Daily Highlights Blog

During the show, this space will contain up-to-the-minute live updates on all the latest Zimmer news. Don't forget to check back often.

Trabecular Metal Monoblock Revision

by Randall J. Lewis, MD

Apr 23, 2006 5:00 PM

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Trabecular Metal Monoblock Revision

Anthony S. Unger, MD, and Randall J. Lewis, MD, discussed the Trabecular Metal Monoblock Revision Shell at the Zimmer Theater. They provided an overview of Trabecular Metal Material and focused on its use in acetabular revision arthroplasty. Their presentation included a review of cup revision literature, an overview of the implant design and indications, a summary of the surgical technique, and a review of clinical results. The Trabecular Metal Monoblock Revision Shell has been used clinically since 1997.

Mar 24, 2006 4:33 PM

The Latest on Bone Cement

Frank R. Dimaio, MD, has studied and examined the nature and applications of bone cement in total joint arthroplasty for the past 15 years. Calling on this experience, he presented an overview of bone cement at the Zimmer Theater. He discussed the etiology of cemented TKA failure. Dr. Dimaio also discussed new innovations in bone cement preparation and delivery systems, and gave suggestions on how to improve preparation and delivery. Finally, he discussed the application of PALACOS Bone Cement with and without antibiotics during total joint replacement surgery. He explained the mechanical performance of PALACOS and discussed its long history.

Mar 24, 2006 4:15 PM

Trabecular Metal Primary Hip Prosthesis

The Trabecular Metal Primary Hip Prosthesis was discussed by George J. Haidukewych, MD, at the Zimmer Theater. Dr. Haidukewych explained that a tapered stem makes sense because it is applicable to a wide variety of femoral morphologies, has a long clinical history, and can be implanted using a predictable, reproducible technique. He then discussed the design rationale for the Trabecular Metal Primary Hip Prosthesis. He explained that its key differentiating features include Trabecular Metal Material, a 14-degree proximal taper, a 23.5-degree neck resection angle, and A/P reliefs on the proximal stem body. Dr. Haidukewych then summarized the surgical technique and discussed specific cases and clinical results.

Mar 24, 2006 3:18 PM

Global Surgeon Solutions

Mar 24, 2006 2:55 PM

What You Should Know About the Patellofemoral Joint

Jeffrey H. DeClaire, MD, discussed the Patellofemoral Joint at the Zimmer Theater. His presentation covered an overview of the implant and a profile of the patient who may be a candidate for the implant. Typically, Dr. DeClaire's patients are young, with significant loss of function, and involvement limited to the patellofemroal articulation. They have experienced failure of multiple attempts at more conservative treatment. Among the goals of the implant design, according to Dr. DeClaire, are to preserve the anatomy and provide a less invasive solution. He also provided a historical overview of previous patellofemoral implant designs. Dr. DeClaire reviewed the indications, instrumentation, and surgical technique, and then discussed clinical results.

Mar 24, 2006 2:35 PM

NCB Plating System Polyaxial Locking Technology

Michael Suk, MD, JD, MPH, reviewed the NCB Plating System Polyaxial Locking Technology at the Zimmer Theater. He provided an overview of the features and advantages of the system relative to polyaxial locking and noncontact bridging. The system includes a friction fit locking cap, and uses spacers to achieve noncontact bridging. The hole configuration on the plates, combined with the wide range of screw angulation that can be achieved, allows the system to be used with a variety of fractures. Dr. Suk reviewed the biomechanical testing that was used to verify the design, and presented specific cases to demonstrate applications of the system.

Mar 24, 2006 2:07 PM

Metasul Metal-on-Metal Tribological Solution

Pascal-A Vendittoli, MD, MSc, FRCS, presented a review of large head and metal-on-metal hip designs at the Zimmer Theater. He explained that he uses these implants in young active patients. According to Dr. Vendittoli, the main issues associated with these patients are early complications, longevity, and function. Treatment options include standard THA, large-diameter head THA, and resurfacing. Dr. Vendittoli explained the advantages of large-diameter heads. For example, he generally imposes fewer physical restrictions on his large-diameter head patients. Dr. Vendittoli also discussed the 18-year results of studies involving Metasul Metal-on-Metal Tribological Solution, covering aspects such as cobalt serum levels and wear.

