Reducing Opiate Use: The Tourniquetless TKA
Tourniquetless TKA with CarboJet Reduces Opioid Consumption
Orlando, Florida (December 2017) – A new study demonstrates reduced opioid consumption in female patients when a tourniquet was not used in total knee arthroplasty (TKA). The study was conducted by R. Michael Meneghini, M.D, of the Indiana University School of Medicine and presented at the 34th Annual Current Concepts in Joint Replacement (CCJR) Winter Meeting. The CarboJet® bone preparation system was used to maximize cement interdigitation in tourniquetless knees. CarboJet has been widely adopted wherever cemented implant fixation is employed, including in tourniquet-free TKA. Tourniquet-free TKA, also referred to as “No Tourniquet TKA,” “Tourniquet-less TKA,” and “TKA Sans Tourniquet,” has been shown to offer many benefits over traditional TKA with a tourniquet. The ability to reduce opioid consumption using this technique is significant, since opioid addiction has become a national crisis and protocols that result in reduced patient pain are highly sought after.
Reducing Opiate Use: The Tourniquetless TKA
R. Michael Meneghini, M.D.
Director of Joint Replacement – IU Health Saxony Hospital
Associate Professor of Orthopaedic Surgery
Indiana University School of Medicine Indianapolis, Indiana, USA
Introduction: Tourniquet use in total knee arthroplasty (TKA) remains controversial and few reports exist using contemporary pain protocols and tranexamic acid (TXA). This study aimed to examine whether a modern TKA protocol without a tourniquet results in less blood loss, patient-reported pain, and opioid consumption compared to TKAs with a tourniquet.
Methods: A retrospective study was performed on 210 consecutive primary cemented TKAs using computer-assisted navigation with or without tourniquet. The tourniquet was inflated the entire procedure or not at all, and sterile CO2 gas was used to maximize cement interdigitation in non-tourniquet knees. All patients received identical implants and underwent the same TKA peri-operative protocols. Standardized inpatient pain level targets were utilized and medication titrated to control post-operative pain. Pain on a 10 point scale in the first 24 hours after surgery and blood loss (pre-operative to post-operative day 1 decline on hemoglobin, total blood loss in liters, drain output in milliliters, and drain output per hour) were analyzed relative to tourniquet use.
Results: After exclusions for confounds, 184 consecutive TKAs (93 tourniquet; 91 tourniquetless) were analyzed. Age (p = 0.561) and BMI (p = 0.580) did not differ between the two groups. By chance, there were significantly more females in the tourniquet group (55.9%) compared to the no tourniquet group (44.1%) (p = 0.019). Consequently, outcome analyses were performed separately for females and males. Median pain in the first 24 hours was significantly lower for women without a tourniquet (1.9 vs. 2.7, p = 0.002). This corresponded to significantly less opioid consumption in the first 24 hours among women without tourniquets (18.8 vs. 42.8 Me, p < 0.0001). Neither pain nor opioid consumption in the first 24 hours differed based on tourniquet use in men (p ≥ 0.114). Not surprisingly, significantly more blood loss was observed on all four metrics in tourniquetless knees for both women (p ≤ 0.040) and men (p ≤ 0.020).
Discussion: In contemporary TKA using multi-modal pain protocols and TXA, not using a tourniquet resulted in less pain and lower narcotic consumption in the first 24 hours after surgery for women, but not for men. It is possible that women may be more effected by tourniquet-induced ischemia in the early post-operative period. These results are timely with current national initiatives to minimize peri-operative opioid consumption.
Presented at the Winter 2017 Current Concepts in Joint Replacement Meeting in Orlando, FL, USA
CarboJet Effective at Removing Immunogenic Marrow Elements from Osteochondral Allografts
Naples, Italy (September 2016) – A new study looking at the effects of different bone cleaning techniques on the removal of immunogenic marrow elements from osteochondral allografts was presented at the 13th World Congress of the International Cartilage Repair Society (ICRS) by Brian Cole, MD, MBA, and Adam Yanke MD of Rush University Medical Center in Chicago, Illinois. The study compared three treatment arms: A; no lavage, B, saline lavage only; C saline lavage with CarboJet. The results showed that the third arm was significantly more effective at removing marrow debris from osteochondral allografts than saline lavage alone, especially in the deepest portion of the allograft plug.
