BB&T Executive Editor

SAN FRANCISCO — "Modern war produces devastating, high-energy wounds," said U.S. Navy Captain D.C. Covey, moderator of a panel on the work of orthopedists in Iraq and Afghanistan at the American Academy of Orthopaedic Surgeons (AAOS; Rosemont, Illinois) annual meeting here in March.

If those words didn't resonate with the press attendees, the vivid pictures used by panel participants as part of their presentations certainly did. But "vivid" really is too placid and comfortable a term to describe the images typifying the critical injuries that these surgeons have to work on every day.

Covey and his panelists described extremity wounds that are, well, extreme. While body armor safeguards the head and torso to some extent, military orthopedic surgeons "are seeing a group of extremity wounds that have been infrequently seen in survivors of previous conflicts," he said.

Covey also noted that about seven out of 10 battlefield wounds sustained by soldiers in these wars are musculoskeletal traumas.

Air Force Col. Mark Richardson, MD, outlined some of the work done by orthopedic surgeons in providing trauma care for Iraqi nationals in that war. These include military and police personnel, as well as civilians injured in attacks.

An important point, he said, is that the care provided Iraqis is "the same as for Coalition [military] members." And "triage in Iraq has noting to do with which side you're on. It does not consider nationality or status."

Trauma care is done at Echelon 3, which Richardson described as "a fully equipped hospital." The difference, he said, is that care beyond initial trauma treatment is carried out in Iraq, while soldiers are sent on to facilities in Germany following initial treatment.

Fellow panelist Army Major Eric Bluman, MD, discussed the use of augmented sub-atmospheric wound dressings (SAWD), used to create a pressure gradient between the wound and the surrounding atmosphere. These "relatively simple" dressings "are very effective for the treatment of a variety of wounds," he said.

"War wounds are severe," Bluman said, characterized by highly irregular borders, large amounts of debris and dead tissue, and often-damaged surrounding skin.

The severity of these wounds is then is compounded by antibiotic-resistant organisms that can easily infect the wounds.

An adapted version, called SAWDA the extra A standing for "augmented," is helping, with sewn-in sponges to enhance conformity with irregular wound borders, an adherent added to minimize the amount of skin covered by plastic, and antibiotic beads added to help prevent infection.

Bluman cited a study of the augmented dressing in which SAWDA was applied to 52 extremity wounds in 40 patients between October 2006-February 2007. The incidence of infection was just 3.8% (two patients), with no reports of infection in patients transferred to the Medical City hospital in Baghdad with SAWDA pressure applied.

SAWDA, he said, overcomes the drawbacks of conventional SAWD dressing treatment and "is effective in treating war wounds in a host-nation patient population."

And Bluman urged continued research of SAWDA on long-term wound outcomes.

Panelist Lt. Commander William Krissoff of the Naval Reserve had an especially noteworthy presentation, in no small measure because his decision to quit his private orthopedic practice and overcome bureaucratic obstacles to join the military medical service was an outgrowth of considerable personal and painful loss.

His son was killed in combat in Iraq in 2006, leading Krissoff to decide to attempt entry to military service — at age 60.

He was initially rebuffed by the expected age restriction, but after he and his wife had "an unexpected meeting with President Bush" in August 2007, "an age waiver came through in a few days."

Krissoff was commissioned in November and is completing his training in preparation for being sent to Iraq.

He noted that with the pressures of the war on terror, there is a growing gap in military medical care, in particular in the need for general and orthopedic surgeons, anesthesiologists and emergency room physicians.

"That gap can be filled by senior surgeons like myself who are nearing the end of their private careers," Krissoff said.

When deployed to Iraq, he will become part of a group of providers with great pride in what they are doing.

"We're doing good work there," Richardson said. "It's a great example of real teamwork in action."

Also during the briefing, panelist Steven Morgan, MD, of the University of Colorado's Denver Health Medical Center, described the visiting orthopedic scholars program that has been put together by AAOS, the Orthopaedic Trauma Association and the U.S. Army.

