Joint Replacement with IO 2015

Osseointegrated Implant connected to Joint replacement

Munjed Al Muderis

MB ChB, FRACS, FAOrthA

Chairman of the Osseointegration Group of Australia

Adjunct Clinical Associate Professor, School of Medicine, Sydney

University of Notre Dame Australia,

Clinical Lecturer at Macquarie University

and the Australian School of Advanced Medicine

A. Khemka, S Lord, B Bosley

Total Knee Replacement with Osseointegration

7

Total Hip Replacement with Osseointegration

3

Why Joint Replacement ??? •

Joint Osteoarthritis •

Osseointegrated Implants

•

Moments & Forces

•

Transmitted through the Knee

•

Benefits Vs Harms

Why Joint Replacement ???

Joint Osteoarthritis Osseointegration transmits weight to proximal joint (hip or knee) NORMALLY Hence increased mobility increases joint wear

Joint Osteoarthritis

Why Joint Replacement ??? •

Ultra Short Stumps •

•

Small Bony Contact •

< 60 mm For BKA

•

< 120 mm For AKA

Risk of failure of Osseointegration

O’Donnell R. Compressive Osseointegration of Tibial Implants in Primary Cancer Reconstruction. Clin Orthop Relat Res 2009; 467 (11): 2807-12.

Ultra Short Residuum

Solution

Explore the Unknown Novel Joint Replacement with Osseointegration

Joint Replacement with TCBAP Takes away the arthritis Proximal joint becomes Weight Sharing rather than Weight Bearing Physiological load is transmitted directly to the femur (transtibial), pelvis (trans-femoral) Enables TCBAP

Implant Planning

Implant Planning

Implant Planning

Functional Tests Mobility Health Related Quality of Life Functional Outcome Predictor Q-TFA SF-36 K-Levels 6 MWT TUG PCS MCS (pt) (pt) (pt) (K0-K4) (m) (s) Pre-operative results 1 40.00 26.00 28.50 0 WB WB 2 42.90 51.10 58.50 2 372.00 8.80 3 54.00 36.10 59.00 3 375.00 8.60 4 40.00 26.00 60.60 2 350.00 10.50 44.23 34.80 51.65 1.75 274.25 9.30 Mean 6.66 11.86 15.46 1.26 183.17 1.04 SD Follow-up results 1 83.00 80.00 88.00 4 512.00 6.31 2 95.00 52.10 58.50 4 456.00 7.83 3 83.00 50.80 59.30 3 412.00 8.50 4 90.00 54.50 60.60 4 418.00 8.80 Mean 87.75 59.35 66.60 3.75 449.50 7.86 SD 5.85 13.85 14.29 0.50 45.99 1.11 Differences between follow-up and pre-operative (in unit) 1 43.00 54.00 59.50 4 2 52.10 1.00 0.00 2 84.00 -0.97 3 29.00 14.70 0.30 0 37.00 -0.10 4 50.00 28.50 0.00 2 68.00 -1.70 Mean 43.53 24.55 14.95 2.00 175.25 -0.92 SD 10.44 22.62 29.70 1.63 225.35 0.80 Differences between follow-up and pre-operative (in percentage of pre-operative) 1 108 208 209 2 121 2 0 23 -11 3 54 41 1 10 -1 4 125 110 0 19 -16 Mean 102 90 52 141 -9 SD 33 90 104 247 8 P-value 0.005* 0.02* 0.1 0.05 0.07 Case

Activity Level Daily Average NofS TEE (#) (Kj)

AEE (j)

PAD (min)

N/A 3495.00 5494.00 2713.00 3900.67 1434.19

N/A 6.34 8.81 6.21 7.12 1.46

N/A N/A N/A 1810 58 6335 1472 49 8808 113 8 6213 1131.66666738.33333333 7118.67 898.23 26.65 1464.28

N/A 7267.00 6489.00 19877.00 11211.00 7515.05

N/A 16.77 11.42 38.54 22.24 14.37

N/A N/A 3787.29 131 1737 58 1742 44 2422.10 77.67 1182.29 46.72

N/A 16765 11422 38543 22243.33 14366.5

N/A 3772.00 995.00 17164.00 7310.33 8645.75

N/A 10.43 2.61 32.33 15.12 15.40

N/A N/A 1977.29 73 265.00 9.00 1629.00 36.00 1290.43 39.33 904.96 32.13

N/A 10430 2614 32330 15124.67 15404.22

N/A 108 18 633 252.90 331.93

N/A 165 30 520 238 253 0.07

N/A N/A 109.2425414125.862069 18 18 1442 450 522.95 198.08 796.88 224.70

N/A 165 30 520 238 253 0.07

Adverse Events Event

Type

Numbers

Treatment

Infection

Early SSI

0

———— •

Oral Antibiotics

Late SSI

2

Explantations

TT / TF

0

————

Peri-prosthetic Fractures

TT / TF

0

————

Adaptor Breakage

TT

1

Replaced

Granulation (SII)

1

————

Neuroma

0

————

No Major Adverse Events

Skin Implant Interface

1

2

3

4

Range of Motion !

!

!

!

Thank You