DOST develops knee replacement at half the cost of regular treatment

July 27, 2015




A LOCALLY designed and manufactured replacement to problem knees is now available, at half the regular price.

The Axis Knee System was developed by Filipino inventor and entrepreneur Dr. Ramon Gustilo, an orthopedic surgeon, and first made available only in May.

Half of the 2.5-year, P150-million research and development cost was funded by the Philippine Council for Health Research and Development (PCHRD), Department of Science and Technology.

“About 100,000 Filipinos need knee replacements, according to our estimates,” Jude L. Sasing, president of Orthopedic International, a 60-person orthopedic device manufacturing company based in Cabuyao, Laguna, said yesterday in a PCHRD forum. 

“A painful knee is disabling, and in extreme conditions prevents walking, standing, going up or down the staircase,” said Sasing, a biomedical engineer. “The cartilage in the knee doesn’t regenerate although it is replenished naturally. If it is completely worn out, it needs to be replaced after other alternatives like weight control, pain killers and other treatments have been explored. If one lives long enough, arthritic patients will eventually need knee replacements.”

He said about three percent of Filipinos are arthritic. 

“We didn’t invent knee replacement,” Sasing explained. “What’s new is that the knee replacement is designed for Asians.” Orthopedic International also focused on the instrumentation that dispenses of the one year training required by conventional replacement procedure. 

This is true not only in the Philippines; many other Asian countries need skilled surgeons to do the procedure, he said. “There’s a big market out there, we have a system that other orthopedic surgeons in other countries can use, so it can expand beyond the 2,000 Filipino patients now needing knee replacements a year.

“Knee implants need to be aligned right relative to the patient’s bone, which needs specialized skills,” he pointed out. “There are computer-aided navigation, an instrument that costs P25 million which is why there’s only one in Manila and another in Cebu. This instruments also ups the cost of surgery by P25,000.”

The technology does the alignment without the computerized navigation, Sasing said. 

“This is where our innovation comes in–we measure the center of the knee, center of the ankle and center of the hip, the part where computer navigation comes in. Our mechanical axis finder is an instrument that measures from the center of the hip to the center of the knee to the center of the ankle–all must be aligned right,” he added.

The rejection rate is very low because the replacements use standard implant-grade materials , a super alloy made of cobalt chromium and polyethylene.

“After the procedure, the patient can do ballroom dancing, bowling and is ambulant without crutches,” Sasing said, adding it will take 20 years before replacement is required.

The local knee replacement each costs P60,000 in government orthopedic hospitals and P70,000 in private hospitals, or about half the cost of imported knee implants. The one-and-a-half hours procedure and about three days of hospitalization needed for a conventional knee replacement procedure costs about P250,000 to P450,000 for the whole procedure, including professional fee, hospitalization and medication.

One reason for the high cost is that there are only 60 orthopedic surgeons qualified to do joint replacement surgery in the Philippines where just 2,000 procedures are conducted each year. 

The technology should increase the number of qualified surgeons from about 700 orthopedic surgeons in the Philippines today. “With our simple procedure, many would be qualified to do it,” Sasing said.

Since May, the procedure has been made on five patients, including a priest, lawyer and school teacher–all senior citizens.

The implant is approved by the Department of Health’s Food and Drug Administration; “we’re walking on its approval by the US FDA,” Sasing said. Patent is pending, a process that takes about five years to complete.

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