From the military's perspective, the program provides civilian orthopedic trauma experience in areas where more such help is greatly needed. The civilian surgeons who participate serve as a sort of consultant, offering what Morgan characterized as "a pair of fresh eyes" to review "war-related trauma care."

From the civilian participant's perspective, it's an opportunity to gain experience in war-related trauma care, providing a broader background in what he termed "war-like injuries" that may occur in domestically.

The civilian participants, all of whom must have at least 10 years of experience in the practice of extremity trauma, work at Landsthul Regional Medical Center (Landsthul, Germany), located near Ramstein Air Base in Germany, where U.S. service personnel injured in Iraq and Afghanistan are transported following their initial treatment in those regions.

Among the lessons learned by the visiting surgeons, according to Morgan, is that, while there may be some similarities between civilian trauma and war injuries, on the whole, "war-related extremity wounds are different."

He noted that the experience would help the participating surgeons be better-prepared to treat citizens targeted by an act of terrorism.

MRSA, other infections posing problems

Infections of both the community-acquired and hospital-acquired varieties are a huge problem facing healthcare, and more and more attention is being given the problem on local and global levels. Controlling methicillin-resistant Staphylococcus aureus (MRSA) and other super bugs was the topic of a media briefing during the AAOS meeting.

Moderator Richard Parker Evans, MD, chief of adult reconstructive surgery and associate professor of orthopedics at the University of Arkansas for Medical Sciences (Little Rock), said that surgical sites are "particularly prone" to developing MRSA infections, especially open fractures with large wounds.

More than 500,000 surgical-site infections occur every year, "and we are running out of options to treat them." As orthopedic surgeons, "learning how to prevent them is going to be the key for us and for the safety of our patients."

Panelist David Wong, MD, of Presbyterian St. Luke's Medical Center (Denver), reported on the World Health Organization's (WHO; Geneva, Switzerland) efforts with its World Alliance for Patient Safety.

The two-pronged program is focused first on hygiene, including pressing for hand hygiene protocols to reduce hospital-acquired infections, and secondly on surgical safety, with emphasis on reducing medical errors and promoting surgical team communication.

James Stannard, MD, professor of surgery and chief of orthopedic trauma at the University of Alabama at Birmingham, presented findings of a randomized study on use of negative-pressure wound therapy via Kinetic Concepts' (KCI; San Antonio) VAC device to guard against infection and wound breakdown following high-risk fracture surgery.

"We hit the wound with sub-atmospheric pressure, or negative pressure," Stannard said. "The VAC creates a suction, which helps pull off excess fluid and increase blood flow to the site."

In all, 248 patients with 262 fractures were randomized, 118 patients with 1231 fractures into the control group and 130 patients with 141 fractures into the NPWT group.

The mean VAC treatment time was remarkably short just 59 hours, or about 2-1/2 days. Infection results included 24 total in the control group and 14 in the VAC arm.

Stannard, said, "We need a lot more data, including more patients and more wound types, but it appears this treatment can help solve infection problems before they become worse" and much more costly than the relatively low cost of the VAC treatment, which he pegged at perhaps $500 for the 2-1/2 days it was applied.

InteguSeal cuts surgical-site infections

Kimberly-Clark Health Care (K-C; Roswell, Georgia) is focusing on the infection sector with its latest product, InteguSeal Microbial Sealant. Featured at the K-C booth during the AAOS meeting, InteguSeal is a microbial barrier whose intent is to reduce the risk of skin flora contamination during s surgical procedure.

One of the key attributes of the new product, beyond its ability to reduce the chances of a surgical-site infection, is that it's a logical fit with existing hospital procedures.

Dr. Charlotte Owens, medical director at K-C Health Care, told Biomedical Business & Technology: "[InteguSeal] doesn't cause an extra burden on the operating-room staff," she said. "It goes along with the procedures already being followed."

