London, Britain - The Full Function, Faster® 2018 didactic conference, organized by MicroPort® Orthopedics, was recently held in London, Britain. The conference gathered more than 450 orthopedics specialists arriving from 35 different countries, with over 30 experts on total joint replacement from 20 countries delivering speeches. The conference comprised the sessions of fast recovery , peri-operative management, total hip replacement, SuperPath® Superior Percutaneously Assisted Total Hip ("SuperPath®"), total knee replacement and Medial-pivot Knee Replacement system ("Medial-pivot Knee") concept and technology, addressing post-operative fast recovery and patient satisfaction after the total joint replacement.
MicroPort® Orthopedics President Aurelio Sahagun delivered the opening speech of the conference by touching briefly on the role of the orthopedics business within MicroPort® Scientific Corporation ("MicroPort®"), which is a leading globalized high-end medical device group headquartered in China with more than 260 sorts of marketed products utilized in more than 5,000 hospitals globally, more than 3,000 patents and over 5,000 global employees. He concluded by adding that on average, every 12 seconds, there is a MicroPort® product utilized somewhere around the world to save the life of a patient, improve the life quality of the patient, or change the life of a patient. MicroPort® and MicroPort® Orthopedics continuously apply the most advanced orthopedic medicine, innovate in R&D, and are dedicated to the development of products improving patients' quality of life.
MicroPort® Orthopedics International Business Vice President Stefano Peverelli introduced the overall aims of the conference, which were to provide an academic exchange platform for joint surgeons around the world to discuss peri-operative management through the most advanced clinical research, focusing on patient satisfaction and fast recovery. Through this focused approach, the conference would lay a solid foundation for the promotion of new concepts and the development of new technologies.
Fast Recovery Concept and Peri-operative Management in the Spotlight
Professor Karachalios from Greece introduced the new demands of the current joint replacement technologies. He said that with the emergence of new diagnostic technologies, medicines and biological materials, particularly given the rapid population growth and higher expectations for joint replacement, the effect of the health economy of medical technology has grown increasingly important. He added that the current joint replacement technologies should be more focused on individualized treatment of the patients, therefore the joint department and surgeons should provide solutions with better therapeutic effect and more economy.
Professor Incavo from the US said that Total Intravenous Anesthesia (TIVA) is effective in the reduction of length of hospital stay, improvement in economy and acquisition of better operation results. He added that TIVA has the advantages of easing the reactions to inhalation of toxic materials and shorter post-operative recovery time.
Professor Cronin from Britain introduced the fast recovery concept, saying that fast recovery is a multi-discipline and multi-model technology, which can be improved through advancement in operation technologies. He emphasized that the combination of fast recovery concept with SuperPath® turns out to be a successfully applied daycase model.
Professor Bruce from Australia introduced the three most important ways for fast recovery: pre-operative education that improves patients' psychological pressures, cooperation among different teams including anesthesia and nursing to improve patients' physiological conditions, and early stage rehabilitation exercises to improve patients' body functions.
Professor Dervin from Canada stated that compared to the conventional in-hospital surgeries, the daycase model can save nearly 30% of the medical cost and is a safe, effective and practical operation model.
Professor Somers from Belgium said that the patients developing severe complications after joint replacement amount to more than 100,000 a year, with the patients in need of ICU after operations and deaths totaling 30,000 and 1,500 a year. Hence the precautionary measures are very important ahead of the joint replacement including the choice of appropriate anesthesia types, optimal operation methods, standard operative skills, early-stage rehabilitation exercises and patient fast recovery.
SuperPath® Makes Post-operative Recovery Faster
During the hip replacement and SuperPath® session, MicroPort® Orthopedics' SuperPath® received favorable comments by experts.
Professor Auen from Germany summarized the often utilized approaches in hip replacement surgeries. He thought the minimal invasive approach can achieve higher performance scores, less pain during early stage rehabilitation exercises and shorter length of hospital stay. The post-operative effects resulted from DAA, SuperPath® and other mini-invasive approaches are significantly superior to the conventional approaches. He also emphasized that the minimal invasive hip replacement technology can significantly quicken the post-operative recovery.
