Corin were proud sponsors of the Great Debate event held on the 6 and 7 February 2020 at the Royal Society of Medicine, London. Chaired by Professor Justin Cobb and Professor Andrew Shimmin, the meeting showcased intriguing presentations, focussed discussions and case studies from more than 20 highly respected surgeons.
The theme of the event was ‘fact vs fiction’ in hip and knee arthroplasty with many of the speakers choosing to shed light on the most common myths around joint arthroplasty.
Day 1 began with an introduction to current knee implant designs, the evolution of primary TKR, and the factors of implant design that influence joint stability and overall patient outcomes. In the first debate session, Professor Justin Cobb reflected on the design evolution and importance of medial stability and influence of range of motion and stability on patient satisfaction in TKR. The first session ended with a debate panel challenged by the chair on ‘Why are THR patients happier than TKR patients?’ Some of the obvious reasons like different biomechanics and less forgiving soft tissue envelopes were discussed and the great debate about managing patient expectations effectively was raised.
A very extensive discussion was centred around robotics in TKR surgery. Chris Plaskos, PhD, Corin‘s V.P. of Clinical Innovation, presented strong evidence on how soft tissue balance can be achieved using OMNIBotics® and the Predictive Balance™ surgical technique. He demonstrated that component position can be optimised intraoperatively to have a balanced joint gap, resulting in good stability in extension, flexion as well as in mid flexion. He also hinted at the advert of the Corin Joint Registry, which will be used to collect data from Corin’s clinical sites across the globe, leveraging large-scale industry studies to understand which patient factors influence outcomes.
Dr Jeffrey DeClaire further emphasised this concept in his talk on coronal ligament balance and its effect on patient outcomes, satisfaction, soft tissue releases and PROMs. He concluded his talk by using OMNIBotics® to identify 3 soft tissue targets that can influence improved patient pain scores:
- Balanced or tighter medial structures in extension
- Medial mid flexion gap within 1mm of implant thickness
- Equal balance in flexion
The session ended with the panel being challenged by Tom Schmalzried on the importance of sagittal plane stability as well as medial coronal stability. The panel discussed the dynamic gap balancing technique should ultimately result in improved sagittal stability.
"OMNIBotics® is digital and dynamic! The confidence I have in Robotics is that it shows me in real time what I am actually doing and helps me implement my plan accurately!"commented Professor José Romero.
Day 2 began with a focus on hip replacement, and the impact of how the hip-spine relationship can influence proper cup alignment. Dr. Jonathan M Vigdorchik highlighted a study that found a correlation of spine stiffness and spinal deformity on the risk of complications like dislocation and impingement.
“A study of 6000 cases found a 20% rate of spinal deformity. That’s huge! That’s 1 in 5 cases are completely missed that are having spinal deformity”
Dr. Michael O'Sullivan, in his talk on stem orientation, presented a case study of a 57-year-old female with retroverted stem (-14°). He found that by using Corin’s 3D Optimized Positioning System (OPSInsight™) tool, the pre-operative plan provided valuable insight to assess bony and prosthetic impingement that was useful to drive clinical decision and provide a personalised solution.
A/Professor Andrew Shimmin identified the most common causes of revision of THR:
- Loosening and lysis
- Bearing wear
- Biological reactivity to wear debris
- Sub optimised component orientation
- Sub optimised head size selection
The discussion concluded on how dual mobility articulations could help reduce the risk of dislocation and high wear (edge loading).
Dr. Tarik Ait Si Selmi in his talk on managing leg length and offset, ”Pain relief is the number 1 expectation of patients. Recreating the leg length and offset accurately to the native biomechanics is the key to patient satisfaction.”
In the afternoon session, the panel led by Dr. Jonathan Vigdorchik were challenged to analyse case studies of THR using 3D planning tool such as Corin’s 3D Optimized Positioning System (OPSInsight™). Other topics discussed included cemented v/s cement less stems in THR, optimum stem length and identifying the ideal offset. A variety of balanced opinions shared by the faculty as well as questions and focussed discussion with the delegates ended each session.
The event was a great success and we were delighted to attend the meeting, and especially great to see our leading FDA approved knee technology OMNIBotics® being acknowledged during the talks on Robotics in TKR surgery and our Optimized Positioning System (OPS™) ’s accuracy during the talks on minimising operative errors in total hip replacement by the elite panel of speakers. The debate format helped us understand perspectives and varied opinions in the industry. Thanks to all who attended and engaged with our booth demonstrations, as we are proud to offer a full continuum of care across the hip and knee portfolio with modern solutions in joint replacement.
We look forward to the opportunity to attend next year's Great Debate event and sharing in the contemporary lively debates.
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