She noted that the greatly heightened awareness of hospital-acquired infections in recent years has led to a "We're all in this together" shared sense of need. "The prevailing phrase for healthcare workers is 'Not on my watch.' We're all taking ownership on this issue," Owens said.

"For surgeons," she added, "this fits with their clinical practice. It (the InteguSeal application) comes immediately after the preparation of the surgical site. It's one less worry for the surgeon."

InteguSeal is a sealant that, as Kimberly-Clark puts it, "helps protect against skin flora migration into surgical incisions."

In appearance, it's not unlike the Clorox bleach pens found hanging on the racks near checkout stations in Wal-Mart, Target and supermarket chains nationwide. It's a little larger than those, but not so much that it would look out of place on one of those point-of-sale displays.

The single-use applicator delivers what the company calls "effective amounts of sealant, evenly covering [the] incision area in a single stroke."

So it's easy to apply, but the key, of course, is how it works.

"It's an immobilizer of bacteria," Owens said. "You want to keep [the surgical site] as clean as possible," she told BB&T.

The product comes in two sizes, the IS100 for small-to-medium surgical sites (up to 10" x 10") and the IS200 for larger areas (up to 10" x 20").

Study shows long-term efficacy of Carticel

Carticel, a product made by Genzyme (Cambridge, Massachusetts), while inarguably novel, is far past the novelty stage and its novel action lasts. Carticel, used in a procedure known as autologous chondrocyte implantation (ACI), pretty much had "amazing" written all over it when it was introduced in the mid-1990s as the first cell therapy to be approved by the FDA. And it was the subject of data presentations at the AAOS meeting.

First introduced in March 1995, the product received accelerated approval from the FDA in August 1997 after the agency instituted specific cell therapy guidelines. Genzyme conducted confirmatory post-market clinical studies, and in June of last year, the FDA said the commitment had been satisfied.

Roland DeAngelis Jr., director of global marketing for orthopaedic biologics at Genzyme Biosurgery, told BB&T that one of the points of emphasis for the company in marketing Carticel is that "it doesn't limit [a patient's] future options."

If the Carticel cell-transplantation treatment doesn't work — or at least not as well as the physician and/or patient would desire — "all [other] options are available," up to an including total knee replacement.

Used by orthopedic surgeons to treat patients who have "clinically significant" articular cartilage lesions on the thigh bone part of the knee caused by acute or repetitive trauma that have not responded to a prior cartilage repair procedure, Carticel treatment starts when an orthopedic surgeon provides Genzyme with a biopsy of healthy cartilage taken from a patient's knee in an arthroscopic procedure.

Technicians at Genzyme's cell culture laboratory in Cambridge use proprietary methods to grow millions of cells from the biopsy, and the cells then are delivered to the hospital, where the surgeon implants them into the patient's knee defect.

The cost of the treatment ranges from $20,000-$35,000, with more than 14,000 patients in the U.S. having had Carticel implants to date.

Genzyme acknowledges that the independent contributions of the autologous cultured chondrocytes and other components of the therapy to outcome are unknown. However, the long-term efficacy of ACI treatment now has been demonstrated in a study reported at AAOS.

In the study, 72 patients were enrolled from 35 different centers across the U.S. All enrollees had low functional scores an overall condition score of 3.4 points on the Modified Cincinnati Knee Rating System. At their early follow-up, 75% of all patients had experienced "significant" improvement in their knee function a mean improvement of 4.3 in overall condition. Of those patients, 87% sustained improvement at the later follow-up point.

Allen Anderson, MD, of Tennessee Orthopaedic Alliance (Nashville), a well-known sports medicine orthopedist who presented the data at the meeting in a session titled "Durability of ACI: 10-Year Outcome in Multi-center Observational Study," said, "We knew that autologous chondrocyte implantation worked for select patients, but did it last?"

