HyProCure is not Arthroereisis
-
Upload
gramedica -
Category
Health & Medicine
-
view
3.382 -
download
0
description
Transcript of HyProCure is not Arthroereisis
Extra-Osseous TaloTarsal Stabilization (EOTTS)
Arthroereisis vs HyProCure®
There is a difference.Don’t be fooled.
Arthroereisis
• First of all it is pronounced
r-throw-ear-e-sis
– “operative limiting of the motion in a joint that is abnormally mobile from paralysis.”
Dorlands Medical Dictionary
“operative limiting of the motion in a joint that is abnormally mobile from paralysis”
• limiting of motion • in a joint (an articulation; the place of union or junction
between two or more bones of the skeleton, especially a junction that admits of more or less motion of one or more bones)
• that is abnormally mobile• from paralysis (loss or impairment of motor function in a part
due to lesion of the neural or muscular mechanism)
Arthroereisis
Arthroereisis
This is a procedure to “block” or limit joint motion.
J Bone Joint Surg Am. 1928;10:261-267.G. NOVÉ-JOSSERAND
Subtalar Joint Arthroereisis
This is a procedure to either block/limit or lift up the lateral process of the talus.
Subtalar Joint Arthroereisis
Prior to STJ arthroereisis this was the only other option.
Subtalar Joint Arthroereisis
This technique is focused on lifting and/or blocking the lateral process of the talus.
Plantar view of talus
Subtalar Joint Arthroereisis
The goal is to stop the anterior progression of lateral process by some method within the outer half of the sinus tarsi.
Arthroereisis
Historically , it was performed but cutting and inserting a bone graft into the calcaneus in front of the lateral process.
Long-term Results?
These methods usually failed due to the forces acting on the bone graft material and also since the bone remodeled and therefore failed to restrict lateral process motion.
Evolution of Subtalar Arthroereisis
Later, “newer” materials were used intra-osseously and inter-osseously to restrict talocalcaneal motion.
Arthroereisis Implements
Arthroereisis devices act solely within the
lateral half of the tarsal sinus.
Subtalar Arthroereisis
The end result usually lead to failure due to: – Its poor anatomic design – limitation in material– inadequate biomechanical function
Subtalar ArthroereisisExtra-Osseous Devices.
Due to the previously described limitations and need for something better combined with improved biomaterials, the first extra-osseous titanium device was inserted into the lateral portion of the sinus tarsi.
Subtalar Arthroereisis
• This device was a titanium version with enhancements of a polymer device.
• However, they were still placed in the same spot and had the same function- lateral arthroereisis
Arthroereisis Placement
This device is inserted so that the tip “touched” the bisection of the talus. These are placed in a lateral-to-medial orientation.
Function
This device acts as an anterior extension of the lateral process of the talus.
Talar Supination
There is no limitation of supinatory motion as the talus supinates.
Talar Pronation
As the talus moves from a supinated to pronated position the anterior extension of the talus hits against the posterior aspect of the anterior facet to block further pronation.
Lateral Arthroereisis Devices
Longer term results showed about a 40% removal rate due to device loosening along with other factors.
Subtalar Arthroereisis Device Evolution
• The device had a cylindrical design.• It should be noted that the outer sinus
tarsi shaped is conical not cylindrical. • Newer devices were designed with that in
mind as well as other features with ways to make device removal easier.
Subtalar Arthroereisis
Unfortunately, the new designs did little to decrease the overall removal rate.
Now its time to learn about a major evolutionary leap.
Extra-Osseous TaloTarsal Stabilization with HyProCure®.
Arthroereisis implants act here.
HyProCure® is not an arthroereisis device.
Arthroereisis implants act here.
HyProCure® stabilizes the talotarsal mechanism here.
Do you see the difference?
If not, go back and take another look.
HyProCure® is a talotarsal fixation device.
That is how HyProCure ® is classified with the
Food & Drug Administration.
Arthroereisis Implants
HyProCure® does not act as an anterior extension of the lateral process.
This is where arthroereisis devices are
placed.
This is where HyProCure® is
placed.
HyProCure® is placed deeper into the sinus tarsi.
HyProCure® transforms the abnormal “negative” sinus tarsi space into the normal “positive” space.
HyProCure® is medially anchored by the tissues within the canalis portion of the sinus tarsi.
Tissues within the canalis grow and adhere onto the threads to lock HyProCure in
place.
HyProCure® does not block or limit motion.
The leading edge of arthroereisis devices
come into contact with the calcaneus here.
Top view of the calcaneus
HyProCure internally stabilizes the talus at
the cruciate pivot point here.
HyProCure® stabilizes the talus at the cruciate pivot point to restore the talotarsal
axis of motion back to normal.
See the difference?It may not seem so different but it is the difference
between success and failure.
Normal amount of pronation and supination is still available.
HyProCure® stabilizes the talus on the tarsal mechanism while still allowing the normal
range of motion to occur.
If a wire, staple or screw is used to stabilize the talotarsal mechanism, there will be a complete
limitation of motion.
This is different from arthroereisis devices that
abruptly stops talar motion or arthrodesis which completely eliminates talotarsal motion.
Because of the unique anatomic design combined with the
improved biomechanic function, HyProCure® has a significant
less chance for removal.
Arthroereisis devices are like an octagonal tire.
It kind of works and is better than no tire.
Just doesn’t work so good and doesn’t last too long.
On the other hand…
HyProCure® is like putting a round tire on your car.
You’ve heard the saying
“form follows function”?
A round tire is meant to roll.
HyProCure® is designed to stabilize the talus while still allowing the
normal functions to occur.
This presents a revolutionary breakthrough.
It is a paradigm “shifter”.
It works.
Significantly lower removal rate.(nearly 6% compared to nearly 40%)
Just makes sense.
Leads to better outcomes.
Many are fooled into believing that HyProCure® is
“just another arthroereisis device”…
IT IS NOT!
HyProCure’s effect can benefit not only
the foot but it can lead to improvement
up the MSK chain.
HyProCure® truly “fixes” one thing…
TaloTarsal Dislocation
Dislocation- “the displacement of any part, more especially of a bone”-Dorlands.
TaloTarsal Dislocation (TTD)
This is the pathologic displacement (removal from the normal position) of the talus on the tarsal mechanism.
TTD
Does not “fix” itself
TTD
It is a progressive disease…it only gets worse and the signs and symptoms are far reaching.
TTD
This is an internal deformity occurring above the calcaneal (heel bone) and above the bottom of the foot.
Internal deformity = Internal Solution
HyProCure®