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Archive June 2016 XVII, No. 6

Your Primer on Total Knee Systems

Choose the right implant, cutting guides and instruments to streamline your outpatient joint program.

Kendal Gapinski

Kendal Gapinski, Contributing Editor

BIO

total knee replacement TOOLS OF THE TRADE When it comes to total knee replacement, you have several options for instrumentation and implants.

There are hundreds of total knee systems on the market. That can make choosing and stocking arthroplasty instrumentation, cutting guides, implants and other equipment an overwhelming task if you're just starting out with your total joint program. But to be successful, you need to have a streamlined inventory, especially if you're in a smaller facility that wasn't designed to perform total joint procedures. Here's a look at a few of your total knee system options best suited for outpatient cases.

When you start looking at your options for total knee replacement, it can be helpful to break the systems down into a few larger categories. These groups are broad, but most manufacturers have a system that falls into one of these sets, says Keith R. Berend, MD, an orthopedic surgeon with Joint Implant Surgeons, Inc., and CEO and president of White Fence Surgical Suites in New Albany, Ohio.

  • Standard systems. Most surgeons use a conventional system for a majority of their arthroplasty cases. Standard systems are typically comprised of several trays of reusable instruments and power tools, cutting templates and off-the-shelf implants designed to work with a large range of patients. Within each system, the style of the implant, sizes, materials and more can vary (see "Which Style Implant to Choose?" on p. 48). Most standard total knee systems use anywhere from 7 to 9 large trays per case, though you can work with your vendor to reduce that number. Standard systems are usually more affordable, more accessible and give surgeons more options during the procedure. However, they also can be cumbersome to store and process in smaller facilities.
  • Robotic-assisted systems. These systems use computer navigation and intelligent instruments to help position and fit the implant during surgery. They either use a pre-op CT scan of the patient's knee or specialized handheld instruments to map out the patient's anatomy and create a computerized template. This virtual surgical plan then guides the surgeon as he makes cuts in the bone, eliminating the need for standard mechanical cutting guides. "Robotic-assisted systems may help improve accuracy in some cases, but they may not be of value to high-volume or experienced surgeons, and may also be cumbersome in the outpatient environment," says Dr. Berend.
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