He told BB&T, "We knew the treatment worked, but the question was, 'Does it work long-term?'" In Europe, studies had indicated good results from such treatments for an intermediate term of up to six or seven years, Anderson said, "but no long-term results [had yet been] confirmed in the U.S." He added that the study data "suggest that the ACI technique not only works, but when it works, the results will last for a long time."

Genzyme also is in the pre-clinical stages of studying a second-generation Carticel II product, which is less invasive to apply, requiring only minimally invasive or arthroscopic surgery. Carticel II uses a "fleece matrix" into which the harvested chondrocyte cells are planted. This fleece is then placed back into the body, usually via arthroscopy, to begin the healing.

DeAngelis told BB&T that this newer technique, known as matrix autologous chondrocyte implantation, or MACI, would lessen some of the barriers to use of the original product, namely the surgical procedure needed to implant and hold the liquid cell matrix. "MACI is a much more convenient method of delivery," he said. "It's the same cells, but seeded onto a collagen membrane. The surgeon takes this membrane, sticks it on the wound site, and the cells then do what they do."

Genzyme also noted that data were presented at AAOS on Synvisc-One, the single treatment of Synvis (hylan G-F 20) indicated in the European Union for treating pain due to osteoarthritis of the knee. J rg Jerosch, MD, PhD, of Johanna-Etienne-Hospital in Germany, said patients who received Synvisc through a single-injection regimen achieved a "statistically significant" improvement in pain from osteoarthritis of the knee for up to six months. A study involving 253 patients at 21 sites across Europe showed improvement in pain from osteoarthritis of the knee observed over 26 weeks compared to patients who received placebo.

Patient-specific implants touted

The talk of late about "Gender knees" and the like being all the rage in the orthopedics industry is a little confusing to ConforMIS (Burlington, Massachusetts).That company is all over the "personalized fit" question when it comes to reconstructive implants.

The company's latest patient-specific implant, the iUni, is designed for patients whose arthritic damage is isolated to either the medial or lateral compartments of the knee, with little to no damage present in the other compartments. The use of such a unicompartmental implant often is referred to as "partial knee replacement."

The implant is available for either the medial or lateral compartments and is 510(k) cleared for marketing by the FDA and CE-marked for sale in Europe.

The new implant and its corresponding iJig disposable instrumentation were highlighted by the company at AAOS.

Speaking with BB&T, CEO/chairman Philipp Lang, MD, hailed the bone-conserving nature of his company's products. "Our unicompartmental device is so bone-conserving," he said, adding that ConforMIS has "had this vision from the start."

The privately held company was started in 2004.

Rather than coming in a finite number of sizes that, despite clinician efforts to come up with the best possible fit, still are far from sized to fit, ConforMIS's implants are just that. They are patient-specific, with sizing done from measurements obtained in a preliminary CT scan.

Each iUni is designed from an individual patient's CT scan, using the company's iFit technology and made specifically for that patient.

In the early phase, it is taking up to six weeks between the time of the scan and getting the completed implant back into the surgeon's hands, but the company expects that turnaround time to dip into the three- to four-week range as the process evolves.

The company said the patient-specific iUni "allows for true resurfacing of the femur and complete coverage of the weight-bearing surfaces for each patient, a result not previously achievable with off-the-shelf implants."

With conventional implants, orthopedic surgeons generally must do a fair amount of what we'll term "manipulating" the bones at the implant site. The result is an implant shaped and sized specifically to that patient.

Lang said that conserving bone through the computer-generated model "means no revision problems." Complete cortical rim coverage on the tibia, for example, is expected to reduce the risk of implant subsidence and loosening, key failure mechanisms for standard unicompartmental replacements.

He added that the company's "image-to-implant technology" offers physicians a bone-preserving option for early intervention, "combined with a simplified and reproducible surgical technique."

