Futura Primus Flexible Great Toe Final

8/10/2019 Futura Primus Flexible Great Toe Final

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NAME OF THE TEAM

MEMBERS

1. HEATHER BATESON ()

2. JOSH HASTINGS ()

3. JOSHUA SABERY ()

4. MOHAMMAD NASFIKUR RAHMAN

KHAN (140587243)

Ne!"#$%e U&'e#'$*

FUTURA RIMUS FEIBEGREAT TOE


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Futura Primus Flexible Great

Toe

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To achie!e a total great toe joint replacement a ouble stemme implant is use" the first of

its in" mae from a silicone elastomer with a flexible hinge connecting the two

stems The purpose of the replacement is to replace an% missing or amage

cartilage in the joint where the great toe meets the foot The two silicon

parts glie easil% against one an other allowing the toe to mo!e Thispractice is most fre=uentl% use to treat a problem calle >stiff big toe? or

>allux -igius? This leas on from allux 6imitus where the

mo!ement an motion of %our great toe ecreases o!er time

causing the carriage in the joint becoming eroe This specific

implant is calle @The future Primus Flexible Areat ToeB of FAF It

was esigne using computer moelling to allow multiple esigns

to be compare This esign has progresse through generations" this being the

thir The esign has been teste an impro!e gi!ing an

optimum esign with more a!ance materials an

techni=ues [1#" 14]


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A&"$+*The FuturaE primus flexible great toe implant has been esigne b% Tornier for funamental

usage in a first metatarsophalangeal joint arthroplast% [1] Therefore the joint of concern

when ientif%ing the e% bones" muscles an ligaments is the first metatarsophalangeal joint"

the wor @firstB inicates that it is referring to the metatarsophalangeal joint of the great toe as

oppose to an% of the other lesser toes within the foot The funamental bones that connect

to either sie of the joint are the first metatarsal an the proximal phalanx as can be seen in

Fig1" a rotar% burr is use uring the arthroplast% operation to create the correct shape

slots in the aforementione bones in orer for the primus implant to be fitte [Fig2] The

hea of the first metatarsal bone is con!ex shape while the en of the proximal phalanx

that it is joine to is conca!e allowing seamless articulation $tabilit% of the first .TP is

pro!ie b% the capsuloligamentous,sesamoi complex in conjunction with the

aforementione bones This joint capsule consists of a number of ifferent ligaments" the

meial an lateral sesamoi ligaments" which can be sub,i!ie into the

phalangeosesamoi or metatarsosesamoi meial an lateral ligaments The function ofthese ligaments is to join both the First metatarsal an the proximal phalanx to both the

meial an lateral sesamois within the joint capsule ; sesamoi is a bone that is

embee within a tenon" an in this case the sesamois resie insie the tenons of the

flexor hallucis bre!is muscle ;nother important ligament is the intersesamoi ligament" this

simpl% eeps the two sesamois from being pulle apart within the joint capsule ;lso within

the joint capsule exists the plantar plate which is a fibrocartilaginousstructure joining the

proximal phalanx to the nec of the metatarsal" it pla%s an important part in supporting the

weight of the bo%" istributing this weight an restricting orsiflexion The muscles within

the hallux 'great toe( are also !ital" the flexor hallucis longus muscle !ia the flexor hallucis

longus tenon as well as the flexor hallucis bre!is muscle pro!ie the flexion mo!ement ofthe hallux The abuctor an auctor hallucis muscles pro!ie the extension mo!ement of

the hallux

F%e@'%e ';# Ge"$ T+e

Figure 4 Photograph '$creen $hot( of the great big toe jointuring surger%[)]

Figure * +,-a%s showing a normal first .TPjoint[1" 12]

Figure & +,ra% showing first .TP joint with

arthritis [1/" 12]
http://en.wikipedia.org/wiki/Fibrocartilagehttp://en.wikipedia.org/wiki/Fibrocartilage


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+"# "& M+$'+The function of the toes is to assist whilst waling" to pro!ie balance" to bear weight an to

ai in propulsion uring gait The 6argest of these joints capable of these actions is the first

metatarsophalangeal articulation The normal range of motion in a health% joint is 0/ of

orsiflexion which is the extension of the foot towars the shin an 4* of plantar flexion"

which is the flexion of the foot whilst on %our toes The joint is also able to abuct an auct

from the misagittal plane of the foot[1#" 1*]

