Linvatec Has Taken Absorbable Technology to a New Level

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1 2003 JUNE EDITION LINVATEC L EAST INVASIVE TECHNOLOGIES LINVATEC SPECIALISES IN HALL SURGICAL POWER EQUIPMENT Small and Large bone orthopaedics Otolaryngology ARTHROSCOPY Shaver systems Manual instruments Soft tissue fixation Fluid distention Imaging systems ELECTROSURGERY Argon Beam technology Electrosurgical generators Electrosurgical accessories ENDOSCOPY Endoscopic instruments Endoscopic consumables Imaging systems OUTSTANDING SERVICE Onsite service centre 24/7 customer support No charge loan equipment Reliable delivery CUSTOMER ORDERS & ENQUIRIES TEL FAX WEB Linvatec Has Taken Absorbable Technology to a New Level Bionx Implants now Exclusive to Linvatec Australia AS MENTIONED IN THE last edition of the Source, Linvatec is pleased to announce the purchase of Bionx Implants and looks forward to incorporating this new product range into our current line of absorbable implants. As of 12 th May 2003, Linvatec will be the exclusive distributor of Bionx Implants in Australia and will be able to offer the most complete and advanced range of bioabsorbable products on the market today. Bionx has a proprietary manufacturing process for Self-Reinforced copolymers that will provide a platform for the development of tomorrow s implants. Product Indications Shoulder Rotator Cuff Bankart SLAP Knee Meniscus Repair ACL Reconstruction Foot & Ankle Achilles Syndesmosis/Malleolus Metatarsal Osteotomies Intra-articular Fractures Olecronon Capitellum Radial Head We are excited by this addition to our product range and will continue to ensure product availability, reliability and optimum performance. Would you like to learn more about Linvatec s new product range? You can find more detailed information in this edition of the Source. Linvatec Australia Pty Limited ABN

2 Arthroscopic Soft Tissue Fixation: The Facts about Bioabsorbable Polymers THE USE OF BIOABSORBABLE polymers in the manufacture of implants for soft tissue fixation has been clinically accepted for many years. Bioabsorbable versus Metal Bioabsorbable implants have many advantages over metal implants, including: Load sharing versus stress shielding Reduced risk of articular damage Improved MRI and X-ray imaging for post-operative diagnosis Minimised risk of obstruction during revision surgery if required Minimised risk of stress risers normally associated with implant removal. Bioabsorbable polymers are a special class of polymer that allow the material to serve a function, then gradually break down, metabolise and be eliminated from the body. It is imperative to match the degradation time with the initial period during which the material must function. The ideal bioabsorbable material will provide appropriate initial strength while degrading in a predictable fashion without adverse reactions occurring in the body throughout the healing process. Specific Bioabsorbable Polymers There are three main types of bioabsorbable polymers: PGA: although highly crystalline, PGA absorbs very quickly into the body, losing virtually all strength within 1 month and all mass within about 6 to 12 months. During this phase of rapid absorption, large quantities of a glycolic acid monomer are released, potentially causing clinical complications within a few months following implantation PLLA: PLLA has a much slower rate of absorption than PGA. This polymer is highly crystalline due to the ordered pattern of the monomers, (i.e. L-L-L-L-L- L-L) and has been documented to take as much as 5-7 years to absorb PDLA: the D (Dexo) Isomeric form of PLLA, which has a much faster absorption rate. Copolymers Bioabsorbable polymers are often blended into a copolymer to maximise initial strength and increase the rate of absorption. Typical blends are: PLLA/PGA: normally 80/20, this copolymer holds its mechanical strength for 6-8 weeks and is fully resorbed in approximately one year. This material is predominantly used in paediatrics L/D PLA: a 96%L/4%D copolymer combines the initial strength of PLLA with a faster resorption time. Other blends are available, depending on the clinical requirements for initial strength versus rate of resorption. Bionx Self-Reinforced PLA THERE ARE MANY WAYS of manufacturing bioabsorbable polymers, including compression moulding, casting, injection moulding and extrusion. Although Bionx implants are manufactured from standard bioabsorbable polymers, the polymers are formed using a patented extrusion process. An extruded bar is heated until soft and pulled through a dye in a controlled manner. This aligns the polymer chains in the direction of pulling and also entangles them to form the Self-Reinforced polymer. High Initial Strength This Self-Reinforced polymer has high initial strength that prevents premature fracture during implant insertion. It also allows the implant to maintain holding power throughout the healing process. As with all bioabsorbable implants, they biologically resorb over time, allowing the load to transfer to the bone after primary bone healing and eventually completely disappear through safe biological resorption. Injection Moulded (PLLA): Solid Bionx Self-Reinforced (SR-PLA): Fibres 2 BIONX SOFT TISSUE FIXATION

