoWE ARE NOW ENTERING THE 2ND DECADE OF CLINICAL USE OF THE NAV SYSTEMS AND WE STILL HAVE NOT FOUND THE EVIDENCE OF A CLINICAL BENEFITrdquo
ldquoNAV ALSO DEMONSTRATES A NUMBER OF UNFAVORABLE ISSUES INCREASED SURG TIME(INFECTION) HIGHER COSTS SPECIFIC COMPLICATIONSrdquo
THA-LL
ldquoPARAMONT GOAL OF THA IS IMPLANT FIXATION AND HIP STABILITYrdquo
BUT AVOID LL DISCREPANCY
THA--LL
LL DISCREP COMMON AFTER THA
MINIMIZE LL DISCREPANCY CRUCIAL TO THA SUCCESS
LL DISCREP IS 2ND MOST COMMON SOURCE OF LITIGATION
THAmdashLL
MOST PTS WITH LL DISCREP IMPROVE WITH TIME
PT AND CHIROPRACTORS DRAW ATTENTION AND NEED TO BE EDUCATED
HIP SOCIETY STUDY 05 TO 7 LL PERSIST
TX SHOE LIFT(UP TO 95MM) PT AND IN SEVERE CASES REVISION
THA--LL
frac34 OF PREOP PTS HAVE SHORTEN LIMB
THA LENGTHENS LIMB AVG 25-62 MM
GENERALLY lt 1CM LL DISCREP IS ACCEPTABLE
CAN TECHNOLOGY IMPROVE LL DISCREPANCY AFTER THA
THA--LL
CAN TECHNOLGY HELP
LL DISCREPANCY DIVIDED INTO TWO CATAGORIES
A STRUCTURAL
B FUNCTIONAL
THA-LL
STRUCTURAL ACTUAL DIFFERENCE IN OSSEOUS STRUCTURES
FUNCTIONAL POSTORAL ASSYMETRY RESULTING FROM SOFT TISSUE CONTRACTURES----PELVIC OBLIQUITY
THA--LL
TECHNOLOGY
MAY IMPROVE STRUCURAL ASPECT OF LL
IT WILL NOT ASSESS FUNCTIONAL ASPECTS OF LL
THAmdashLL
INTRAOPERATIVE ASSESSMENTS
STRUCTURAL(TECHNOLOGY) IMAGING COMPUTERS ROBOTS
FUNCTIONAL(NO TECHNOLOGY NEEDED) SHUCK TEST DROPKICK TEST LEG TO LEG COMPARISION
DAA REDUCES LL DISCREPANCY
PT is SUPINEmdashrdquoFEEL THE MALLEOLI ldquo
LL CAN BE EASILY ASSESSED
FUNCTIONAL ASSESSMENT EASY
XRAY CONFIRMATION IF NECESSARY
THA-NO TECHNOLOGY NEEDED
IAN LEARMONTH ldquoTHA AND THE LAW OF DIMINISHING RETURNSrdquo JBJS 2006
THA ADVANCESFIXATIONBEARINGSMIS
LAW OF DIMINISHING RETURNS APPLIES AS PRODUCT IMPROVES A EXPONENTIALLY GREATER INVESTMENT IS NEEDED TO IMPROVE TECHNOLOGY
THAmdashNO TECHNOLOGY NEEDED
LEARMONTH 2006
ldquoCAN WE AFFORD A SUBSTANCIAL INVESTMENT FOR AN ALREADY VERY SUCCESSFUL PROCEDURErdquo
ldquoA GREATER BENEFIT MAY ACCRUE FROM RESEARCH IN ORTHOBIOLOGIS TISSUE ENGINEERING AND GENE THERAPYrdquo
THA-NO TECHNOLOGY NEEDED
PROFESSION IS BEING PUSHED BY OUTSIDE FORCES
MEDIA
PATIENTS
INDUSTRY
SURGEON DESIGNERS
THAmdashNO TECHNOLOGY NEEDED
CONCLUSIONS
NEW TECHNOLOGY HAS NOT PROVEN ITSELF TO IMPROVE OUTCOMES FURTHER INVESTMENT MUST BE ANALYSED IN LIEU OF THIS FACT AS WELL AS THE OPPORTUNITY TO ENHANCE OUTCOMES THROUGH OTHER MEANS
NEW TECHONOLGY SHOULD BE ADVOCATED CAREFULLY AT THIS TIME
THANK YOU
THA-NO TECHNOLOGY NEEDED
ldquoWE ARE NOW ENTERING THE 2ND DECADE OF CLINICAL USE OF THE NAV SYSTEMS AND WE STILL HAVE NOT FOUND THE EVIDENCE OF A CLINICAL BENEFITrdquo
ldquoNAV ALSO DEMONSTRATES A NUMBER OF UNFAVORABLE ISSUES INCREASED SURG TIME(INFECTION) HIGHER COSTS SPECIFIC COMPLICATIONSrdquo
