December 28, 2017
Dear Kinamed Sales Agents and Representatives,
Please read this important message from Bob Bruce, VP Global Marketing & Product Strategy:
A Great CarboJet® Opportunity with DePuy Attune® Knee Surgeons!
As you have probably heard, there are published reports of significant numbers of tibial loosenings with the DePuy Attune total knee [1]. A number of high-volume knee surgeons have told us that they have seen this. In fact, DePuy has recently highlighted the importance of removing lipid/marrow material from the cement interfaces around the tibial component [2]. Over the last few weeks, a significant number of Attune users, and their reps, have sought out CarboJet as a means to improve their cementing technique, clearly indicating the tremendous opportunity before us. As you know, it is not very common for the surgeon to come chasing the manufacturer to obtain a product! The Attune situation is yet another strong “tail-wind” for CarboJet sales, in addition to the ongoing trend towards tourniquetless TKA, where the benefits include reduction of post-op pain and opioid use.[3]
As you know, CarboJet is extremely effective at removing lipids (fat and marrow) from trabecular bone. According to DePuy, lipids can contaminate the tibial base surface and can migrate up from the proximal tibia to the base plate during pressurization. The Attune design is also said to load across the joint in a more posterior position than other knees, resulting in a tendency to rock and lift the anterior part of the tibial component. DePuy is attempting to address the issue with the new Attune S+ which is more highly micro-textured and macro-textured at the cement interface than the original design. However, loosening typically manifests at about 3 years post-op and there have been over 500,000 of the original-design Attune knees implanted.
This episode really drives home the importance of achieving a clean, dry bone bed that reduces the upwelling of lipids during cement pressurization and ensures a good implant/cement/bone bond immediately and for the long-term bond, no matter what knee system is used!
DePuy’s Pain is Our Gain – How to Locate DePuy Attune TKA System Users in Your Area
You will want to capitalize on this opportunity right away. You can locate Attune users via the DePuy surgeon finder web page. Once you have done so, contact these surgeons immediately! Reach out to their DePuy rep as well, as you have a great opportunity to help each other out in this situation and that rep should be able to help facilitate your access to the surgeon. The DePuy reps should be responsive; as they have a problem that they are highly motivated to help their surgeons solve – and that problem is lipids!
Here are step by step instructions on identifying these surgeons in your area using the website:
First, go to this web address: https://www.depuysynthes.com/patients/find-a-doctor
- Go to the “Enter your zip code” box (labeled 1 in the image below) and search on zip codes in your territory.
- Click on the “Where does it hurt?” Dropdown (labeled 2) and choose “Knee”
- Click on the “Choose a procedure” dropdown (labeled 3) and choose “Knee replacement”
Next, expand the radius of the search (up to 100 mi) and make sure the only boxes checked on the right of the page are “Knee Replacement” and “ATTUNE Knee System”.
*Print your lists out right away as DePuy may decide to take the surgeon finder function off their site over concerns of ensuing litigation. ** Note, this is not a comprehensive list of all DePuy surgeons as many are not listed. You may want to identify key DePuy hospitals and then target surgeons at those hospitals.
If you would like us to help with mailings directly from Kinamed to surgeons in your territory, please let us know. Joe Larievy (jlarievy@kinamed.com) would be pleased to help you out with this.
If you have questions or would like to discuss these issues further, please contact me.
Bob Bruce
VP, Global Marketing & Product Strategy
Kinamed, Inc.
tel: 1-805-384-2748 x 202
fax: 1-805-384-2792
PS – Here are some quick calculations of sales potential with just a small number of additional accounts:
| Units Per: | Week | Month | Year | Sales | ||
| 5 | 20 | 240 | $37,200 | $155 | Tube Set ASP | |
| 10 | 40 | 480 | $74,400 | |||
| 15 | 60 | 720 | $111,600 | |||
| 20 | 80 | 984 | $152,520 | |||
| 25 | 100 | 1200 | $186,000 | NOTE: | “Units” refers to number of tubesets. | |
| 30 | 120 | 1440 | $223,200 | 1 tubeset per procedure: UKA, TKA, TSA, THA, Hip Fx |
[1] Bonutti et al (2017) Unusually High Rate of Early Failure of Tibial Component in ATTUNE Total Knee Arthroplasty System at Implant-Cement Interface. J Knee Surg 30:435-439.
[3] Meneghini (2017) Reducing Opiate Use: The Tourniquetless TKA. CCJR Winter 2017