3 Bionx Contour Meniscus Arrow Fixation Device Low Profile, Superior Fixation THE NEW CONTOUR MENISCUS ARROW is indicated for the repair of vertical, longitudinal Bucket-Handle tears of the meniscus in the vascular zone (red-red, red-white) through arthroscopic and open procedures. The Arrow features a low profile contoured head that sinks into the meniscus while compressing the tear and is barbed along the entire length of the implant shaft for superior fixation strength. The Arrow has a diameter of 1.0mm and is available in three lengths: 10, 13 and 16mm. The Arrow is made of the new proprietary Self-Reinforced copolymer (80L/20D,L PLA) that imparts an ultra-high strength microstructure. It is flexible yet has the unique ability to resist shear and torque while the tear is healing. One-Handed and Manual Insertion CrossBow The CrossBow Meniscus Arrow Inserter allows meniscal repair without the need for manual insertion and pre-drilling. By eliminating pre-punching of the meniscus, the initial pull-out strengths of the Meniscus Arrow are increased 30-50% over manual sets. With one pull of the trigger, the CrossBow Inserter uses a spring-loaded obturator to insert the Arrow. For easier handling in theatre, the Contour Meniscus Arrow is available in preloaded cartridges for use with the CrossBow Inserter. Manual Instruments The specially designed instrument set for insertion of the Contour Meniscal Arrow provides tactile feedback during implant insertion. Five area-specific cannulae provide easy access to the tear site. Each cannula tip has teeth that are sloped to securely hold onto the meniscus surface when placing the Arrow. The new copolymer is a faster resorbing implant material that will continue to provide strength for up to 24 weeks while the tear is remodelling and then gradually resorbs away. Bionx Contour Labral Nail Fixation Device Anatomical Design to Reduce Humeral Head Impingement THE CONTOUR LABRAL NAIL is designed to anatomically fix the glenoid labrum in bankart tears and SLAP lesions. The head of the Nail is offset anatomically and is designed to follow the contour of the labral surface and allow cornering of the labral tissue without humeral head impingement. The Inserter and Nail are cannulated to allow accurate placement over a K-Wire. The Inserter also captures the head of the implant, allowing the surgeon to rotate the implant in any direction, ensuring optimal placement and soft tissue fixation. The Contour Labral Nail is made from Bionx proprietary Self-Reinforced copolymer (96L/4D PLA) that resists shear and torque while the tissue is healing. The unique design of the Nail allows for a large tissue/implant interface, ensuring optimal soft tissue fixation with a reduced risk of tissue pull through. For more information on the Bionx product range, please contact your local Linvatec sales representative. 3 BIONX SOFT TISSUE FIXATION

4 Knotless Anchor for Shoulder Instability Redefining Ease-of-Use in Knotless Anchor Technology LINVATEC IS PLEASED to announce the release of the UltraFix Knotless MiniMite Suture Anchor System that is designed for anterior shoulder instability procedures, including: Bankart lesion repairs SLAP lesion repairs Capsular shifts Capsulolabral reconstructions. The Knotless Anchor can be used in arthroscopic or open procedures. The unique 2.3mm implant provides secure fixation while eliminating the difficult knot-tying step. Each stainless steel implant is loaded with USP size 2 non-absorbable coated, braided polyester suture. Unlimited Length of Suture One end of the suture is permanently fixed to the implant, leaving an unlimited length of suture that can capture a large piece of labram and capsule together. Once it is passed through the tissue, the free end of the suture is loaded (outside the cannula) through the shaft of the implant and is able to slide freely. The suture anchor reattaches soft tissue to bone by simultaneously purchasing into bone and mechanically locking a loop of suture upon deployment. Prior to deploying the anchor in the bone, appropriate tension of the tissue can be achieved with a simple technique. This is critical in reconstructing the stabilising structures in the glenohumeral joint. If there is too much tension, it is possible to backoff the tension and start again. The surgeon is in complete control during the entire procedure. For more information on the UltraFix Knotless MiniMite Suture Anchor, or to obtain a copy of the Surgical Technique brochure and CD, please contact your local sales representative or return the attached reader reply card. New Modular Attachment: Radiolucent Drive Compatible with PowerPro Electric and Battery Power Systems THE RADIOLUCENT DRIVE ADAPTER is the latest modular attachment available from Hall Surgical. Compatible with both PowerPro Power Systems (Electric and Battery), the Radiolucent Drive Adapter attaches directly onto the Single- Trigger and Two-Trigger Modular Rotary handpieces. This new compact attachment connects directly to the Synthes Radiolucent Driver used in IM Nail procedures. The quick-connect interface between the attachment and driver makes the system easy-to-use without any compromise in the performance of the PowerPro handpiece. Please call your local representative today for a demonstration of the Hall Radiolucent Drive Adapter. READER REPLY CARD I am interested in the following products: ELECTROSURGERY STATE OF THE ARTS BIONX SOFT TISSUE FIXATION Self-Reinforced PLA Contour Meniscus Arrow Contour Labral Nail POWER INSTRUMENTS Radiolucent Drive MENTICE SIMULATION SYSTEMS Procedicus VA Procedicus Laparoscopic System EDUCATIONAL MATERIAL The UltraFix Knotless MiniMite Suture Anchor System Shoulder Surgical Techniques Knee Surgical Techniques ABC Technology Newsletter Special Events Name... Position... Hospital... State... Postcode... Tel ( ) Please tick if you would like to be ed future editions of the Source as a PDF file