THA-LL
ldquoPARAMONT GOAL OF THA IS IMPLANT FIXATION AND HIP STABILITYrdquo
BUT AVOID LL DISCREPANCY
THA--LL
LL DISCREP COMMON AFTER THA
MINIMIZE LL DISCREPANCY CRUCIAL TO THA SUCCESS
LL DISCREP IS 2ND MOST COMMON SOURCE OF LITIGATION
THAmdashLL
MOST PTS WITH LL DISCREP IMPROVE WITH TIME
PT AND CHIROPRACTORS DRAW ATTENTION AND NEED TO BE EDUCATED
HIP SOCIETY STUDY 05 TO 7 LL PERSIST
TX SHOE LIFT(UP TO 95MM) PT AND IN SEVERE CASES REVISION
THA--LL
frac34 OF PREOP PTS HAVE SHORTEN LIMB
THA LENGTHENS LIMB AVG 25-62 MM
GENERALLY lt 1CM LL DISCREP IS ACCEPTABLE
CAN TECHNOLOGY IMPROVE LL DISCREPANCY AFTER THA
THA--LL
CAN TECHNOLGY HELP
LL DISCREPANCY DIVIDED INTO TWO CATAGORIES
A STRUCTURAL
B FUNCTIONAL
THA-LL
STRUCTURAL ACTUAL DIFFERENCE IN OSSEOUS STRUCTURES
FUNCTIONAL POSTORAL ASSYMETRY RESULTING FROM SOFT TISSUE CONTRACTURES----PELVIC OBLIQUITY
THA--LL
TECHNOLOGY
MAY IMPROVE STRUCURAL ASPECT OF LL
IT WILL NOT ASSESS FUNCTIONAL ASPECTS OF LL
THAmdashLL
INTRAOPERATIVE ASSESSMENTS
STRUCTURAL(TECHNOLOGY) IMAGING COMPUTERS ROBOTS
FUNCTIONAL(NO TECHNOLOGY NEEDED) SHUCK TEST DROPKICK TEST LEG TO LEG COMPARISION
DAA REDUCES LL DISCREPANCY
PT is SUPINEmdashrdquoFEEL THE MALLEOLI ldquo
LL CAN BE EASILY ASSESSED
FUNCTIONAL ASSESSMENT EASY
XRAY CONFIRMATION IF NECESSARY
THA-NO TECHNOLOGY NEEDED
IAN LEARMONTH ldquoTHA AND THE LAW OF DIMINISHING RETURNSrdquo JBJS 2006
THA ADVANCESFIXATIONBEARINGSMIS
LAW OF DIMINISHING RETURNS APPLIES AS PRODUCT IMPROVES A EXPONENTIALLY GREATER INVESTMENT IS NEEDED TO IMPROVE TECHNOLOGY
THAmdashNO TECHNOLOGY NEEDED
LEARMONTH 2006
ldquoCAN WE AFFORD A SUBSTANCIAL INVESTMENT FOR AN ALREADY VERY SUCCESSFUL PROCEDURErdquo
ldquoA GREATER BENEFIT MAY ACCRUE FROM RESEARCH IN ORTHOBIOLOGIS TISSUE ENGINEERING AND GENE THERAPYrdquo
THA-NO TECHNOLOGY NEEDED
PROFESSION IS BEING PUSHED BY OUTSIDE FORCES
MEDIA
PATIENTS
INDUSTRY
SURGEON DESIGNERS
THAmdashNO TECHNOLOGY NEEDED
CONCLUSIONS
NEW TECHNOLOGY HAS NOT PROVEN ITSELF TO IMPROVE OUTCOMES FURTHER INVESTMENT MUST BE ANALYSED IN LIEU OF THIS FACT AS WELL AS THE OPPORTUNITY TO ENHANCE OUTCOMES THROUGH OTHER MEANS
NEW TECHONOLGY SHOULD BE ADVOCATED CAREFULLY AT THIS TIME
THANK YOU
THA-LL
ldquoPARAMONT GOAL OF THA IS IMPLANT FIXATION AND HIP STABILITYrdquo
BUT AVOID LL DISCREPANCY
THA--LL
LL DISCREP COMMON AFTER THA
MINIMIZE LL DISCREPANCY CRUCIAL TO THA SUCCESS
LL DISCREP IS 2ND MOST COMMON SOURCE OF LITIGATION
THAmdashLL
MOST PTS WITH LL DISCREP IMPROVE WITH TIME
PT AND CHIROPRACTORS DRAW ATTENTION AND NEED TO BE EDUCATED
HIP SOCIETY STUDY 05 TO 7 LL PERSIST
TX SHOE LIFT(UP TO 95MM) PT AND IN SEVERE CASES REVISION
THA--LL
frac34 OF PREOP PTS HAVE SHORTEN LIMB
THA LENGTHENS LIMB AVG 25-62 MM