Kinamed Names Executives to Lead Global Sales and Marketing Strategy
Camarillo CA, (September 19, 2016) – Kinamed Incorporated announced today that it has appointed Roy Fiebiger as Vice President of Global Sales, and Bob Bruce as Vice President of Global Marketing & Product Strategy. Mr. Fiebiger and Mr. Bruce will each report to Kinamed President Vineet Sarin, PhD.
Mr. Fiebiger’s role reflects Kinamed’s long-term strategy to target top-line growth by focusing on geographic expansion and deeper market penetration in all regions. As VP of Global Sales, Mr. Fiebiger will lead Kinamed’s global commercialization network, regional sales management, forecasting, sales strategy, and customer sales support.
“Roy is a proven leader who brings significant global commercialization experience to the role and understands all aspects of our business,” Dr. Sarin said. “Under his leadership, we will strengthen our commercialization strategies and bring new ideas and energy to our commercialization partners.”
Mr. Fiebiger has more than 25 years of medical device and orthopaedic product commercialization experience. Mr. Fiebiger joined Kinamed in 2013 and most recently served as its Vice President of International Sales & Business Development. Prior to joining Kinamed, Mr. Fiebiger held executive leadership positions with NeuColl, Laserscope, Norian, Techmedica, and Johnson & Johnson. While at Kinamed, Mr. Fiebiger has helped to significantly expand its international presence.
Bob Bruce’s new role reflects Kinamed’s focus on the promotion of existing and new products in both established and new markets throughout the world. Mr. Bruce began leading Kinamed’s sales and marketing efforts in 1996 as its Director of Marketing and later as its Vice President of Sales & Marketing, and served as its Vice President of Global Sales & Marketing since 2013. Prior to joining Kinamed, Mr. Bruce held key technical and product management positions with The Anspach Effort and Techmedica.
Throughout his successful tenure at Kinamed, Mr. Bruce has played a leading role in the development, launch, and market expansion of all of the company’s major product lines.
Kinamed is eager to explore and develop a number of new product applications and proprietary technologies in its portfolio. “We are delighted to have someone with Bob’s experience, skill, tenacity, and leadership in this key position”, Dr. Sarin said. “Bob will spearhead Kinamed’s marketing and product strategies by working closely with clinicians, our channel partners, and our product development team to define and deliver compelling solutions to customers in the United States and throughout the world.”
About Kinamed
Established in 1987, Kinamed is a privately held designer and manufacturer of implants and surgical instruments. Kinamed’s products include: The flagship SuperCable® Iso-Elastic™ Cerclage System: a non-metallic, iso-elastic cerclage system that solves many of the inherent problems associated with traditional wire and cable cerclage; the CarboJet® Carbon Dioxide Bone Preparation System: a proprietary device for cleaning and preparing bone surfaces during orthopedic procedures; the KineMatch® Patello-Femoral Replacement: a custom unicompartmental (partial) joint replacement designed specifically for patients with isolated, end-stage patello-femoral disease; the NeuroPro® Cranial Plating System; and the NaviPro® Surgical Navigation System. Kinamed products are sold throughout the United States and in over 30 international markets through a network of independent distributors and sales agencies.
To learn more about Kinamed, please visit www.Kinamed.com
Contact
Vineet K. Sarin, Ph.D.
President
Kinamed, Inc.
Technique Using Isoelastic Tension Band for Treatment of Olecranon Fractures
Excerpts
The particular property profile of the isoelastic tension band gives the cable intrinsic elastic and pliable qualities. In addition, unlike stainless steel, the band maintains a uniform, continuous compression force across a fracture site.
The pliability of the band allows the surgeon to create multiple loops of cable without the wire failure side effects related to kinking, which is common with the metal construct.
Abstract
The isoelastic ultrahigh-molecular-weight polyethylene tension band may be considered an alternative to stainless steel wire for tension band fixation of olecranon fractures.
In this article, we present our technique using this isoelastic tension band and describe the outcomes of 7 patients who underwent open reduction and internal fixation of closed, displaced olecranon fractures with minimal or no articular surface comminution. We reviewed medical records and performed physical examinations and functional assessments.
Anatomical reduction was maintained in all elbows through union. Physical examination measurements indicated nominal side-to-side differences in motion and strength. Mean Broberg and Morrey elbow score was good (92/100), and mean (SD) Disabilities of the Arm, Shoulder, and Hand score was 12.6 (17.2). One patient had a minor degree of hardware irritation at longest follow-up but did not request hardware removal. One patient underwent implant removal for a symptomatic implant 5 years after surgery.
This easily reproducible technique yields excellent physical and functional outcomes.
Click here to view complete article and view a video demonstrating the technique.
