All Knee Implants Are Not Created Equally

In 2019, there were approximately three million primary knee replacements performed globally.¹ This number is expected to grow due in large part to the aging population, a rise in obesity, and a generally more active population. Despite knee replacement being one of the most successful orthopedic procedures, research has shown that up to 20 percent of patients are dissatisfied with their knee replacement, which may be due to residual pain and the way the implant feels and functions.^2,3

In order to respond to challenges facing total knee replacement patients, DePuy Synthes developed the ATTUNE Knee System to address unmet clinical needs and close the gap in patient satisfaction. As a developer of both implant design and enabling technologies, DePuy Synthes believes all implants are not created equally.

The ATTUNE Knee represents the largest research and development project in the history of DePuy Synthes and the outcome is an implant that is designed to work in harmony with the patient’s native knee muscles and ligaments to increase stability and reduce pain. Today, the ATTUNE Knee is backed by a comprehensive evidence generation program that encompasses clinical and patient-reported outcomes as well as health economics studies.

The ATTUNE Knee was developed in collaboration with leading orthopedic surgeons around the world, research universities, and key innovation partners, and features several patented technologies designed to improve knee function. These include the ATTUNE GRADIUS Curve, which is designed to address the unnatural sliding of the femur on the tibia, to provide smooth motion and stability during everyday activities, and to provide stability through the range of motion; GLIDERIGHT Articulation, which is designed to accurately replicate the patello-femoral kinematics of the native knee; and LOGICLOCK Tibial Base locking mechanism that is designed to enable enhanced kinematics, stability, and wear reduction.⁴

These technologies were developed to allow for enhanced range of motion and prevent the unstable feeling some patients experience during everyday activities such as bending and walking up and down the stairs, as well as help patients get back to living the life they want to live sooner. They are also the cornerstone for the continued development and innovation of the ATTUNE Knee System.

Since its introduction in 2013, the ATTUNE Knee System has continued to innovate with additions to the platform including the ATTUNE Cementless Knee, which supports younger and more active patients; the tibial base with ATTUNE S+ Technology, designed to enhance tibial fixation; and the ATTUNE Revision Knee System, a comprehensive system that is designed to enable surgeons to effectively manage a broad range of complex primary and revision knee procedures.

Why invest so much in a knee implant? Because implant design, material, and geometry matter; and these factors make a difference in terms of clinical and economic outcomes, implant survivorship, patient satisfaction, and value-based care.

Backed by the largest evidence generation program in the history of the company, the ATTUNE Knee has been provided for more than 900,000 patients in 53 countries and continues to move the needle in terms of outcomes and patient satisfaction. The evidence for the ATTUNE Knee encompasses data demonstrating how the ATTUNE Knee addresses challenges in total knee arthroplasty (TKA) such as crepitus,⁵ patient satisfaction,⁶ stability,⁷ survivorship,⁸ fixation,⁹ and recovery.¹⁰ In addition, according to results of a large U.S. hospital administrative database review, ATTUNE Knee patients were 39 percent less likely to be discharged to a skilled nursing facility compared to patients who received another leading knee system.¹⁰

Beyond implant technology and the surgical episode itself, DePuy Synthes is investing in innovations before, during, and after surgery to further improve patient satisfaction and outcomes, and is working with hospitals and health systems to increase the value of the procedure as more and more patients seek knee replacement.

Today’s healthcare landscape is under pressure, with joint replacement surgery being no exception. No doubt patient volume is growing and surgeons are under increased physical, emotional, and mental burdens, and all this comes at a time when the scrutiny on patient outcomes and the need for cost reduction are increasing.

This has led to the introduction of VELYS Digital Surgery, a platform of connected technologies for orthopedics that leverage data insights from pre-op through surgical planning, intra-op, and post-op to enhance the entire experience for patients, surgeons, and healthcare systems. With VELYS Digital Surgery, DePuy Synthes aims to address these unmet needs in orthopedics by enabling more personalized experiences, automating processes, and providing enhanced data connectivity to improve decision making.