The Primus Flexible Areat toe can hinge up to 5* on its axis without the Titanium grommets

from coming into contact with each other The proximal stem is also angle at 1* upwar

from the hallux to align with the natural form of the bo% This angle ajustment impro!es

the biomechanics from existing metatarsophalangeal joints an reuces stress place upon

the implant[4]

uring normal gait the metatarsophalangeal joint bears between 4/, &/G of the persons

weight This loa on the bo% occurs at the metatarsal heas To o this the joint must

continuousl% remain in contact with the groun from the transition of the foot from heel to toe

propulsion The loa that a normal joint is capable of withstaning can be up to three times

the personBs entire bo% weight in acti!ities such as running[5" 12]

The Primus Flexible joints ouble stemme eigne has pro!ie more trans!erse plane

stabilit% then competing joints" howe!er a negati!e a!antage of fixing the axis of rotation

solel% on the implant was an increase orsiflexion range which increase stress at the stem

hinge interface[4]

8linical research following these operations has foun that the weight bearing on the 1stan

2nmetatarsals changes rasticall% compare with a normal joint uring normal gait there

was an a!erage increase of &*G place on the 2nmetatarsal an a ecrease of 4#G on the

hallux which resulte in a high number of fractures on the secon metatarsal[5]

The transition from heel to toe is achie!e b% the 1stmetatarsal pi!oting against the proximal

phalanx of the allux b% 2/ The metatarsal hea must then slie o!er the articulating

surface of the proximal phalanx towars toe propulsion[0]

F%e@'%e ';# Ge"$ T+e


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+6"'#'+ $+ "%$e&"$'e '6"!$#The hemi,implant which was first introuce in 15&0 an was initiall% !er% popular" but toa%

it is infre=uentl% use at all Instea of two stems" lie the Primus" a hemi,implant onl% hasone stem implante $e!eral companies prouce hemi,implants" howe!er %ears of

experience has shown that the life span on these implants are relati!el% short an ha!e

cause a consierable amount of complications The ioPro First .P3 emi Implant boasts

that the hemi implant is simple to implant an remo!es the minimum amount of bone

possible

The ouble,stem total implant was introuce in 1504 b% $wanson It is extremel% similar tothe Futura Primus implant oth are mae from $ilicone 9lastomer an both use titanium

grommets The $wanson was originall% not a bran new esign" but a moification of a han

implant" just with thicer stems

The 6awrence an 6aPorta Implants were release in 15)2 The% were esigne to offer

impro!e function an mo!ement Their tapere stems are angle at 1* egrees to replicate

the eclination angle of the first metatarsal

F%e@'%e ';# Ge"$ T+e

Figure 0 showing the !arious angles of the foot uring propulsion[0]

Figure 1/ $wanson esign" silicon ouble,stemme" hinge implant[#]


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Futura iomeical were the first to use Cltra$I6 silicone elastomer for its implants in 1550

This material was !er% a!ance compare to pre!ious materials use b% its

competitorsThe Futura Primus Flexible Areat Toe" lie the 6awrence an 6aPorta implants"

has an angle proximal stem to correspon with the natural metatarsal eclination angle

The hinge is highl% engineere to offer a 5* egree range of motion" which is greater than

the natural motion of this joint

Be&e$# "& D""!9# +: $e +#$e#e#;s with all Implants there are positi!es an negati!es when compare to other similarl%functioning implants an the natural joint 8urrentl% there are no joint replacements out there

that are as goo as or better than the natural joint but the% are !ast impro!ements o!er

isease or estro%e joints

The Primus Flexible great toe joint is prouce from a fourth generation $ilicon Pol%mer"

when compare to pre!ious silicon joints it has much impro!e properties It has a higher

tensile strength an greater resistance to tearing an wear

The main reasons for the use of implants is to gi!e the recei!er a greater egree of pain free

motion an to impro!e the cosmetics of the eforme toe cause b% allux !algus The

Primus Flexible pro!ies 5* egrees of motion which is within the normal range of a full%

operating joint of 5/ to 12/ egrees of motion an ue to its axial offset b% 1/ egrees the

stress on the prosthesis is reuce which impro!es biomechanical function[5]

8ompare with other similar implants the Primus has a trapeHoi stem cross section the

same as the anatom% of the intrameullar% canal an onl% simple instrumentation is neee

to fit the implant[1&]

owe!er there are man% rawbacs to $ilicon being place in the bo% the main one being

$ilicon s%no!itis" the inflammation of the joint tissue cause b% the micro silicon particles

being issociate from the implant 8haracteristics of this occurrence is pain within the joint

when in motion" a se!ere loss of motion" implant fracture" subluxation an the worst being

