ALEX FUENTES, EMOVI
Osteoarthritis (OA) is known to be one of the most disabling chronic conditions, leading to pain and limitations in both daily living activities and work. It is the most common form of arthritis, and it is described as a degenerative disorder. In Canada, there are more than 4.6 million people living with OA. With the aging population, the increasing life expectancy and the growing obesity prevalence, OA prevalence in Canada in 15 years old and older is expected to increase from 10% to 20% by 2026. This pathology mostly affects hip and knee joints. It is estimated that about 1 out of 4 people older than 65 years old in the province of Quebec is suffering from knee osteoarthritis.
The cause of knee osteoarthritis is multifactorial. Some risk factors are non-modifiable, such as age, gender and genetics, but other can be addressed within the treatment plan such as obesity and joint-level factors (joint mechanics, alignment, previous injury, etc.). It is well establish, clinically and scientifically, that a faulty joint mechanics is directly linked with the development and the progression of knee OA and more so, during walking. To this date, there is no cure for knee OA, but conservative management aims at delaying the progression of the pathology while improving patient’s symptoms and function. Despite numerous non-surgical clinical guidelines published by renowned committees, the recommendations on the optimal care pathway are not well put into practice. This might be one of the reasons why the ultimate treatment for knee OA, which is total joint replacement surgery, is increasing rapidly. In 2013-2014, with 11,207 knee joint replacement in the province of Quebec, its represents a 42,4% increase over the last 5 years in the province (the mean increase Nationally is 22.9%).
OA is also one of the most important chronic diseases in the use of health services. In 1998, the economic burden of arthritis in Canada reached about $4.4 billion (direct and indirect cost). This can be attributed to multiple factors: the long time between the onset of symptoms and the diagnosis, the inadequate patient management by general practitioners with inappropriate use of costly imaging such as MRIs, unsuitable referrals to orthopaedic surgeons for which patient are frequently returned to their family doctor since they are not surgical candidate (about 50%), and the increasing number of joint surgery.
Current non-surgical management focussed on pain and weight management and not on addressing the other causes of the pathology. Clinical studies demonstrated that patients are unsatisfied with the current continuum of care in OA, leading to less treatment compliance and the use of more alternative medicine. The same study also highlighted “the other side of the coin” with physicians finding difficult to elaborate adequate treatment strategy, they are looking for new tools to help them guide the care pathway. Current imaging methods do not correlate well with patient symptoms and provide limited information to guide the treatment. A key opinion leader in osteoarthritis, the rheumatologist Dr D Hunter stated that “Greater therapeutic attention to the important role of mechanical factors in OA etiopathogenesis is required if we are to find ways of reducing the public health impact of this condition”. However current methods to assess knee joint mechanics (mechanical factors) are not applicable into the clinical setting due to technical limitations (space required to assess patients, time of the evaluation and interpretation, accuracy of the data, etc.).
A local innovation
The Laboratoire de recherche en imagerie et orthopédie (LIO) from the École de technologie supérieure (ÉTS) in Montreal under the supervision of Professor Jacques A. de Guise have been working on a 3D knee analyzer that could fill that clinical need. In the early 1990s, this multidisciplinary team of engineers, doctors, rehabilitation and exercise specialist, started to develop a unique device that would allow assessing the three dimensional movements of the knee while the patient is performing dynamic tasks. These scientists published multiple peered reviewed papers on the validation of the technology, which was then followed by numerous clinical studies. The innovation in knee functional assessment had reached an impressive scientific and clinical recognition.
In the late 2000s the LIO partnered with Emovi Inc, a local small medium-sized enterprise from Montreal to achieve the knowledge transfer “from bench to bedside” of the technology. Regulatory approvals, simplification of the hardware for easy clinical integration, adjustments to for a user-friendly interface, automatic data interpretation, and generation of report with clinical actionable data were some of the key steps needed to go from a research tool to a clinical tool. During that process, the technology was baptized, the KneeKGTM, which is a play of word with the EKG (electrocardiogram). Both technologies assesses human function and provides valuable information to help health care professional optimize the patient’ care pathway.
Local innovation at the service of patient
In 2009, the Centre du genou clinic based in Laval was the first clinic to offer the KneeKG exam for measuring, documenting, and aiding in the rehabilitation, pre-intervention planning, and conservative management of knee pathologies, such as OA. The innovation is unique in the sense that it allows to identify and measure faulty functional issues previously reported to be link with an earlier onset or faster progression of OA. Since these deficits cannot be identified through a visual assessment and are not assessed by imaging investigation (x-ray, MRI), it makes the KneeKG valuable in patient management.
With the known clinical limitations in knee OA management, the Clinic developed the My Knee Osteoarthritis program; a program founded on evidenced based recommendations from renowned international clinical committees with the key addition of the KneeKG exam. Assessing and monitoring known OA mechanical risk factors allows health care professionals to better define and develop personalized approach for each patient, leading to better clinical outcomes while reducing costs. The technology also allows patients to better understand the source of their pain and therefore increase the adherence to the treatment.
A recent analysis of the My Knee OA program published in the scientific journal Osteoarthritis and Cartilage demonstrated that this multimodal conservative management of knee OA based on a functional assessment (KneeKG) allows to improve patient outcomes even if they were previously manage by their family doctor. Indeed, validated questionnaires showed that patients significantly reduced their pain and symptoms, while improving their quality of life, function in daily living activities and function in sports and recreation. Results at the 10 months follow up showed a socio-economical impact by reducing absenteeism, reducing regular intake of medication and analgesics, and interestingly postponing for 7 out of 11 patients initially scheduled for a joint replacement their surgery because they were doing better.
The program has gain national recognition and his described on the Bone and Joint Canada website. Although the KneeKG is already exported in Australia, France, United-States, Switzerland and China, discussions are ongoing to implement this program in these countries. To further demonstrate the impact of the “My knee OA program” and the use of KneeKGTM on clinical outcomes and health care related costs compared to the current medial practice in the province of Quebec, a randomized clinical trial on 2000 patients is currently in process.
It is with great pride that through this innovation we can underline the merits of researches, clinicians and industrial partners from the province of Quebec working together to bring this breakthrough technology to the service of patients in Quebec and around the world. This is only one of many technologies for which the idea originated from Quebec and was realized here by local experts.
Vice-president Clinical Affairs
Testimonials of patient participating in the My Knee Osteoarthritis program:
They offer precious information and advice. Their exercise program helped me improve my quality of life. I can now look to the future with more confidence. I no longer need my cane and I feel more self-sufficient.
Mrs. M. Gagnon
It's a disciplined approach with qualified professionals who inspire confidence and know how to convey relevant information. They offered me an exercise program tailored to my condition. Excellent program.
Mrs. L. Lacaille
I'm satisfied with the program because it helped improve my condition. As an ex-athlete, I'm now capable of practicing sports much more than expected.
Mr L. Gagnon
The program provided me with precise information on my condition. This new awareness helped me manage my pain.
Mrs. M. Dupont
I'm satisfied across the board. They helped me resolve my issue by giving me exercises and following up on my medical condition. I resumed my activities and my morale has considerably lifted.
Mr J. Dupont