Professor Cardenas from Spain said that post-operative dislocation of hip replacement is due to various factors, but capsule and muscle are critical for the stability of hip. He thought a right acetabular component placement angle alone cannot guarantee the post-operative stability. Protection of soft tissues should also be stressed. The SuperPath® is an approach that truly preserves the functions of capsules and muscles.
Professor Civinini from Italy said that local infiltration analgesia (LIA) is more effective than nerve block analgesia, as zonal peri-articular hip infiltration has the biggest possible analgesia effect.
Professor Somers from Belgium introduced the choice of a hip implant in details. He thought that screws have limited impacts on the stability of acetabular implant. As to patients with severe osteoporosis, cemented implant should be considered and early walking should be avoided. He said that SuperPath® significantly reduces post-operative dislocations. The initial implant stability is critical to the early walking bearing weight and fast recovery. He also stressed that whatever sorts of fast recovery technologies should not damage the final result of hip replacement. The radical fast recovery should not be applied, with sufficient time be given to the human body to adapt to the new physiological environment.
Professor Mertens from Belgium said that there is a consensus exercises should be started as soon as possible after total hip replacement surgery, but the ways of exercises, time for bearing weight and its intensity are yet to be determined. No matter young or old, the patients should use progressive strength training to prevent muscles from atrophying.
Professor Qurashi from Australia has studied the brake reaction time of the patients who has undergone SuperPath® operations. He discovered that the patients need only one to two days to return to the normal brake reaction time after the operations. He argued that the patients who have undergone SuperPath® operations could drive within six weeks after operation, which is suggested to the conventional operations.
Professor Cronin from Britain said the factors influencing patients' length of hospital stay include the patients such as ages, concomitant disease, expectations and education levels, peri-operative factors such as anesthesia and post-operative nursing, as well as operative factors such as soft tissue protection, blooding and inflammation. However, the length of hospital stay can be reduced by improving operative technologies. He emphasized that SuperPath® can significantly improve the early post-operative physiological conditions and muscle function, so as to further cut the length of hospital stay.
Professor Marega from Italy stressed the efficacy of the total hip replacement can be significantly bettered by the preservation of piriformis. The implantation of a conventional cementless femur implant needs the removal of bone at the insertion of piriformis, which damages the function of piriformis. Not 100% SuperPath® surgeries can preserve the piriformis. He suggested that when it is tremendously difficult or impossible to preserve the piriformis, the loosened piriformis should be stitched back to the original position after the implantation rather than left damaged or torn.
Professor Cardenas from Spain's research indicated that SuperPath® can cut the length of hospital stay by 29%, the time of physiotherapy by 27%, the disposable medical materials by 32% and the cost of medication, with the vast majority of it being analgesics, by 16%. Meanwhile, he stressed that SuperPath® can preserve the function of the soft tissues around the hip to obtain immediate initial stability and good proprioception.
Medial-Pivot Knee Implant Delivers Outstanding Stability Performance
In the discussions on knee replacement and Medial-Pivot knee concept, Professor Wu Haishan from Shanghai No. 9 People's Hospital gave a speech on early stage rehabilitation exercises following total knee replacement. He firstly introduced his experience on early stage post-operative exercises, adding that 78% of the patients started rehabilitation exercises one day after the operation so that they sustained less pains, had better functions with shorter hospital stay (on average 4.6 days) and more satisfaction. He said that restricting patients' activities after knee replacement decreases oxygen saturation, delays tissue healing and causes the complications such as hypostatic pneumonia, muscular atrophy, deep venous thrombosis and decubitus. He emphasized in the end that the early stage rehabilitation exercises following total knee replacement will raise patient satisfaction, reduce length of hospital stay, avoid deep venous thrombosis and decrease post-operative complications.
Professor Landgraber from Germany said after summarizing various knee implant designs that the key factors that have impacts on the function recovery after total knee replacement include stability, range of motion and implant reliability (complications and longevity). Among the factors, however, the most important one is the restoration of knee's natural biomechanics.
