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A-1175 Silicone MCP and PIP joint arthroplasty – still the gold standard?
Kevin Chung, USA
Friday, June 15, 2018 · 2:01 p.m. · 13m 32s
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00:00:03
we have this going on there to please thank you a graph and walking back from a good on the for lunch
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this is gonna be really interesting uh symposium it might charges
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to uh put it in there yeah controversial format with the silicon
00:00:18
p. i. p. and c. v. joint are still the standard
00:00:23
but it wasn't a case i think it's good to look at a case to set
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the context what we're talking about this is a fifty three year old female
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that i met many many years ago when i first saw the pact is just osteoarthritis of the laugh index
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p. i. p. joint after previous what's injury and she has no function of the drawing with intractable pain
00:00:43
so what do we have that we have some local we actually don't know how many other choices silicone or fusion
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so i perform a index finger out of plastic which at that time this almost
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sacrilege because of the the uh fear maybe they join made the subject
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but nevertheless this all x. ray you can see the p. i. p. joint of index finger quite optimistic and deviated
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i use it was so approach and i put in a silicone
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implants two month after surgery this is what she is she
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doesn't have much motion when compared to p. obviously other pain this
00:01:19
whole lot better five months later implants eating very well
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and a years later she could tina come say hello to me she likes me and come to
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see me every few years to say hello and then look at the joint not much motion
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but she's happy because a joint is not this located and there is virtually no okay
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now she came in and said i'll touch on my other finger is for the what can you do
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well this is doing the power cop and time and we have a service we place that implants what that is that
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well even those local well for a years let's try new
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technology so i put and a power comet implant
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you can see that index finger is quite often looks very similar to the other side and this is a entrap the picture
00:02:05
the power comment was put in using that was sort approach three months later same as the
00:02:11
other side the pain is a whole lot better but the motion is not much better
00:02:16
and it's three months later and you come in to see me every year just to say hello thirty
00:02:21
months later both sides similar function no pain and
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this is say x. ray from thirty month
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and then this is my most recent followup picture i don't know what you can see well but comparatively seven
00:02:36
years after the power car but more recently and fifteen
00:02:40
years after so local low side of the same
00:02:45
so now you pose the question how this one choose given that you have the same patient with the
00:02:51
same finger with the same how come how do you choose the right operation for the patient
00:02:56
and this is a really nice chronology uh p. i. p. implant off across the done by uh my fellow
00:03:02
which euro from another university which are sitting over there with his very nice pasta he brought up
00:03:08
would that all his fellows come and train with me thank you very much yeah but but my my impression is that
00:03:15
we have a uses so look on for so many years i'm sure of it and a very nice study
00:03:20
the chronology all the advancements of implant out of plastic
00:03:24
so current here it of surveys replace making fun
00:03:27
so where's the technology in the go to silicone implant is a historic implant has a lot of good properties
00:03:34
such as joint space maintenance you have joint motion there is the put it really inexpensive
00:03:41
and once they fail it's you can replace it easily
00:03:44
easy to manufacture has so many wonderful properties
00:03:48
but if you look at this in fact is not an atomic imply is simply a piece of so look or a space
00:03:56
so with the advancement of awful plastic why can't be events than using imply that look like this
00:04:03
well we have an atomic imply the common apparel cobb and we have so many other
00:04:08
and uh tommy implies nowadays you look at this implant it has the inherent already
00:04:13
of a p. i. p. join it looks beautiful the colours beautiful as well and handling qualities
00:04:18
so wonderful we also the use and city use i use a park ave implied
00:04:23
and uh it was first used the n. c. p. joint but because the data for the p. i. p. joint
00:04:28
has not be fully established in the us at least at this point is only through humanitarian device exemption
00:04:35
so that's another case sixty euro would diffuse oh april o. hands
00:04:41
very nice lady and this is all all picture from so many years ago you came in with
00:04:47
intractable pain similar to the other lady at a. p. i. p. join for the index and
00:04:51
middle finger i put in one implant and three months later she did pretty good
00:04:57
implants it's okay and then one year later i put it another in fine for the middle
00:05:02
finger you see the one your follow up with after class the a one year
00:05:06
follow up is insufficient you would need to continue the vocational but hard as your yearly
00:05:12
basis at three year ten month she's not paying the joint doesn't move very well
00:05:18
i started to see a little problem currency index finger p. i. p. joint start subsiding and
00:05:23
start this okay she didn't have much discomfort so didn't do anything five years later
00:05:29
now she has a problem to join is totally dislocated and
00:05:33
the joints the bone already there's really no cost integration
00:05:37
the uh subsidence it's a big problem subsequently eleven years later would have to fuse it to give her a function hand
00:05:45
and this is the x. ray with a fusion of the index finger p.