F%e@'%e ';# Ge"$ T+e


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the estruction of bones ue to the growth of


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Figure 1# table $howing the class IIb meical e!ices 7 routes to 89 maring[*]


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%'&'!"% "& "+"$+* "#e $e"$e&$# "& e#;%$#There are a !ast arra% of 1st.TP joint implants on the maret" so it woul follow that there

are a !ariet% of ifferent clinical an laborator% test results a!ailable to anal%se The

following results specificall% relate to the primus first .TP joint ouble,stemme silicone

implant[1)] ; lin was foun on the K8I 'national centre for biotechnolog% information(website containing post,operati!e anal%sis etails on the aforementione implant ; total of

144 patients were in!ite to participate" an between them the% represente 2/1 implants

'*0 patients ha both of their 1st.TP joints replace( The post,operati!e anal%sis perio

range between #2 an 1/) months with an a!erage of &&4 months owe!er onl% *4

patients representing 0/ implants respone to the in!itation 'the low participation rate is

possibl% inicati!e of patient satisfaction( The stu% that the patients were subject to

consiste of the following: Lisual ;nalogue $cale" Foot an ;nle 'L;$ F;( patient outcome

an satisfaction =uestionnaire" clinical examination" an +,ra% e!aluation ecause of the

nature of the anal%sis" the scale create b% the ;


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+&!%;#'+&There are man% ifferent t%pes of implant a!ailable for the replacement of the Areat Toe

3oint The% ha!e progresse through # generations of aaptations an impro!ements The%

!ar% from single stemme implants" ouble stemme" tapere an angle

The Futura Primus Implant offers one of the most a!ance of these esigns" combining

C6T-;$I6D meical grae silicone elastomer with titanium" one of the most bio compatible

materials ItNs tapere" angle stems allow a more natural metatarsal eclination angle

F%e@'%e ';# Ge"$ T+e


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Re:ee&!e#>1. S!'e&!e J.+.O.Ankle Hind foot scale. Se6 200=C A"'%"%e :+>

$$6>.&!'.&%.&'.,+6!"$'!%e#M27=7841$"%eT"1 .2. B'++. FIRST MPJ HEMI IMPLANT. 2014C A"'%"%e :+>$$6>.'+6+'6%"&$#.!+#$6e' .

3. I&!. .M.T. SWANSON Titanium Geat Toe Im!lant. 2005C A"'%"%e :+>$$6>."$e.eB'%e20026:"$e'e"+&$'$"&e.6:.

4. T+&'e I. Futua" FoeFoot At#o!last$. 2014 10$ O!$+e 2014/CA"'%"%e :+> $$6>.$+&'e;#.!+%+e:++$:++e!001F.

5. MHRA. %lass II &'( Medical de)ices. J;&e 2013C A"'%"%e :+>$$6>.".,+.;9+e,+;6#$##+!;e&$#e#'$ee#+;!e#!+&28?77?.6:.

?. S;66%'e# G. Tonie *+ Futua Pimus Fle,i'le Geat Toe &FGT(. =$+!$+e 2014C A"'%"%e :+> $$6#>.*+;$;e.!+"$!

,;H'*e$$6>."#+;!e.;#!%'&'!0303 .

12. S+!'e$* A.O.F.A. Foot%aeM*/. F'#$ MT J+'&$ Re6%"!ee&$ 2014CA"'%"%e :+> $$6>."+:"#.+,:++$!"e$e"$e&$#",e#F'#$MTJ+'&$Re6%"!ee&$."#6@.

13. '9'6e'".Anatomical Tems of Motion. -!'$e 2014 25$ O!$+e/CA"'%"%e :+> $$6>e&.'9'6e'".+,'9'A&"$+'!"%$e#+:+$'+&.

14. '9'6e'". Titanium 'iocom!ati'ilit$. A"'%"%e :+> T'$"&';'+!+6"$''%'$*.

15. :++$E;!"$'+&. 0ones and Joints of t#e Foot and Ankle O)e)ie1. 2?$ J;%e

2014C A"'%"%e :+> $$6>.:++$e;!"$'+&.!++&e#"&+'&$#+::++$"&"&9%e+e'e.

1?. B""9' S. IMPLANTS OF SMALL JOINTS IN HAN*. 14$ A;,;#$ 2013CA"'%"%e :+>$$6>."!"e'".e;5?3?87=I6%"&$#+:#"%%+'&$#I&H"&S"'&eB""9'.

17. '&" K. T'%++9 ..B. MD He"%'+ O$+6e'!# O!$+e 2011. 34(10>745 81?818).

