Patient Matched Instrumentation Dr. Vivek Mittal Sr Consultant Delhi Institute of Trauma & Orthopaedics, Sant Parmanand Hospital, Delhi www.drvivekmittal.com

TKA : What are we seeking? Accuracy Alignment Balance Longevity 2 wks Postop

Line of sight remains the best CAS / Navigation Clinical assistance? Learning Curve Rotational Align’t Accuracy? Outliers? Sales technique? Line of sight remains the best

Patient Matched Instrumentation One of the most exciting and visionary technologies to hit the Orthopedics market in years! Game-changing possibilities Surgical efficiencies for surgeon and the O.R. Patient benefits Company inventory reduction!

Patient Matched Instrumentation What is it? Manufactured medical grade Nylon-12 Single use cutting blocks Distal Femur Proximal Tibia

Patient Matched Instrumentation What is it? Utilizes Pre-Operative MRI and Full-Leg X-ray To design from & built to pt’s specific anatomy Alignment based off the gold standard of Mechanical Axis

How Is It Done?

Design Features AP Axis AP Axis Cutting Slot Match Standard MIS Cutting Block Patient Information Epicondylar Axis Set Alignment and Rotation Match pins from AP block

Design Features Oblique Fixation Pin Medial 1/3 of Tibia Tubercle Cutting Slot Match Standard MIS Cutting Block Patient Information Set Alignment and Rotation Match pins holes on tibial trial

Week 5

Week 5

Vs Standard TKA PMI Eliminates intra-medullary canal violation reducing blood loss and complications from fat emboli

Eliminate large number of surgical steps vs. Standard TKA & CAS PMI Reduces Eliminate large number of surgical steps Step 1 Step 2 Step 3

vs. Standard TKA & CAS PMI Improves Alignment and sizing Whiteside Line Alignment and sizing Patient Information Epicondylar Axis Built into the design Alignment, rotation and sizing are Osteophytes included in block design Set Alignment and Rotation Match pins from AP block

vs. Standard TKA & CAS PMI Advantage Compatibility Incorporates with standard instrumentation for intra-operative adjustments Incorporates pre-operative, surgeon specific design parameters

The Opportunity What is it? Why we want it? Patient matched cutting blocks built from the patient’s own preop images Disposable, single patient use distal femoral and proximal tibial cutting blocks; based off the mechanical axis Why we want it? Surgical efficiency – removes all alignment instruments Improved outcomes – gives the accuracy of CAS Reduced complications – no IM rod reducing incidence of fat emboli Reduced inventory – sizing determined preoperatively

Patient Matched Instrumentation Who Benefits? Surgeons More efficient surgery – less instruments Greater accuracy – preop determination of alignment and sizing Hospitals Cost savings Increase in orthopaedic surgeries – market technology to patients in local and regional campaigns

Patient Matched Instrumentation Who Benefits? Patients Reduce Complications– preserve I/M canal Faster surgery – less blood loss & anesthesia Faster Recovery Expensive as of today Waiting Period of 4 wks 3rd Postop Day