00:05:48
i. p. joint and then the uh middle finger still works okay
00:05:54
so given that the power power but the sofas replace an implied doesn't have a longevity and
00:06:00
the only option when if they all the p. i. p. door level is a fusion
00:06:04
why do we even want to use that in fact have stopped using the power common implies because of
00:06:08
this measles because invariably you would fail there is some of the picture that you have c.
00:06:13
but what about so call now can i actually go back to my
00:06:16
historical perspective or uses so the call what about the exposure
00:06:21
but also approaches look awful classic p. acted one really easy very easy however
00:06:27
some of our colleagues such a starter herons and simmons from switzerland
00:06:31
have actually explore the differences between the doors of all approach the problem with that was approaches silicone
00:06:36
implant insertion is that you have to disrupt accents attend which invariably give you extension that
00:06:42
they have gone wholly which is much more difficult in a very tight space to put in the
00:06:47
silicone implants and i start doing that so how does one ships let's look another case
00:06:53
if you want the most difficult patient to take care of pick a musician
00:06:59
in the little finger that is the most the focal combination this is a musician in the
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orchestra actually does the for the living shit common with the p. i. p. joint circle
00:07:09
that is very painful for the little finger a musician we cannot use the little
00:07:14
finger is a disaster so this is a high profile case to be
00:07:19
and this is my first case of trying the ball approach for the p. i. p. joy
00:07:24
you can see the little finger p. i. p. joins very destroyed and the insert a reasonable approach remember readable
00:07:30
approach is absolutely no need to to shock on the joint you retracted tendons and then you cut the
00:07:37
the head of the problem of alex and the joys fully exposed or you have to be made precise in the middle because it's
00:07:43
easy to pull free of all the cortex of the approaching is
00:07:47
not precise anyway the implant was put in four months later
00:07:53
and this is remember as a musician for little finger
00:07:57
i can see the implants it's quite well
00:08:05
this is the whole approach i think of all approach beast the approach allow you to start moving
00:08:12
much faster usually within a week after implants place and then you don't disrupt accents attendant which means that you
00:08:18
don't have really any extension that rehabilitation is so much easier even though it's a much more difficult operation
00:08:25
and then turned off the animal so make sure oh this is my review comparing to was of all approaches may review of the literature
00:08:31
in the case that the torso approach compatible approach the border pros gain you additional ten to fifteen
00:08:37
degrees with compared to what's approach and we're collecting prospect of data and we shouldn't right now
00:08:43
to understand really usable approach the complications and potential longevity and
00:08:48
outcomes based on patient it all comes and measurements
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so my conclusion is that silicone implants usable approach you to
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pass i'll come at least using the silicone implant today
00:08:59
but i'm still a fervent believer that we have to advance the p. i. p. drawn construct
00:09:04
we have to use number one better technique but respect make sense attendant and that up
00:09:09
on the kind of bandage avoiding find design so i'm not giving up on him
00:09:13
plan designed for t. i. b. joint but at this current stage have went back to
00:09:17
my all imply which is local and using a different approach to put it
00:09:23
if you look at it and see if your p. i. p. g. one by the m. c. p. joints
00:09:26
and she was very different happy happy joy i think the p. i. p. p. m. c. p. joints
00:09:32
using a power couple implants for patient with osteoarthritis is very suitable
00:09:38
has very good qualities and give you two peas in plan
00:09:40
designed to give you predictable eighty to ninety degrees of n. c. p. joe motion with a power cobb however remember
00:09:47
you cannot put two piece implied in the remote locations because fundamentally remote locations