Mar 24, 2006 1:56 PM

Zimmer® MIS™ Quad-Sparing™ TKA

Mar 24, 2006 1:32 PM

Highlighting the MIS Anterolateral Hip Procedure

Richard E. White, Jr., MD, discussed the intermuscular anterolateral approach to MIS total hip replacement at the Zimmer Theater. Dr. White explained that the approach is a modification of the Smith-Peterson approach, and can be used in almost all primary hip patients and with almost any prosthetic design, including both cemented and cementless designs. He discussed the rationale, the anatomical factors involved, and the surgical technique. Dr. White then detailed his preoperative planning, pain management, and rehabilitation techniques, as well as his clinical results.

Mar 24, 2006 1:01 PM

Health Economics: What's It All About?

The economics of total joint replacement were front and center at the Zimmer Theater as Carlos Lavernia, MD, discussed the important aspects involved. Dr. Lavernia focused on the United States health care arena, and how surgeons can address reimbursement issues now and in the future. Dr. Lavernia has recognized that orthopaedic surgeons receive little or no training in health care economics and has taken a great interest in implant pricing, as well as Medicare and Medicaid reimbursement. He pointed out that reimbursement is becoming increasingly complicated, but surgeons need to have a better understanding of health plans. For example, he said that most surgeons understand Medicare parts A and B, but not parts C and D. Dr. Lavernia also provided an overview of how reimbursements are determined.

Mar 24, 2006 12:23 PM

Trabecular Metal Technology in Total Shoulder Arthroplasty

Among the many uses of Trabecular Metal Technology are total shoulder applications. These applications were discussed by Evan L. Flatow, MD, at the Zimmer Theater. Dr. Flatow suggested that Trabecular Metal is of particular interest in shoulder arthroplasty because of the high number of fractures accompanied by soft tissue damage that are treated with shoulder replacement. He reviewed the properties of Trabecular Metal Material, and then focused on why it makes a good choice for shoulder arthroplasty. Specifically, Dr. Flatow discussed humeral fixation, tuberosity ingrowth, and reverse shoulder fixation. He reviewed the features of the Trabecular Metal prosthesis, highlighting its small proximal size and improved geometry. He then outlined the surgical technique, including his use of the sutures holes during the procedure.

Mar 24, 2006 11:48 AM

MIS Femoral Nailing Solutions

Clifford B. Jones, MD, discussed Zimmer MIS Femoral Nailing Solutions at the Zimmer Theater. He reviewed the indications and applications, and then discussed some of the key points of femoral anatomy relative to femoral nailing. Dr. Jones provided results of clinical and cadaveric studies, in addition to gait lab studies. He discussed various surgical techniques and offered a number of tips that he uses to facilitate the procedure.

Mar 24, 2006 10:59 AM

Advanced Rotator Cuff Repair

The Zimmer Collagen Repair Patch was discussed by Gregory P. Nicholson, MD, at the Zimmer Theater. Dr. Nicholson outlined the use of the patch for advanced rotator cuff repair, and how it may contribute to better healing rates. He reviewed the retear rates of rotator cuff tears and noted that they are especially high after revision procedures. Dr. Nicholson cited animal studies that demonstrated excellent mechanical properties in the Zimmer Collagen Repair Patch, and also discussed his early clinical results. The patch is a nonresorbable material consisting of collagen and elastin. According to Dr. Nicholson, the animal studies showed a strong mechanical repair with good interdigitation of the patch at 24 weeks. Dr. Nicholson concluded by reviewing the indications for the patch and then outlined the surgical technique.