Lang cited a study headed by Wolfgang Fitz, MD, of Brigham & Women's Hospital and Harvard Medical School (both Boston), which showed that being able to utilize imaging data to develop patient-specific knee implants "provides a significant advantage over existing traditional knee-replacement techniques."

Jong Lee, senior VP, marketing for ConforMIS, told BB&T the technology is built around the data gathered in the CT scan. "We harvest the data [and] use it to make patient-specific implants," he said. Asked about response from AAOS members on the exhibit floor to the just-introduced iUni, Lee said, "We're getting fast uptake in terms of surgeon interest."

He added that clinicians see the product as offering an opportunity for early intervention in the osteoarthritic knee before reaching the point of total knee replacement. "Early intervention is a problem they don't really have an answer for at present."

A filmless flow for surgeons

When it comes to orthopedic case planning, Orthocrat (Petah-Tikva, Israel) has the proverbial better idea. The company's TraumaCad web-based solution is aimed at helping orthopedic surgeons plan their pending procedures with precision. The software helps surgeons "plan their surgeries with the utmost precision, allowing them to take very precise measurements of the anatomy and implants they will need," Orthocrat said.

TraumaCad allows surgeons to develop a pre-operative surgery plan via clinical manipulation of digital orthopedic images, using the best in image processing techniques, including the application of digitally rendered and accurately-sized fixation systems or prosthetic systems.

The application also includes a set of tools to visualize the reduction of fractures, to determine the axis of deformity, to simulate osteotomy procedures, and much more.

Othocrat says TraumaCad "solves the problem of how to read digital images in situations when the precise scale of a picture is hard to assess, saving doctors time and money, before and during the surgery."

It calls the technology "the most versatile, powerful, web-based solution for orthopedic surgery planning."

Adam Ehrenraich, MD, himself an orthopedic surgeon and TraumaCad product manager, told BB&T during the AAOS meeting: "We make a solution for all kinds of surgeons." He added, "Orthopedic surgeons may buy a lot of metal [in the form of implants and surgical tools], but what they need is software."

The intent behind the TraumaCad product is to aid in the translation from the imaging studies to the surgical plan. "Translation is a big problem for the orthopedic surgeon," he said. TraumaCad allows those surgeons to determine "exactly how they will conduct the surgery prior to entering the operating room."

The goal is to improve the workflow of the surgeon, who, Ehrenraich said, "is evaluating patients in the clinic, but operating on them in perhaps several hospitals." The question, he said, "is how do you get these images to the hospital okay?"

Besides TraumaCad, the answer lies in Orthoweb, a new, online service for storing and sharing pre-operative data that was launched by Orthocrat at AAOS. Orthoweb allows orthopedic surgeons from private clinics, who often have little or no access to existing hospital PACS, easy access to their patients' files through its secure Internet service that stores pre-operative data and images needed during surgery.

"This is a real step forward in bridging the workflow gap between private clinics and hospitals," said company co-founder Zeev Glozman. "Instead of bringing CDs or devices that need to be hooked up to hospital computers, surgeons can just log onto the Internet and download surgery plans into the operating room with a few clicks."

Orthoweb, which is an add-on service for surgeons, hospitals and research centers currently using the TraumaCad software, also includes an automated system for surgeons to request and book operating rooms by simply e-mailing a patient's file to a hospital, rather than the time-consuming process of faxing or mailing pre-operative data and images.

Also during AAOS, Orthocrat reported a partnership with WebOps Mobile (Atlanta), an online service that streamlines the supply and service chains of medical device companies. The companies said that through integration of their software, surgeons, technicians and medical device suppliers can use a wireless Bluetooth or PC-connected scanner and a mobile hand-held device to securely and accurately embed patient X-rays and data to a surgical case record in WebOps.

Orthocrat was founded in 2003 by Glozman, an entrepreneur, and Doron Noman, MD, deputy director of the department of orthopedics and traumatology at Rambam Medical Center (Haifa, Israel). The 25-employee company says its mission is to advance the orthopedic community to a 100% filmless work mode.