GENERALLY lt 1CM LL DISCREP IS ACCEPTABLE
CAN TECHNOLOGY IMPROVE LL DISCREPANCY AFTER THA
THA--LL
CAN TECHNOLGY HELP
LL DISCREPANCY DIVIDED INTO TWO CATAGORIES
A STRUCTURAL
B FUNCTIONAL
THA-LL
STRUCTURAL ACTUAL DIFFERENCE IN OSSEOUS STRUCTURES
FUNCTIONAL POSTORAL ASSYMETRY RESULTING FROM SOFT TISSUE CONTRACTURES----PELVIC OBLIQUITY
THA--LL
TECHNOLOGY
MAY IMPROVE STRUCURAL ASPECT OF LL
IT WILL NOT ASSESS FUNCTIONAL ASPECTS OF LL
THAmdashLL
INTRAOPERATIVE ASSESSMENTS
STRUCTURAL(TECHNOLOGY) IMAGING COMPUTERS ROBOTS
FUNCTIONAL(NO TECHNOLOGY NEEDED) SHUCK TEST DROPKICK TEST LEG TO LEG COMPARISION
DAA REDUCES LL DISCREPANCY
PT is SUPINEmdashrdquoFEEL THE MALLEOLI ldquo
LL CAN BE EASILY ASSESSED
FUNCTIONAL ASSESSMENT EASY
XRAY CONFIRMATION IF NECESSARY
THA-NO TECHNOLOGY NEEDED
IAN LEARMONTH ldquoTHA AND THE LAW OF DIMINISHING RETURNSrdquo JBJS 2006
THA ADVANCESFIXATIONBEARINGSMIS
LAW OF DIMINISHING RETURNS APPLIES AS PRODUCT IMPROVES A EXPONENTIALLY GREATER INVESTMENT IS NEEDED TO IMPROVE TECHNOLOGY
THAmdashNO TECHNOLOGY NEEDED
LEARMONTH 2006
ldquoCAN WE AFFORD A SUBSTANCIAL INVESTMENT FOR AN ALREADY VERY SUCCESSFUL PROCEDURErdquo
ldquoA GREATER BENEFIT MAY ACCRUE FROM RESEARCH IN ORTHOBIOLOGIS TISSUE ENGINEERING AND GENE THERAPYrdquo
THA-NO TECHNOLOGY NEEDED
PROFESSION IS BEING PUSHED BY OUTSIDE FORCES
MEDIA
PATIENTS
INDUSTRY
SURGEON DESIGNERS
THAmdashNO TECHNOLOGY NEEDED
CONCLUSIONS
NEW TECHNOLOGY HAS NOT PROVEN ITSELF TO IMPROVE OUTCOMES FURTHER INVESTMENT MUST BE ANALYSED IN LIEU OF THIS FACT AS WELL AS THE OPPORTUNITY TO ENHANCE OUTCOMES THROUGH OTHER MEANS
NEW TECHONOLGY SHOULD BE ADVOCATED CAREFULLY AT THIS TIME
THANK YOU
THA--LL
LL DISCREP COMMON AFTER THA
MINIMIZE LL DISCREPANCY CRUCIAL TO THA SUCCESS
LL DISCREP IS 2ND MOST COMMON SOURCE OF LITIGATION
THAmdashLL
MOST PTS WITH LL DISCREP IMPROVE WITH TIME
PT AND CHIROPRACTORS DRAW ATTENTION AND NEED TO BE EDUCATED
HIP SOCIETY STUDY 05 TO 7 LL PERSIST
TX SHOE LIFT(UP TO 95MM) PT AND IN SEVERE CASES REVISION
THA--LL
frac34 OF PREOP PTS HAVE SHORTEN LIMB
THA LENGTHENS LIMB AVG 25-62 MM
GENERALLY lt 1CM LL DISCREP IS ACCEPTABLE
CAN TECHNOLOGY IMPROVE LL DISCREPANCY AFTER THA
THA--LL
CAN TECHNOLGY HELP
LL DISCREPANCY DIVIDED INTO TWO CATAGORIES
A STRUCTURAL
B FUNCTIONAL
THA-LL
STRUCTURAL ACTUAL DIFFERENCE IN OSSEOUS STRUCTURES
FUNCTIONAL POSTORAL ASSYMETRY RESULTING FROM SOFT TISSUE CONTRACTURES----PELVIC OBLIQUITY
THA--LL
TECHNOLOGY
MAY IMPROVE STRUCURAL ASPECT OF LL
IT WILL NOT ASSESS FUNCTIONAL ASPECTS OF LL
THAmdashLL
INTRAOPERATIVE ASSESSMENTS
STRUCTURAL(TECHNOLOGY) IMAGING COMPUTERS ROBOTS
FUNCTIONAL(NO TECHNOLOGY NEEDED) SHUCK TEST DROPKICK TEST LEG TO LEG COMPARISION
DAA REDUCES LL DISCREPANCY
