For many patients with symptomatic knee osteoarthritis (OA), clinical management reaches a frustrating plateau. Having an inadequate response to conservative modalities including physical therapy, NSAIDs, and injections these patients can find themselves trapped in a treatment gap: conservative therapies aren’t providing relief and they are either not-yet indicated for, or unwilling to undergo, knee replacement.
Historically, orthopedists have not had much to offer these patients for effective relief. Concurrently, healthcare executives are seeking to expand specialized, high-efficiency service lines within Ambulatory Surgery Centers (ASCs).
The MISHA® Knee System directly addresses this clinical and operational inflection point. Backed by 15 years of empirical research and granted FDA authorization in 2023, the MISHA Knee System is an implantable shock absorber (ISA) designed to mitigate medial compartment loading1. The technology allows orthopedic surgeons to intervene effectively within the contemporary treatment gap, offering a structured surgical alternative for patients who have exhausted non-operative care but are not candidates for, or are unwilling to undergo, TKA.
“Patients with knee osteoarthritis don’t just lose cartilage; they lose their lives, in pieces,” Mark Galland, MD, at OrthoNC in Wakefield, N.C., said. “Little by little, they give up what they love, until they’re living for their knee instead of living at all. The MISHA implant helps them take it back.”
Clinical and Operational Synergy in the Ambulatory Setting
The MISHA Knee System, which allows immediate weight-bearing, is well-suited for the ASC ecosystem, where optimized clinical flow and predictable outcomes drive value.
The ambulatory model provides highly focused, specialized care delivered by a dedicated clinical team, isolated from the operational friction and competing resource demands typical of large, multi-specialty tertiary hospital systems.
“We understood early on that MISHA had the potential to be a high-volume procedure at our ASC,” Emily Mader, Chief Financial Officer and practice administrator at OrthoNC, said.
For ambulatory platforms, integrating this system establishes a high-yield service line that maximizes facility utilization and captures an untapped patient pipeline. Because operational efficiency is paramount in the ASC environment, adoption is designed to be seamless. There are no upfront costs as product is delivered on the day of the case and there is no capital investment required. Additionally, there are no minimum purchase requirements and MISHA will not interfere with any existing vendor commitments.
“From an operational standpoint, MISHA was easy to adopt and has resulted in service line revenue growth and new patient acquisition,” Lisa Johnson, director of surgical services at OrthoNC, said.
For facilities with established sports medicine or orthopedic programs, the MISHA Knee System serves as a highly compatible extension. Furthermore, pioneering ASCs have successfully established predictable reimbursement pathways across a diverse payer mix, including commercial carriers, Medicare, and the Veterans Health Administration (VA).
“By offering this procedure at an ASC, we aren’t just changing the location of the surgery, we are optimizing the entire clinical pathway,” Dr. Galland said. “Patients benefit from a more personalized touch from a specialized staff and the psychological benefit of returning to their homes more quickly.”
1. Ranawat, A., Flanigan, D., Crawford, D., et. al. 5-year results of an implantable shock absorber demonstrate durable outcomes in patients with medial knee osteoarthritis. JBJS Open Access, 11(2), Article e25.00187. https://doi.org/10.2106/JBJS.OA.25.00187
INDICATIONS FOR USE: The MISHA Knee System is indicated for patients with medial compartment knee osteoarthritis that have failed to find relief in surgical and/or non-surgical treatment modalities and are still experiencing pain that interferes with activities of daily living and are also unwilling to undergo or ineligible for total knee replacement due to age or absence of advanced osteoarthritis.
See IFU for a complete list of indications, contraindications, warnings and precautions.
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