Zimmer Biomet Holdings, Inc.’s new Vanguard ID [individualized design] is, according to Todd Davis, Zimmer Biomet’s VP and GM of their Global Knee Business, “unlike any other total knee arthroplasty on the market.”
Right.
So we called Dr. Tom Aleto of the Missouri Orthopedic Institute in Columbia, Missouri.
Tom, marketing hype or what?
Actually, said Tom, the Vanguard ID is doing something interesting.
Here’s how he explained it to us. “The Vanguard ID is built around a philosophy of soft tissue preserving arthroplasty. The importance of maintaining the envelope of functional motion has become critical to restoring knee kinematics in total knee arthroplasty.”
Then we called Zimmer’s Todd Davis. He expanded on Aleto’s comments saying, “It [Vanguard ID] allows the surgeon to combine independent bearings of varying thickness and constraint which facilitates personalized treatment while also potentially minimizing the need for soft tissue release.”
Individualized TKA is not new. Nor is, as a matter of fact, the concept of minimizing the need for soft tissue release. But, with the Vanguard ID, it seems as though Zimmer may well have designed a system that takes these concepts one, maybe two, steps forward.
As Davis explained the entire Vanguard concept to us; “The ability to meet the individual patient requirements of the medial and lateral compartments, expand what’s possible in total knee arthroplasty.”
OK, time for context.
History and Background
Biomet (of course, now part of Zimmer Biomet) has a long history of innovation.
In 2008, Biomet introduced the first antioxidant infused polyethylene tibial bearing for the knee. Their bearings are infused with vitamin E the most abundant and effective antioxidant present in the body. This unique infusion process prevents oxidative degradation of the polyethylene bearing maximizing strength and wear resistance.
Biomet’s original Vanguard® Knee system was introduced in 2003. It was a personalized approach to knee replacement and it allowed surgeons to offer patients a broader range of sizes.
Better fit, better outcome, right?
Thirteen years after the original Vanguard here comes the Vanguard ID with some expanded personalization options like a large number bearing thickness (which can be varied up to 2 mm), to tibial, femoral and patellar articulations.
But wait, there’s still more.
Surgeons who use traditional total knee arthroplasty work hard to avoid any loss of normal kinematics which arise from ligament resection. For the patient, ligament damage which does not heal well makes routine activities like kneeling and squatting especially difficult.
“With traditional total knee arthroplasty surgeons execute their mechanically aligned cuts on the tibia and femur and then they release the ligament to obtain balanced flexion and extension gaps. This often creates a distraction of the joint and alters the kinematics of the knee. Also, the surgeon has to estimate how much he or she should release the ligaments to balance the knee, ” Dr. Aleto explained.
Here’s where the Vanguard ID has advantages over the traditional approach. The Vanguard ID keeps the patient’s ligaments intact and therefore improves the post-operative knee joint function as much as possible. And it accomplishes this with more bearing choices.
Dr. Aleto again: “With Vanguard ID the ligaments are not released, and balance is achieved through utilizing differential bearing thicknesses and levels of constraint. This allows the surgeon intraoperatively to have the ability to trial different bearing combinations to balance the medial and lateral compartment individually.”
Beyond Implant Survivorship
In a blink of an eye, the measure of a superior implant has changed from durability to patient satisfaction—and not in 5 or 10 years, but rather span of time it takes them to fill out the surgeon and hospital rating form.
Every major orthopedic company has gotten the message.
Help us improve our patient satisfaction rates while also keeping us within the new bundled care reimbursement guidelines.
As Todd Davis said so well: “Zimmer-Biomet recognizes that as an industry, we are past the point of considering survivorship and reproducibility as the only means of measuring success.”
And, remember, ligaments have nerve cells too.
Studies have shown that the ligaments contain nerve cells which contribute to proprioception that is important for proper knee kinematics and function. In studies where patients have received two different types of prosthesis, the bi-cruciate retaining knee implants were preferred when compared to more constrained designs.
And here is where the particular design of the Vanguard ID captured our interest. By specifically emphasizing the integrity of particular ligaments, the Vanguard ID may well be a true step change improvement.
“The goal of the Vanguard ID is to preserve the medial and lateral collateral ligament, as well as the posterior cruciate ligament, in their natural state, ” Todd Davis said.
Dr. Aleto agrees and feels from a technical standpoint that protecting the superficial and deep medial collateral ligament during the exposure and with retraction during the procedure is key. He also commented on the importance of the posterior cruciate ligament (PCL).
“It is critical that PCL insertion on the tibia is not compromised during the tibial preparation and that appropriate posterior slope is obtained on the tibia. The native tension in the MCL [medial collateral ligament] is then utilized to balance the knee, ” Dr. Aleto emphasized.
Indications
The Vanguard ID implant is indicated for patients with osteoarthritis, rheumatoid arthritis, traumatic arthritis, the correction of a deformity and the revision of a previously failed knee joint replacement.
Dr. Aleto explains that the ideal patient is “one with a correctable deformity with ligaments that are functioning normally. In these patients, with a cautious soft tissue exposure, the ligaments can be used to balance the knee back to its pre-disease state.”
“Vanguard ID is designed to treat a wide variety of patient indications and gives the surgeon the flexibility to treat each patient’s anatomy, as they deem necessary, ” Davis adds.
Contraindications
Patients with infection, sepsis and osteomyelitis should not have total knee arthroplasty with the Vanguard ID implant. Additionally, patients with neurological or neuromuscular disorders, osteoporosis, metabolic disorders, osteomalacia, or vascular insufficiency should consult with their orthopedist.
Possible Adverse Effects
Many possible adverse effects may occur with total knee arthroplasty (TKA) implants including sensitivity to the materials of the implant, postoperative infection, allergic reaction and loosening, fracture or migration of the implant.
Vanguard ID Implant Components
The femoral and tibial components are made up of a cobalt, chromium, and molybdenum alloy, combined with a titanium alloy, which are used in many other TKA implants.
For more information you can go to the official Vanguard ID site: http://www.zimmerbiomet.com/