PT is SUPINEmdashrdquoFEEL THE MALLEOLI ldquo
LL CAN BE EASILY ASSESSED
FUNCTIONAL ASSESSMENT EASY
XRAY CONFIRMATION IF NECESSARY
THA-NO TECHNOLOGY NEEDED
IAN LEARMONTH ldquoTHA AND THE LAW OF DIMINISHING RETURNSrdquo JBJS 2006
THA ADVANCESFIXATIONBEARINGSMIS
LAW OF DIMINISHING RETURNS APPLIES AS PRODUCT IMPROVES A EXPONENTIALLY GREATER INVESTMENT IS NEEDED TO IMPROVE TECHNOLOGY
THAmdashNO TECHNOLOGY NEEDED
LEARMONTH 2006
ldquoCAN WE AFFORD A SUBSTANCIAL INVESTMENT FOR AN ALREADY VERY SUCCESSFUL PROCEDURErdquo
ldquoA GREATER BENEFIT MAY ACCRUE FROM RESEARCH IN ORTHOBIOLOGIS TISSUE ENGINEERING AND GENE THERAPYrdquo
THA-NO TECHNOLOGY NEEDED
PROFESSION IS BEING PUSHED BY OUTSIDE FORCES
MEDIA
PATIENTS
INDUSTRY
SURGEON DESIGNERS
THAmdashNO TECHNOLOGY NEEDED
CONCLUSIONS
NEW TECHNOLOGY HAS NOT PROVEN ITSELF TO IMPROVE OUTCOMES FURTHER INVESTMENT MUST BE ANALYSED IN LIEU OF THIS FACT AS WELL AS THE OPPORTUNITY TO ENHANCE OUTCOMES THROUGH OTHER MEANS
NEW TECHONOLGY SHOULD BE ADVOCATED CAREFULLY AT THIS TIME
THANK YOU
THAmdashLL
MOST PTS WITH LL DISCREP IMPROVE WITH TIME
PT AND CHIROPRACTORS DRAW ATTENTION AND NEED TO BE EDUCATED
HIP SOCIETY STUDY 05 TO 7 LL PERSIST
TX SHOE LIFT(UP TO 95MM) PT AND IN SEVERE CASES REVISION
THA--LL
frac34 OF PREOP PTS HAVE SHORTEN LIMB
THA LENGTHENS LIMB AVG 25-62 MM
GENERALLY lt 1CM LL DISCREP IS ACCEPTABLE
CAN TECHNOLOGY IMPROVE LL DISCREPANCY AFTER THA
THA--LL
CAN TECHNOLGY HELP
LL DISCREPANCY DIVIDED INTO TWO CATAGORIES
A STRUCTURAL
B FUNCTIONAL
THA-LL
STRUCTURAL ACTUAL DIFFERENCE IN OSSEOUS STRUCTURES
FUNCTIONAL POSTORAL ASSYMETRY RESULTING FROM SOFT TISSUE CONTRACTURES----PELVIC OBLIQUITY
THA--LL
TECHNOLOGY
MAY IMPROVE STRUCURAL ASPECT OF LL
IT WILL NOT ASSESS FUNCTIONAL ASPECTS OF LL
THAmdashLL
INTRAOPERATIVE ASSESSMENTS
STRUCTURAL(TECHNOLOGY) IMAGING COMPUTERS ROBOTS
FUNCTIONAL(NO TECHNOLOGY NEEDED) SHUCK TEST DROPKICK TEST LEG TO LEG COMPARISION
DAA REDUCES LL DISCREPANCY
PT is SUPINEmdashrdquoFEEL THE MALLEOLI ldquo
LL CAN BE EASILY ASSESSED
FUNCTIONAL ASSESSMENT EASY
XRAY CONFIRMATION IF NECESSARY
THA-NO TECHNOLOGY NEEDED
IAN LEARMONTH ldquoTHA AND THE LAW OF DIMINISHING RETURNSrdquo JBJS 2006
THA ADVANCESFIXATIONBEARINGSMIS
LAW OF DIMINISHING RETURNS APPLIES AS PRODUCT IMPROVES A EXPONENTIALLY GREATER INVESTMENT IS NEEDED TO IMPROVE TECHNOLOGY
THAmdashNO TECHNOLOGY NEEDED
LEARMONTH 2006
ldquoCAN WE AFFORD A SUBSTANCIAL INVESTMENT FOR AN ALREADY VERY SUCCESSFUL PROCEDURErdquo
ldquoA GREATER BENEFIT MAY ACCRUE FROM RESEARCH IN ORTHOBIOLOGIS TISSUE ENGINEERING AND GENE THERAPYrdquo
THA-NO TECHNOLOGY NEEDED
PROFESSION IS BEING PUSHED BY OUTSIDE FORCES
MEDIA
PATIENTS
INDUSTRY
SURGEON DESIGNERS
THAmdashNO TECHNOLOGY NEEDED