Click here to view the article pdf.
The Role of CarboJet in the Reduction of Aseptic Loosening
Recent evidence from a large multicenter study shows that aseptic loosening has become the single largest cause of failure of modern primary knee arthroplasties requiring revision. Earlier studies, conducted in the 1990s, had shown polyethylene wear to be the leading cause of failure. The more current study found that 28.0% of all knee failures were due to aseptic loosening, comprising the single most common failure mode. In the case of unicompartmental knees, 60.6% of failures were due to aseptic loosening. A significant portion of the aseptic loosening failures were early failures, with 32.9% of these failures classified as never successful, suggesting failure of initial fixation.
These findings suggest that meticulous attention to cement technique and proper preparation of the bone bed prior to cementation may improve implant longevity and quality outcomes. There is also considerable evidence suggesting that increased cement penetration depth into the bone bed improves cement mantle toughness and reduces cement-bone interface stresses. Of particular note, a recent tibial component retrieval study showed that there is a time dependent resorption of interlocking trabecular bone away from the cement mantle. This progressive loss of cement interdigitation with time in service suggests that it is important to ensure maximum cement penetration and interdigitation at implantation…
Kinamed Supports Orthopeadic Research
Kinamed was named as a 2014 “Corporate Associate” of the Orthopaedic Research and Education Foundation (OREF), whose mission is “Improving lives by supporting excellence in orthopaedic research.” Kinamed, a longtime supporter of OREF, recognizes the importance of this mission.
Kinamed CEO on Importance of Orthopaedic Research
Mr. Clyde Pratt, Chief Executive Officer of Kinamed, shares why he believes it is important to support OREF and its mission of advancing the field of orthopaedic research.
Surgical Techniques of Olecranon Fractures
Another study demonstrating the clinical benefits of SuperCables was recently published: Rosenwasser (2014) Surgical Techniques of Olecranon Fractures. J Hand Surg Am 39(8): 1606-14. The article can be accessed via PubMed here
Abstract: Olecranon fractures are common upper extremity injuries. The vast majority are treated with operative fixation. Many treatment techniques have been described including tension band and plating. This review covers the most commonly used fixation techniques in detail, including pearls and pitfalls with case examples of both successful treatments and potential complications.
The authors note that proper tensioning a figure-of-8 wire is technically challenging and it is difficult to both teach and learn because of a tendency to either undertwist or overdo it and break the wire . Plus, any kink in the figure-of-8 passage will decrease the equalization of tension in the construct despite 2 twisting points. The authors state that they are now using SuperCable because its locking mechanism can be easily positioned laterally where it will be least prominent, the isoelastic nature of the material has a more uniform tension, and the nylon is softer than traditional wire and seems to be better tolerated by patients along the posterior border of the ulna. They further state that they prefer K-wire and tension cables instead of traditional 18-gauge wire for transverse fractures. Finally, they state that the need for secondary surgery for hard-ware removal after SuperCable fixation is less often than with twisted wire fixation.
Kinamed’s KineMatch Partial Knee Technology
Camarillo, Ca. – In the competitive medical device field, Camarillo-based Kinamed Inc. continues to thrive by making unique, highly differentiated products, such as a partial knee replacement that is custom-manufactured for each patient.
MD&DI Interview with Kinamed CEO
Overseas sales focus keeps surgical products company operating at high level despite recession, CEO says.
Kinamed’s first overseas sales venture taught Clyde Pratt the importance of offering distinctive merchandise. During that mid-90s foray to Japan, the company’s neurosurgical products faced tough regulatory scrutiny in a device business then rife with consolidation, and Pratt learned an important lesson about its product line, the CEO says.
That focus on “specialty products with their own particular reason for being,” as Pratt puts it, has proved profitable for Kinamed over the ensuing years, according to the executive. The approach attracted an enthusiastic Japanese distribution network, an essential element that has fueled the small company’s successful run in not only Japan but also in China and other foreign markets. Overseas sales account for nearly half of Kinamed’s business, and in 2010 MDDI selected Kinamed as one of its Top 50 companies to watch.
Established in 1987 and based in Camarillo, CA, Kinamed operates partly in a $30-billion orthopedic space that one market research firm says is growing at an annual compound rate of 5% to 7%. Kinamed manufactures instruments and implants for orthopedic and neurosurgery applications. The product line includes the CarboJet CO2 lavage system, the SuperCable IsoElastic Cerclage system, and the KineMatch patello-femoral joint replacement device.