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Issue 4 | July 2016 Corin’s Optimized Positioning System (OPS™) receives 510(k) clearance Corin is pleased to announce United States 510(k) clearance of the Optimized Positioning System (OPS™), the first FDA-cleared technology to help surgeons achieve functional, patient specific component alignment in total hip replacement. The approval allows Corin to be the first company to offer a technology that optimises the orientation of each individual patient’s acetabular component by incorporating functional assessments into the planning phase, whilst utilising a laser-guided Patient Specific Instrument platform to accurately reproduce the surgical plan intraoperatively. Following the acquisition of the technology in 2014 a significant number of procedures in Australia and Europe have been completed, Corin now look forward to launching OPS™ in the world’s largest orthopaedic market. The combination of the IP-protected OPS™ technology, alongside the company’s strong hip portfolio and rapidly expanding distribution network, provide a strong foundation for future growth of the company. Jim Pierrepont, Corin’s Head of Procedural Technologies commented “We are delighted to gain access to the US market and be the first company to offer such an exciting technology. This solution is a significant step forward in helping to improve the performance of total hip replacement, as conventional acetabular cup placement does not take into account the patient’s individual functional movement and relies instead on guidance for cup positioning defined some 36 years ago”. Pierrepont went on to say “By commercialising the OPS™ technology, Corin will offer surgeons and patients a unique customised, patient specific solution for hip surgery that will help to provide optimal implant positioning with the goal of improved functional outcome”. Corin’s US President, Paul Berman added “OPS™ is the first orthopaedic technology to facilitate functional implant positioning without adding complexity or substantial cost to the surgical procedure. We are excited to be bringing this technology to the US to further advance orthopaedic care.” 4 Interview with renowned orthopaedic surgeon Miss Sarah Muirhead-Allwood, London Hip Unit, London, UK 6 Why I came to adopt the MiniHip™ David Watson MD, Florida Orthopaedic Institute, Tampa, USA 7 My experiences with Zenith™ TAR Mr Shashi Garg, Westmorland General Hospital, Kendal, UK 9 Use of Revival™ in treatment of CDH/DDH Mr Duncan Whitwell, Nuffield Orthopaedic Centre, Oxford, UK Corporate news COMPANY NEWS Australia Patients are becoming more informed and active decision makers in their surgical experience, with many using online and digital resources to better understand their condition and treatment options. The Australian designed OPS™ LCD brochures are equipping surgeons with patient education tools aligned with their consultation dialogue. Corin is committed to investing in education resources that empower patients by directing them to trustworthy information supporting their surgeon’s treatment preferences which can have a significant impact on treatment outcomes and patient satisfaction. The OPS™ LCD brochures are pre-loaded with an autoplay video outlining the OPS™ total hip replacement process and rationale. They complement Corin’s existing suite of print and online education brochures and enable patients to engage their family, friends and allied health support network in their treatment pathway. To view the OPS™ patient LCD brochure and see how these educational tools can support your practice please visit: www.bit.ly/1TfEi9z Japan Corin is delighted to announce the introduction of TriFit TS™ into Japan. TriFit TS™ was approved for use in March 2016 and is an excellent addition to MiniHip™, CTi II™ and Trinity™ cup which already have approval. This opens up another option for surgeons in Japan wanting to use a modern blade style stem. Dr Funayama of Keio University commented that he saw a real need for this type of short blade stem with calcium phosphate coating, designed anatomically with high offset option in Japan. In its first month of launch 20 stems have been implanted by seven surgeons. Dr Kim of Hanwa Reconstruction Centre commented that he feels implanting TriFit TS™ stems is stress free surgery compared with other blade stems and the instruments are simple and easy to use. Corin look forward to a continued close working relationship with Japanese surgeons as we continue to develop the business in Japan. 2 Company update Vaughan Bonny, General Manager, Australia and New Zealand reflects on his first six months at Corin My time has been action packed and a lot of fun since joining the Corin team. I feel fortunate to have joined Corin at such an exciting time in its evolution. The momentum building in Australia and New Zealand as well as globally is exciting to be a part of. There is no doubt in my mind that Corin is extremely well placed in the market. As I reflect on the last six months, there has been an exceptional amount of activity. We have run and sponsored several major meetings, Vaughan Bonny expanded our sales network in three states, record numbers of surgeons are booking first hip cases, record OPS™ volumes have been achieved, increased LARS™ usage in the gluteal repair indication by 35% and finally we signed a deal to become the exclusive distributor for intellijoint HIP™ (smart hip navigation technology) at the AAOS in March. I’m sure most would agree the Corin Australia, New Zealand and the Optimized Ortho teams have been running fast in Q1 and are doing a sensational job! Pleasingly all of this activity is yielding results: 15 new LARS™ customers and 12 new OPS™ customers are trialling. Exciting times! Armen Bakirtzian, Co-founder and At our national sales meeting I shared with our CEO Intellijoint Surgical (left) organisation the reasons why I was attracted to Russ Mably COO Corin (right) Corin. Quite clearly for me it’s the potential of the whole organisation, both people and products. Corin has embraced the advancement of procedural technologies well ahead of the market. Of course being an Aussie it’s hard not to mention our locally developed OPS™ technology. This is an amazing piece of technology that seeks to provide a patient specific orientation for implants in total hip replacement surgery. Having seen many podium presentations on the benefits of this product there is no doubt the Optimized Ortho team have only scratched the surface in this space. Taking this a step further, OPS™ in combination with Corin’s market leading implants is an envious position to be in. So being six months into the role I am feeling bullish on the commercial outlook for Corin ANZ. Our people, put simply we have a fantastic team. I believe as we continue to develop our talent base, expand our sales network and grow as a business we will build a great company that people want to be part of. Finally and arguably most importantly, it’s Corin’s ability to be nimble in the market and react to what our surgeon customers require to provide the best possible surgical experience for them and their patients. To me that embodies our tag line of ‘Responsible Innovation’ and makes it a delight to engage with our