Professor Macheras from Greece is very experienced in the use of ADVANCE® Medial-Pivot Knee system. He stated that 94% of his patients had returned to daily life after operations, with 78% of them being able to do heavy labor or even have sports. He stressed that the Medial-Pivot implant has high conformity in medial condylar, allows roll-back in lateral condylar, and accurately reconstructs the motion model of normal knees, so that it can provide better stability in the whole range of motion of the knees.
Professor Dervin from Canada compared the motor function of Medial-Pivot implant with PS implant and said that gait analysis indicated that both Medial-Pivot Knee and PS implant delivered good performance in horizontal walking, but Medial-Pivot Knees could absorb more impacts in downslope walking. The Medial-Pivot Knee also outperforms PS implant in terms of dynamic performance in cases of standing on one leg or high flexion knee. In horizontal and downslope walking, the EVOLUTION® Medial-Pivot Knee makes bilateral muscle strength more balanced, which means that Medial-Pivot Knee can bear the same weight as that of the normal knee, so as to avoid the weight imbalance.
Professor Backstein from Canada said he started to use EVOLUTION® Medial-Pivot Knee four years before while he continued to use PS implant. The clinical outcome, however, indicated that Medial-Pivot led to less swelling, lighter pains, faster recovery and no complaints of unexplainable discomforts at all. He thought that the factors such as elevated medial anterior and posterior lips of the inserts without lateral constraint, single radius of curvature femoral component and more natural tensioning of the collateral ligament contributed to the better dynamics characteristics of the Medial-Pivot Knee. He stressed that Medial-Pivot Knee has significantly higher FJS (Forgotten Joint Score) than PS implant, particularly with outstanding performance in high flexion motion and implant stability.
Professor Minoda from Japan had gauged and analyzed polyethylene debris in joint cavity. He concluded that the inserts in Medial-Pivot Knee have a lower wear rate due to the "single-repeatable-path" motion, which is characteristic of Medial-Pivot Knee. He stressed that Medial-Pivot Knee is more suitable for young and active patients.
Professor Lagast from Belgium possesses 20-year experience with Medial-Pivot Knee, with nearly 3,000 cases of Medial-Pivot Knee surgeries completed. The balanced cutting is a difficulty in the knee replacement. He summarized his experience with Medial-Pivot Knee, pointing out that patients with knock-knee deformity have medial collateral ligament intact but lateral collateral ligament stretched, so the medial plane should not be a reference for cutting, and over-loosening of medial collateral ligament should be avoided, with the joint line lifted and lateral gap left. The medial collateral ligament of the patients with valgus knee deformity is more loosened than the lateral collateral ligament. The loosened medial collateral ligament causes malfunctions so that the Medial-Pivot is unable to work as originally designed. Thus a thorough evaluation should be conducted ahead of the surgery. Professor Lagast especially emphasized that 3 to 4 degrees of varus angle should be maintained for varus knee after the implantation, resulting in the superiority to neutral position, while valgus knee should never be tightened despite being loosened after the implantation.
As the last speaker of the conference, Professor Karachalios from Greece emphasized in comparison of the patellar trackings of various knee implants that the patellofemoral joint design of Medial-Pivot Knee implant is excellent, which is able to obviously mitigate pains in anterior patella with superior patellar tracking.
The conference also used the occasion to proudly celebrate the 20th year anniversary of the Medial-Pivot Knee system, to which the conference dinner at London Tower was dedicated, with more than 400 guests and MicroPort® Orthopedics employees present. As one of the world's most established knee systems, MicroPort®'s Medial-Pivot design has witnessed more than 600,000 cases of implantation in the past 20 years. Its importance to the development of total knee replacement technologies has been confirmed in over 90 peer-reviewed publications on the basis of more than 15 years of clinical follow-up studies and the experience of clinical experts and patients. In the years to come, MicroPort® Orthopedics will contribute to the development of the global orthopedic device like before, and provide more medical solutions with safety, efficacy and high cost-performance ratio to increase the life quality of the patients.