KineSpring^® Procedure: Touchless Arthroplasty

The KineSpring System represents a new class of therapy that may bridge the gap in knee osteoarthritis (OA) treatment between conservative care and joint-modifying surgical procedures. This revolutionary new device is designed to absorb painful loads on the medial compartment of the knee joint, without transferring that load to the lateral compartment. The completely reversible, joint preserving procedure is both extra-articular and extra-capsular, with no bone, ligament, or cartilage removal.

Scroll over treatment options for additional information.

The joint-preserving KineSpring Procedure may be especially attractive to patients who hope to avoid or delay future primary arthroplasty, if needed. Younger patients often have longer life expectancies and higher anticipated activity levels, which place increased demands on a knee prosthesis and may make some patients poor candidates for early UKA procedures.^1,2,3 In a recent analysis of patients in Sweden, the revision rate for UKA patients under 55 years of age was almost three times higher than the revision rate for patients over 55 years of age.¹ In addition, a New Zealand study states that patients report significantly worse functional outcomes when revised from UKA to TKA compared to patients who had only a primary procedure.² Revision from HTO to TKA can also be associated with complications, surgical difficulty, and in some cases, inferior outcomes.^4,5 Lofty performance expectations, combined with high revision rates and poor outcomes of traditional therapies for certain patient populations, may make the joint-preserving KineSpring Procedure an attractive option for patients with knee OA.

The KineSpring System is comprised of femoral and tibial bases and an articulated load absorber. In a one-hour, minimally invasive procedure, the joint preserving device is implanted alongside the joint through two small incisions near the medial femoral and tibial condyles. Bone screws anchor the bases to the femoral and tibial cortices using standard surgical technique. This straight forward procedure was designed to keep orthopaedic surgeons' lives uncompromised.

Patients in recent clinical trials of the KineSpring System typically left the hospital after less than one week and resumed full weight bearing on the knee less than two weeks after the procedure. To date, the KineSpring Knee Implant System has been successfully implanted in patients with a range of disease severity, activity levels, and ages.⁶

Moximed^® is committed to helping surgeons provide the highest quality of patient care, and only trained and qualified surgeons are permitted to implant the KineSpring System. Please contact Moximed if you are a surgeon interested in learning how to implant the KineSpring System.

1. W-Dahl, A. et al. Surgery for Knee Osteoarthritis in Younger Patients. Acta Orthopedica 2010; 81(2): 161-164.
2. Pearse, A. et al. Survival and Functional Outcome After Revision of a Unicompartmental to a Total Knee Replacement. JBJS[Br] 2010; 92-B: 508-512.
3. Bert, Jack. Unicompartmental Knee Replacement: Indications and Results. Arthroscopy Association of North America Web Video Archive, published 2007.
4. Karabatsos, et al. Functional Outcome of Total Knee Arthroplasty After High Tibial Osteotomy. Journal Canadiene de Chirurgie 2002; 45(2): 116-119.
5. Koval, KJ (ed): Orthopaedic Knowledge Update 7. Rosemont, IL. American Academy of Orthopaedic Surgeons. 2002 Ch. 44.
6. Data on file at Moximed.

Braces & Orthotics

Knee braces and shoe orthotics that effectively reduce the Knee Adduction Moment (KAM) can unload the joint.^1,2 However, braces and orthotics typically do not reduce the total load on the knee; they simply transfer loads to other compartments of the joint. The KineSpring® System actually absorbs excess stresses, reducing the total weight supported by the knee. To achieve effectiveness, braces are also dependent on each individual patient: the brace must be put on properly, positioned correctly, and worn for long periods of time. As a device implanted by trained surgeons, the KineSpring System eliminates non-compliance and attempts to reduce patient-to-patient variability.

1. Self, B. A Biomechanical Analysis of a Medial Unloading Brace for Osteoarthritis in the Knee. Arthritis Care Res 13: 191-197.
2. Draganich, et al. The Effectiveness of Self-Adjustable Custom and Off-the-Shelf Bracing in the Treatment of Varus Gonarthrosis .J Bone Joint Surg Am 2006; 88(12): 2645-52.

Pain Medications & Injections

Numerous classes of pain medications and injections, such as non-steroidal anti-inflammatory drugs (NSAIDS), COX-2 inhibitors, corticosteroid injections, and other analgesics, can provide temporary pain relief to the OA sufferer. Unfortunately, these pain medications often do not treat the underlying cause of knee OA. Even worse, when knee pain is temporarily relieved, many patients actually alter their biomechanics and increase the load placed on the diseased compartment of their knee, thus potentially accelerating the degradation of their knee joint.¹

The KineSpring^® System, by comparison, is designed to reduce the joint overload that may have led to the onset and progression of OA and subsequent knee pain.

