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  • Osteoarthritis (OA) affects 21 million people in the U.S. 1 Quality of life is more affected by OA symptoms than by other chronic conditions such as respiratory and/or heart disease 2 OA is the #1 cause of joint problems and disability in the U.S., leading many people to joint replacement surgery 3 1: The Arthritis Foundation 2: The Neuroscience Institute 3: American Academy of Orthopaedic Surgeons
  • Osteoarthritis is extremely debilitating for many people. It’s caused by the cartilage between the joints wearing away, leading to symptoms such as pain, stiffness and difficulty with even the simplest activities Audience participation question How many of you had trouble just getting here today because of your osteoarthritis, with driving or walking into this building? People with OA find that many simple activities most of us take for granted are now difficult.
  • These are some simple tasks that can help you see if your mobility is limited These are also on the card you all have so you can try this at home If you find that you can’t comfortably perform these simple tasks, talk to your doctor about ways to get your mobility back. Suggestion: Use your patient spokesperson to demonstrate the movements
  • You can do a number of things on your own early on to reduce the daily discomfort of osteoarthritis. No matter where you’re at on this continuum, you’ve probably tried some of these treatments. Today we’ll be focusing on joint replacement.
  • This animation shows that very little bone is actually removed. The damaged cartilage, along with a very small amount of bone, is removed. The knee replacement, which is made of metal and plastic, is then fitted to the bone to provide an artificial surface.
  • When other treatments are no longer relieving your pain and you’re giving up activities, knee replacement may help. How do you know when you’re ready? These questions may help. If you answer yes to one or more of these, talk to your doctor about whether knee replacement is an option for you.
  • Knee replacement is commonly used and highly effective. One question my patients often ask is “how long will it last?” Discuss clinical success of knee replacement in your experience
  • It’s important to remember that joint replacement is major surgery and complications can occur. These are the most common.
  • Use the model of the RP knee during this time to demonstrate the difference between fixed-bearing and mobile-bearing knees.
  • In my practice, I use a unique type of knee replacement called a “Rotating Platform Knee”. This type of knee replacement has a long history of use and over 97% of patients are pleased with it. It’s unique because it rotates as it bends, just like your natural knee does. It’s a great option for active patients because the components move in tandem to minimize wear and tear on the implant. My patients who have this knee tell me…. Let me show you how it works…
  • What makes the Rotating Platform knee unique is that the part of the implant that replaces the worn cartilage actually rotates slightly as you move, imitating the natural movement of the knee. On traditional knee replacements, this piece stays locked in place. While these types of knee replacements are extremely successful, for more active patients the rotation is beneficial because it helps minimize wear and tear on the implant and potentially prolong the performance. Comment during animation: Note the white component is moving slightly side to side Your knee rotates slightly during normal movement: Walking-5 degrees of rotation Climbing stairs-8 degrees of rotation Kneeling-15 degrees of rotation
  • Patients have a tendency to delay surgery too long, even with daily pain and difficulty with simple activities like walking up and down stairs and driving. But there are good reasons not to wait—it will take longer to get your movement back if you wait too long, and you may develop other conditions, such as complications from obesity, that will keep you from having surgery even when you’re ready. It’s important to know that OA is incurable—it’s not going to get better. But it is likely to get worse.
  • When my patients ask me when they should move forward with surgery, I explain that in six months from the time you have surgery, it’s very likely that you’ll be finished with rehabilitation, experiencing little knee pain, and, with few exceptions, back to doing things they’ve given up. If they postpone surgery, I tell them that in six months their condition will likely be worse. I also advise them that the longer they wait, the more difficult the surgery and rehabilitation may be.