surgeon customers. In my mind we should never lose sight of our customers and their needs. Certainly, my first six months at Corin would suggest we are on the right track here. I believe 2016 holds a lot of promise and I’m delighted to be part of the team. Corin Australia and Optimized Ortho teams. Technology news The femoral story. . . the next chapter in The evolution of OPS™ continues with the recent addition of the femoral planning tool. Prosthesis type and size can now be virtually positioned to understand changes in leg length, offset and femoral version and their impact on the patient’s hip alignment. Once the plan has been agreed, a 3D printed patient specific osteotomy guide is provided, enabling simple and accurate intraoperative implementation (Riddell et al. 2015). Since 2013, Corin’s Optimized Positioning System (OPS™) has been used in over 2500 total hip replacement surgeries in Australia, Germany, Austria and the UK, enabling preoperative functional analysis for each patient. The femoral planning system complements Corin’s unique OPS™ acetabular planning platform to provide a comprehensive total hip replacement solution. replacement. This 3D–based femoral plan also contains detailed information to flag key ‘watch-outs’ to the surgeon preoperatively, thereby reducing unexpected decision complexities within the operating room. The product is soon to be released more widely as interest continues to grow in key markets around the globe. Importantly, the technology continues to be supported by a strong foundation of clinical research, with multiple case series being exhibited at a number of key orthopaedic congresses. This year results have been presented at meetings including ICJR (Sydney), JSRA (Osaka), AAOS (Orlando), COMOC (Capetown) and will continue at SICOT (Rome), BOA (Belfast), ISTA (Boston), AOA (Cairns) and DKOU (Berlin). Dr Christoph Schnurr Verbund Katholischer Kliniken Düsseldorf, Germany What do you see as the major challenges in THR today? A key challenge in total hip replacement is the ability of the surgeon to correctly select and orient prostheses intraoperatively. To do this appropriately, a thorough understanding of a number of patient specific variables is required. One of the most significant factors is the dynamic behavior of the pelvis and lumbar spine – which can vary significantly from one patient to the next. This variation can provide important information to the surgeon to help make the most appropriate ™ technology decision as to the design of prosthesis and bearing surface to be utilised in surgery. What role do patient specific factors play when planning and performing a THR? Patient specific variables play a key role in the planning and execution of a total hip replacement. Aspects such as age, gender, weight, sports activities, physical and psychological health status need to be carefully considered in the planning phase. Knowledge of these factors helps the surgeon to better profile each patient and understand their postoperative expectations. Further, by understanding the dynamics of the pelvis and lumbar spine in functional positions, we can better comprehend their range of motion requirements as well as the risk of instability during flexion and extension manoeuvers. How do you use the information provided by OPS™ in your THR practice? OPS™ provides detailed, patient specific information for me to better plan and execute a total hip replacement. The preoperative dynamic analysis provides key information that enables me to target and achieve a personalised safe zone for the placement of the acetabular component. In addition, OPS™ also gives me the ability to accurately reconstruct leg length and offset, giving me added confidence that function and stability are better restored postoperatively. In combination, this has given me the ability to optimise outcomes and achieve predictably high levels of patient satisfaction. To find out more about this exciting technological advancement and how OPS™ technology may benefit your practice please visit www.bit.ly/1XfkZyv “Femoral OPS™ gives me another level of confidence that the femoral implant ends up where I want it to be, particularly in regards to the leg length” Dr Jorgen Hellman – over 100 OPS™ THR’s Early validation work has shown encouraging results, with 85% of achieved osteotomies being executed to within 1mm of the preoperative plan (Riddell et al. 2015). By accurately controlling the resection level, the surgeon has the potential to better control biomechanical parameters, while also managing the definitive position of the femoral component during total hip Responsible Innovation 3 Global surgeon feature Interview with world-renowned orthopaedic surgeon – Miss Sarah Muirhead-Allwood Miss Sarah Muirhead-Allwood MB BS FRCS London Hip Unit, London, UK Miss Sarah Muirhead-Allwood qualified in medicine from St Thomas' Hospital in London. She was appointed as a Consultant Orthopaedic Surgeon at the Whittington Hospital in London and the Royal Northern Hospital in 1984. The same year she was also appointed as Honorary Senior Clinical Lecturer at University College London. In 1991 she was appointed as a Consultant at the Royal National Orthopaedic Hospital, where she remains an Honorary Consultant. For the last 15 years Miss Muirhead-Allwood has exclusively performed primary and revision hip surgery, and lectures on these procedures all over the world. She is a member of the British, European and International Hip Societies. Miss MuirheadAllwood set up the London Hip Unit in 2002 to provide a fully supported specialised service for adults with hip problems. In her spare time Miss Muirhead-Allwood enjoys golf and photography. 1. What do you see as the most important changes in hip arthroplasty in the last ten years? I think the biggest change is the improvements in coatings, but more particularly bearing surface technology. Over the last decade within Europe we have seen an increase in ceramicon-ceramic hips which are performing well and data shows a more normal tissue reaction around ceramic debris. However the improvements in plastic technology have been even greater, and the understanding of poly treatment has revolutionised our practice. HXLPE seems to give better 20 years survivorship over UHMWPE. The addition of vitamin E poly may well produce a bearing surface with the ability to compete against ceramic-on-ceramic for 30 years survivorship. 4. What changes do you think are likely to occur in THA in the next five years? I may retire which will leave the total hip replacement world in disaster. Joking aside I feel that technology will play a bigger role in orthopaedics in the future. The other area I feel technology will affect future surgery will be the use of ALM (additive layer manufacture) in component production. This will almost certainly reduce costs but also address issues with implant stiffness. 2. What do you see as the issues/ unsolved problems in THA today? 