CONCLUSIONS
NEW TECHNOLOGY HAS NOT PROVEN ITSELF TO IMPROVE OUTCOMES FURTHER INVESTMENT MUST BE ANALYSED IN LIEU OF THIS FACT AS WELL AS THE OPPORTUNITY TO ENHANCE OUTCOMES THROUGH OTHER MEANS
NEW TECHONOLGY SHOULD BE ADVOCATED CAREFULLY AT THIS TIME
THANK YOU
THA--LL
frac34 OF PREOP PTS HAVE SHORTEN LIMB
THA LENGTHENS LIMB AVG 25-62 MM
GENERALLY lt 1CM LL DISCREP IS ACCEPTABLE
CAN TECHNOLOGY IMPROVE LL DISCREPANCY AFTER THA
THA--LL
CAN TECHNOLGY HELP
LL DISCREPANCY DIVIDED INTO TWO CATAGORIES
A STRUCTURAL
B FUNCTIONAL
THA-LL
STRUCTURAL ACTUAL DIFFERENCE IN OSSEOUS STRUCTURES
FUNCTIONAL POSTORAL ASSYMETRY RESULTING FROM SOFT TISSUE CONTRACTURES----PELVIC OBLIQUITY
THA--LL
TECHNOLOGY
MAY IMPROVE STRUCURAL ASPECT OF LL
IT WILL NOT ASSESS FUNCTIONAL ASPECTS OF LL
THAmdashLL
INTRAOPERATIVE ASSESSMENTS
STRUCTURAL(TECHNOLOGY) IMAGING COMPUTERS ROBOTS
FUNCTIONAL(NO TECHNOLOGY NEEDED) SHUCK TEST DROPKICK TEST LEG TO LEG COMPARISION
DAA REDUCES LL DISCREPANCY
PT is SUPINEmdashrdquoFEEL THE MALLEOLI ldquo
LL CAN BE EASILY ASSESSED
FUNCTIONAL ASSESSMENT EASY
XRAY CONFIRMATION IF NECESSARY
THA-NO TECHNOLOGY NEEDED
IAN LEARMONTH ldquoTHA AND THE LAW OF DIMINISHING RETURNSrdquo JBJS 2006
THA ADVANCESFIXATIONBEARINGSMIS
LAW OF DIMINISHING RETURNS APPLIES AS PRODUCT IMPROVES A EXPONENTIALLY GREATER INVESTMENT IS NEEDED TO IMPROVE TECHNOLOGY
THAmdashNO TECHNOLOGY NEEDED
LEARMONTH 2006
ldquoCAN WE AFFORD A SUBSTANCIAL INVESTMENT FOR AN ALREADY VERY SUCCESSFUL PROCEDURErdquo
ldquoA GREATER BENEFIT MAY ACCRUE FROM RESEARCH IN ORTHOBIOLOGIS TISSUE ENGINEERING AND GENE THERAPYrdquo
THA-NO TECHNOLOGY NEEDED
PROFESSION IS BEING PUSHED BY OUTSIDE FORCES
MEDIA
PATIENTS
INDUSTRY
SURGEON DESIGNERS
THAmdashNO TECHNOLOGY NEEDED
CONCLUSIONS
NEW TECHNOLOGY HAS NOT PROVEN ITSELF TO IMPROVE OUTCOMES FURTHER INVESTMENT MUST BE ANALYSED IN LIEU OF THIS FACT AS WELL AS THE OPPORTUNITY TO ENHANCE OUTCOMES THROUGH OTHER MEANS
NEW TECHONOLGY SHOULD BE ADVOCATED CAREFULLY AT THIS TIME
THANK YOU
THA--LL
CAN TECHNOLGY HELP
LL DISCREPANCY DIVIDED INTO TWO CATAGORIES
A STRUCTURAL
B FUNCTIONAL
THA-LL
STRUCTURAL ACTUAL DIFFERENCE IN OSSEOUS STRUCTURES
FUNCTIONAL POSTORAL ASSYMETRY RESULTING FROM SOFT TISSUE CONTRACTURES----PELVIC OBLIQUITY
THA--LL
TECHNOLOGY
MAY IMPROVE STRUCURAL ASPECT OF LL
IT WILL NOT ASSESS FUNCTIONAL ASPECTS OF LL
THAmdashLL
INTRAOPERATIVE ASSESSMENTS
STRUCTURAL(TECHNOLOGY) IMAGING COMPUTERS ROBOTS
FUNCTIONAL(NO TECHNOLOGY NEEDED) SHUCK TEST DROPKICK TEST LEG TO LEG COMPARISION
DAA REDUCES LL DISCREPANCY
PT is SUPINEmdashrdquoFEEL THE MALLEOLI ldquo
LL CAN BE EASILY ASSESSED
FUNCTIONAL ASSESSMENT EASY
XRAY CONFIRMATION IF NECESSARY
THA-NO TECHNOLOGY NEEDED
