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iForma patient-specific knee implant

Let’s say you’re a patient in your early forties, suffering from moderate osteoarthritis of the knee. You need relief, but a total knee replacement would be the surgical equivalent of killing a fly with a sledgehammer.

Hendersonville orthopedic surgeon Gregg A. Motz, MD, is the first in Tennessee to offer a less-invasive alternative called the iForma knee interpositional device.

Developed by Massachusetts-based ConforMIS Inc., the iForma is a patient-specific knee implant for either the medial (inner) or lateral (outer) knee compartment. Each iForma is designed using a magnetic resonance image of the patient’s knee. The scan provides information about the knee’s shape and condition, so the personalized implant closely conforms to the natural joint structures. There’s no need for screws, pegs or cement. More importantly, according to Motz, there’s no need for bone cuts.

“Traditional knee replacement removes bone, and if you are at a certain age, you would very much like to avoid that,” Motz explained. “This (the iForma) is similar to a partial knee replacement, but different in the fact that traditional partial knee replacements or unicompartmental knee replacements actually remove bone and the components are then generally cemented in place. This component does not remove any bone.” Patients who receive an iForma implant may eventually need total knee replacement, he added, and the more bone the better when that time comes.

Motz first learned about the iForma at an annual meeting of the American Academy of Orthopaedic Surgeons, and the procedure “made a lot of sense to me,” he said. Last December, he headed to Fort Worth to observe the procedure by Bruce A. Bollinger, MD, whom Motz described as “one of the initial pioneers  using this implant.” Motz’s first iForma implant was scheduled for the end of June and another is scheduled in August.

The “i” in iForma stands for “individual,” and Motz said that’s the reason patients are enjoying success with the new implants. “It’s a custom-made component based exactly on the geometry of the patient’s knee,” he said. “So that spacer conforms exactly to the joint surface on that side of the knee that it’s going into.”

ConforMIS calls the technology iFit, which is based on image-to-implant software. “Our proprietary algorithms convert the imaging data into a 3-D representation of the patient’s knee,” company literature explains. The implants are manufactured in cobalt, chromium and molybdenum.

“The initial recovery is a little bit quicker,” Motz said of iForma patients. “Because you’re not cutting into bone, there is probably a smaller blood loss and less initial pain post-operatively. It makes that initial post-operative recovery a little bit easier.”

Motz said it’s “possible” that he may consider the other three ConforMIS products for his patients in the future. Those are:

1. The iUni, a unicompartmental knee resurfacing device for one side of the knee or the other.

2. The iDuo, designed for patients with arthritic damage to either the medial or lateral compartment plus the patellofemoral compartment located behind the knee cap.

3. The iTotal, ConforMIS’ tricompartmental knee resurfacing device, a personalized total knee implant that uses scan data to resurface rather than to replace the end of the thigh bone.

According to the Arthritis Foundation, osteoarthritis affects nearly 27 million Americans, with women over 50 more affected than men. While the cause of osteoarthritis isn’t known, certain factors increase the risk, including heredity, obesity, joint injury and repeated joint overuse. Symptoms typically begin after the age of 40 and progress slowly.

That’s why incremental treatment steps such as the iForma are making news. In May, ConforMIS was named a winner of the 2008 Red Herring North America 100 Award, which recognizes promising technology companies. Winners are selected based on criteria such as unique technology, experienced management, a strong customer base, a solid business model and financial performance. Past winners include Google, Yahoo!, eBay, Skype and YouTube.

About the iForma, Motz said, “There are some people who are too young for tradition knee replacement, who prior to this procedure just didn’t have a real good surgical option. This may be their best surgical option.”

Motz is with Premier Orthopaedics and Sports Medicine, with several Middle Tennessee locations. He completed his undergraduate studies at Miami of Ohio University in 1991 and graduated from the Ohio State University College of Medicine in 1995. He completed his residency training in orthopedic surgery at West Virginia University and then a one-year specialty fellowship in arthroscopy and sports medicine at the Jennings Clinic in Winston-Salem, N.C., in 2001. He spends much of his time in sports medicine, performing arthroscopies of knees and shoulders. He joined Premier five years ago.



July 2008

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