EXCEEDING THE HIGHEST STANDARDS. YOURS.synthes.vo.llnwd.net/o16/LLNWMB8/INT Mobile/Synthes... · Femoral Neck System (FNS) Femoral Neck Fractures- Repair The FNS System is a dedicated

EXCEEDING THEHIGHEST STANDARDS.

YOURS.

Hip Fracture Solutions

Putting the Patient at the Center of Value Based Healthcare

Clinical and Economic BurdenHip fractures result in pain, loss of mobility and high mortality rates. Nearly all patients are hospitalized, and most undergo surgical repair of unstable fractures using orthopedic implants.3 There is often a significant loss of function, in patients above 60 with fewer than 50% of patients having the same walking ability they had prior to the fracture.4 Comorbidity is an important contributory factor to hip fractures and is often a determinant of outcome.3 These patients often suffer from post-operative complications that result in revision surgery in around 6.3% of trochanteric fractures5 and 33% of femoral neck fractures.6 The cost of managing these elderly hip fractures in the EU was estimated to be nearly €19.2 billion in 2010.2

The Hip Fracture Patient

Johnson & Johnson Medical Device Companies provides products and services to help hospitals provide the best possible care for hip fracture patients, from the operating room to the post-operative care environment. We offer solutions to enable hospitals and healthcare providers to achieve their Triple Aim goals of enhancing patient experiences and improving outcomes, while reducing costs.

TRIPLE AIM

IMPR

OVE

HEA

LTH

BETTER CARE

LOW

ER COST

Hip fractures are a major public health problem in terms of patient morbidity, mortality and costs to health and social care. The incidence of hip fractures rises steeply with age, with higher rates of osteoporosis and falls in the elderly population.1 In 2010, the annual incidence of hip fractures in the European Union was estimated at around 615,000 fractures, and this number is expected to rise to around 815,000 by 2025.2

Ambulation7

Institutionalism8 Delirium9 Fracture Risk10 Mortality8

Prognosis of hip fracture in the elderly

Our Patient Pathway Solution

Driving consistency among the multi-disciplinary team across the entire patient

pathway episode

Providing continuity of care (in and out of the hospital setting) throughout the patient journey

Empowering patients through shared decision-making and technology to take control of

their own treatment and recovery

Deploy Track

Measure

On-siteassessment

Data-drivenanalysis

Discussion of yourneeds

Priorities of Hip Fracture TreatmentHip fracture treatment guidelines highlight the importance of:11,12

• Early surgical intervention

• Early management of comorbidities

• Prevention of delirium

• Early supported discharge

• Coordinated multidisciplinary approach

Hip frHip fracture: managementacture: management

Clinical guideline

Published: 22 June 2011

nice.org.uk/guidance/cg124

© NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-of-

rights).

MANAGEMENT OF HIP FRACTURES IN THE ELDERLY

EVIDENCE- BASED CLINICAL PRACTICE GUIDELINE

Adopted by the American Academy of Orthopaedic Surgeons Board of Directors September 5, 2014

This Guideline has been endorsed by the following organizations:

A component of our CareAdvantage offering is our Patient Pathway programs

Our Patient Pathway capabilities are built with the patient at the center to help ensure patients receive consistent, coordinated care, while supporting patients to take control of their own treatment and recovery.

CareAdvantage is our approach to partnering with hospitals and healthcare providers in order to achieve the Triple Aim of enhancing patient experiences and improving outcomes, while reducing costs. It consists of programs and services that align our broad capabilities to your individual needs.

Program ComponentsOn-site opportunity assessment

• Conducted by local J&J specialist

• Includes identification of and involvement of key stakeholders

• Includes interviews with multi-disciplinary stakeholders

Implementation support & facilitation

• Conducted by clinical subject matter experts

• Facilitates collaboration among providers to provide coordinated efficient care

• Utilizes multi-factorial interventions to manage various aspects of geriatric care

• May include visit to reference center to learn best practices

Implementation Toolbox

• Includes best practice materials to guide through implementation

Diagnostic Health Check

• Tracks data, visualizes progress and provides benchmarks

Hip Fracture Care Program Implementation at the OLVG HospitalThrough the on-site opportunity assessment at the OLVG Hospital in Amsterdam, it was discovered there were several variables in patient flow that influenced length of stay and the involvement of the orthogeriatrician. These included inefficiencies in A&E specialist review, OR scheduling, discharge and the pre-operation and post-operation ward process.