00:09:53
have little problems you put two peas implied that's not stable you're gonna
00:09:57
have this picture is a picture the refer to me with the silicone
00:10:01
implant placed at um the remote way hand and very very shortly
00:10:06
this okay that i even what dangers is to use a cement in the remote location because
00:10:12
once it's cemented and this okay that is almost impossible to get
00:10:16
him find out and you have to shorten the medical many
00:10:19
many cases let's look at the station to station has a dislocated by x. your power common
00:10:24
implant scene you know that this is quite some time ago and what do i do
00:10:29
c. d.'s are the hand she has my hand you can extend the finger because the choice of this okay that the power couple implied
00:10:36
if you go back to the traditional implant was silicone implants a remote locations
00:10:41
with with stabilisation implant the actually do very well so why's that
00:10:46
you can look at the let's concentrate on the right hand they cannot extent
00:10:50
i went and remove the implant and then see the silicone implant in
00:10:53
there and this patient the right hand the right hand again about sixty to
00:10:58
eighty degrees some motion as quite stable over the last few years
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so i think that the remote white patients the standard is still silicone implant because of stability issue
00:11:09
but i do think that's so fraser clancy implants for remote way patience is not suitable however
00:11:16
we do have a seven year outcomes database on the international study
00:11:20
costs are they that there has been published many places
00:11:23
to actually come from the only to us but also to mythology us that m. c. d. john
00:11:28
arthur plus the user silicone implant is the coast and is the ideal standard to here too
00:11:36
but uh buttons you join comparison conversant powered car but i think her car but if you
00:11:40
want to use it for the m. c. p. g. y. is actually very suitable
00:11:44
so this is a patient with osteoarthritis of the uh m. c. p. joints is hard
00:11:48
to see the article where that article service is complete one out ends tractable painting
00:11:54
i put in a a silicone uh put in the surface replacement implant
00:11:58
such as the power comment implant and after lee's son three months
00:12:02
patient has very commotion typically about eighty degrees of motion
00:12:07
for these implants so in my hand i think that you can either use silicone or use use the
00:12:14
uh some kind of service replacement for the m. c. v. joint and both worked just as well
00:12:20
so some right oh my conclusion based on going from different different experiments on different kinds implant
00:12:28
is that i think that's the power carbon or the surveys replace some of the plastic
00:12:33
is it really a future of ah special t. we cannot give up on the new designs of these implants however
00:12:39
we're not there yet i think that's for power comma implants specifically power com implant is indicated
00:12:45
if you wanna use of and see the joint away patients was certainly no other indications and how to
00:12:51
use power problem for the p. i. p. joining more because of all the problems i show you
00:12:55
by silicone out of class that you still the prefer implant alright because of the
00:13:00
laxity of the uh ligaments and i think the complications of being reported
00:13:05
between the car park on and and at least in my practised i
00:13:09
do not want to use power common implant anymore but for the p. i.
00:13:13
p. joint i think that you absolutely should consider using the silicone implant
00:13:18
not just that was approach but try the ball approach because i think that you find it
Conference Program
A-1174 Introduction
Torben Bæk Hansen, Holstebro, Denmark
June 15, 2018 · 2:01 p.m.
A-1175 Silicone MCP and PIP joint arthroplasty – still the gold standard?
Kevin Chung, USA
June 15, 2018 · 2:01 p.m.
199 views
A-1176 Pyrocarbon MCP and PIP joint arthroplasty – what are the benefits
Sumedh Talwalker, Wrightington, UK
June 15, 2018 · 2:15 p.m.
155 views
A-1177 Modular PIP joint implants – why?
Philippe Bellemère, Nantes, France
June 15, 2018 · 2:31 p.m.
164 views
A-1179 Wide awake surgery in PIP and MCP total joint arthroplasty
Mike Hayton, Wrightington, UK
June 15, 2018 · 3 p.m.
118 views
