@MariaFontanazza	@hjluks

OrthoTec: Thanks for taking some time today to discuss OA & tech. What is OA?
Howard J. Luks: Thanks Maria. OA=Osteoarthritis. It is a progressive degenerative disease resulting in loss of cushioning or cartilage in [the] knee.

ORT: How prevalent is OA in the U.S.?
Luks: Osteoarthritis is very prevalent in our society. It is estimated that 65% of people will be affected at some point in time.

ORT: Are there certain factors that come into play? Genetics? Rising obesity rates?
Luks: Absolutely. Obesity can exacerbate or worsen arthritic progression. There are many causes of arthritis. They include trauma, genetics, and prior history of meniscus tears. There are rarer forms of arthritis too...Rheumatoid disease, Lupus, etc.

ORT: What technologies are used to treat OA?
Luks: Early treatment is geared towards easing discomfort—certain medications, injections, [and] physical therapy can all help. Treatment alternatives change depending on severity of the disease and the effect it is having on the patient’s quality of life.

ORT: So at what point does technology have to intervene in treating OA?
Luks: Ultimately, patients will opt for a knee replacement if they feel the pain and quality of life limitations are worth risks/pain of surgery. Technologies available include total knee replacements (TKR) and partial knee replacement (UKR). Ultimately it is the patient's choice when to proceed with surgery.

ORT: Are there limits to TKR?
Luks: Limits to TKR...hmmm, yes. It is a metal and plastic knee. As such, it begins to wear out the moment it is put into the knee. There are certain activities that we prefer patients not pursue to minimize risk of wearing out components too early.

ORT: Are there any TKR technologies that are improving wear rate?
Luks: Yes, some companies are working on alternative surfaces such as ceramics to diminish wear rates.

ORT: Are there benefits of custom vs. off-the-shelf implants when performing a knee replacement?
Luks: The concept of custom implants is just starting to hit the market. Some manufacturers claim they can customize knee [implants], but they are using off the shelf components with special cutting techniques. Companies such as ConforMis are actually manufacturing the prosthesis to fit your knee precisely! 

ORT: Are there benefits to using imaging to create custom implants?
Luks: There are industry advantages to custom implants, too. Hospitals do need to manage inventory. [The] cost of providing a custom replacement can actually be less than cost of TKR in most circumstances when [the] supply chain [is] considered.

Imaging is very important to determine the proper sizing of your knee and to create a custom implant to precisely fit your knee. Custom implants can be designed from CAT scan data.

Storage, sterilization, set-up time, etc are also strong considerations from [a] hospital perspective when evaluating [a] custom implant program.

ORT: So should more docs be using custom implants?
Luks: Great question. IMO [In my opinion], they should strongly consider it. Research takes time to generate actionable data. But it stands to reason that it is wiser to build the implant to fit the knee than to cut the knee to fit the implant!!

ORT: Do you expect more manufacturers will start to move forward with a true custom implant device?
Luks: I think that the evolution of TKR solutions will move towards customization. Most companies I am familiar with are thinking about it. At this time, only ConforMis has custom implants available. 

ORT: Any final thoughts about where tech is headed in this area? TKR, etc.
Luks: We are heading towards customization. ConforMis is the current leader in the field. Others will likely follow.

ORT: In addition to docs, should device companies be more involved in healthcare social media to communicate with patients?
Luks: As any of you who read my blog know. I am a huge believer in the power of social media. The more information that patients have, the more accurate of an assessment they can make in choosing to proceed with surgery or whether nonoperative measures are still appropriate.

Industry, as long as they are transparent and engage intelligently, can serve the healthcare social media audience quite well.

ORT: What can device co's do to get more involved in healthcare social media?
Luks: Engage, engage, and engage. Humility, sincerity, etc are key drivers. Yes, their goal is to make a profit, but all industry hcsm [healthcare social media] efforts do NOT have to have an ROI attached to it! Blog, sections for patient interaction and feedback, engage on Twitter, Facebook, You Tube channel, etc.— the more info the better.