Mar 24, 2006 10:42 AM

Zimmer MIS Anterolateral Hip Procedure

by Richard E. White, Jr., MD

Mar 23, 2006 5:00 PM

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Advanced Rotator Cuff Repair, Zimmer® Collagen Repair Patch

by Gregory P. Nicholson, MD

Mar 23, 2006 5:00 PM

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Zimmer Health Economics of Total Joint Replacement

by Carlos J. Lavernia, MD

Mar 23, 2006 5:00 PM

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Palacos®** Bone Cement

by Frank R. DiMaio, MD

Mar 23, 2006 5:00 PM

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Trabecular Metal Technology: Not Just For Revision TKA

David G. Lewallen, MD, reviewed the many uses of Trabecular Metal Technology in TKA at the Zimmer Theater. He discussed the need to minimize osteolysis in an effort to maintain bone quality around a knee implant. According to Dr.Lewallen, this is achieved by considering the effects of wear debris and stress shielding. He sited examples of previous implant designs that may have contributed to these concerns, and explained the benefits of Trabecular Metal tibial components in addressing them. Dr. Lewallen then discussed the design features and material properties of the Trabecular Metal Monoblock Tibial Component.

Mar 23, 2006 4:58 PM

Why Use NexGen LPS Flex?

Giles R. Scuderi, MD, discussed the design rationale for the NexGen LPS Flex Knee at the Zimmer Theater. After reviewing the key design features, which include extended posterior condyles, a recess on the anterior lip of the tibial articular surface, and a lower contact height on the tibial spine, Dr. Scuderi presented clinical data that supports the design. He also discussed the significance of crosslinked polyethylene relative to wear resistance and the strength of the tibial spine. Dr. Scuderi also reviewed the surgical technique considerations that are important in achieving high flexion angles.

Mar 23, 2006 4:41 PM

The Case for Large Head Metal-on-metal Designs

Clive P. Duncan, MD, FRCSC, presented a review of large head and metal-on-metal hip designs at the Zimmer Theater. According to Dr. Duncan, the benefits of large femoral head components include greater range of motion, a reduced risk of dislocation, and an opportunity for a more active lifestyle. He explained that large-diameter femoral heads provide a more favorable head/neck ratio and a reduced risk of impingement and dislocation. Dr. Duncan contends that metal-on-metal hip prostheses can also have important advantages, such as reduced wear rates. He then explained some of the reasons for this, which include the surface finish and the self-polishing nature of metal-on-metal components. Tolerances are also important in achieving these benefits. To achieve optimal lubrication of the articulation, the spacing between the metal implants must be carefully determined.

Mar 23, 2006 3:49 PM

When to Use Modular Tapered Stems

Wayne G. Paprosky, MD, FACS, answered the important questions about the selection of a stem design for revision hip arthroplasty at the Zimmer Theater. He discussed how to deal with bone loss and other joint conditions that may impact surgical reconstruction. Dr. Paprosky reviewed femoral defect classifications and what type of prosthesis is appropriate for each. He focused on the choice between a monoblock design and a modular design, as well as determining whether a cylindrical stem or a tapered, porous-coated stem should be used. Dr. Paprosky discussed the benefits of using a modular tapered stem, and provided technique tips for implanting the device.

Mar 23, 2006 2:54 PM

The Use of Periarticular Locking Plates

The use of periarticular locking plates was discussed by David Templeman, MD, and Stephen Benirschke, MD, at the Zimmer Theater. Dr. Templeman reviewed the use of locking plates as a reduction tool, and discussed the importance of bone-specific implants and key design elements when selecting an implant. The keys to treatment with these implants include achieving anatomic reduction, preserving the blood supply, and achieving stable internal fixation. Dr. Benirschke then discussed specific techniques used with periarticular locking plates, and provided tips to facilitate the procedure.

Mar 23, 2006 2:22 PM

Low Modulus Hip Prosthesis

The evolution of a low modulus hip prosthesis was discussed by Andrew Glassman, MD, at the Zimmer Theater. Dr. Glassman studied the adaptive remodeling relating to stem stiffness, and discussed issues relating to both cemented and cementless stems. Dr. Glassman also discussed the evolution of the Epoch Hip Prosthesis, which is designed to address concerns about proximal femoral bone resorption resulting from stress shielding. He discussed the rigorous mechanical testing that was performed as well as the clinical investigation programs.