5. What changes have you seen in your patient population and expectations for total joint replacement during your career? Many of the previous issues in THR have been addressed. We have now mastered implant fixation at the bony interface using porous metals and even cement, plus we now have access to bearing surfaces which seem to show longevity of 30 years. Early in my career my major interest was in revision hip surgery as I trained and became a Consultant at a time where total hip replacements were failing in large numbers. These failures needed to be revised to a more time lasting solution. However, bone loss around the implant due to prosthesis rigidity still seems to be an issue. Previous attempts have been made to make a more flexible hip replacement prosthesis. As we are now able to manufacture using modern technology we should in theory be able to make products which mimic the natural anatomy. This ultimately led to a search for a primary THR with better longevity. Today my revision practice is much smaller, which in part reflects the low failure rates of the THRs I have performed over the last 20 years. 3. What place do you think technology has in THA today and in the future? Though we have introduced various technologies the results of hip replacement would suggest we still have a high failure rate particularly when looking at dislocation and wear of the implant. A better understanding of what the functional anteversion of the socket should be, combined with the knowledge of PSI, could improve our understanding of cup placement. No doubt the threshold of primary THR has lowered. When I became a Consultant a patient who was able to walk as far as a mile would not be considered appropriate for THR surgery. Today patients have high aspirations following THR surgery, and many expect to be able to ski, run and play sports such as tennis. 6. Has this led to any differences in your approach to treating patients today? I have always sought to use prostheses which provide the optimal function and longevity for each patient. I still believe resurfacing is a good option for young, fit men and statistically functions better than THR in this group of patients. This is to do with the ability to maintain stiffness in the upper femoral neck. Trinity™ Advanced Bearing Acetabular System All opinions and advice expressed in this article are the surgeon’s and may not represent the opinions of Corin Group or its affiliates. Use of any orthopaedic implant should be in line with the IFU guidelines and associated surgical technique. 4 Company News Intellijoint Surgical and Corin Group enter strategic partnership for intellijoint HIPTM Corin and Intellijoint Surgical Inc have recently entered into a strategic partnership for distribution rights for Intellijoint’s flagship product, intellijoint HIP™, in Australia and paves the way for broader distribution and co-development between the two companies. intellioint HIP™ provides orthopaedic surgeons with vital intraoperative measurements in real time, enabling accurate delivery of the target cup orientation, equalisation of leg length and restoration of hip offset. These critical measurements enable surgeons and hospitals to improve surgical outcomes by reducing uncertainty and risk, while improving patient outcomes and economics. Russ Mably, Corin’s Chief Operating Officer commented “We are delighted to partner with such a progressive company as Intellijoint Surgical, and are excited about our future collaboration. This partnership will further strengthen our market leading position in functional implant positioning with our existing OPS™ (Optimized Positioning System) technology, and underlines our commitment to continue to invest in personalised procedural innovation”. Armen Bakirtzian, Chief Executive Officer and Co-founder of Intellijoint Surgical further commented “We are pleased to partner with Corin to offer intellijoint HIP™ to surgeons in Australia. The broader capability of Corin’s organisation and their commitment to innovation will expand access to the latest technology available for 3D surgical measurement for the growing Australian hip replacement market where surgeons currently perform about 45,000 procedures annually. We look forward to the beginning of a meaningful relationship between our two companies and are excited about future opportunities”. To learn more about intellijoint HIP™ please visit http://bit.ly/28J3we3 Unity Knee™ – The clinical evidence is building... The Unity Knee™ system was designed to address the long standing issues in total knee replacement and strive to target and improve patient satisfaction and quality of life post-surgery. Since the launch of the system in 2012, Corin has been dedicated to clinical research with a robust clinical programme investigating topics such as MCL isometry as well as short-term functional outcomes. Two papers have recently been published and are available online in US journal Reconstructive Review reporting excellent survivorship and functional outcomes in the cruciate retaining and posterior stabilising designs. Kreuzer et al. (2016) reported the early outcome of Unity Knee™ CR KOOS results and also compared them to Triathlon® CR results reported in a recent paper by Molt et al. (2014). The Unity Knee™ scores are comparatively higher than that of Triathlon® demonstrating excellent functional outcomes when compared with this other popular system. Corin continues to take a proactive approach in collecting clinical data with a number of global studies currently running. We expect to have further publications available on the system over the coming months to further build on these early results and support of the Unity Knee™. Product update Unity Knee™ first stems implanted The Unity Knee™ offers the unique ability to stem a primary PS femur and tibia for use in difficult primary situations where additional stability is required. The first Unity Knee™ stems have been implanted by Dr Stefan Kreuzer (USA), Dr Tom McCoy (USA) and Professor Johan Bellemans (Belgium) in the first phase of the design surgeon evaluation. Instrument and implant feedback from these initial cases has been very positive as well as the patients performance and satisfaction postoperatively. The DPI instrument sets are currently being manufactured for global evaluation with non-design surgeons which will begin later in the year before broad launch of the system. For more information on the Unity Knee™ system and to access the clinical news papers please visit the following link www.bit.ly/1TPKLbw Responsible Innovation 5 Global surgeon feature COMPANY NEWS Why I came to adopt the MiniHip™ USA 2016 began with a strong presence at AAOS in Orlando, FL where over 90 individuals attended Corin’s ‘Form to Function’ educational dinner from Argentina, Australia, Brazil, Ecuador, Germany, The Netherlands, UK and the USA. The event was hosted by Corin’s KOLs, Stefan Kreuzer, MD, John Masonis, MD, Charlie DeCook, MD and Jim Pierrepont presenting on a range of topics from biomechanical restoration in DA approach THA with MiniHip™, restoration of functional soft tissue isometry and anatomic component positioning in TKA with the Unity Knee™ and the world-first Optimizing Positioning System (OPS™) technology. The evening generated a lot of lively debate and provided attendees with the opportunity to share their opinions with their colleagues from around the world. The first MetaFix™ collared hip stems were successfully implanted in Q1 by Dr Juan Suarez of The Cleveland Clinic in Weston, FL and Dr Steve Barnett of HOAG Orthopaedic