Over time, VELYS Digital Surgery will add new technologies like patient selection tools, robotics intra-operatively, advanced visualization, sensors, and apps. The objective is for these technologies to collect and analyze data across the care continuum in order to create actionable insights that can help enable real-time decisions, improve efficiencies, and optimize patient outcomes.

DePuy Synthes continues to innovate around the ATTUNE Knee Platform, the surgical approach, and digital surgery technologies, all with the goal of helping improve functional outcomes for patients, performance for surgeons, and value for stakeholders. 

References

1. 2019 GlobalData – 39 Country Knee Reconstruction Market Model Dataset bit.ly/odt03201
2. Bourne RB, Chesworth B, Davis A, Mahomed N, Charron K, Comparing Patient Outcomes after THA and TKA: Is there a Difference? Clin Orthop Relat Res 2010; 468:542-6.
3. Baker PN, Rushton S, Jameson SS, Reed M, Gregg P, Deehan DJ. Patient Satisfaction with total knee replacement cannot be predicted from pre-operative variables alone: A Cohort Study From the National Joint Registry for England and Wales. The Bone Joint & Joint Journal. 2013 Oct; 95-B(10): 1359-65.
4. Leisinger S, Hazebrouck S, Deffenbaugh D, Heldreth M. Advanced Fixed Bearing TKA Locking Mechanism Minimizes Backside Micromotion. International Society for Technology in Arthroplasty (ISTA) Annual Meeting. 2011.
5. Martin JR, Jennings JM, Watters TS, Levy DL, McNabb DC, Dennis DA. Femoral Implant Design Modification Decreases the Incidence of Patellar Crepitus in Total Knee Arthroplasty. J Arthroplasty 2017;32(4):1310-1313.
6. Hamilton W, Brenkel I, Barnett S, Allen P, Kantor S, Clatworthy M, Dwyer K, Lesko J. Comparison of Existing and New Total Knee Arthroplasty Implant Systems from the Same Manufacturer: A Prospective, Multicenter Study. Poster Presentation # 06014, AAOS. Las Vegas, Nev. 2019.
7. Clary, C.W., Fitzpatrick, C.K., Maletsky, L.P., & Rullkoetter, P.J. Improving dynamic mid-stance stability: an experimental and finite element study. Orthopaedic Research Society, 2012; 58th Annual Meeting San Francisco, Calif. Poster Number 1044.
8. National joint Registry for England, Wales, Northern Ireland and the Isle of Man. 16th Annual Report. (2019). Table 3.27. Retrieved from: bit.ly/odt03202
9. Richardson, G., Turgeon, T., Gascoyne, T., Laende, E., Bohm, E., Dunbar, M. Roentgen stereophotogrammetric analysis (RSA) of the Attune posterior stabilized fixed bearing knee system. Poster Presentation at the 5th International RSA Meeting, 6-8 October 2018, Adelaide, Australia.
10. Etter K, Lerner J, Kalsekar I, de Moor C, Yoo A, Swank M. Comparative Analysis of Hospital Length of Stay and Discharge Status of Two Contemporary Primary Total Knee Systems. J Knee Surg. 2017. 1(212):1-10. DOI https://doi.org/10.1055/s-0037-1604442. Premier Perspective Database analysis including 38 hospitals, representing 1,178 primary, unilateral TKAs with the ATTUNE Knee and 5,707 primary, unilateral TKAs with Triathlon.

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Rajit Kamal is the vice president and global franchise leader for Knees. In this role, Kamal leads the global $1.5 billion knee business for J&J and is responsible for global sales, P&L, global strategy, portfolio and new product development for global knee business. Kamal leads a cross functional team of marketing, R&D, operations, quality, regulatory, clinical and regions (US, EMEA, ASPAC, LATAM) to manage DePuy Synthes’ $1.5 billion knee replacement business. He earned a bachelor of science degree in chemical engineering with distinction from Indian Institute of Technology, a master’s of science degree in chemical engineering from Georgia Institute of Technology, and an MBA from Harvard Business School.