Starting Jan. 1 Medicare reimbursement for total knee arthroplasty has been reduced 11%.
As a result, Orthopedic surgeon Howard Luks has decided that he will do less knee replacements this year. That’s bad news for device makers.
“My response is, no. 1 am cutting the number of knee replacements that I am doing and I am cutting the demographics of the patient for whom I am doing it,” said Luks in an interview at the annual meeting of the American Academoy of Orthopaedic Surgeons in New Orleans in mid March.
But when the time comes for him to choose a knee for a patient for whom a TKA is appropriate therapy, how will he and other surgeons decide?
|Tim Czartoski, Worldwide Director of Knee Marketing at DePuy Synthes Joint Reconstruction|
Executives at DePuy Synthes Joint Reconstruction hope that patient satisfaction data will help to seal the deal for surgeons. The division is part of DePuy Synthes Companies of Johnson & Johnson, the largest provider of orthopaedic and neurological solutions in the world.
“Well, so the pressures of healthcare [reform] exist in the market for all of us," said Tim Czartoski, Worldwide Director of Knee Marketing at DePuy, in an interview at AAOS. "Our approach to that is that at the same time, [more people are measuring] patient satisfaction, and hospitals and surgeons and everyone in the value chain is becoming more accountable to patient satisfaction, including us."
This is where DePuy’s Attune knee comes in, which executives say helps patients feel more confident about being able to move about without feeling wobbly and unstable, as well as not feel knee pain - instability and anterior knee pain are major causes of patient dissatisfaction following a knee replacement procedure.
“A technology like Attune was designed to meet the unmet patient needs and improve patient satisfaction,” Czartoski noted. "... we want to do all we can to collect data and demonstrate those benefits to patients and work with surgeons to bring to light and make visible the potential improvements to patient satisfaction.”
To that end the company is conducting multiple clinical studies worldwide involving more than 2,500 patients where patients themselves report on how satisfied they are following their knee replacements.
“We call it patient-reported outcomes,he said. "So the patients themselves are giving their input through a tool that we designed that gives their feedback on patient satisfaction. That data involving the study, which is ongoing, will help us and our surgeon demonstrate the benefits of a technology like this.”
But DePuy is not simply collecting data on the Attune through this multiple studies.
|Hannah McEwen, Worldwide Director for Knee Product Development, DePuy Synthes Joint Reconstruction|
“The studies are built to collect data obviously on Attune, but it will also collect satisfaction and other patient-reported information on existing designs so it can be comparative,” said Hannah McEwen, Worldwide Director for Knee Product Development at DePuy. “So we will be able to compare Attune versus our other knees and those made by other companies.”
And this can go a long way in convincing surgeons that they should choose DePuy's Attune over other competing devices, should the data show that patients have better satisfaction when they are implanted with it.
Still, patient satisfaction is only one piece of the puzzle.
Attune has been designed in such a way that surgeons can feel the stability of the implant intraoperatively, Czartoski said. The knee system also offers a larger degree of customization to address anatomical structure of people of various ethnicities around the globe - it comes in 10 tibia and 10 femur sizes, McEwen said. [Still, it is not a totally customizable knee, the likes of which are being made by startups like ConforMIS in Boston.]
Since the launch of Attune Knee System more than a year ago Czartoski said that surgeons have been very happy with the device.
“What we are finding is that the feedback we get somewhat unsolicited in many cases is that with this knee you can feel the stability intraoperably by the surgeon and by the patient going up and down stairs” he said.
Attune has something even for hospitals who are concerned about improving efficiency as reimbursement rates fall.
“One of the things we did with Attune and the Intuition instruments was to design instruments with the thought in mind of how do we improve efficiency in the OR, how do we make cases and trays that are lighter weight for staff, that are easier to move…,” Czartoski said. "Our goal is to work with the hospital to reduce times in the OR and to improve efficiency.
He added that this mindset has led the company to use polymers and materials that they have never used before.
|The Attune Knee System|
And in another first, the company has added new capabilities to the Attune knee - they are the Attune Rotating Platform Knee and the Anatomic Patella.
The main advantage of rotating platform knees is that the knee bearing can rotate as the knee flexes, which enables and mimics the natural movement of the knee. That can also reduce stress and wear of the implant.
“A rotating platform allows us to have greater conformity, which allows us to have even more stability for the component … and that addresses the unmet need of instability,” McEwen said.
The anatomic patella is designed to address the issue of anterior knee pain, one major cause of dissatisfaction among patients.
“We are the only company in the U.S. to have a rotating platform knee, but not just have a rotating platform knee but have the same knee system in both fixed bearing and rotating platform with the same instruments, so that is unique to DePuy," McEwen said.