Institute in Irvine, CA following the FDA 510(k) clearance in the USA. This innovative stem system is based on a long-term proven design philosophy and with the recent clearance in the USA this provides surgeons with a full range of ‘collared HA-coated stems’ and unique option of ‘short neck’ variants to provide a truly customised approach to individual patient anatomical variations. Q1s success has been followed in Q2 with the announcement of the 510(k) clearance for the Revival™ Modular Revision Hip Stem and more recently the OPS™ technology. These additions to Corin’s hip and knee portfolio will further accelerate growth in the US market and more importantly provide surgeons with greater options for patients requiring hip surgery. Revival™ David Watson, MD, Florida Orthopaedic Institute, Tampa, Florida, USA David T. Watson, MD, specialises in Orthopaedic Trauma and Adult Reconstruction and Arthritis Surgery. He received his Medical degree from Dalhousie University in Halifax, Nova Scotia, Canada and performed his Orthopaedic Residency and Internship training at Queen's University in Kingston, Ontario, Canada. Dr Watson completed his fellowship training in Adult Reconstruction at Cornell University Hospital for Special Surgery in New York and his fellowship training for Orthopaedic Trauma at Florida Orthopaedic Institute in Tampa, Florida. 1. What was it about MiniHip™ that appealed to you in the first place? I have developed an arthroplasty practice with a high percentage of younger patients, many of whom bring a different set of concerns and functional demands when compared with our geriatric patients. I was drawn to MiniHip™, as I became concerned about the potential issues with hip resurfacing. I still wanted something designed to meet the demands of fitter patients with good bone quality. I feel MiniHip™ is an alternative bone conserving / proximal bone loading arthroplasty option for these younger patients with high functional demands and good bone quality. the MiniHip™ philosophy was an easy one after a brief period of trialing this stem in my practice. This was not the first ‘short stem’ I’ve used and truly appreciating the difference took a few cases. Once I got it – that length and offset can be modulated to the patients anatomy through the level the neck cut it became my stem of choice for patients with appropriate bone quality. 3. What were some of the initial hurdles to overcome? I was surprised at the intensity of the learning curve I encountered, though in retrospect with a better understanding of the stem philosophy, I appreciate that it is unlike switching between conventional stems. By moving the neck cut to mid neck the bone anatomy and quality changes compared to that in a conventional neck cut. This takes getting used to, to avoid intraoperative angst and fracture complications I would highly recommend cadaver training with an experienced mentor. I’ve always templated hip cases very methodically on the AP pelvis but other than an assessment of femoral anteversion spent little time assessing the femoral neck on the lateral projection. Stem fixation within the neck requires rigorous templating on both AP and lateral to truly anticipate and plan the needed reconstruction. 4. What has your experience been like using MiniHip™? Positive. There was a learning curve and patient selection is critical to success as this is not a stem for every patient in my opinion. I have been particularly pleased with the ability 2. How did you make the decision to adopt the MiniHip™ stem philosophy? The decision to adopt MiniHip™ All opinions and advice expressed in this article are the surgeon’s and may not represent the opinions of Corin Group or its affiliates. Use of any orthopaedic implant should be in line with the IFU guidelines and associated surgical technique. 6 Global surgeon feature My experience with the Zenith™ Ankle to reliably recreate a patient’s native length and offset – even in those outliers with the long valgus or high offset varus necks that can be challenging with standard stems. 5. How is MiniHip™ different to other short stems? Simply put – it’s not just another short stem. Length and offset are recreated to match anatomy via the level of neck resection. It’s bone conserving and most importantly the preserved proximal bone sees physiologic loading. This is not always the case with other so-called ‘short stems’. 6. What are the three most important things in your opinion with regard to your outcomes with MiniHip™? Maintenance / restoration of native anatomy is a driver of patient satisfaction. Hip arthroplasty reliably alleviates arthritis pain regardless of stem design. MiniHip™ fine-tunes the reconstruction minimising the early feelings of limb length inequality and trochanteric bursitis that can detract from accelerated rehab. With experience, the stem design allows for implantation with less soft tissue releasing (through a DA approach). With this winning combination, my MiniHip™ patients resume normal gait earlier and with less pain. 7. How has MiniHip™ made a difference in your practice? There are two aspects to that question. The first is clinical. Adoption of the MiniHip™ has facilitated accelerated rehab protocols given its natural fit with DA hip surgery, which in turn helps with short stay and ambulatory hip arthroplasty. With anatomic restoration of length and offset in these patients the shortened recovery has been impressive. The second issue is marketing. Patients, particularly the younger crowd tend to be informed consumers with hours of internet research under their belt. They are truly engaged and appreciate the advantages offered with MiniHip™ and I’ve witnessed a growth in my practice with this segment of patients. Mr Shashi Garg, MBBS, MS (orth), FRCS, FRCS (orth) Westmorland General Hospital, Kendal, UK The number of total ankle replacement (TAR) surgeries performed in the UK is significantly lower than the number of hip or knee replacements, with fusion often seen as the preferred treatment option for ankle arthritis. However, TAR is considered to be a reasonable alternative to ankle arthrodesis in certain patient groups. Whereas ankle arthrodesis eliminates movement of the tibiotalar joint, TAR can maintain dorsi/plantarflexion and allow patients to recover a more normal walking gait (especially helpful on inclines and stairs) and to protect other joints of the foot, in particular the Chopart joint, from developing arthritis. Certain patients who have bilateral ankle arthritis with arthritis of hindfoot or midfoot will be more suitable for TAR than arthrodesis. I have been performing TAR surgery since 2004, and started using the Zenith™ implant in 2008 following experience with the BP™ and Mobility™ systems. My decision to change to the Zenith™ ankle replacement was due to the design features of the implants and the user-friendly instrumentation, and I have performed 120 TARs using the Zenith™ system. The talar component has three flat cut surfaces with two pegs providing good fixation and is suitable for early weight bearing at two to three weeks. The talar jigs are well designed and The Zenith™ talar component incorporates a patented ‘opening wedge’ design with two anterior pegs providing initial implant stability while the biomimetic