Mar 23, 2006 2:05 PM

Forging a Path to Outpatient TKA

Richard Berger, MD, discussed outpatient TKA at the Zimmer Theater. His presentation covered MIS muscle-sparing approaches as they relate to outpatient surgery. Specifically, Dr. Berger provided an explanation of how outpatient TKA is performed at Rush-Presbyterian-St. Luke's Medical Center in Chicago. He detailed the surgical technique used, including the use of specific instruments, the incision and exposure, the placement of retractors, and the landmarks to use to guide the surgeon during the procedure.

Mar 23, 2006 1:07 PM

Knee Solutions

Mar 23, 2006 12:56 PM

O/R Efficiencies Outlined

Jeffery Pierson, MD, discussed the importance of O/R efficiencies in TKA at the Zimmer Theater. He began by reviewing the trends in surgeon and hospital Medicare reimbursement, then discussed the options available to help increase productivity and improve efficiency. Generally, the idea is to standardize the entire process, according to Dr. Pierson. He suggested developing teams throughout every department, and establishing protocols that will provide consistency in all procedures. He stressed the important of getting support from the hospital and the entire staff.

Mar 23, 2006 12:23 PM

Zimmer MIS

Mar 23, 2006 12:09 PM

Women Are Not Just Little Men

The strong interest in Gender Knee Solutions was obvious as Robert E. Booth, Jr., MD, discussed gender issues as they relate to knees at the Zimmer Theater. A full theater heard Dr. Booth as he outlined the reasons that he believes surgeons need to recognize the unique aspects of female anatomy. He pointed out that women represent about 60% of TKA patients, and he expects that percentage to rise. He also suggested that women are becoming more athletic and, therefore, have a greater need for implants that are designed specifically for them.

Among the many differences mentioned by Dr. Booth were fat distribution, limb alignment, and flexibility. But the most important difference is in the shape of the distal femur. Dr. Booth defined this difference in terms of aspect ratio, that is, the AP/ML ratio. According to Dr. Booth, a male femur tends to be about 10% greater in the AP dimension, and 14% greater in the ML dimension. "Women are not just little men," he said. "Their femurs have different shapes." To help avoid overhang in female patients, Dr. Booth suggested that it isn't enough to simply use smaller implants. He suggested that surgeons use implants designed to fit the shape of a female knee.

"I think we should celebrate these differences," he concluded. "This is an exciting time."

Mar 23, 2006 11:53 AM

Gender HipTalk Draws Large Crowd

Gender solutions continued to be a topic of great interest at the Zimmer Theater as Lawrence Dorr, MD, discussed his studies on gender hips. Dr. Dorr reviewed the differences between male and female hips, focusing on three main areas of difference. These include bone, hip anatomy, and stature. Dr. Dorr explained that the majority of patients with Types B and C bone are women. He went on to define the geometries that are more common in women; also, that soft tissue tends to be more flexible in women. Dr. Dorr then discussed the differences in stature between men and women, specifically that women tend to have shorter hips with more varus. Dr. Dorr concluded by suggesting that it is good to be aware of these differences so that appropriate treatment can be determined.

Mar 23, 2006 11:27 AM

MIS Anterior Hip Procedure

Prof. Nikolaus Bohler discussed the advantages of anterior approaches in MIS total hip arthroplasty at the Zimmer Theater. He reviewed the Watson-Jones and Smith-Peterson approaches, then detailed the specifics of the approach he uses when implanting the Alloclassic Hip. Prof. Bohler discussed all aspects of the surgery, including patient positioning and draping, preoperative planning, surgical approach, preparation of the acetabulum and femur, and implantation. He particularly focused on retractor placement.

Mar 23, 2006 11:01 AM

Ray Elliott Hosts Investor Meeting

Ray Elliott, Chairman, President and CEO of Zimmer Holdings, Inc., hosted the annual AAOS investor meeting on Wednesday, March 22. Elliott stated that the year's upcoming highlights include many new products and Zimmer® Gender Solutions™ Innovations.