  • Double click on slide to play video
  • Patient welcome/introduction Patient tells their story of before, during and after surgery Share any concerns before surgery and what helped with the decision What rehab was like Why the patient is glad they had the surgery Physically Socially Well-being Patient welcome/introduction Patient tells their story of before, during and after surgery Share any concerns before surgery and what helped with the decision What rehab was like Why the patient is glad they had the surgery Physically Socially Well-being
  • Ask attendees to fill out the evaluation forms Thank them for coming Remind them to pick up the educational materials if they don’t have them already
  • These “Top 10” questions are designed to be Q&A starters. You can choose three or four to warm up the discussion, and then take audience questions. Sample responses are available as part of the program materials from DePuy.

* Remove this slide before presentation* * Remove this slide before presentation* Presentation Transcript

    • *** Remove this slide before presentation***
    • This presentation was created to assist you during local market educational seminars given to patients. Before each segment of information contained herein, you will see a title screen informing you of the section to follow. You should not include every slide in the presentation if you do not want to . Please review the presentation prior to the event and choose only the screens you’d like to include when delivering the presentation itself. Don’t forget to delete the screens you do not wish to include.
    • The different buckets of information to choose from within this presentation include:
    • General Osteoarthritis
    • General Facts About Knee Replacement
    • Knee Replacement Options: Rotating Platform Knees
    • Consequences of Delaying Surgery
    • Patient Testimonials
    • Computer Assisted Surgery
    • Women’s Issues in Knee Replacement
    • Minimally Invasive Surgery
    • Additionally, there are scripts from which you can refer while the two animations are playing.
    • If you have any questions or need help, contact Jessica Masuga at (574) 371-4830.
  • [Insert name] Emcee representing DePuy Orthopaedics, Inc.
  • Welcome!
    • You should have with you several forms:
      • Event Questionnaire – an event feedback form
        • Please return this to us at the end of the event
      • Personal Assessment Form – a self-test of your mobility
      • “ For More Information” Form – please return this to us to request additional information about knee replacement
  • Agenda
    • Discuss treatment options for severe knee pain
    • Patient stories
    • Questions & answers
  • Dr. [insert name] Orthopaedic Surgeon
  • General Osteoarthritis Remove this slide
  • What’s the Leading Cause of Knee Pain?
    • Osteoarthritis
  • What is Osteoarthritis?
    • Cartilage deteriorates and friction is created between bone surfaces.
    • Symptoms include:
      • Chronic knee pain
      • Knee stiffness
      • Difficulty with everyday activities (walking, driving, stair climbing)
  • Check Your Mobility If you have difficulty performing any of the movements below, it may be time to talk to your doctor about next steps
  • Knee Osteoarthritis Treatments Early Intervention Non-surgical Treatments Knee Replacement
    • Medication
    • Weight control
    • Prescription medications
    • Physical therapy
    • Injection therapy
        • Orthovisc(R)
    • 400,000 performed yearly in the U.S.
  • General Facts About Knee Replacement Remove this slide
  • Knee Replacement Knee replacement surgery is the replacement of the worn and arthritic surfaces of the knee joint
  • Script to Use During Animation
    • This animation shows that very little bone is actually removed.
    • The damaged cartilage, along with a very small amount of bone, is removed, and the knee replacement, which is made of metal and plastic, is then fitted to the bone to provide an artificial surface.
    • The components of a knee replacement comprise the femoral component, the tibial tray, and the tibial component
    (Remove this slide)
  • Are You Ready for Knee Replacement?
    • Does your knee hurt one or more days per week?
    • Does the pain interfere with your sleep?
    • Is it painful for you to walk more than a block?
    • Are pain medications no longer working?
    • Is knee pain limiting your participation in activities?
    • Has inactivity from knee pain caused you to gain weight?
    • Can you limit activities for a few months to recover from surgery?
    • Are you willing to commit to work hard during rehabilitation for a successful recovery?  
  • Knee Replacement Facts
    • Based on a National Institute of Health (NIH) study, 85% of patients are satisfied with the results of their knee replacement surgery 1
    1: NIH Consensus Development Conference on Total Knee Replacement, NIH Consensus Development Program ( http://www.guideline.gov/summary/summary.aspx?view_id=1&doc_id=5299 )
  • But You Should Also Know…
    • Performance of joint replacements depends on age, weight, activity level and other factors.