cementless coating on both tibial and talar components allows good osseous integration for longterm stability. The Zenith™ instrumentation includes cutting guides that allow accurate, reproducible parallel resection of the tibia and talus. I strongly recommend that surgeons new to TAR attend a Zenith™ ankle replacement workshop including cadaveric surgery, and visit experienced surgeons performing surgery. All surgeons new to TAR should start with simple cases with no deformity and should invite experienced surgeons to assist with initial cases. Pre-op Two years post-op A recent review of 70 consecutive patients1 who received a Zenith™ TAR between April 2008 and March 2012 demonstrated 96% survivorship (a small number of patients develop medial pain in the first year following surgery but this resolves spontaneously). Our patients demonstrated very high patient satisfaction at minimum three years follow-up. Cysts remain a concern following TAR but I now obtain preoperative CT scans of all patients. It is interesting to see that 10% of patients have cysts prior to surgery and one patient underwent grafting of a cyst at the same time as TAR surgery. The Zenith™ TAR demonstrates good medium-term survivorship. It produces significant improvements in VAS and AOFAS scores, with high patient satisfaction and low risk of complications. 8. What do you feel is the key takeaway from your clinical experience for surgeons interested in MiniHip™? It’s a great stem, probably best suited to experienced hip surgeons. I would highly recommend a training session with an experienced user to discuss some of the subtleties and shorten the learning curve. Once adopted it’s hard not to love it. To find out more about how the MiniHip™ bone conserving hip stem can meet the needs of your younger, more active patients please visit http://bit.ly/1zdnyGG allow accurate cuts for talar component implantation. I found this to be a great improvement compared to earlier designs I have used. References 1.Presented at BOFAS 2015 Zenith™ Total Ankle Replacement All opinions and advice expressed in this article is the surgeon’s and may not represent the opinions of Corin group or its affiliates. Use of any orthopaedic implant should be in line with the IFU guidelines and associated surgical technique. Responsible Innovation 7 Clinical news LARS™ – Managing lateral hip pain In 1923 Stegemann et al.1 first described ‘juxta-trochanteric pain’ and attributed this to the condition of trochanteric bursitis. Bursitis implies that the condition must involve an inflammatory component, but more recently it has become apparent that a number of different pathologies could account for lateral sided hip pain. Trochanteric bursitis is still used to describe pain around the greater trochanteric region of the hip despite the absence of key signs of inflammation. Currently the most common term used to describe this condition in the literature is Greater Trochanteric Pain Syndrome (GTPS). LARS™ LARS™ tears seen in the shoulder3, are the most common cause of GTPS4,5,6. Patients usually present with chronic lateral hip pain specifically located around the greater trochanteric region and weakness of the hip abductors, or tears can be identified during, or subsequent to, hip replacement surgery. X-ray can be used to exclude hip joint involvement (OA) and MRI scans have shown to be an accurate means of diagnosing abductor tendon tears7. Do current treatment modalities work? Current conservative treatment options, involving activity modifications, nonsteroidal anti-inflammatory medications, physiotherapy and corticosteroid injections, tend to show high symptom recurrence rates at one year8. When conservative treatment fails, the next logical step is surgical investigation and repair of any tendon tears. Whilst Walsh et al.9 reported approximately 90% good results with suture repair alone, patients were required to remain non-weight bearing for six weeks. Extended periods of non-weight bearing can lead to additional postoperative complications with 8.3% of patients presenting with DVT in this study. Other studies using suture and anchor based surgical repairs have demonstrated good initial pain relief but high re-rupture rates of up to 31% at 12 months8 suggesting a more robust repair is required. LARS™ is a third generation synthetic, incorporating a high strength, novel design technology which minimises postoperative strength loss and material degradation11,12,13. As an augment, LARS™ provides immediate strength and stability to the repair, with increased resistance to elongation and low re-rupture rates, thereby facilitating rapid return to function and pain elimination post-surgery10,14,15. LARS™ LARS™ How is LARS™ different in gluteal repairs? Images from animation and live surgery video show LARS™ sutured to the gluteal tendons and drawing the tendons down to the footprint on the GT What is GTPS attributable to? GTPS is often misdiagnosed or neglected due to a lack of clear understanding of the pathology involved and uncertainty surrounding how to treat patients. Patients are commonly prescribed conservative treatment options including antiinflammatory medication and physiotherapy. Fearon et al.2 found that people with GTPS had low levels of full time work participation with pain and dysfunction levels indistinguishable from patients with severe osteoarthritis (OA) of the hip, awaiting total hip arthroplasty. Recent improvements in the understanding of the pathology of GTPS have revealed that tears of the gluteus medius or minimus muscles or their tendinous insertions, similar to rotator cuff Rotator cuff repairs are routinely protected in an abduction sling, but this is impractical in gluteal tendon repairs. Early mobilisation may be a contributing factor to the high rerupture rates seen with traditional suture based repairs. The use of LARS™ to augment the repair aims to decrease the stress of the repair in the ambulating patient by spreading the load over a larger surface area of the soft tissues, providing an improved mechanical environment to facilitate healing rates. The LARS™ ligament is sutured to the deep surface of the gluteal tendons, pulled through a bone tunnel in the greater trochanter drawing the tendons back on to the decorticated footprint. The LARS™ is secured in the bone tunnel using an interference screw and the repair is completed using trans-osseous suturing of the lateral portion of the tendons to the trochanteric bone. Over 1200 gluteal tendon repairs reinforced with LARS™ have been performed in Australia with very high patient satisfaction and low failure rates10, without the need for patients to remain non-weight bearing post-surgery. Reinforcing the gluteal tendon repair with LARS™ allows patients to be weight bearing as tolerated from 24 hours after surgery. Images from animation and live surgery video show LARS™ sutured to the gluteal tendons and drawing the tendons down to the footprint on the GT To view the LARS™ gluteal repair surgical technique and learn more about LARS™ indications please visit www.bit.ly/1TX55on References 1. Stegemann H. Arch Klin Chir. 1923. 2. Fearon A, et al. J Arthroplasty 2014. 3. Bunker TD et al. JBJS [Br]. 1997. 4. Williams BS et al. Anaesthesia and Analgesia. 2009. 