IAN LEARMONTH ldquoTHA AND THE LAW OF DIMINISHING RETURNSrdquo JBJS 2006
THA ADVANCESFIXATIONBEARINGSMIS
LAW OF DIMINISHING RETURNS APPLIES AS PRODUCT IMPROVES A EXPONENTIALLY GREATER INVESTMENT IS NEEDED TO IMPROVE TECHNOLOGY
THAmdashNO TECHNOLOGY NEEDED
LEARMONTH 2006
ldquoCAN WE AFFORD A SUBSTANCIAL INVESTMENT FOR AN ALREADY VERY SUCCESSFUL PROCEDURErdquo
ldquoA GREATER BENEFIT MAY ACCRUE FROM RESEARCH IN ORTHOBIOLOGIS TISSUE ENGINEERING AND GENE THERAPYrdquo
THA-NO TECHNOLOGY NEEDED
PROFESSION IS BEING PUSHED BY OUTSIDE FORCES
MEDIA
PATIENTS
INDUSTRY
SURGEON DESIGNERS
THAmdashNO TECHNOLOGY NEEDED
CONCLUSIONS
NEW TECHNOLOGY HAS NOT PROVEN ITSELF TO IMPROVE OUTCOMES FURTHER INVESTMENT MUST BE ANALYSED IN LIEU OF THIS FACT AS WELL AS THE OPPORTUNITY TO ENHANCE OUTCOMES THROUGH OTHER MEANS
NEW TECHONOLGY SHOULD BE ADVOCATED CAREFULLY AT THIS TIME
THANK YOU
THA-LL
STRUCTURAL ACTUAL DIFFERENCE IN OSSEOUS STRUCTURES
FUNCTIONAL POSTORAL ASSYMETRY RESULTING FROM SOFT TISSUE CONTRACTURES----PELVIC OBLIQUITY
THA--LL
TECHNOLOGY
MAY IMPROVE STRUCURAL ASPECT OF LL
IT WILL NOT ASSESS FUNCTIONAL ASPECTS OF LL
THAmdashLL
INTRAOPERATIVE ASSESSMENTS
STRUCTURAL(TECHNOLOGY) IMAGING COMPUTERS ROBOTS
FUNCTIONAL(NO TECHNOLOGY NEEDED) SHUCK TEST DROPKICK TEST LEG TO LEG COMPARISION
DAA REDUCES LL DISCREPANCY
PT is SUPINEmdashrdquoFEEL THE MALLEOLI ldquo
LL CAN BE EASILY ASSESSED
FUNCTIONAL ASSESSMENT EASY
XRAY CONFIRMATION IF NECESSARY
THA-NO TECHNOLOGY NEEDED
IAN LEARMONTH ldquoTHA AND THE LAW OF DIMINISHING RETURNSrdquo JBJS 2006
THA ADVANCESFIXATIONBEARINGSMIS
LAW OF DIMINISHING RETURNS APPLIES AS PRODUCT IMPROVES A EXPONENTIALLY GREATER INVESTMENT IS NEEDED TO IMPROVE TECHNOLOGY
THAmdashNO TECHNOLOGY NEEDED
LEARMONTH 2006
ldquoCAN WE AFFORD A SUBSTANCIAL INVESTMENT FOR AN ALREADY VERY SUCCESSFUL PROCEDURErdquo
ldquoA GREATER BENEFIT MAY ACCRUE FROM RESEARCH IN ORTHOBIOLOGIS TISSUE ENGINEERING AND GENE THERAPYrdquo
THA-NO TECHNOLOGY NEEDED
PROFESSION IS BEING PUSHED BY OUTSIDE FORCES
MEDIA
PATIENTS
INDUSTRY
SURGEON DESIGNERS
THAmdashNO TECHNOLOGY NEEDED
CONCLUSIONS
NEW TECHNOLOGY HAS NOT PROVEN ITSELF TO IMPROVE OUTCOMES FURTHER INVESTMENT MUST BE ANALYSED IN LIEU OF THIS FACT AS WELL AS THE OPPORTUNITY TO ENHANCE OUTCOMES THROUGH OTHER MEANS
NEW TECHONOLGY SHOULD BE ADVOCATED CAREFULLY AT THIS TIME
THANK YOU
THA--LL
TECHNOLOGY
MAY IMPROVE STRUCURAL ASPECT OF LL
IT WILL NOT ASSESS FUNCTIONAL ASPECTS OF LL
THAmdashLL
INTRAOPERATIVE ASSESSMENTS
STRUCTURAL(TECHNOLOGY) IMAGING COMPUTERS ROBOTS
FUNCTIONAL(NO TECHNOLOGY NEEDED) SHUCK TEST DROPKICK TEST LEG TO LEG COMPARISION
DAA REDUCES LL DISCREPANCY
PT is SUPINEmdashrdquoFEEL THE MALLEOLI ldquo
LL CAN BE EASILY ASSESSED
FUNCTIONAL ASSESSMENT EASY
XRAY CONFIRMATION IF NECESSARY