    • There are potential risks and recovery takes time.
    • People with current infections or conditions limiting rehabilitation should not have this surgery.
    • Potential complications which could result in pain, stiffness or dislocation of the joint include:
      • Loosening
      • Fracturing
      • Wearing of the components
  • Knee Replacement Options: Rotating Platform Knees Remove this slide
  • Knee Replacement Options
    • Traditional: fixed-bearing
    • Unique: mobile-bearing (also called Rotating Platform)
  • Unique Options in Knee Replacement
    • Rotating Platform Knee
      • Designed to rotate as it bends, imitating natural knee movement
        • The surfaces roll and glide against each other as the knee bends, just as your natural knee does
        • Designed for patients who want to remain active since it minimizes implant wear, compared to fixed-bearing knees 1
        • A multi-center internal study shows 97% patient satisfaction at 5 years 2
    1: McNulty, D. et al. “In Vitro Wear Rates of Fixed-bearing and Rotating Platform Knees (Rev. 2)” (2003) 2: DePuy Multi-Center Study (2006)
  • Why is Rotation Important?
  • Script to Use During Animation
    • What makes the Rotating Platform knee unique is that the part of the implant that replaces the worn cartilage actually rotates slightly as you move, imitating the natural movement of the knee.
    • On traditional knee replacements, this piece stays locked in place. While these types of knee replacements are extremely successful, for more active patients, the rotation is beneficial because it helps minimize wear and tear on the implant.
    • Comment during animation:
      • Note the white component is moving slightly side to side
    • Your knee rotates slightly during normal movement:
      • Walking-5 degrees of rotation
      • Climbing stairs-8 degrees of rotation
      • Kneeling-15 degrees of rotation
    (Remove this slide)
  • Consequences of Delaying Surgery Remove this slide
  • Should You Delay Surgery? 1: Fortin, Paul R., et al. “Outcomes of Total Hip and Knee Replacement.” Arthritis & Rheumatism 42 (1999): 1722-1728 2: Fortin, Paul R., et al. “Timing of Total Joint Replacement Affects Clinical Outcomes Among Patients with Osteoarthritis of the Hip or Knee.” Arthritis & Rheumatism 46 (12) (2002): 3327-3330 3: www.jointreplacement.com
    • Early diagnosis and treatment for total knee replacement are important 1
      • Delaying surgery can lower quality of life before the operation and up to two years after surgery 2
    • Pre-existing medical conditions may become more serious, delaying elective surgery 3
    • Osteoarthritis is degenerative – it won’t get better and will likely get worse!
  • What to Expect With or Without Knee Replacement Severe pain Inability to walk any distance Medications don’t help Interrupted sleep Surgery is recommended 3-6 months+ Return to activities 3-6 months+ Continued or increased pain and reduced mobility 1-2 months Rehabilitation 1-2 months Continue to address symptoms Have Surgery Delay Surgery
  • Patient Testimonials Remove this slide
  •  
    • Patient Testimonial
    • Received Rotating Platform Knee
    • Date of Surgery
    • Insert quote
  • Computer Assisted Surgery Remove this slide
  • Computer Assisted Surgery
    • What is computer assisted surgery (CAS)?
      • A new approach to knee replacement
      • The patient’s anatomy is simulated and displayed on a computer
      • Computer provides information about where to place the components
  • How Does CAS Work? Your anatomical information is entered into the computer through a process called registration This information is fed back to the camera and communicated to the computer Computer calculates the best position to place the components for accurate alignment Camera searches for arrays placed on the patient via infrared signals
  • Potential Benefits of CAS
    • Guides surgeon in areas that are difficult to visualize
    • Relays specific measurements not previously available to surgeons
    • Gives precise, accurate data on your specific anatomy
    • Allows surgeons to make informed decisions about precise implant placement based on detailed data from the computer
  • Why Use Computer Assisted Knee Replacement Surgery?