1. Henriksen, M. et al. Increased Joint Loads During Walking – A Consequence of Pain Relief in Knee Osteoarthritis. Knee 2006; 13: 445-50.

Arthroscopy

A number of arthroscopic procedures, ranging from debridement to microfracture, have been attempted for OA treatment. Joint lavage and debridement may provide short-term pain relief for some patient groups, but the level of clinical evidence is lacking, and these procedures are not recommended for routine therapy.^1,2 Attempts to repair and regrow healthy cartilage include arthroscopic abrasion and microfracture surgery, but these techniques are unlikely to address the underlying disease mechanism of joint overload, and their longer-term durability has been questioned.³

The KineSpring^® System, in contrast, is designed to absorb the excess joint loads that may have led to knee OA.

1. Zhang, W. et al. OARSI Recommendations for the Management of Hip and Knee Osteoarthritis, Part II: OARSI Evidence-based, Expert Consensus Guidelines. Osteoarthritis and Cartilage 2008; 16: 137-162.
2. Siparsky, P. et al. Arthoscopic Treatment of Osteoarthritis of the Knee. Clinical Orthopedics and Related Research 2007; 455: 107-112.
3. Brandt, KD. The Futility of Current Approaches to Chondroprotection – A Different Perspective: Comment on the Article by Felson and Kim. Arthritis Rheum 2007; 56: 3873-4.

High Tibial Osteotomy (HTO)

HTO can benefit sufferers of knee OA, but the procedure requires an invasive, anatomy-altering procedure that may prevent patients from weight-bearing on the treated limb for six weeks.¹ The procedure has demonstrated some long-term clinical success, but the technically demanding surgery and longer hospital stay and recovery period have limited the treatment to a small, niche patient population.^2,3 In addition, HTO does not reduce the overall load on the knee joint; it transfers load from one compartment of the knee to the opposite side of the joint.

Alternatively, the KineSpring^® System is minimally invasive, maintains natural knee joint anatomy, and is designed to allow rapid patient recovery. Patients in recent clinical trials of the KineSpring System typically left the hospital after one day and resumed full weight bearing on the knee within a week of the procedure.⁴

1. Franco, V. et al. Open Wedge High Tibial Osteotomy. Techniques in Knee Surgery 2002; 1: 43-53.
2. Akizuki S. et al. The Long-Term Outcome of High Tibial Osteotomy: A 10 to 20-Year Follow-Up. JBJS 2008; 90-B:592-596.
3. Amendola, A. and Pnarella, L. High Tibial Osteotomy for the Treatment of Unicompartmental Arthritis of the Knee. Orthop Clin N Am 2005; 36: 497-504.
4. Data on file at Moximed.

Unicompartmental Knee Arthroplasty (UKA)

Unicompartmental Knee Arthoplasty may be an effective therapy for patients with OA restricted to the medial compartment of the knee.¹ However, UKA is a joint modifying procedure that may restrict future treatment options and may not be indicated for active or obese patients.²

The KineSpring^® System is completely joint preserving and reversible: no bone, ligament, or cartilage is removed, preserving future treatment options. To date, the KineSpring Knee Implant System has been successfully implanted in patients with a range of disease severity, activity levels, and ages.³

1. Zhang, W. et al. OARSI Recommendations for the Management of Hip and Knee Osteoarthritis, Part II: OARSI Evidence-based, Expert Consensus Guidelines. Osteoarthritis and Cartilage 2008; 16: 137-162.
2. Bert, Jack. Unicompartmental Knee Replacement: Indications and Results. Arthroscopy Association of North America Web Video Archive, published 2007. http://www.aana.org/VideoEducationLibrary/ CourseListings/Knee/UnisOsteotomies/tabid/283/Default.aspx
3. Data on file at Moximed.

Total Knee Arthroplasty (TKA)

Total Knee Arthroplasty is considered an effective procedure for restoring function and improving health-related quality of life in patients who are unable to achieve pain relief and functional improvement through other treatments.¹ TKA is, however, not without tradeoffs, as the procedure is invasive and completely joint-altering. While some TKA implants have demonstrated longer-term durability, particularly in elderly patients, the possibility of difficult revision procedures often eliminates younger, active OA sufferers as candidates for the procedure.²

1. Zhang, W. et al. OARSI Recommendations for the Management of Hip and Knee Osteoarthritis, Part II: OARSI Evidence-based, Expert Consensus Guidelines. Osteoarthritis and Cartilage 2008; 16: 137-162.
2. Hanssen, A. et al. Surgical Options for the Middle-Aged Patient with Osteoarthritis of the Knee Joint. Selected Course Lectures from AAOS Annual Meeting, JBJS 2000; 82-A, No.12: 1768-1781.
3. Data on file at Moximed.