Boosting ranks of women in orthopedics

Another interesting briefing at the conference focused on the paucity of women among the ranks of orthopedic surgeons, with a caveat that change may be in the air. Panelists noted that today, more than 90% of orthopedic surgeons are men, and that just 3% of board-certified orthopedic surgeons are female.

However, they also noted that women now comprise more than 50% of medical school classes in the U.S., so it's a matter of convincing a larger number of them that orthopedics is the specialty for them.

Panel moderator Mary O'Connor, MD, department chair of orthopedic surgery at the Mayo Clinic (Jacksonville, Florida), said, "It is ... important to the public at large that more women become involved in the practice of orthopedics. If we work to increase diversity within the orthopedic workforce, it stands to reason we will probably have more awareness and sensitivity to gender and racial differences across the board."

"On some level, young women are still given negative messages on surgical training, especially orthopedic training. We are here to tell them that ... as orthopedic surgeons they can really help patients improve their quality of life."

No BONES about it

The BONES Society (Rosemont, Illinois), an organization focused on orthopedic practice management, has changed its name to better reflect that purpose. It now is known as the American Association of Orthopaedic Executives (AAOE), with that name highlighted in the group's booth in the Moscone Convention Center South.

AAOE President David Demchuck, CEO of Front Range Orthopedic Center Longmont, Colorado), said the organization's board of directors "felt it was time to adjust the association's image to reflect more accurately the professional sophistication of our members. Our new name and brand ... [showcase] our energy and industry leadership."

From the exhibit floor

• BioMimetic Therapeutics (Franklin, Tennessee) presented data highlighting its clinical and pre-clinical studies on products that combine recombinant protein therapeutics with tissue-specific scaffolds to stimulate tissue-healing and regeneration.

The company is developing recombinant protein/device combination products for the healing of musculoskeletal injuries and disease.

Two podium presentations at AAOS focused on the use of recombinant human platelet-derived growth factor-BB (rhPDGF-BB). Dr. Michael Ehrlich presented "rhPDGF-BB Increases New Bone Formation in a Rat Model of Distraction Osteogeneis" during a Pediatrics session. Dr. Christopher DiGiovanni presented "A Human Feasibility Trial Evaluating rhPDGF vs. Autologous Bone Graft during Foot and Ankle Fusion" during a Foot/Ankle session.

In addition, seven posters on various studies involving rhPDGF-BB I were presented at the Orthopedic Research Society meeting preceeding AAOS.

The company has received marketing approval from FDA for its first product, GEM 21S, as a grafting material for bone and periodontal regeneration. It also has clinical trials ongoing with product candidates GEM OS1 and GEM OS2 in multiple orthopedic bone-healing indications, including the treatment of foot and ankle fusions and the stimulation of healing of fractures of the arm.

• Carestream Health (Rochester, New York) launched a new miniPACS platform designed for orthopedic practices and displayed the advanced orthopedic capabilities of its fully featured Kodak Carestream PACS. The MX-Orthopedic miniPACS platform, which is now available in the U.S. and Canada, is offered as a web-server configuration along with concurrent access user licenses.

Carestream also introduced a new tabletop laser imaging system, the Kodak Dryview 5800, that prints laser-sharp grayscale images with the same technology used in the company's high-volume Kodak Dryview Laser Imager Systems. The tabletop imager is designed for radiology departments, imaging centers and small clinics, and dedicated modality printing.

• CoolSystems (Alameda, California), d/b/a Game Ready, released the next generation of Game Ready, its injury treatment system for musculoskeletal injuries and post-operative rehabilitation. The system offers a combination of form-fitting wraps, cold and intermittent compression, and adjustable pressure and temperature settings for a "simple, convenient and effective treatment." The system includes a number of contemporary design features to enhance the patient's experience and ease-of-use during recovery. Like its predecessor, the system still leverages patented NASA spacesuit technology to simultaneously deliver intermittent compression and controllable cold therapy to help people recover from injuries or orthopedic surgery. CoolSystems makes pneumatic cryotherapy systems.