Through the implementation of the Care4Today® Hip Fracture Care Program, interventions were designed to improve the process in care. Results were achieved throughout the total patient pathway.

Absence of flow in patient journey

No uniform pathway design

No pre-scheduled discharge date

Overcrowded A&E and long waiting hours due to over processing and shared resources

No scheduled OR time slot

Understaffing for the orthogeriatrician

Late involvement of transfer nurses

Insufficient multidisciplinary meetings (took place only once a week)

Inefficiencies in the Patient Value Stream

Length of stay reduced from 9 to 7 days13

Significant reduction in costs for the hospital of €252,000/year13

Orthogeriatrician support for elderly patients increased

from 44% to 92%13

Outcomes from Hip Fracture Care Program Implementation

Case StudyCare4Today® Hip Fracture Care ProgramAn evidence-based care improvement program for the elderly fragility fracture patient population that facilitates interdisciplinary care coordination and clinical standardization to reduce variation and costs, improve outcomes and optimize care.11,12

Optimization of processes for fragility hip fractures that supports a coordinated interdisciplinary care pathway

Emergency Department Pre-Operative Peri-Operative Discharge

References

TFN-ADVANCEDTM Proximal Femoral Nailing System with

TRAUMACEM™ V+ Augmentation System Trochanteric Fractures

The TFNA System is designed to advance the treatment of hip fractures by providing surgical options to enhance stability in poor bone, improved anatomical fit14 and increased implant strength.15 It is designed to reduce the risk of cut-out,16,17 distal cortical impingement14 and nail breakage,15 which are common post-operative complications.5,18,19 Several clinical studies have published reporting favorable outcomes in cut-out resistance.20-22*

4.5mm LCP™ Hook Plate with 3.5mm Locking Attachment Plate (LAP) Periprosthetic fractures

The 4.5mm LCP Hook Plate includes two proximal hooks to engage the superior tip of the greater trochanter. The 3.5mm Locking Attachment Plate is a less invasive alternative to cerclage cables and bypasses the prosthesis stem with an angular stable solution.23,24 LAP provides a stiffer, stronger construct than an orthopedic cable.25

Femoral Neck System (FNS) Femoral Neck Fractures - Repair

The FNS System is a dedicated solution for femoral neck fractures, designed for improved angular stability26 and rotational stability27 with the intent to reduce reoperations related to fixation complications. It is also designed to reduce the risk of lateral implant protrusion that can contribute to post-operative thigh pain.28 Additionally, FNS has a reduced incision size compared to a sliding hip screw which may minimize the risk of infection.28

CORAIL® Hip System Femoral Neck Fractures - Replace

The CORAIL® Hip System has over 30 years of clinical history and a 96.3% stem survivorship rate.29 It can be combined with a variety of cup options, including the PINNACLE® Acetabular Cup System, for a complete total arthroplasty solution. In addition, when combined with the Bipolar and Unipolar head options for hemiarthroplasty, the construct can be a cost-effective and efficient approach to treat femoral neck fractures and avascular necrosis.

1. Leal J, Gray AM, Prieto-Alhambra D, et al. Impact of hip fracture on hospital care costs: a population-based study. Osteoporosis international: a journal established as a result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2016;27(2):549-558.

2. Hernlund E, Svedbom A, Ivergård M, et al. Osteoporosis in the European Union: medical management, epidemiology and economic burden: A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Archives of Osteoporosis. 2013;8(1-2):136.

3. Woolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bulletin of the World Health Organization. 2003;81(9):646-656.

