Procured Health Senior Medical Product Specialist Simon Kerr recently attended the Current Concepts in Joint Replacement (CCJR) Spring Meeting 2017. In this blog post he answers a few questions about key topics.
Procured Health: Interest in robotic surgery for arthroplasty has surged over the past few years. Any takeaways from CCJR?
Simon Kerr: This is a compelling topic because of the extremely precise implant placement that robotic surgery provides. However, there are a couple important considerations to balance against the enthusiasm.
The first is the expense—capital costs may exceed $1 million, even before annual service contracts and disposables are factored in. When you weigh this against the fact that there’s no robust data demonstrating improved patient outcomes, Procured Health is cautioning against adoption.
Procured Health: Was there much talk about antibiotic-loaded bone cement (ALBC)?
Simon: There was an interesting debate between Dr. Thorsten Gehrke, a German-based surgeon, and Dr. Thomas Sculco from the Hospital for Special Surgery. Dr. Gehrke favored ALBC use based on a demonstrated reduction in infection rates following primary total hip arthroplasty (THA). However, as Dr. Sculco argued, bone cement is used much more frequently in primary total knee arthroplasty (TKA) than primary THA in the U.S., and there’s a lack of demonstrated benefit of ALBC in primary TKA.
Procured Health agrees with Dr. Sculco—based on the evidence and the high cost relative to plain bone cement, ALBC should be reserved for revision and high-risk primary cases, such as those patients with previous infection, diabetes, immunosuppression and rheumatoid arthritis.
Procured Health: Exparel has become a popular analgesic for the treatment of pain following joint arthroplasty. Was it discussed?
Simon: Exparel’s popularity is due to it being a non-narcotic option for managing pain. The active ingredient is liposomal bupivacaine, which is designed to slowly release bupivacaine to prolong the analgesic effect.
However, the high cost associated with Exparel and the lack of evidence supporting improved pain relief compared to cheaper alternatives (such as bupivacaine and ropivicaine) suggests that its use may not be justified in hip or knee arthroplasty. In fact, when the audience was polled, only a handful of the hundreds of surgeons in the room indicated they used Exparel.
Procured Health: Thanks for your insights. Any final thoughts?
Simon: On behalf of all of us at Procured Health, I’d like to congratulate Rachel Frank, MD, from Rush University Medical Center here in Chicago. She received the OREF/CCJR Clinical Award for her and her colleagues’ research on evaluating outcomes associated with shoulder arthroplasty in surgery-naïve patients. Their work will be extremely valuable in properly managing patients’ expectations following shoulder arthroplasty. Congrats, Dr. Frank!
The Procured Health research team will keep these and similar topics on our watch list as we continue to review indications and outcomes.