18. E@e%%e&!e N.I.:.. Inte)entional !ocedues o)e)ie1 of !ost#etice!lacement of t#e #allu,2Fe;"* 2005(282).

1=. B;!e R "e&!e E.T.A etos!ecti)e e)ie1 of t#e !imus 3st MTP .ointdou'le4stemmed silicone im!lant2De!ee 1 2103(?> 471478).

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797841/table/Tab1/http://www.bioproimplants.com/first-mpj-hemi/http://www.amt-med.de/Bilder2002/pdf_dateien/swanson_titan_zeh.pdfhttp://www.tornier-us.com/lower/foot/foorec001F/http://www.mhra.gov.uk/home/groups/dts-bs/documents/websiteresources/con286776.pdfhttp://www.mhra.gov.uk/home/groups/dts-bs/documents/websiteresources/con286776.pdfhttp://www.youtube.com/watch?v=gzuHWiyedQshttp://www.youtube.com/watch?v=gzuHWiyedQshttp://www.thealliancepsp.com/CPD/FIRST%20METATARSOPHALANGEAL%20JOINT%20ACTION.pdfhttp://www.thealliancepsp.com/CPD/FIRST%20METATARSOPHALANGEAL%20JOINT%20ACTION.pdfhttp://www.youtube.com/watch?v=gzuHWiyedQshttp://www.youtube.com/watch?v=gzuHWiyedQshttp://www2.kent.edu/cpm/academics/library/hallux/HV-ch-24-First-Metatarsophalangeal-Implants.pdfhttp://www2.kent.edu/cpm/academics/library/hallux/HV-ch-24-First-Metatarsophalangeal-Implants.pdfhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797841/table/Tab3/http://www.radsource.us/clinic/0303http://www.aofas.org/footcaremd/treatments/Pages/First-MTP-Joint-Replacement.aspxhttp://www.aofas.org/footcaremd/treatments/Pages/First-MTP-Joint-Replacement.aspxhttp://en.wikipedia.org/wiki/Anatomical_terms_of_motionhttp://www.footeducation.com/bones-and-joints-of-foot-and-ankle-overview/http://www.footeducation.com/bones-and-joints-of-foot-and-ankle-overview/http://www.academia.edu/5636879/Implants_of_small_joints_In_Hand_Samineh_Barmakihttp://www.academia.edu/5636879/Implants_of_small_joints_In_Hand_Samineh_Barmakihttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797841/table/Tab1/http://www.bioproimplants.com/first-mpj-hemi/http://www.amt-med.de/Bilder2002/pdf_dateien/swanson_titan_zeh.pdfhttp://www.tornier-us.com/lower/foot/foorec001F/http://www.mhra.gov.uk/home/groups/dts-bs/documents/websiteresources/con286776.pdfhttp://www.mhra.gov.uk/home/groups/dts-bs/documents/websiteresources/con286776.pdfhttp://www.youtube.com/watch?v=gzuHWiyedQshttp://www.youtube.com/watch?v=gzuHWiyedQshttp://www.thealliancepsp.com/CPD/FIRST%20METATARSOPHALANGEAL%20JOINT%20ACTION.pdfhttp://www.thealliancepsp.com/CPD/FIRST%20METATARSOPHALANGEAL%20JOINT%20ACTION.pdfhttp://www.youtube.com/watch?v=gzuHWiyedQshttp://www.youtube.com/watch?v=gzuHWiyedQshttp://www2.kent.edu/cpm/academics/library/hallux/HV-ch-24-First-Metatarsophalangeal-Implants.pdfhttp://www2.kent.edu/cpm/academics/library/hallux/HV-ch-24-First-Metatarsophalangeal-Implants.pdfhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797841/table/Tab3/http://www.radsource.us/clinic/0303http://www.aofas.org/footcaremd/treatments/Pages/First-MTP-Joint-Replacement.aspxhttp://www.aofas.org/footcaremd/treatments/Pages/First-MTP-Joint-Replacement.aspxhttp://en.wikipedia.org/wiki/Anatomical_terms_of_motionhttp://www.footeducation.com/bones-and-joints-of-foot-and-ankle-overview/http://www.footeducation.com/bones-and-joints-of-foot-and-ankle-overview/http://www.academia.edu/5636879/Implants_of_small_joints_In_Hand_Samineh_Barmakihttp://www.academia.edu/5636879/Implants_of_small_joints_In_Hand_Samineh_Barmaki

Futura Primus Flexible Great Toe Final

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