Slide 1: Triathlon knee replacement
Triathlon ® knee replacement TRIATH-PRE-19_Rev-2_26805 1
Slide 2: Paid consultant disclosure
Dr. ______ is a paid consultant of Stryker. The opinions expressed by Dr. ______ during this presentation are those of Dr. ______ and not necessarily those of Stryker. Individual experiences may vary. TRIATH-PRE-19_Rev-2_26805 2
Slide 3: Topics
Topics • Why single radius? • Designed to work with the body • Clinical data • Orientation and fit • System options • My experience with Triathlon TKA TRIATH-PRE-19_Rev-2_26805 3
Slide 4: Why single radius?
Why single radius? Mid-flexion stability1-5 Quadriceps efficiency6 4
Slide 5: Why do TKAs fail?
Why do TKAs fail?7 TRIATH-PRE-19_Rev-2_26805 5
Slide 6: What is mid-flexion instability?
What is mid-flexion instability? The knee is stable in extension and 90° of flexion but symmetrically unstable during varus-valgus testing at 30° to 45° of flexion8 TRIATH-PRE-19_Rev-2_26805 6
Slide 7: Some common symptoms of instability
Some common symptoms of instability Common expressions used by patients: • “Giving way” or “Just will not hold them up”9 • “Get their knee in gear” before starting to walk9 • Potential difficulty with ascending / descending stairs (attributed to instability, not to pain)10 TRIATH-PRE-19_Rev-2_26805
Slide 8: Physical exam
Physical exam Anterior or posterior drawer test11 TRIATH-PRE-19_Rev-2_26805 8
Slide 9: Potential factors contributing to mid-flexion instability following TKA
Potential factors contributing to mid-flexion instability following TKA Technical error10 • Gap imbalance • Joint-line malposition Implant design1,3,5 • Single vs. multi-radius TRIATH-PRE-19_Rev-2_26805 9
Slide 10: Single vs. multi-radius
Single vs. multi- radius Traditional ML perspective12 Modern TEA perspective13 TRIATH-PRE-19_Rev-2_26805 10
Slide 11: Sagittal geometry
Sagittal geometry The posterior condyles are circular Hollister et al.14 • Magnetic resonance (MR) images in planes perpendicular to the FE axis show a circular profile for the femoral condyles Iwaki, Freeman et al.13 • The lateral condyle, like the medial condyle, is circular posteriorly TRIATH-PRE
Slide 12: Motion in the normal knee
Motion in the normal knee Stability12 • Functional flexion arc from 10° to 110° • Consistent sagittal geometry • Single flexion / extension axis TRIATH-PRE-19_Rev-2_26805 12
Slide 13: Single vs. multi-radius
Single vs. multi-radius Single radius Multi-radius • Circular sagittal geometry • Variable sagittal geometry • Single axis of rotation • Multiple axes of rotation TRIATH-PRE-19_Rev-2_26805 13
Slide 14: Single vs. multi-radius
Single vs. multi-radius Single radius Multi-radius TRIATH-PRE-19_Rev-2_26805 14
Slide 15: Single radius mid-flexion stability
Single radius mid-flexion stability The single radius knee replacement is designed to maintain ligament balance through the active range of motion, including mid-flexion.2,5,14 A study of patients who underwent a Mako SmartRobotics™ knee replacement showed that patients with Triathlon implants achie
Slide 16: Single radius quadriceps efficiency
Single radius quadriceps efficiency6 57% less force required for Triathlon single radius design to achieve extension compared to multi-radius design6 TRIATH-PRE-19_Rev-2_26805 16
Slide 17: Designed to work with the body
Designed to work with the Rotary arc Flared, shorter posterior condyles body Post/cam engagement (PS) Anatomic patellofemoral track 17
Slide 18: Rotary arc
Rotary arc15 The Triathlon rotary arc design allows for +/- 20° of internal/external rotation and reduces contact stresses.15 TRIATH-PRE-19_Rev-2_26805 18
Slide 19: Flared, shorter posterior condyles
Flared, shorter posterior condyles15 Triathlon’s shortened, flared posterior condyles are designed to facilitate the relaxation of the soft tissues to enable deep flexion without excessive slope.15 TRIATH-PRE-19_Rev-2_26805 19
Slide 20: Post/cam engagement (PS)
Post/cam engagement (PS)16 The Triathlon PS femur is designed to engage the post of the tibial insert at approximately 45°, where natural PCL loading occurs.16 TRIATH-PRE-19_Rev-2_26805 20
Slide 21: Anatomic patellofemoral track
Anatomic patellofemoral track17 Triathlon’s deepened trochlear groove is designed to help relax the extensor mechanism, enable deeper flexion and reduce contact stresses exerted across the patella.17 Triathlon incorporates the same patellofemoral design as Duracon, which demonstrated <1% patellofemo
Slide 22: Clinical data
stryker Clinical data
Slide 23: Single radius clinical outcomes
Single radius clinical outcomes A fluoroscopic study on 20 Triathlon TKAs showed the femoral component was kinematically stabilized in mid- flexion ranges, and posterior femoral rollback occurred in deeper knee flexion with this knee design.3 TRIATH-PRE-19_Rev-2_26805 23
Slide 24: Single radius clinical outcomes
