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Oxford® Partial Knee Michael O. Williams, M.D., F.A.A.O.S.

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Presentation on theme: "Oxford® Partial Knee Michael O. Williams, M.D., F.A.A.O.S."— Presentation transcript:

1 Oxford® Partial Knee Michael O. Williams, M.D., F.A.A.O.S.

2 Oxford Partial Knee Replacement The Oxford partial knee replacement is indicated for treatment of anteromedial osteoarthritis of the knee. This arthritis involves primarily the medial compartment of the knee with joint space narrowing seen on X-rays. The lateral compartment and patella are usually not arthritic in this condition. The Oxford differs from other partial knees in that it has a mobile UHMWPE bearing which duplicates normal knee kinematics.

3 Arthritis Defined as inflammation of the joint Number one cause of disability in the United States 1 More than 100 different types Two primary types – Rheumatoid – Osteoarthritis

4 Rheumatoid Arthritis Inflammatory Diagnosed at younger ages than osteoarthritis Can affect multiple joints at one time Excess synovial fluid Cartilage destruction

5 Osteoarthritis Degenerative joint disease Most common form of arthritis Wear and tear condition Develops over time – Overuse, injury or repetitive movement – Developmental disorders Results in pain, stiffness

6 Symptoms of Osteoarthritis 2 Pain Stiffness Grating or catching sensation during joint movement Bony growths at the margins of affected joints

7 X-Rays Helps determine severity of joint damage Cannot see cartilage on an X-ray Space on normal X-ray is healthy cartilage

8 Healthy X-ray Space shows healthy cartilage

9 Osteoarthritis X-ray Joint space narrowing Abnormal bone formation – spurs Joint deformity – Bowleg – Knock-knee A manageable, treatable condition

10 When to Consider Joint Replacement Conservative non-operative treatments fail to provide adequate pain relief Diminished quality of life Diminished joint function

11 Joint Replacement Also called arthroplasty Implants to resurface damaged bone and cartilage Metal alloy and durable plastic Traditional vs. min. invasive with Oxford ® Partial Knee

12 Traditional Total Knee Replacement Resurfaces damaged cartilage on: – End of femur – Top of tibia – Back of patella Incision between six and eight inches long

13 Primary Knee Components Femoral Component Polyethylene Bearing Tibial Tray

14 Minimally Invasive Knee Replacement Potential advantages to traditional knee replacement – Healthy muscles and tissues preserved May be through a shorter incision – Less blood loss – Less tissue damage Not all patients are candidates

15 Minimally Invasive vs. Traditional Incisions Traditional IncisionMinimally Invasive Incision

16 Minimally Invasive Partial Knee Replacement Replaces one compartment of the knee Knee cartilage resurfaced – Metal alloy and polyethylene (plastic) components Instrumentation for minimally invasive technique to help preserve healthy tissue

17 Oxford Partial Knee Components Femoral Component Polyethylene Bearing Tibial Tray

18 Oxford ® Partial Knee Animation

19 Oxford ® Partial Knee Implant Only mobile-bearing partial knee in U.S. – Mobile plastic bearing moves with knee motions – Mobile bearing helps limit forces to help avoid loosening 4,5 One clinical study yielded a 94% success rate at 10 years and an 89% success rate at 20 years 6 There is no specific expected survivorship for joint replacement

20 Examples of Potential Complications of Total Joint Replacement, Any of Which Can Lead to Revision Surgery Infection Blood clots Implant breakage Malalignment Wear Loosening Dislocation No implant will last forever

21 Complications Affecting Outcome & Longevity Malalignment of implants - Very dependent on surgical technique and surgeons skill level - Can be prevented with Signature cutting blocks and guides

22 Signature Personalized Patient Care

23 Signature System Patient-specific femoral and tibial positioning guides (not implanted) used for instrument placement to remove damaged bone and cartilage Developed from MRI Scan Allows for personalized instrumentation for implant positioning

24 Before Surgery Traditional – X-rays to plan implant size Signature System – MRI Scan to plan surgery Digital, interactive planning software – Plans implant size and placement before surgery

25 Pre-op MRI/CT Scan About 20 minutes for MRI scan Scan of hip, knee and ankle Head stays outside of machine MRI

26 The Surgical Procedure Signature – Patient-specific Guides Unique to every patient Placed directly on bone/cartilage Position pins for cut blocks Cut blocks guide removal of damaged bone and cartilage

27 Surgical Instrumentation Signature SystemTraditional

28 Signature System Benefits Does not invade the bone canal Fewer surgical instruments than traditional partial knee replacement Allows for personalized instrumentation for placement of the Oxford® Partial Knee implant Reduces the incidence of malaligned components do to surgeon error Implant alignment optimized for that patient

29 Value of Joint Replacement Total joint replacement can save an individual as much as $68,000 (total knee replacement) to $180,000 (total hip replacement) in medical costs over the life of the average total joint recipient as compared to nonsurgical treatment. 4,5

30 Success of Total Joint Replacement Every year, over 1,000,000 people in the United States have joint replacement Joint replacement treats debilitating pain and deformity from various forms of arthritis

31 Closing A proper diagnosis from an orthopedic surgeon can help identify cause of joint pain Many conservative treatments available Arthritis can be treated New surgical treatments also now available with joint replacement implants with improved function and longevity

32 References 1.Centers for Disease Control and Prevention http://www.cdc.gov/chronicdisease/resources/publications/AAG/arthritis.htm http://www.cdc.gov/chronicdisease/resources/publications/AAG/arthritis.htm 2.The Arthritis Foundation http://www.arthritis.org/rheumatoid-arthritis.phphttp://www.arthritis.org/rheumatoid-arthritis.php 3.Vanguard Complete Knee System Package Insert http://www.biomet.com/orthopedics/getFile.cfm?id=2171&rt=inlinehttp://www.biomet.com/orthopedics/getFile.cfm?id=2171&rt=inline 4.Argenson, J. et al. Polyethylene Wear in Meniscal Knee Replacement. A One to Nine-year Retrieval Analysis of the Oxford Knee. Journal of Bone and Joint Surgery [Br]. 74 B:228–32, 1992. 5.Psychoyios, V. et al. Wear of Congruent Meniscal Bearings in Unicompartmental Knee ArthroplastyA Retrieval Study of 16 Specimens. Journal of Bone and Joint Surgery [Br]. 80-B:976–82,1998. 6.Price, A. and Svard, U. A Second Decade Lifetable Survival Analysis of the Oxford Unicompartmental Knee Arthroplasty. Clinical Orthopaedics and Related Research. Published Online 13 August 2010 7.AAOS. http://orthoinfo.aaos.org/topic.cfm?topic=A00233 http://orthoinfo.aaos.org/topic.cfm?topic=A00233 8.Chang RW, Pellissier, JM, Hazen GB, A Costeffective Analysis of Total Hip Arthroplasty for Osteoarthritis of the Hip, Journal of the American Medical Association (JAMA), Vol. 275, No.11, 1996, pp. 858865. (Figures apply to average 60 year old patient and adjusted for inflation.)

33 Questions

34 Thank You


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