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AAOS annual meeting

Medical Device Daily Staff Writer

CHICAGO — Day two of the American Academy of Orthopedic Surgeons (AAOS; Rosemont, Illinois) 2013 annual meeting kicked off inside McCormick Place with the official opening of the technology exhibits on the main floor. Occupying space among the many exhibitors is the DePuy Synthes Joint Reconstruction Division of DePuy Orthopedics (Warsaw, Indiana). Among the technology products from DePuy is its latest innovation in total knee replacement, the Attune knee system.

Created as a result of more than six years of extensive research to address unmet patient, surgeon and provider needs, DePuy says the Attune knee is an advancement in knee replacement options. It is designed to provide better range of motion and address the unstable feeling some patients experience during everyday activities, such as stair descent and bending.

Through a research collaboration with the University of Denver (Colorado), DePuy Synthes Joint Reconstruction evaluated contemporary knee designs to assess how implant geometry aids in maintaining stability through patient's daily activities. Additional research with a team of surgeon and industry experts from around the world led to more than 19 patented technologies for the Attune Knee.

In an effort to showcase this new technology, media and invited guests were treated to a special tour, the Stable Motion Experience at the company's booth. A large crowd gathered and chatted expectantly to see just what all the fuss was about on the other side of the door, and were soon ushered into the first room. The guests were taken through four separate rooms, each one focusing on a specific technological aspect of the total knee replacement.

The company says that with a focus on patients always in mind, it set out six years ago to discover a new technology for patient satisfaction in total knee replacement. An introductory video claimed that company research "finds there is a patient cohort of 15%-20% that aren't satisfied" with their knee replacement. So, what DePuy desired to achieve was "incremental improvement" that worked specifically on knee kinematics with research partners, as well as a surgeon design team that gave constant feedback on the R&D process. "We have received positive feedback so far on the implants we have completed in our development so far. Surgeons and patients report a 10%-15% increased range of motion," the presenter said. He added that "of course, this is all anecdotal and not official, but encouraging nonetheless."

Asked about the cost of the six-year R&D project, the figure of "close to $200 million" was disclosed. After that question, the door magically opened and we moved along to what can be described as "geometry class" where we learned about the Attune Gradius Curve. The design of the curve gradually reduces the radius that provides optimum conformity throughout the range of motion and is designed to achieve anterior/posterior stability. The S-curve design, called Softcam contact, provides a smooth engagement for stability through flexion, while reducing stresses placed on the implant. Its ultimate goal is to "reduce anterior slide to gain more stability for the overall knee."

In the locking design and development presentation, guests are treated to a demonstration of the company's Logiclock Tibial Base. It provides a "low level of micromotion." This is a locking design that provides the architecture to optimize kinematics while reducing wear to "the lowest reported levels in the industry." As a result, surgeons do not have to compromise on component size, picking the optimum size and fit for each patient from the range of sizing options. The are ten standard sizes and four narrow sizes of tibial inserts offered with the Logiclock Tibial Base. The presenter showed how the surgeon could "fine tune the gaps" he experiences when locking the Attune onto the bottom base.

This is called the Gliderlight Articulation, which is designed to accommodate patient variation and soft tissue interaction, while optimizing patella tracking. The implants are made of antioxidant polyethylene.

The theory that a surgeon is only as good as his tools is behind the development of the Intuition Instruments, a product of the Attune Knee R&D. The instruments are compatible specifically with the Attune Knee and are designed to help the surgeon deliver "stability in motion." Our final presenter from Leeds, UK, explained more about the devices with his keen English accent. "There are three design pillars we look to achieve with our Intuition Instruments . . . precise control, design clarity and efficient path."

The Intuition group feature single-layer instrument cases that are lightweight with fewer instruments, reducing weight by 51% as compared to previously available instruments. The instruments also minimize the number of cases in the operating room (OR) while maintaining durability. The tools have design clarity through the use of color coding and clear markings, potentially reducing OR surgical errors. One member of the group could easily read the "5" on the side of the implant tool from the back of the room as compared the markings of a traditional version. This "helps cut down on mistakes in the OR and helps speed up productivity."

Finally, the tools are "delivered consistently across the whole kit, one tool works with all the other ones. Similar to how Apple does it with the iPad or iPod," he said.

"With the advanced technologies of the Attune Knee, surgeons like myself are able to offer patients a new knee replacement option that provides freedom to move while remaining stable during everyday activities," said William Barrett, MD, Attune Knee System Design Team Surgeon in a video presentation. "I was excited to be part of the extensive research process that led to the Attune Knee. My experience with the Attune Knee has been very positive, including feedback from my patients who have received the Attune Knee and have returned to doing the things they enjoy."

After the tour, the excitement and enthusiasm regarding the Attune was apparent in the booth. When asked about it, one representative said: "This is truly a new product for [DePuy Synthes]. By improving upon current equipment, we discovered new proprietary technology. Over the [six] years of research and development, we have been able to patent and now launch our new device."

The Attune is FDA approved, and in addition to the U.S. introduction, DePuy Synthes Joint Reconstruction plans to make the Intuition Knee commercially available in select countries outside the U.S. later this year.

Robert Kimball, 404-262-5451

Published  March 21, 2013

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