THA-NO TECHNOLOGY NEEDED
IAN LEARMONTH ldquoTHA AND THE LAW OF DIMINISHING RETURNSrdquo JBJS 2006
THA ADVANCESFIXATIONBEARINGSMIS
LAW OF DIMINISHING RETURNS APPLIES AS PRODUCT IMPROVES A EXPONENTIALLY GREATER INVESTMENT IS NEEDED TO IMPROVE TECHNOLOGY
THAmdashNO TECHNOLOGY NEEDED
LEARMONTH 2006
ldquoCAN WE AFFORD A SUBSTANCIAL INVESTMENT FOR AN ALREADY VERY SUCCESSFUL PROCEDURErdquo
ldquoA GREATER BENEFIT MAY ACCRUE FROM RESEARCH IN ORTHOBIOLOGIS TISSUE ENGINEERING AND GENE THERAPYrdquo
THA-NO TECHNOLOGY NEEDED
PROFESSION IS BEING PUSHED BY OUTSIDE FORCES
MEDIA
PATIENTS
INDUSTRY
SURGEON DESIGNERS
THAmdashNO TECHNOLOGY NEEDED
CONCLUSIONS
NEW TECHNOLOGY HAS NOT PROVEN ITSELF TO IMPROVE OUTCOMES FURTHER INVESTMENT MUST BE ANALYSED IN LIEU OF THIS FACT AS WELL AS THE OPPORTUNITY TO ENHANCE OUTCOMES THROUGH OTHER MEANS
NEW TECHONOLGY SHOULD BE ADVOCATED CAREFULLY AT THIS TIME
THANK YOU
THAmdashLL
INTRAOPERATIVE ASSESSMENTS
STRUCTURAL(TECHNOLOGY) IMAGING COMPUTERS ROBOTS
FUNCTIONAL(NO TECHNOLOGY NEEDED) SHUCK TEST DROPKICK TEST LEG TO LEG COMPARISION
DAA REDUCES LL DISCREPANCY
PT is SUPINEmdashrdquoFEEL THE MALLEOLI ldquo
LL CAN BE EASILY ASSESSED
FUNCTIONAL ASSESSMENT EASY
XRAY CONFIRMATION IF NECESSARY
THA-NO TECHNOLOGY NEEDED
IAN LEARMONTH ldquoTHA AND THE LAW OF DIMINISHING RETURNSrdquo JBJS 2006
THA ADVANCESFIXATIONBEARINGSMIS
LAW OF DIMINISHING RETURNS APPLIES AS PRODUCT IMPROVES A EXPONENTIALLY GREATER INVESTMENT IS NEEDED TO IMPROVE TECHNOLOGY
THAmdashNO TECHNOLOGY NEEDED
LEARMONTH 2006
ldquoCAN WE AFFORD A SUBSTANCIAL INVESTMENT FOR AN ALREADY VERY SUCCESSFUL PROCEDURErdquo
ldquoA GREATER BENEFIT MAY ACCRUE FROM RESEARCH IN ORTHOBIOLOGIS TISSUE ENGINEERING AND GENE THERAPYrdquo
THA-NO TECHNOLOGY NEEDED
PROFESSION IS BEING PUSHED BY OUTSIDE FORCES
MEDIA
PATIENTS
INDUSTRY
SURGEON DESIGNERS
THAmdashNO TECHNOLOGY NEEDED
CONCLUSIONS
NEW TECHNOLOGY HAS NOT PROVEN ITSELF TO IMPROVE OUTCOMES FURTHER INVESTMENT MUST BE ANALYSED IN LIEU OF THIS FACT AS WELL AS THE OPPORTUNITY TO ENHANCE OUTCOMES THROUGH OTHER MEANS
NEW TECHONOLGY SHOULD BE ADVOCATED CAREFULLY AT THIS TIME
THANK YOU
DAA REDUCES LL DISCREPANCY
PT is SUPINEmdashrdquoFEEL THE MALLEOLI ldquo
LL CAN BE EASILY ASSESSED
FUNCTIONAL ASSESSMENT EASY
XRAY CONFIRMATION IF NECESSARY
THA-NO TECHNOLOGY NEEDED
IAN LEARMONTH ldquoTHA AND THE LAW OF DIMINISHING RETURNSrdquo JBJS 2006
THA ADVANCESFIXATIONBEARINGSMIS
LAW OF DIMINISHING RETURNS APPLIES AS PRODUCT IMPROVES A EXPONENTIALLY GREATER INVESTMENT IS NEEDED TO IMPROVE TECHNOLOGY
THAmdashNO TECHNOLOGY NEEDED
LEARMONTH 2006
ldquoCAN WE AFFORD A SUBSTANCIAL INVESTMENT FOR AN ALREADY VERY SUCCESSFUL PROCEDURErdquo
