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It’s Better Knee Replacements Through Chemistry, Literally

DJO GLOBAL

CEO: Mike Mogul.

Revenue: $1.1 billion in 2011; $966 million in 2010.

No. of local employees: 449.

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Investors: The Blackstone Group L.P.

Headquarters: Vista.

Year founded: 1978.

Company description: A leading global provider of high-quality orthopedic devices, with a broad range of products used for rehabilitation, pain management and physical activity. DJO Global is the largest non-surgical orthopedic rehabilitation device company in the United States and among the largest globally, as measured by revenues.

There are vitamin-enriched foods, bottled water with added vitamins and now — taking it several steps further —vitamin-fortified knee replacements.

DJO Global’s new technology intended to extend the life of knee replacements is being introduced locally at Tri-City Medical Center where Dr. James Helgager recently implanted one of the first vitamin E total knee replacements.

Helgager, an orthopedic surgeon who has performed several thousand knee replacements during a career that spans more than 30 years, is among the first surgeons nationally to use e-plus (e+) in conjunction with the 3DKnee, both of which are developed, manufactured and distributed by DJO Surgical, an Austin, Texas, division of Vista-based DJO Global.

Although the 3DKnee has been available for more than eight years as a knee replacement designed for improved strength, stability and mobility, e-plus was released on a limited basis to select surgeons in 2011 and has only been commercially available since early 2012.

Time for a Change

Helgager said orthopedic literature indicates 640,000 knee replacements were performed in the U.S. in 2009, and that number is expected to double in the next 10 to 15 years. He said in his experience, implanting 200 knees a year, as many as 95 percent of the patients are satisfied — their pain is essentially gone — and they have good function and stability of the knee, but concerns remain over the longevity of the knee replacements.

“We think these will last 15 to 20 years, but with our aging population and people being active as they’re getting older there’s concerns the knees are not lasting as long as they’d like,” said Helgager, who is the medical director of Joint Replacement for the Orthopaedic & Spine Institute at Tri-City Medical Center in Oceanside.

Helgager turned to e-plus as an option as it’s touted for its ability to improve the knee material’s strength while preventing polyethylene degenerating oxidation.

John Vinciguerra, director of advanced technologies for DJO Surgical, a division of about 180 employees that focuses on joint replacements of hips, knees and shoulders, said knee replacements typically consist of two metal portions — one placed at the end of the thigh bone and one over the top of the shin bone, or tibia — and a plastic portion generally made of polyethylene that is fitted between the metal inserts. The polyethylene tends to oxidize over time similar to the way an apple turns brown or a metal fence rusts, he said. The vitamin E in e-plus helps prevent oxidation and consequently the polyethylene lasts longer, he said.

“The vitamin E is blended directly into the resin before we actually compression mold the product,” said Vinciguerra. “The vitamin E eats up all the free radicals and prevents oxidation.”

Vinciguerra said a simulated test with the e-plus and a DJO device resulted in a 57 percent reduction in wear rate compared with conventional polyethylene. The product was developed over a span of four years and more than 26 tests were run to get FDA clearance in 2010, he said.

“This seems to be a promising step forward in terms of reducing the wear rate of polyethylene and it allows the knee replacement to last longer,” said Helgager.

How much the life of the replacements is extended will have to be seen in actual users.

Expanding Market

Now more than 50 percent of the 3DKnees sold are in conjunction with the e-plus rather than conventional polyethylene, Vinciguerra said. And DJO is introducing a vitamin E version of a Patella, or knee cap, that commonly wears out as well.

Donald Dawkins, vice president of strategic integration for Tri-City Medical Center, said that while DJO is just one of many corporations Tri-City works with, a concerted effort is made to support industries in the San Diego region that are creating innovative products that benefit the patients and the community.

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