5. Bird PA et al. Arthritis and Rheumatology. 2001. 6. Kingzett-Taylor A, et al. AJR. 1999. 7. Cvitanic O et al. AJR. 2004. 8. Davies H et al. Hip Int. 2009. 9. Walsh M et al. J Arthroplasty. 2011. 10.Bucher TA et al. Hip Int. 2014 11.LARS™ laboratory testing. Data held on file, Corin Group PLC 2005. 12.Ardern CL et al. Arthroscopy. 2010. 13.Mascarenhas R et al. MJM. 2008 14.Bajwa AS et al. Hip Int. 2011 15.Holroyd B et al. European Musculoskeletal Review. 2009 All opinions and advice expressed in this article is the surgeon’s and may not represent the opinions of Corin group or its affiliates. Use of any orthopaedic implant should be in line with the IFU guidelines and associated surgical technique. 8 Global surgeon feature Use of Revival™ in treatment of CDH/DDH to femoral anatomy and ease of surgical restoration of the joint biomechanics. Mr Duncan Whitwell BMBS FRCS (Orth) Nuffield Orthopaedic Centre, Oxford, UK The term ‘developmental dysplasia of the hip’ (DDH) describes a spectrum of disorders ranging from mild dysplasia of the acetabulum or femur, to subluxation and high dislocation of the hip joint. In order to encourage normal development of the hip joint, the femoral head must lie congruently within the acetabulum. DDH is the most common cause of secondary osteoarthritis in young adults, a pathology more frequently encountered in women and in countries such as Japan. As part of CDH/DDH the following are often seen in the femur: Excessive femoral neck anteversion, and the variability in the degree of anteversion has also been well documented. Anteversion in DDH was 22.2° (SD 10.8) compared with a mean of 14.3° (SD 6.8) in normal hips, with a wide variation from -3.2° to 58.2° in the DDH group1. The medullary canal of the hypoplastic femur narrows in both the mediolateral and the anteroposterior planes, and the shape of the often straight femoral canal becomes more rotationally abnormal with increasing subluxation2. The greater trochanter is located more posteriorly. The femoral neck is shorter and coronal plane deformities have also been reported, with increasing coxa vara noted with increasing severity3. This unique set of symptoms in the femur can make total hip arthroplasty challenging. These requirements often mean a conventional stem used for primary THA is not appropriate. A modular stem which allows for fixation of the stem in the diaphysis of the femur is more appropriate. This means offset and version can be adjusted to recreate the required biomechanics. Shorter stems are often required for this type of patient due to more distal deformity and to preserve as much bone as possible at the time of initial surgery. These patients are often young, active patients who may go on to require future surgeries. The Revival™ 100mm distal stem is ideally suited for these cases as stem size, offset and neck length are independent variables which allow improved fitting Distal stem length (mm) Stem diameter (mm) 100 (straight) 14 16 18 20 22 24 ■■ ■■ ■■ Conical stem with splines Modular proximal body to set the correct anteversion Different stem diameters and proximal body lengths There have been some reported outcomes on treatment of CHD/DDH with modular stems. In this retrospective analysis of 61 modular neck prostheses implanted for DDH, the cumulative survival was 97.5% at 11 years4. A study reporting 28 THRs in severely subluxed or dislocated DDH using femoral stems with a modular neck, showing no femoral revisions or loosening at a mean of ten years’ follow-up were reported. In my opinion Revival™ is a good alternative for treating this group of patients. To find out how the Revival™ Revision Hip Stem allows the surgeon to address every patient effectively and efficiently please visit www.bit.ly/1O4Ci1W References 1. Liu RY et al. Acta Radiol. 2009 2. Noble PC et al. CORR . 2003 3. Robertson DD et al. CORR . 1996 4. Traina F et al. JBJS [Am]. 2009 COMPANY NEWS South Africa During the week of 11 - 15 April, Cape Town hosted the 13th Meeting of the Combined Orthopaedic Associations (COMOC). Corin South Africa were proud to be part of this meeting, and used it as a launch opportunity for the Optomized Positioning System (OPS™) in South Africa. OPS™ is a unique technology offering significant benefits for patients and surgeons in optimising implant orientation in total hip replacement. At the launch event hosted on the Monday afternoon Corin South Africa were privileged to have a faculty of international experts comprising of Dr Michael Solomon (Sydney, Australia), Mr David Woodnutt (Swansea, Wales) and Mr Giles Stafford (London, UK). The faculty presented their experience in the use of the of the OPS™ technology to the audience. Following the launch event OPS™ generated significant interest on the Corin booth for the entire week as surgeons from all the attending countries were keen to learn more about this exciting technological advancement. In addition to OPS™ we showcased our comprehensive hip portfolio with MiniHip™, TriFit TS™ and Trinity™ proving to be the most popular products being discussed. The focus on the knee side of the booth was the Unity EquiBalance™ technology and the advantages this instrument system offers patients being treated with this implant. Corin South Africa would like to thank all of our customers for the valuable time spent with us on the booth and for the significant interest shown in our exciting product portfolio. Revival™ All opinions and advice expressed in this article is the surgeon’s and may not represent the opinions of Corin group or its affiliates. Use of any orthopaedic implant should be in line with the IFU guidelines and associated surgical technique. Responsible Innovation 9 Surgeon training In the first six months of 2016 we have been delighted to welcome Key Opinion Leader surgeons from around the world to our Global Headquarters and stateof-the-art manufacturing plant based in Cirencester, England. During the course of these visits surgeons meet with and discuss their topics of interest with the Executive Leadership Team as well as learn about the progressive nature of Corin, why we are at the cutting edge of arthroplasty technology and how this enhances individual patient care. With the acquisition of the Optimized Positioning System (OPS™) surgeons are now even better placed to make more accurate plans for surgery based on the patient’s individual pelvic dynamic movements whilst maintaining procedural simplicity in the operating theatre, combined these lead to more accurate personalised cup positioning and precise restoration of leg length, offset and combined anteversion. We look forward to ever greater numbers of surgeons visiting us, learning more about the direction Corin is taking to enable better end-to-end patient care and experiencing the results of significant investment in our state-of-the-art manufacturing facility. In addition to visiting our facility we also arrange personalised visits to meet Key Opinion Leader surgeons in their theatres and see how they are utilising Corin implants and technologies to improve patient care. If you would like the opportunity to visit Corin’s Global Headquarters please speak with your Corin representative or distributor organisation. We very much look forward to meeting you and