Single radius clinical outcomes Gait study20 • In a study that compared three cohorts of 16 patients who received single radius TKAs or multi-radius TKAs to healthy control knees, patients who received single radius TKA exhibited gait that more closely mimicked that of a healthy control knee. Functi
Slide 25: Triathlon clinical outcomes
Triathlon clinical outcomes Triathlon patient satisfaction reported in literature • Hamilton et al. reported 90.5% at eight-year follow-up21 • Scott et al. reported 88% at 10-year follow-up22 • Hamilton et al. reported 99% at three-year follow-up23 Patients with Triathlon TKA continue to show favora
Slide 26: Clinical performance: Triathlon survivorship
Clinical performance Triathlon survivorship Source Triathlon all-cause survivorship at 10 years Mistry et al. 201624 99.0% Scott et al. 201922 97.9% 2019 National Joint Registry (UK/Wales)25 96.4% 2019 Australian Orthopaedic Association 96.2%/94.6% (CR/PS) National Joint Replacement Registry26 Ortho
Slide 27: Orientation and fit
Orientation and fit FlexRod 27
Slide 28: FlexRod
FlexRod FlexRod is designed to aid component placement matched to individual patient anatomy in the sagittal plane. *Hitt, et al TRIATH-PRE-19_Rev-2_26805 28
Slide 29: Sizing and fit with FlexRod
Sizing and fit with FlexRod • Oversizing of the femoral component may lead to ML overhang. ≥3 mm ML overhang of the femoral components has been shown to be associated with increased knee pain.28 • A CT scan–based study showed that the use of the FlexRod allowed Triathlon to fit 99.4% of patients.29
Slide 30: Component positioning with FlexRod
Component positioning with FlexRod TRIATH-PRE-19_Rev-2_26805 30
Slide 31: Functional outcomes with FlexRod
Functional outcomes with FlexRod • Prospective study of 100 TKA recipients • The FlexRod cohort demonstrated improved KSS compared to the rigid rod cohort at two-year follow-up30 30 30 TRIATH-PRE-19_Rev-2_26805 31
Slide 32: System options
stryker System options
Slide 33: Tibial constraint options
Tibial constraint options Varus/valgus Internal/external Insert type Maximum flexion constraint rotation Cruciate Retaining (CR) None +/- 20˚ 150˚ Condylar Stabilized (CS) None +/- 20˚ 150˚ Posterior Stabilized (PS) None +/- 20˚ 150˚ Total Stabilized* (TS) +/- 2˚ +/- 7˚ 135˚ TRIATH-PRE-19_Rev-2_2680
Slide 34: The Triathlon Condylar Stabilized (CS) Tibial Insert
The Triathlon Condylar Stabilized (CS) Tibial Insert CS Tibial Insert • 2 mm more anterior height compared to CR insert to provide anterior stability • Alternative for patients with an incompetent or sacrificed PCL CS outcomes • An in vivo investigation compared the intraoperative kinematics of CR,
Slide 35: Triathlon Universal Baseplate
Triathlon Universal Baseplate Universal Baseplate is compatible with the CR, CS, PS and TS insert • TS Tibial Insert provides +/- 2˚ valgus-varus constraint but permits +/- 7˚ rotational freedom. • In a study of 172 difficult primary TKAs with two-year follow-up and 41 difficult primary TKAs with fi
Slide 36: Triathlon Tritanium cementless TKA clinical outcomes
Triathlon Tritanium cementless TKA has demonstrated excellent clinical outcomes in multiple studies with five- year follow-up36-38 Triathlon Tritanium TKA survivorship with Source five-year follow-up 99.5% implant survivorship in 228 Triathlon Tritanium Journal of Knee Baseplates at five-year follow
Slide 37: X3 polyethylene
X3 polyethylene X3’s patented40 sequential irradiation and heat process allows for: • Mechanical strength: Triathlon PS with X3 showed no mechanical failures at minimum five years in two separate clinical studies.41,42 • Wear resistance: The Australian Joint Registry data has demonstrated a lower ra
Slide 38: References
References 1. Cook LE, Klika AK, Szubski CR, Rosneck J, Molloy R, Barsoum WK. Functional outcomes used to compare single radius and multiradius of curvature designs in total knee arthroplasty. J Knee Surg. 2012;25(3):249-253. doi:10.1055/s-0031-1299660 2. Piazza S. Designed to maintain collateral li
Slide 39: References
References 19. Mont MA, Yoon TR, Krackow KA, Hungerford DS. Eliminating patellofemoral complications in total knee arthroplasty: clinical and radiographic results of 121 consecutive cases using the Duracon system. J Arthroplasty. 1999;14(4):446-455. doi:10.1016/s0883-5403(99)90100-6 20. Larsen B, Ja
Slide 40: References
References 35. Stryker technical report: Report number RD-10-053. Evaluating the effect of cemented tibial stems on bone cement stresses as a function of patient body weight. 2010. 36. Tarazi et al. Cementless Tritanium Baseplate total knee arthroplasty: survivorship and outcomes at 5 year minimum f
Slide 41: A surgeon must always rely on professional clinical judgment
A surgeon must always rely on his or her own professional clinical judgment when deciding whether to use a particular product when treating a particular patient. Stryker does not dispense medical advice and recommends that surgeons be trained in the use of any particular product before using it in s