• Orthovita (Malvern, Pennsylvania) reported the launch of Vitoss bioactive foam as the newest addition to its bone graft substitute product line. The foam contains bioactive glass that induces natural calcium phosphate growth onto the surface of the implant. The foam has the ability to soak and hold its own volume in bone marrow aspirate while retaining these biological fluids in pliable and compression resistant forms. Orthovita is a spine and orthopedic biosurgery company.

• Osteotech (Eatontown, New Jersey) said that the FDA has cleared its 510(k) submission for its Plexur M biocomposite. Adapting the company's Plexur technology, Plexur M is intended for use in filling bony voids or gaps of the skeletal system that are not intrinsic to the stability of the bony structure. During the healing process, Plexur M is remodeled and replaced by host bone. Plexur M is a flexible biomaterial composed of mineralized cortical fibers bound in a resorbable polymer. When heated, this biocomposite becomes moldable and pliable allowing a surgeon numerous options for use during surgery. During the cooling process, Plexur M hardens providing a versatile porous scaffold to assist in regeneration of damaged and diseased bones. Osteotech specializes in regenerative medicine.

• The Orthopaedic Reconstruction business of Smith & Nephew (Memphis, Tennessee) reported the introduction of its Verilast technology. Verilast technology "represents a technological leap forward in implant performance for knee replacement surgery. It is an optimized material combination engineered to improve knee implant performance and durability." S&N said the new technology combines its Oxinium material with highly cross-linked polyethylene (XLPE) to produce what it characterized as "a one-of-a-kind total knee replacement device."

Joseph DeVivo, president of Orthopaedic Reconstruction, said, "Initial data on implant wear compared to competitive systems has been very encouraging. Due to the significant improvements we are observing in wear rates over competitive material combinations, a knee with Verilast technology may be the only implant many patients ever receive."

Smith & Nephew also launched the R3 Acetabular System, an advanced multi-bearing acetabular cup system used in total hip replacement procedures. The R3 Acetabular Cup is engineered for multiple bearing options and features Stiktite porous coating that is designed to enhance fixation and bony in-growth. The multi-bearing cup, in addition to providing flexibility for surgeons, provides a foundation designed to reduce wear and the subsequent need for revision surgery. Optimized inserts accommodate larger head sizes and help the R3 system achieve a greater range of motion.

• Stryker Orthopaedics (Mahwah, New Jersey), maker of the Triathlon Knee System that it says is the industry's fastest-growing total knee replacement system worldwide, unveiled the Triathlon PKR, a partial knee resurfacing system. "Triathlon PKR with X3 is a great addition to the Triathlon Knee family, which allows surgeons to treat the unique needs of each patient and provide them with a personalized solution," said Mike Mogul, President, Stryker Orthopaedics.

Triathlon PKR is the first partial knee resurfacing product that utilizes Stryker's X3 advanced bearing technology, which the company said has demonstrated up to a 96% decrease in wear in laboratory testing compared to competitive premium bearing surfaces in total knee replacements.

Potential benefits of partial knee resurfacing include a quicker operation and a shorter hospital stay, with the procedure in some cases being performed on an outpatient basis. With Triathlon PKR, less bone is removed and there is often less trauma to soft tissue during surgery, which may leave the patient with a more natural feeling knee than with a total knee replacement. The device is also anatomically shaped and designed to enable surgeons to use the latest minimally invasive surgical techniques, which may result in a smaller scar for the patient.

Also unveiled at AAOS was Stryker's Triathlon TS Revision System, designed to provide Triathlon performance in a streamlined revision procedure. The design is based on the Triathlon Primary System and millions of Stryker knee implantations.