New products, with anticipated launch dates, include:

Trabecular Metal™ Stem - limited release 3/06; full release 7/06
Trabecular Metal™ Acetabular Revision System
Metasul® and Durom® "LDH" (Large Heads) - Durom® received FDA 510K on 3/17/06
EPOCH® II Composite hip Stem - limited release 4/06; full release 9/06
TRILOGY AB® Ceramic-on-Ceramic - full launch Q2 2006
B/F Reverse and Anatomical Inverse Shoulder - limited release 6/06; full release 9/06
Zimmer MIS™ Femoral Nailing Solutions - full release 3/06
Zimmer NCB® Plating (Non-Contact Bridging) - full launch 9/06
MIS™ Instrumentation for Peri-Locking Plates - full launch 9/06
Optima Pedicle System - available now
Spine Trabecular Metal - available now
CopiOs™ Sponges - available now

The highlight of the investor meeting was the introduction of Zimmer® Gender Solutions™ and the science behind the new implant technology. Mr. Elliott discussed the reasons behind the development of the implant and the anatomical differences that dictate the shape and size changes of the Gender Solutions product. Additionally, Mr. Elliott outlined the Gender Solutions introductory plan, which includes direct-to-consumer efforts, the sister product "BRIGIT," an economics program and the infrastructure to teach the technology through the Zimmer Institute.

Mar 22, 2006 8:59 PM

Ray Elliott Hosts Investor Meeting (cont.)

Relating to these direct-to-consumer efforts, an additional new product announcement was Zimmer® BRIGIT™ Bone Resection Instrument Guide. "BRIGIT," an acronym for "Bone Resection Instrument Guidance by Intelligent Telemanipulator, is a new technology for which Zimmer last week gained sole control of all IP rights. And another new product announcement was the introduction of the Zimmer Health Economics Division, which will facilitate and promote economic efficiencies between physicians, hospitals, payors and patients. This new Zimmer Health Economics Division last week issued a mutual LOI to acquire a hospital economics consulting business and is in negotiations for economic value enhancement (EVE) with a major hospital group.

Mr. Elliott then introduced Dr. Robert Booth, Chief of Orthopaedics at Pennsylvania Hospital and Clinical Professor of Orthopaedic Surgery at the University of PA; Ms. Sheryl Conley, Group President, Americas & Global Marketing, and Chief Marketing Officer; and Mr. John Gauger, Senior Director, Global Brand Management, Knees & Sports Medicine, all of whom comprised the expert panel for a Q&A session that ended the meeting on a high note.

Mar 22, 2006 8:58 PM

O/R Efficiencies

by Jeffery L. Pierson, MD

Mar 22, 2006 5:00 PM

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Evolution of a Low Modulus Stem - VerSys® Epoch® Hip Prosthesis

by Andrew H. Glassman, MD, MS

Mar 22, 2006 5:00 PM

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Zimmer MIS Anterior Hip Procedure

by Prof. Nikolaus Böhler

Mar 22, 2006 5:00 PM

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Dr. Alfred Tria Discusses Zimmer MIS Quad Sparing Procedure

Dr. Alfred Tria presented his two-year MIS Quad-Sparing TKA procedure results to a full house at the Zimmer Theatre. Dr. Tria acknowledged that 70% of his practice is smaller incisions, 40% of which are Quad-Sparing procedures. What does Quad Sparing mean? According to Dr. Tria QS involves no muscle incision, no subvastus and no quadricepts incision. And the procedure is here to stay. Dr. Tria presented data from his two-year study that included shorter lengths of stay, longer operations, less post-op pain, and greater range of motion. Dr. Tria emphasized that the keys to success are choosing the right patients, having a good surgical approach (techniqes and instruments), using a good prosthesis, and yourself. Get the right training and make yourself comfortable with the incisions.

Mar 22, 2006 3:40 PM

Anatomical Shoulder Reconstruction Detailed

Anatomical shoulder reconstruction was the topic discussed by Christian Gerber, MD, at the Zimmer Theater. Among the specific tips presented were the locking of the prosthetic head in the anatomic position, avoidance of glenoid loosening and mismatch, and achieving appropriate version of the glenoid component. Dr. Gerber then discussed specific cases to show how he has addressed these issues. He then reviewed various prosthetic designs, including implants designed for fracture cases.