helping you experience Corin’s new facility and our vision for the future. Manufacturing facility at Corin’s Global Headquarters PD Prof Dr Philip Schöttle’s visit to Corin Headquarters, Cirencester, UK Associate Professor Schöttle visited us from Munich where he runs the orthopaedic department of the Isar Clinic. He performs 150 TKA procedures per annum and has a special interest in ligament balancing surgical techniques, this particular attentiveness to soft tissue balancing of 10 the knee allowed us to share our thoughts on the Unity Knee™ and more specifically the soft tissue balancing instrumentation options for our market leading device. From right to left: PD Prof Dr Schöttle, Mr Klaus Clemens (Corin GSA Managing Director), Mr Andrew Edwards (Corin Group Manufacturing Director) Associate Professor Schöttle is a dedicated educator and surgical proctor who firmly believes in a strong programme of surgeonto-surgeon training and thus is very well aligned with the Corin Academy ‘Centres of Excellence’ programme. Associate Professor Schöttle commented: “I was honoured to have been able to visit Corin’s facilities in Cirencester. The way Corin designs and manufactures is unique and the feeling I get is that of a big family. The concept and thinking behind OPS™ for the hip and hopefully for the knee in the future is astonishing. I very much enjoyed the open discussion with the Product Management and R&D teams about the Unity Knee™, the unique thought process behind implanting a knee replacement based on the specific needs of each patient using a simple and reproducible technique leads to many possibilities. I hope to return soon, exchange more ideas and be an active part of the Corin family, helping our patients to reach their goals more effectively than ever before.” Dr Charles DeCook on his visit to the Princess Elizabeth Orthopaedic Centre, Exeter, UK “What an incredible trip! I had the opportunity to observe Mr Andy Toms in surgery putting in anatomically aligned Unity knees, a great opportunity to see such an accomplished surgeon at work. I gained a better appreciation for anatomic alignment as well as the tremendous value of the EquiBalancer. It was also very valuable to tour Corin’s Global Headquarters in Cirencester. I think you really have to visit to appreciate the passion the entire group has around quality. They clearly want to be the very best when it comes to manufacturing joint implants and it shows in everything they do. Their passion permeated through each person I met. I would highly recommend it to any surgeon considering the trip.” – Charles DeCook, MD Dr Paolo Camos visit to University Hospital of Coventry and Warwickshire, UK Visiting us from the Saronno Hospital in the Lombardia region of Italy, Dr Camos has a keen interest in both hip and knee arthroplasty. Following on from his visit to our Global Headquarters where he met with members of the Executive Leadership Team and Product Management, he was taken to the University Hospital of Coventry and Warwickshire to meet with Professor King for the second day of his visit. Professor King performed three Optimized Positioning System (OPS™) cases with Dr Camos, demonstrating the efficacy of this technology to deliver accurate placement of both acetabular cup and hip stem based on the patient functional requirements. Dr Camos observed: “It was with great pleasure that I accepted the invitation to visit both Corin in Cirencester and Professor Richard King at Rugby Hospital. I had the opportunity to meet Executive Management, R&D and take a tour around their new state of-the-art manufacturing facility. Manufacturing facility at Corin’s Global Headquarters Surgeon support I met a dynamic company focused on innovation, specifically the personalisation of patient care and procedural efficiency. The focus is not on implant customisation per-se but a functional, patient specific plan and procedural simplicity in theatre. This philosophy embraces my personal approach to hip and knee arthroplasty. I had the pleasure to assist Professor Richard King during three total hip procedures utilising Corin’s OPS™ system. This peer-to-peer opportunity confirmed to me the ability of Corin’s OPS™ platform to precisely reproduce the preoperative functional surgical plan. The OPS™ system represents a true innovation. I am convinced that no two hips or knees are the same and thus each patient requires a specific plan. Professor King was very kind, generous with his time, and above all very professional. I had the opportunity to exchange thoughts in a comprehensive way, since sharing opinions with him was extremely useful, I look forward to continuing the relationship with Professor King moving forward. I would like to thank Corin and all their staff who facilitated such an interesting and enjoyable visit. A special thank you to Professor Richard King for his time and expertise, I look forward to reciprocating his kindness and meeting with him in my department in Italy.” The start to 2016 has been a busy one delivering on the product and sales training needs of the sales forces around the world. So far we have delivered Unity Knee™ training in both its basic and more advanced forms to the UK sales force based on their identified knowledge and experience level. The second advanced Unity Knee™ sales training course focused on key messages, soft tissue balancing and selling against the competition. We look forward to helping to develop sales opportunities with the UK team throughout 2016. “I recently attended both the basic and advanced Unity Knee™ product / sales training courses and found them stimulating, engaging and beneficial. The concept of MCL isometry to eliminate paradoxical anterior glide whilst allowing rotational freedom and soft tissue-guided kinematics I can see appealing to many surgeons, when you partner this with the ligament balancing device and soft tissue-guided motion I anticipate winning key competitor business utilising these powerful messages.” – Rob Linsell – Sales Agent Australia. Product training, 4-25 February 2016 Australia continues to be a strategically important market and the team here are always excited to both deliver and take part in training and development activities. As well as running ‘train the trainer sessions’ enhancing the ability of our local team to run courses themselves, on this occasion we also undertook assessment and validation of previous trainings. In addition we also worked closely with new team members both in Perth and Brisbane whose excitement, knowledge and active engagement in the programme made training a pleasure. Jordana Cashman, National Sales and Marketing Manager for Australia commented: “The impact of Brian’s visit was to give a strong focus on an area fundamental to our success. Our structured learning and development program empowers our team with best-in-field knowledge and this visit also accelerated our local capability to independently deliver the program. Ultimately, quality training elevates the standard of Corin representation in the market. We thank Brian for his contribution, he is an asset to our business.” South Africa. Product training, 18-24 March 2016 Corin SA continues to grow rapidly as surgeons come to better understand Corin’s core product portfolio