Meeting the challenges of osteoarthritis

Professor David Barrett, lead consultant at Southampton University Hospital and professor of orthopaedic engineering, discusses the development of the ATTUNE Knee System to combat osteoarthritis.

Osteoarthritis (OA) is the most common form of arthritis and is a leading cause of disability. Over 250 million people are affected globally, with nearly nine million of them being in the UK alone. 

Total knee arthroplasty (TKA), commonly known as knee replacement surgery, is the gold standard treatment for OA, and the number of procedures carried out annually is projected to grow 189% by 2030, representing 1.28 million procedures annually. The image of an older person undergoing a knee replacement before settling down to a quiet, sedentary life is outdated. The success of TKA has led to its increasing use in younger patients, with a recent study indicating an increase of 188% in procedures among people aged 45 to 64 years old. 

Younger patients, however, have higher expectations for treatment outcomes, often driven by ongoing commitments to work and family life and a wish to resume normal activity such as regular sport or exercise. In addition, up to a fifth of all patients are dissatisfied with their surgery, with their expectations for ease of movement post-surgery unmet. It’s clear that OA treatment with TKA faces significant challenges. Health services are expected to deliver increasing numbers of procedures to higher standards or risk OA becoming an economic burden that society, and patients, can ill-afford. Recent pressures on elective surgeries have also significantly impacted patients. A recent UK-wide survey showed that one in four people waiting for a TKA reported their quality of life so poor it was considered ‘worse than death’, and there was a direct correlation between waiting time and deterioration in health-related quality of life. 

Innovation offers a solution. The ATTUNE Knee System was developed from a commitment to put patient (of all ages) needs at the heart of product design. Innovation is not just about the implant itself, it’s about improving the patient experience at every touchpoint, from pre-surgery assessment to post-surgery rehab. By addressing every element of knee revision, as well as using best-in-class implants, it is possible to improve outcomes and, importantly, reduce length of stay, which in turns creates much-needed healthcare capacity in both the OR and in rehab/recovery settings as healthcare systems aim to restore elective services post pandemic. 

Liam Rowley, vice president Knee Research & Development at DePuy Synthes, said: “The ATTUNE Knee System is created around one key principle: the right implant for the right patient, in the right setting with the right surgical approach at the right cost. This important principle supports quicker recovery.”

To put this into context, a review of medical records in the UK found that ATTUNE Knee patients stayed an average between 0.8 and 1 day fewer than patients receiving other knee systems. When this length of stay saving is multiplied across the number of procedures, it is clear that there are significant capacity gains to be made by using the right technology.

In 2019, several innovations were also introduced across primary and revision procedures that had the potential to significantly transform patient outcomes by achieving improved stability in motion. However, it’s what happens before the patient reaches the operating theatre that really makes the difference. The more the procedure and the implant are appropriate for the specific needs and physiology of the patient, the less likely the patient is to be dissatisfied and/or need revision surgery, and the more likely they are to recover more smoothly. Investing in the pre-surgery stage leads to downstream savings post-surgery.

Pre-operative surgical planning and patient-specific guides are enabling technology to design customised instruments.

Rowley added: “Using proprietary software, the surgical team works to better understand the patient’s anatomy and soft tissue, to ensure the implant is placed as accurately as possible. ATTUNE’s guiding principle is Stability in Motion, giving the patient the knee implant which will give them long-lasting satisfaction and avoid the need for additional surgery in years to come.”

Reducing healthcare utilisation is only part of the solution to finding more capacity. DePuy Synthes’ digital workflow platform can transform the surgical process and create increased consistency and quality. Synchronised digital workflow technology and real-time insights reduce variability and work to support surgical teams by giving them increased, and more detailed, information. The end result is a streamlined patient pathway, with savings of time, space and efficiencies across the whole treatment pathway. The pandemic has also accelerated new ways of managing patients, such as via remote appointments and real-time monitoring, which are better for patients and health systems. It’s critical these innovations continue to help address capacity challenges.

So, what’s next? This is an exciting time in joint replacement.

Rowley concludes: “While increased patient expectation brings challenges for surgeons and healthcare systems, it also means that as innovators in this space, industry has a powerful role to play in driving the best possible outcome for patients, while also supporting healthcare systems to manage a growing workflow.”

By truly understanding the patient journey and perspective, DePuy Synthes, with its innovative ATTUNE Knee System, has been able to introduce a suite of solutions and tools that addresses the complex needs of patients (young or old), surgeons and health systems in tackling the evolving challenges of OA, not just for today, but well into the future.