4. Sernbo I, Johnell O. Consequences of a hip fracture: a prospective study over 1 year. Osteoporosis international : a journal established as a result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 1993;3(3):148-153.

5. Parker MJ, Handoll HH. Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults. The Cochrane database of systematic reviews. 2010(9):1-240.

6. Enocson A, Lapidus L. The vertical hip fracture - a treatment challenge. A cohort study with up to 9-year follow-up of 137 consecutive hips treated with sliding hip screw and antirotation screw. BMC Musculoskeletal Disorders. 2012; 13:171.

7. Morrison RS, et al. The impact of post-operative pain on outcomes following hip fracture. Pain. 2003 Jun; 103(3):303-311.

8. Fransen M, et al. Excess mortality or institutionalization after hip fracture: mean are at greater risk than women. Journal of American Geriatric Society 2002 Apr;50(4):685-90.

9. Homes J, House A. Psychiatric illness in hip fracture. Age and Aging. 2000;29:537-546.

10. Emeric CC et al. The contribution of hip fracture to risk of subsequent fractures: data from two longitudinal studies. Osteoporosis International. 2003 Nov;14(11):879-83.

11. NICE. Hip Fracture Guideline. CG 124, https://www.nice.org.uk/guidance/cg124/resources. Retrieved from the worldwide web September 24, 2018.

12. American Association for Orthopedic Surgeons. Management of Hip Fractures in the Elderly, http://www.aaos.org/research/guidelines/HipFxGuideline.pdf. Retrieved from the worldwide web September 24, 2018.

13. Hage D and van Veen R. Using ‘LEAN Thinking’ when Implementing the Geriatric Fracture Program in the OLVG Hospital Amsterdam. Presented as a Poster at the 7th Annual Fragility Fracture Network Meeting. Dublin. July 5th to 8th. 2018.

14. Schmutz B, Amarathunga J, Kmiec S, Jr., Yarlagadda P, Schuetz M. Quantification of cephalomedullary nail fit in the femur using 3D computer modelling: a comparison between 1.0 and 1.5m bow designs. Journal of orthopaedic surgery and research. 2016;11(1):53.

15. DePuy Synthes Trauma. Fatigue strength testing of cephalomedullary nails. 2014. Refs: 0000131715, 0000122418.*

16. DePuy Synthes Test Data. Biomechanical Evaluation of Non-Augmented & Augmented TFNA Head Elements in Surrogate Femoral Heads. 2017. Ref: 0000268245.*

17. Hofmann L. AO Foundation: Final Report for biomechanics evaluation of a non-augmented nail head element in surrogate femoral heads [Synthes GmbH:USTRA09022 Trochanteric Fixation Nail-Advanced (TFNA)] 2015.

18. Parker MJ et al. Sliding hip screw versus the Targon PF nail in the treatment of trochanteric fractures of the hip. JBJS British Volume. 2012;94-B(3):391-397.

19. Brammar et al., Reverse obliquity and transverse fractures of the trochanteric region of the femur; a review of 101 cases. Injury. 2005;36)7:851-857.

20. Kammerlander C, Gebhard F, Meier C, et al. Standardized cement augmentation of the PFNA using a perforated blade: A new technique and preliminary clinical results. A prospective multicenter trial. Injury. 2011; 42 (12): 1484-1490.

21. Kammerlander C, Doshi H, Gebhard F, Scola A, Meier C, Linhart W, Garcia-Alonso M, Nistal J, Blauth M. (2014) Long-Term results of the augmented PFNA: a prospective multicenter trial. Arch Orthop Trauma Surg. 134(3):343-9.

22. Kammerlander C, Hem E, Klopfer T, Gebhard F, Sermon A, Dietrich M, Bach O, Weil Y, Babst R, Blauth M. Cement Augmentation of the Proximal Femoral Nail Antirotation (PFNA) - A Multicenter Randomized Controlled Trial. Injury. https://doi.org/10.1016/j.injury.2018.04.022

23. Kammerlander C, et al. Minimally invasive periprosthetic plate osteosynthesis using the locking attachment plate. Oper Orthop Traumatol 2013; 25:398-410.