Mar 22, 2006 2:24 PM

Review of Crosslinked Polyethylene

Giles Scuderi, MD, discussed crosslinked polyethylene at the Zimmer Theater. He reviewed the occurrence of surface and back-side wear in conventional polyethylene, and the specific types of wear that result from each. He also assessed back-side wear relative to component design, and reviewed efforts to improve the wear properties of polyethylene. These efforts have centered around various crosslinking techniques, which Dr. Scuderi assessed. He then presented the results of lab tests that show the differences between the various crosslinked polyethylenes and conventional polyethylene. Finally, he outlined the important factors involved in determining a method of crosslinking that results in the best combination of mechanical properties.

Mar 22, 2006 1:38 PM

Dr. Berger Provides Detailed Review of 2-incision Hip Procedure

Richard A. Berger, MD, explained the Zimmer MIS 2-Incision Hip Procedure at the Zimmer Theater. He discussed the location of the incisions and showed detailed animations in conjunction with surgical video and fluoroscopic images to show the exposure complete with retractor positioning. Dr. Berger then reviewed the step-by-step surgical procedure with specific surgical tips. Other important considerations discussed included the learning curve, patient selection, and postoperative rehabilitation and recovery. The presentation concluded with a summary of a study involving 300 consecutive cases.

Mar 22, 2006 12:58 PM

The History of Unicompartmental Knee Implants

Jean-Noel A. Argenson, MD, presented a review of the evolution of unicompartmental knee implant design at the Zimmer Theater

Beginning in the 1980s with the Marmor prosthesis, he progressed to the metal-backed design of the 1990s before addressing contemporary design features. Dr. Argenson reviewed primary and revision arthroplasty, and the changing patient expectations that have prompted modifications in contemporary designs. He discussed the design features of the Zimmer Unicompartmental Knee System, and the instrumentation and surgical technique options available with the system.

Mar 22, 2006 12:15 PM

Gender Solutions

Mar 22, 2006 12:10 PM

Dr. Lewallen Discusses Trabecular Metal Revision Hip System

A large crowd gathered at the Zimmer Theater to hear David G. Lewallen, MD, discuss the Trabecular Metal Revision Hip System.

After reviewing acetabular bone defect classifications, Dr. Lewallen explained the physical properties of Trabecular Metal Material, particularly as they relate to friction and biological ingrowth. He then continued by explaining various reconstruction strategies using Trabecular Metal Material in various implants such as cages, acetabular augments, and revision shells. He presented a 2- to 5-year follow-up study of the Trabecular Metal Revision Shell System. According to Dr. Lewallen, the Trabecular Metal implants are part of an integrated system of revision implants.

Mar 22, 2006 11:59 AM

Zimmer Booth

Mar 22, 2006 10:58 AM

Review of Studies Analyzing Knee Design Elements

Richard D. Komistek, PhD, presented a review of his research of studies analyzing various knee designs to determine how design aspects affect in vivo kinematic function. Dr. Komistek, who presented at the Zimmer Theater, used two-dimensional analysis as well as analysis in live patients, including a mobile fluoroscopy unit that followed the patient to analyze gait. The analysis looked at both unicompartmental and total knee designs. He examined both cruciate retaining and posterior stabilized designs, as well as mobile-bearing and high flex designs. Dr. Komistek concluded that design elements can have a significant impact on in vivo kinematic function.

Mar 22, 2006 10:42 AM

2 Year Zimmer® MIS™ Quad-Sparing™ Total Knee

by Alfred J. Tria, Jr., MD

Mar 21, 2006 5:00 PM

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TKA Design - In Vivo, Fluoroscopic Studies

by Richard D. Komistek, PhD

Mar 21, 2006 5:00 PM

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Zimmer MIS Posterior Hip Procedure

by Lawrence D. Dorr, MD, MS

Mar 21, 2006 5:00 PM