5 Educational Initiative: Arthroscopic and Laparoscopic Medical Simulation A Collaboration Between Mentice and Linvatec MENTICE, A WORLD LEADING company within the field of virtual reality based medical education and assessment, offers simulation systems to fulfill both laparoscopic and arthroscopic training requirements. These simulators are geared towards surgical residents or practicing surgeons wishing to specialise or adopt these surgical skills. Procedicus VA The Procedicus VA (Virtual Arthroscopy) offers training within the area of arthroscopic shoulder and knee surgery, helping surgeons to overcome orientation, instrument handling and hand-to-eye coordination difficulties. This arthroscopic trainer has realistic anatomy and tactile feedback that reduces the need for animals and cadavers in surgical education. Procedicus Laparoscopic System The Procedicus Laparoscopic system offers a range of modules aimed at teaching procedures such as triangulation, scope navigation, cutting, suturing, needle passing and diathermy. The system incorporates tactile feedback with realistic 3D anatomy, including stomach, gall bladder, liver and the surrounding anatomies. The hardware for both systems is identical and allows for training of different surgical techniques across several different departments, providing a cost effective multi-specialty solution. If you would like to learn more about either simulation system, please fill out the attached reader reply card. New Surgical Techniques available on DVD The Ultrafix Knotless MiniMite Suture Anchor System This CD has been produced in conjunction with Dr. Hugh West from Utah and demonstrates an arthroscopic Bankart repair using the latest product designed for arthroscopic inferior shoulder instability procedures. Shoulder Surgical Techniques for rotator cuff repair and arthroscopic anterior shoulder stabilisation utilising SuperRevo and the UltraFix RC Anchor System Knee Surgical Techniques for meniscal and ACL repair using semi-t and gracilis tendon grafts with the BioScrew bioabsorbable interference screw. If you would like to receive one of these educational products, please complete and return the attached reply card and your local sales representative will arrange to deliver a copy to you. No stamp required if posted in Australia

6 Argon Beam Coagulation Technology For Bloodless Joint Replacement AS FEATURED IN THE LAST EDITION of the Source, the CONMED ABC System 7500 is a fully integrated, full-featured electrosurgical generator combined with an Argon Beam Coagulator. This article looks in greater detail at the benefits of Argon Beam technology in orthopaedics. The Argon Beam Coagulator is a significant advance in the use of RF energy for instantaneous intra-operative surgical coagulation. Inert argon gas is used to carry the RF energy from the electrode to the tissue. The delivery of RF energy through the more conductive medium of argon gas produces an instantaneous effect. The argon gas blows blood and fluids from the surgical site, resulting in a smoother, more uniform eschar. This allows hemostasis at the very source of the bleeding, creating a thinner, more adherent eschar. Dealing with profuse bleeding from an active bleeding surface, i.e. bone graft, acetabula etc. may be futile using conventional electrosurgery. However, the Argon Beam Coagulator can provide excellent hemostasis to a raw surface of bone without damaging it. The cool beam inert argon plasma also dramatically reduces thermal penetration of the tissue. Studies have shown that the depth of tissue necrosis using argon beam technology is approximately one third the depth of conventional electrosurgery. More stable and adherent eschar Less tissue damage Ease of use on more delicate structures Reduced blood loss Shorter procedural time Effective on high impedance tissue such as bone Reduced smoke plume for better visualisation For further information regarding Argon Beam technology, please contact your local sales representative. Clinical Benefits Faster and more reliable hemostasis Blows blood away Better visibility State of the Arts Take a Closer Look at the Arts World with Linvatec LINVATEC S PARTNERSHIP WITH State of the Arts has proven to be highly successful among the orthopaedic society. Since it was first published, the State of the Arts magazine has undergone a number of changes to improve the design and format and provide more pages of arts information and opinion. State of the Arts Newsletter In addition to the quarterly magazine, subscribers receive a fortnightly newsletter, courtesy of Linvatec, updating them on the best arts events in their city. This newsletter also includes giveaways and offers exclusive to Linvatec subscribers. Special Events Linvatec is planning some great events this year in conjunction with State of the Arts, including special movie previews and a series of premium champagne and wine tastings in each capital city. If you would like to receive the newsletter or an invitation to the State of the Arts/Linvatec events, please complete and return the attached reader reply card. 6 CONMED ELECTROSURGICAL GENERATORS Linvatec Australia Pty Limited ABN

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