Dr. Rosa: In my 30 plus years of practice, what I’m finding is that since I started using the iTotal, whether it’s the PS or the CR, patients have been doing overall extremely well. I’m finding the results to be very favorable in comparison to the previous knees that I was. I find the patients seem to recover more quickly. Many more my patients are coming in two weeks post operatively, walking into the office without canes, without any type of assistive devices, which was rare in prior patients before switching to the ConforMIS iTotal knee replacements.
Question: What do you attribute those results to?
Dr. Rosa: I attribute the success of the outcomes to the anatomic nature of the implant. And by that, I mean that you are maintaining the patient’s own offset, such that the knee is balanced. In a standard, off the shelf implant, there is a straight line cut, or a straight line joint space. With the iTotal, you’ve offset the medial and lateral joint space, so that it matches the patient’s own anatomy to a T. When we are doing an off the shelf design, there is a fixed J curve that we are using and we are matching that size as closely as possible to the patient’s own knee. When you’re using a patient specific knee, that J curve is specific for that patient. And in every patient, there’s going to be a little bit of difference. If we can match that J curve exactly, which we are doing with this design, theoretically we will have perfectly balanced that patient’s ligaments, throughout the entire range of motion. Not just an extension, not just in full flexion, but throughout that entire range of motion. And with that mind, theoretically we should be able to eliminate those outliers that have what appear to be perfect knee replacements, but have continued pain or continued complaints.
Question: Where do you see the biggest advantages of the iTotal?
Dr. Rosa: One of the big advantages–this has allowed me to achieve a more reproducible result. I don’t need to worry as much about balancing the ligaments. In fact, with this system, I do significantly less soft tissue release. I’ve abandoned gap balancing, because my results using the computerized instruments were so good and so accurate and so reproducible, it’s pretty much on the money every single time I do it. So I’m relying on and actually trusting more that computerized model and the jigs that I’m using than I am on my own ability to manually balance those ligaments. With the development of the patient specific, customized implant, we have jumped to the next frontier. We have arrived at a point where we are exactly matching that patient’s anatomy. It doesn’t get any better than this. You can’t be more accurate than you can with this, with any other knee design on the market, because they are not patient specific.
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