In 1Q19, DePuy Synthes announced the Anterior Advantage Matta Method, a defined surgical technique combined with tools such as orthopedic tables and intraoperative imaging. The namesake of the program, Joel Matta, M.D., is a surgeon at The Steadman Clinic, Co-founder and Chairman of the Anterior Hip Foundation and a pioneer of the anterior approach. Dr. Matta began using the anterior approach in the late ‘90s and has remained dedicated to the technique, noting that it results in tissue preservation and shorter recovery time. More than two decades later, he remains committed to teaching and advancing the anterior approach.
We spoke with him at AAOS about what’s still to come with anterior hip replacement.
What improvements need to be made for greater adoption of the anterior approach?
While progress has been made over the last decade and a half, Dr. Matta noted that the procedure needs to be more repeatable, resulting in less chance for error and complications and ease of adoption by high- and low-volume surgeons. That means not only proper teaching of the technique, but also using the right tools. Dr. Matta and DePuy Synthes have partnered on a full solution, including implants, instruments and enabling technology like JointPoint.
“If we look back at orthopedics and ask how is hip surgery going to be done right, at the beginning, the emphasis was on the implant. The different companies and surgeon designers were saying, ‘We've designed this implant, it’s the best implant; you put in this femoral and acetabular implant and the patient is going to do great,' ” Dr Matta said. “I think the concept now is that you need a package of a number of techniques and technologies. You can’t just ignore one of them.”
What is the growth potential of the direct anterior approach?
As more hip replacements move to outpatient or ambulatory surgery center settings, the anterior approach is likely to increase due to the quicker recovery time, says Scott Zellner, Senior Director of U.S. Joint Reconstruction and Outpatient Marketing at DePuy Synthes.
DePuy Synthes points to research that states that more than 40% of hip replacement surgeons currently use the anterior approach, a growth of 6% since 2016. Dr. Matta has noticed an increasing number of fellows and residents choosing the anterior approach over the posterior.
“I think it's just about reaching a tipping point where most hips in the U.S. will be done with the anterior approach,” Dr. Matta says. “I believe the number of patients getting the anterior approach is more important than the number of surgeons doing it. I think a higher percentage of patients are getting the anterior approach than the percentage of surgeons doing it, because patients are seeking it out now.”
For a full look at how companies have responded to surgeon voices and augmented their hip lines, we recap new product launches in 2018 and 1Q19.
Corin launched the Trinity Dual Mobility System, designed to support a wide range of motion and a reduction in instability and dislocation following primary or revision hip arthroplasty. It works with Corin’s Optimized Positioning System and puts two articulating surfaces in one joint space for stable, multi-directional movement not available with conventional hip replacements. A base of Corin’s ECIMA polyethylene reduces the risk of in vivo oxidation, and a self-centering polyethylene liner reduces load and risk of impingement between stem and polyethylene.
DePuy Synthes introduced the ACTIS Total Hip in the U.S. ACTIS represents the company’s first hip designed for both traditional and tissue-sparing approaches, such as the minimally invasive anterior approach that can allow patients to return to function more quickly.
DJO introduced ADAPTABLE, a sterile surgeon-controlled leg and retractor holder designed for the direct anterior approach for total hip arthroplasty. The fully-mechanical carbon fiber surgical arm works with any standard operating table, may reduce the number of assistants in the O.R., and is easy to set up, transport and store. It offers an alternative to costly specialty surgical tables that weigh 800+ pounds and occupy significant space in the O.R. ADAPTABLE weighs ~10 pounds and can be used for retractor placement or leg positioning for femoral exposure, range of movement and leg length assessment.
LimaCorporate introduced the 3D-printed DELTA TT Pro Acetabular System, with enlarged bearing options specifically designed to serve the U.S. market. The DELTA TT Pro cup uses proprietary Trabecular Titanium, which was developed to optimize primary fixation and encourage bone integration. The technology will also be employed to build custom implants for complex joint reconstruction, such as those to be manufactured by the company’s collaboration with Hospital for Special Surgery in the first 3D printing facility to be established on hospital grounds. DELTA TT Pro includes new LimaVit highly cross-linked polyethylene + Vitamin E liners and additional bearing options.
Medacta introduced the MasterLoc LAT PLUS wedge stem, an addition to its MasterLoc hip. The component includes a progressive triple offset to enhance stability without affecting leg length. MasterLoc systems employ Mectagrip plasma-sprayed titanium coating to enhance initial fixation.
OrthoGrid Systems unveiled the PhantomMSK Hip Preservation System, with new applications for peri-acetabular osteotomy and treatment of femoral acetabular impingement. PhantomMSK is a digital fluoroscopic grid technology platform that informs intra-operative decision making. Alongside the company’s HipGrid and HipGrid NINE products, PhantomMSK offers a cost-effective and mobile solution that can be installed in ambulatory surgical centers and hospitals.
OsteoRemedies launched the REMEDY SPECTRUM GV Hip Spacer and SPECTRUM GV Bone Cement, featuring both Gentamicin and Vancomycin antibiotics. This represents what is reported to be the first FDA-cleared dual-antibiotic spacer and bone cement system. The company also markets the REMEDY Acetabular Cup with the only pre-formed PMMA hip spacer on the market.
Stryker launched the Trident II Acetabular System, based on AMagine additive-manufactured Tritanium In-Growth Technology and compatible with the Mako Robotic Arm. The design features a slim wall (enabled by additive manufacturing) that supports large femoral head size options and poly thickness that may support a greater range of motion, joint stability and lower dislocation risk. Trident II shells feature the Innerchange Locking Mechanism that allows intra-op choice among bearing options like Modular Dual Mobility, X3 engineered polyethylene or Trident constrained liners.
United Orthopedic Corporation launched UTS, the United Tri-tapered Short Hip Stem. UTS, suitable for the direct anterior approach, is designed for insertion through small incisions with simple femoral preparation. Features include standard and high offset options, a triple-taper design with Titanium Plasma coating for initial fixation and rotation stability and a reduced lateral shoulder to conserve bone.
Vomaris Innovations launched Procellera FlexEFit Antibacterial Wound Dressing in the U.S. For procedures such as hip and knee replacement, FlexEFit can provide seamless coverage of incisions of any length or curvature, with one product configuration. FlexEFit is based on V.Dox technology that uses embedded moisture-activated microcell batteries that wirelessly generate microcurrents, designed to mimic the skin’s electrical energy. A “Link & Build” design enables it to be built during application. The covering provides the incision protection without the use of additional antibiotics, and extends a measure of infection control beyond the O.R. In clinical and scientific studies, V.Dox has been shown to kill microbes, including multidrug-resistant and biofilm-forming bacteria.
Julie A. Vetalice is ORTHOWORLD’s Editorial Assistant.
Photo courtesy of DePuy Synthes