and services through the knowledge and understanding of well-informed representation. In addition to Cape Town and Johannesburg we were delighted to also welcome new team members from Durban, Pretoria and KwaZulu-Natal. Nico Wiese, General Manager SA commented: “As we continue to grow and expand into new geographical regions within South Africa, it is imperative that we engage with our highly skilled team in order to deliver best-in-market support to our customers and their patients. Reliability of service, in-depth product knowledge and being at the cutting edge of personalised treatment pathways are all important to our surgeons.” USA. Medical compliance and credentialing As the medical device industry continues to expand globally, Corin USA is growing at an exceptional rate. As part of this growth it is important that not only do we educate our sales talent in relation to products and services but also better prepare our team in the field to handle the ever more complex regulatory relationships with the surgeons and the hospitals. Michel Rhee, Vice President – General Manager Corin USA said: “Corin takes great pride in providing highperforming sales agents with the skills to deliver unmatched customer focused sales and service. It is imperative that Corin also provide compliance training to ensure everyone is committed to abiding by the laws and regulations while interacting with health care professionals.” Responsible Innovation 11 Charity news Orthopaedic trauma relief in Africa About ten years ago (October 2006) a team of six British volunteers belonging to the UK-based registered medical charity, Motec Life UK supported by Corin Group made a maiden working visit to Ghana full of enthusiasm, ambition and hope. The group planned to take personnel from the UK to Ghana to provide orthopaedic-trauma training, education and relief. A series of working visits to Ghana including exchange programmes between the sub-region and British health workers from various health institutions continue to this day, supported by the British public and UK companies. hip and knee replacements using Corin products in Ghana each year with the active participation of local staff, some of whom have progressed to become independent hip and knee surgeons. Motec is a non-profit organisation, any funds generated by the services in the hospitals are ploughed back into on-going improvements in healthcare delivery improving patient experiences. The sad common story of the routinely prescribed Girdlestone hip arthroplasty as the primary surgical care for arthritic hips is now consigned to history in Ghana. The benefits of arthroplasty have transformed the thinking of surgeons, patients and carers in the West African sub-region. Arthroplasty for disabling joint diseases has proven to be an acceptable practice especially in younger patients who are often in their ‘bread winning’ years. Arthroplasty plays a significant role in returning patients to a socio-economically productive group and contributing to the wealth of their families and the nation. Surgery preparation in Ghana Motivated by the success of our surgeries and perhaps the economic benefits of joint arthroplasty, the number of orthopaedic surgeons in Ghana has now increased from about 15 to 50 over the last decade. Patients waiting weeks for their trauma and orthopaedic surgical care in targeted orthopaedic hospitals has been eradicated, through education and training on the impact of early effective treatment and rehabilitation of surgical and non-surgical patients. For Motec’s strategy to deliver better and safer orthopaedic trauma services in Ghana the charity embarked on a programme of training and education for orthopaedic trauma. Surgeons, nursing staff, physiotherapists, laboratory and plaster technicians, theatre support workers, hospital administrators, ward and outpatient staff and health policy makers of the Ghana Health Service have been the targeted group at the forefront of our collaborative work in Ghana. Motec’s work in training and education has extended to member states of the West African College of Surgeons (WACS, 16 member countries) with support for improvements in the standard of examinations in the exit Fellowship examinations of WACS. Motec makes three working visits to Ghana, organises two national orthopaedic trauma workshops and one Masterclass meeting each year. This is mainly orthopaedic trauma, hip and knee arthroplasty, arthroscopy, and cruciate ligament reconstruction using materials, implants and equipment from Corin Group. This is always accompanied by live surgeries. The teaching programme involves the teaching hospitals, regional orthopaedic health institutions in Ghana and the West African College of Surgeons collaborating with the London Post Graduate School of Surgery. Some surgeons from Ghana have had training post-appointment in St Mary’s and St George’s Hospitals in London and some observational attachments in teaching hospitals throughout the UK. Through this approach, from a modest three major operations on the maiden visit and a handful of orthopaedic surgeons in Ghana, Motec now performs about 65 COMPANY NEWS MetaFix™ collared evaluation Corin continues to develop its hip portfolio with the introduction of the MetaFix™ collared stem. This will be available in a 125° and a 135° variant. Additionally MetaFix™ collared will have short necks in the smaller sizes to accommodate better recreation of the anatomy. Evaluations have begun in the USA and UK. Around 75 MetaFix™ collared stems have been implanted to date with promising results and positive feedback from the evaluator surgeons. We will continue to monitor the evaluation cases and we anticipate the UK and USA evaluation to be completed by the end of June with commercial launch expected in Q3 2016. LARS™ PCL From left to right: Mr Paul Ofori-Atta, HE President John Atta Mills (late) On the public front, attracted by the news of Motec’s campaign, The President of Ghana His Excellency President John Atta Mills (late) held meetings with Motec at his office during which discussions were held on ways and means to help Ghana benefit from the training and provision of specialist orthopaedic services. Motec has also had the honour of an audience with HM The Queen and HRH Princess Anne in London. www.bit.ly/1TX55on The organisation is guided by a consortium of patrons led by Lord David Alton. Motec wishes to express its profound gratitude to Corin Group, the British public and the Ghanaian authorities for their support of our humanitarian work. Courtesy of Mr David Houlihan-Burne, Consultant Knee Surgeon, BSc MB BS MRCS FRCS (Tr & Orth), The Fortius Clinic, London, UK Important: Not all products are available or cleared for distribution in all international markets. For more details, please contact your local subsidiary or distributor by visiting the Corin worldwide section. www.coringroup.com www.linkedin.com/company/corin-uk-ltd [email protected] www.youtube.com/user/coringroup/ +44 (0) 1285 659 866 www.coringroup.com/surgeonresourcehub Get in touch If you are interested in hearing more about our company or want more information about our products please complete the form on www.coringroup.com/articulate
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