24. Wagner M, et al. Trauma Lower Extremity: 3.5mm Locking Attachment Plate. AOTK TK System Innovations. 2010 (1):34-36.

25. Lenz M. et al. The locking attachment plate for proximal fixation of periprosthetic femur fractures- a biomechanical comparison of two techniques. International Orthopedics (SICOT) (2012) 36:1915-1921.

26. Stoffel K, Zderic I, Gras F, Sommer C, Eberli U, Mueller D, Oswald M, Gueorguiev B. Biomechanical evaluation of the femoral neck system in unstable Pauwels III femoral neck fractures: a comparison with the dynamic hip screw and cannulated screws. J Orthop Trauma. 2017; 31(3):131-137.*

27. DePuy Synthes Report: Static Cut Through Rotation Test in Bone Foam. 2016. Ref: 0000165855.*

28. DePuy Synthes Report: FNS Design and Procedure Comparison. 2018. Ref: 0000274963.

29. Vidalain JP (2011) 25-year ARTRO Results: A special Vintage from the Old World. In: Vidalain JP et al; The CORAIL Hip System: A Practival Approach Based on 25 Years of Experience. Springer; pg 94-101.

30. Internal Case Study: CareAdvantage Partnership leads to Co-creation of Care4Today(R) Orthopedic Program at Guy’s and St. Thomas’ Hospital (GSTT). Data on file at Hospital. May 2017.

31. Internal Case Study: CareAdvantage Supply Chain Capabilities drive efficiencies at Sant’Andrea Hospital Vercelli. Data on file at Hospital. May 2017.

32. Internal Case Study: CareAdvantage Supply Chain eSIMS pilot makes an impact at Fachklinik Schwarzach & Spital Zolikerberg. Data on file at Hospital. May 2017.

* Benchtop testing may not be indicative of clinical performance.

Our Product Solutions

*Data is for augmentation used with the Proximal Femoral Nailing Antirotation System.

© DePuy Synthes 2019. All rights reserved. 103365-181129 DSEM

Synthes GmbHEimattstrasse 34436 OberdorfSwitzerlandTel: +41 32 720 40 60Fax: +41 32 720 66 00

www.depuysynthes.com

This publication is not intended for distribution in the USA.

Results from case studies are not predictive of results in other cases. Results in other cases may vary.

Additional CareAdvantage SolutionsIn addition to hip fracture care, other services are available to reduce costs and improve efficiency in your hospital.

Procedural volume of Hip and Knee product portfolio increased by approx. 23%

Large-volume orthopaedic trust with approx. 1,000 patients per year30

Time taken to manage supplies for Medical Staff reduced by 73%

Local hospital with 270 beds; 65 surgeries per week31

Saved 30 mins per day (based on 30 line items) for operating room staff

Pilot data collection taken at three different European sites32

Care4Today® Hip & Knee Program

Customer Supply Chain: Resolution

Customer Supply Chain: eSIMS

23%

73%

30mins

Hip Fractures Solution Summary

The rise of hip fractures is a major public health problem in terms of morbidity, mortality and costs to health and social care. Johnson & Johnson Medical Device Companies provides products and services to address the needs of hip fracture patients.

Our patient pathway solution, the Care4Today® Hip Fracture Care Program, is an evidence based care improvement program aimed to reduce variation and costs, improve outcomes and optimize care. In a case study with the Hip Fracture Care Program at the OLVG Hospital in Amsterdam, length of stay was reduced by 2 days, orthogeriatrician support was increased 48% and the hospital saved €252,000/year in costs.13 In addition, our hip fracture implants are designed to reduce the risk of complications associated with hip fractures and improve patient outcomes.

Our solutions help hospitals and healthcare providers to achieve their Triple Aim goals of enhancing patient experiences and improving outcomes, while reducing costs.

DePuy (Ireland)LoughbegRingaskiddyCo. CorkIrelandTel: +353 21 4914 000