    • Advanced knee replacement technology combined with widely used, clinically successful implants
    • Allows surgeons to be more precise when making decisions about placing knee components
    • Provides the surgeon with extensive information to assist with surgical decisions
  • Women’s Issues in Knee Replacement Remove this slide
  • Important Considerations for Women
    • Osteoarthritis affects three times more women than men 1
      • Women are more likely than men to be disabled
      • The pain is more severe for women 2
    • Women’s knees rotate more than men’s, especially during deep bending (kneeling) 3
    • Current knee replacements are designed to fit the anatomies of both women and men
    1: Hawker, Gillian A., et al. "Differences Between Men and Women in the Rate of Use of Hip and Knee Arthroplasty." The New England Journal of Medicine 342 (2000): 1016-1022 2: Harris Interactive research survey, April 2005 3: Hsu, Wei-Hsiu, et al. “Difference in Torsional Joint Stiffness of the Knee Between Genders.” The American Journal of Sports Medicine Vol. 34, No. 5 (2006): 765-770.
  • Gender-Specific Implants
    • There is no clinical support of the need for gender-specific implants
    • It is too new for any clinical data; won’t know results of the implant for 10-15 years
    • All orthopaedic manufacturers have knee implant systems with sizes appropriate for both females and males
    • More than 60% of knee replacements have been implanted in women 1
    • Current knee replacement patients have a 90 to 95% satisfaction rate with the results of their surgery 2
    1: American Academy of Orthopaedic Surgeons ( http://www. aaos .org/ wordhtml /research/stats/ Hipkneefacts . htm ) (2006) 2: The Arthritis Foundation ( http://www.arthritis.org/research/Bulletin/vol51no11/Printable. htm ) (2006)
  • Gender Issues in Knee Replacement: The Bottom Line
    • Rotation is important, especially for women
    • Women’s knees rotate more than men’s
      • In deep flexion (deep knee bending)
      • Daily activity
    • Only one knee, the Rotating Platform knee, is designed to accommodate your knee’s anatomical need for rotation
  • Minimally Invasive Surgery Remove this slide
  • Minimally Invasive Knee Replacement Surgery
    • Minimally invasive surgery (MIS) is still very new
    • Visibility of your knee during surgery to help ensure proper alignment is more important to the long-term success of your knee replacement than the length of your incision or even your recovery
    • Alignment affects:
      • How long your knee replacement lasts
      • Long-term success
  • Benefits of MIS
    • Some early studies of MIS have shown some benefits of the surgery (when compared to traditional, “open” surgery), such as:
      • Less blood loss
      • Shorter hospital stays
      • Faster recovery
  • Complications of MIS
    • Other studies, however, have shown several complications with the surgery, (when compared to traditional, “open” surgery), including:
      • Increased number of surgical complications
      • Poor implant positioning
      • No difference in the length of recovery
  • What Really Matters When It Comes to MIS
    • MIS is still relatively new
    • It won’t be known for 10 to 15 years if the new techniques affect the long-term function and durability of the implant
    • You should discuss with your surgeon whether MIS is an appropriate surgical course of treatment for you
  • Additional Slides (if applicable)
  • Event Questionnaires
    • Please take a moment to complete the event questionnaires
    • Please pick up additional information about knee replacement as you leave
    • Don’t forget your free gift!
    • Thank you for attending our event:
    • “ Restoring the Joy of Motion ”
    • Questions?
    • For more information:
    • Include surgeon
    • information here
    • www.kneereplacement.com
    • or visit www.aaos.org
    TM
  • Potential Questions to Be Asked During Q&A Remove this slide
  • Q&A
    • What can I expect during recovery and rehabilitation from knee replacement?
    • Should I be concerned about anesthesia during surgery?
    • Will I recover at home or at a rehab facility?
    • How long will the implant last?
    • When can I drive, work, resume activities?
    • I’ve heard there are knee replacements made just for women. Do I need one of these?
    • How can I prepare my family and myself before surgery?
    (Remove this slide)