Persona Sales & AAOS Notes


Anonymous

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So I heard from some Zimmer folks at AAOS that Persona was selling well, only constrained by production capacity (a good problem to have), but still a small percentage of total knee sales. Apparently the self aligning tibia component for rotation, along with the precise fitting femur (24 total SKU's in femurs), and the 1 mm poly with the modular trialing system is yielding better results for patients. Good enough but a nightmare for inventory. The Zimmer people defended the 2 mm sizing strategy of Persona due to the results they're seeing. Finally, the Z is moving to kitting one knee femoral unit in with the polys as Arthrex has done on their total knee. A 3 pan case (1 up / 1 down). I hear they have plastic trials now for tibias as well, which were initially metal (a bit lighter than the metal ones, but not as sturdy).

Now I hear that Smith and Nephew is moving to 1 mm sizing for their poly to compete...

I still didn't see the new TM Modular asymmetric tibia tray yet. I was told it would feature offset TM pegs (anterior / posterior) on the bottom. I didn't see any revision system components, though one of their developing surgeons said it had been promised in a year.

Finally, has anyone else noticed how many new knee systems are on the market? It seems the European companies are all getting killed on reimbursement and so are seeking sales in the US. Corin (out of UK, but to be sold in US) has a new knee, Arthrex has a "new" knee (purchased but modified), Amplitude (France) was showing at AAOS, Renovis (Austin TX), Kyocera out of asia (not in US yet), United Technologies (Taiwan, but not in US yet), Medacta (Switzerland but selling in the US already) and others I can't remember. Are all of these companies showing to their customers that traveled to the US to go to AAOS or are they testing the waters to enter our market? About a third of the traffic is international so probably a bit of both.

Did anyone see the ACL / PCL sparing knee from Biomet called the Vanguard XP? A quick google search will provide the images of the tibia. Rumor had it that Smith and Nephew is about to launch one as well and was going to call it the XR, but now have to rename it (that from a S&N rep working the show). My question is, how easy is this thing to put in without releasing the ACL? Cementing in a tibia with poor visibility was tried back in MIS days, with some variability in results (and revisions for loose tibia components).
 



So I heard from some Zimmer folks at AAOS that Persona was selling well, only constrained by production capacity (a good problem to have), but still a small percentage of total knee sales. Apparently the self aligning tibia component for rotation, along with the precise fitting femur (24 total SKU's in femurs), and the 1 mm poly with the modular trialing system is yielding better results for patients. Good enough but a nightmare for inventory. The Zimmer people defended the 2 mm sizing strategy of Persona due to the results they're seeing. Finally, the Z is moving to kitting one knee femoral unit in with the polys as Arthrex has done on their total knee. A 3 pan case (1 up / 1 down). I hear they have plastic trials now for tibias as well, which were initially metal (a bit lighter than the metal ones, but not as sturdy).

Now I hear that Smith and Nephew is moving to 1 mm sizing for their poly to compete...

I still didn't see the new TM Modular asymmetric tibia tray yet. I was told it would feature offset TM pegs (anterior / posterior) on the bottom. I didn't see any revision system components, though one of their developing surgeons said it had been promised in a year.

Finally, has anyone else noticed how many new knee systems are on the market? It seems the European companies are all getting killed on reimbursement and so are seeking sales in the US. Corin (out of UK, but to be sold in US) has a new knee, Arthrex has a "new" knee (purchased but modified), Amplitude (France) was showing at AAOS, Renovis (Austin TX), Kyocera out of asia (not in US yet), United Technologies (Taiwan, but not in US yet), Medacta (Switzerland but selling in the US already) and others I can't remember. Are all of these companies showing to their customers that traveled to the US to go to AAOS or are they testing the waters to enter our market? About a third of the traffic is international so probably a bit of both.

Did anyone see the ACL / PCL sparing knee from Biomet called the Vanguard XP? A quick google search will provide the images of the tibia. Rumor had it that Smith and Nephew is about to launch one as well and was going to call it the XR, but now have to rename it (that from a S&N rep working the show). My question is, how easy is this thing to put in without releasing the ACL? Cementing in a tibia with poor visibility was tried back in MIS days, with some variability in results (and revisions for loose tibia components).

Hey, I heard this just recently.....who gives a flying fuck about all of this bullshit???
 


















Science is great, but total knees are as much about feeling soft tissue as about measuring resection levels. Trial and error are important elements intraoperatively during trialing to optimize the feel of the knee through the range of motion. Sort of why obese patients are hard to work on (besides visualization). Their legs weight so much it's difficult to feel the soft tissue subtleties. Feel is something that can't be determined pre-operatively.
 



Science is great, but total knees are as much about feeling soft tissue as about measuring resection levels. Trial and error are important elements intraoperatively during trialing to optimize the feel of the knee through the range of motion. Sort of why obese patients are hard to work on (besides visualization). Their legs weight so much it's difficult to feel the soft tissue subtleties. Feel is something that can't be determined pre-operatively.

Hahahah...

"Science is great..." Quote of a lifetime. You should put your name on here to take credit for that one.

I don't work for either of these companies, but I had to comment. Who said there is no room for intraoperative "feel/manipulation/hands on assessment" when using Patient Specific implants/instruments? If these systems are developed correctly, they should allow for the user to do these things.

You are correct feel cannot be determined pre-operatively; but you can determine size, surgeons have been doing it for 40+ years. The advances in imaging just allow for better resolution. Now sizing can confidently be determined to within 1-2 sizes.
 



"I don't work for either of these companies, but I had to comment. Who said there is no room for intraoperative "feel/manipulation/hands on assessment" when using Patient Specific implants/instruments? If these systems are developed correctly, they should allow for the user to do these things."

You mentioned sizing, I can do that with Medstrat software already, but to the PSI point: "Hands-on" I assume he means making judgments on things like external rotation/slope, things that the program presets and are not amenable to easy change. Other than that I agree, his point makes no sense.

Honestly I had high hopes for this technology but it only takes one outlier to lose confidence in it and we've all had them (As the biomet rep found out two weeks ago). There is a very damaging article on it recently in JOA/JBJS where PSI had more outliers and didn't really save any time.

I cannot believe the insurance companies still pay for this.....
 















Seems like Zimmer has focused more on fit than kinematics with Persona. L/R tibias and many femoral options, plus 1mm poly, but same Sagittal femoral design, or was that changed as well?
 



Seems like Zimmer has focused more on fit than kinematics with Persona. L/R tibias and many femoral options, plus 1mm poly, but same Sagittal femoral design, or was that changed as well?

They wanted to differentiate themselves from Stryker so they made a square instead of a round knee. AP dimension on the square changes 2mm every size with standard and narrow ML options for each size square.
 












Regarding Trumatch and JBJS- one of the surgeons / authors mentioned he cuts the tibia with an extramedullary system often as it seldom correct. Never saw it in the study = one lie all lies or DePuy shifting the facts again like they attempted with the ASR.