ldquoA GREATER BENEFIT MAY ACCRUE FROM RESEARCH IN ORTHOBIOLOGIS TISSUE ENGINEERING AND GENE THERAPYrdquo
THA-NO TECHNOLOGY NEEDED
PROFESSION IS BEING PUSHED BY OUTSIDE FORCES
MEDIA
PATIENTS
INDUSTRY
SURGEON DESIGNERS
THAmdashNO TECHNOLOGY NEEDED
CONCLUSIONS
NEW TECHNOLOGY HAS NOT PROVEN ITSELF TO IMPROVE OUTCOMES FURTHER INVESTMENT MUST BE ANALYSED IN LIEU OF THIS FACT AS WELL AS THE OPPORTUNITY TO ENHANCE OUTCOMES THROUGH OTHER MEANS
NEW TECHONOLGY SHOULD BE ADVOCATED CAREFULLY AT THIS TIME
THANK YOU
THA-NO TECHNOLOGY NEEDED
IAN LEARMONTH ldquoTHA AND THE LAW OF DIMINISHING RETURNSrdquo JBJS 2006
THA ADVANCESFIXATIONBEARINGSMIS
LAW OF DIMINISHING RETURNS APPLIES AS PRODUCT IMPROVES A EXPONENTIALLY GREATER INVESTMENT IS NEEDED TO IMPROVE TECHNOLOGY
THAmdashNO TECHNOLOGY NEEDED
LEARMONTH 2006
ldquoCAN WE AFFORD A SUBSTANCIAL INVESTMENT FOR AN ALREADY VERY SUCCESSFUL PROCEDURErdquo
ldquoA GREATER BENEFIT MAY ACCRUE FROM RESEARCH IN ORTHOBIOLOGIS TISSUE ENGINEERING AND GENE THERAPYrdquo
THA-NO TECHNOLOGY NEEDED
PROFESSION IS BEING PUSHED BY OUTSIDE FORCES
MEDIA
PATIENTS
INDUSTRY
SURGEON DESIGNERS
THAmdashNO TECHNOLOGY NEEDED
CONCLUSIONS
NEW TECHNOLOGY HAS NOT PROVEN ITSELF TO IMPROVE OUTCOMES FURTHER INVESTMENT MUST BE ANALYSED IN LIEU OF THIS FACT AS WELL AS THE OPPORTUNITY TO ENHANCE OUTCOMES THROUGH OTHER MEANS
NEW TECHONOLGY SHOULD BE ADVOCATED CAREFULLY AT THIS TIME
THANK YOU
THAmdashNO TECHNOLOGY NEEDED
LEARMONTH 2006
ldquoCAN WE AFFORD A SUBSTANCIAL INVESTMENT FOR AN ALREADY VERY SUCCESSFUL PROCEDURErdquo
ldquoA GREATER BENEFIT MAY ACCRUE FROM RESEARCH IN ORTHOBIOLOGIS TISSUE ENGINEERING AND GENE THERAPYrdquo
THA-NO TECHNOLOGY NEEDED
PROFESSION IS BEING PUSHED BY OUTSIDE FORCES
MEDIA
PATIENTS
INDUSTRY
SURGEON DESIGNERS
THAmdashNO TECHNOLOGY NEEDED
CONCLUSIONS
NEW TECHNOLOGY HAS NOT PROVEN ITSELF TO IMPROVE OUTCOMES FURTHER INVESTMENT MUST BE ANALYSED IN LIEU OF THIS FACT AS WELL AS THE OPPORTUNITY TO ENHANCE OUTCOMES THROUGH OTHER MEANS
NEW TECHONOLGY SHOULD BE ADVOCATED CAREFULLY AT THIS TIME
THANK YOU
THA-NO TECHNOLOGY NEEDED
PROFESSION IS BEING PUSHED BY OUTSIDE FORCES
MEDIA
PATIENTS
INDUSTRY
SURGEON DESIGNERS
THAmdashNO TECHNOLOGY NEEDED
CONCLUSIONS
NEW TECHNOLOGY HAS NOT PROVEN ITSELF TO IMPROVE OUTCOMES FURTHER INVESTMENT MUST BE ANALYSED IN LIEU OF THIS FACT AS WELL AS THE OPPORTUNITY TO ENHANCE OUTCOMES THROUGH OTHER MEANS
NEW TECHONOLGY SHOULD BE ADVOCATED CAREFULLY AT THIS TIME
THANK YOU
THAmdashNO TECHNOLOGY NEEDED
CONCLUSIONS
NEW TECHNOLOGY HAS NOT PROVEN ITSELF TO IMPROVE OUTCOMES FURTHER INVESTMENT MUST BE ANALYSED IN LIEU OF THIS FACT AS WELL AS THE OPPORTUNITY TO ENHANCE OUTCOMES THROUGH OTHER MEANS
NEW TECHONOLGY SHOULD BE ADVOCATED CAREFULLY AT THIS TIME
THANK YOU
THANK YOU