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A-1177 Modular PIP joint implants – why?
Philippe Bellemère, Nantes, France
Friday, June 15, 2018 · 2:31 p.m. · 12m 16s
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00:00:00
thank you for your intuition for this uh symposium good afternoon everyone
00:00:07
so i have a conflict of interest to disclose in my talk so if you look at the p.
00:00:13
i. p. joint what is the hands of a successful actor pesky it's to get the functional
00:00:19
much of motion close to the normal work of motion of one hundred
00:00:23
degrees to get the norm out by you mechanics which depends on
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i anatomy of the giants and also the semantics to provide stability to get good been fixation
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to have easy implantation good where resistance of the material and must be easy to remove
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it's not so easy to reproduce a p. i. p. anatomy and
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it's by you make an x. it's really challenging because
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it is not only one p. l. p. in the hon but for p. l. p.s c. r. uh or different
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regarding the orientation of the space of the joint line
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also sickness of the joint and also uh that was nice of the joints o. h. t.
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a. p. r. difference so reproducing with the implant
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he's a compromise to z. normal anatomy
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so if you look at the chronology the so called anatomical implement uh
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now we can uh use all rows award are only five implant
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and since it to just released three euros we can use
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uh it's a a cap as a a model are implant which as ray's recently
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why modularity faster for its to avoid they're up there operative technical issues
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i do too much to to a component prostheses is sometimes
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very difficult especially if you use bright public opinion and
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and and that's create bone fracture during the preparation because you have some time now will convert
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sure you have a symmetric ceased less of the cup of the uh got to call
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and you can humans impression of the implant create a factor of the implant
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and sometime and very frequently it's a difficult to a match the
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size of each implant and the same and the uh
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so face are sometime difference and there is a publication recently
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that i've shown that sixty seven percent of the implantation
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are my position it is a p. i. p. is a big p. i. p. joints so it's quite difficult
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the second uh argument for modularity is to balance properly the
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soft issues is the city's attention of the collateral ligament
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which are very very important and this is in the dependence of the sickness
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of the joint you john created and also to get a an uh oh
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the balance between the tension as a fixed or an extension or muscle
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you also also due to the to sickness of the jain then also the position of the axis of rotation
00:03:17
so the mother i'm plant we can use in europe now there are two
00:03:21
models that kept tracks implant down she not the publication in uh
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a street three years ago and the tactics implant a nearly uh had the same date a little bit later
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let's is attacked this intent it's a fall popular implant made it off
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uh for the stance of a drum corp about a a coated with it would
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see a petite and the autographs of face are made on the proximal
00:03:49
that with body eighteen and under the style in a from about and the stem hiring titanium
00:03:55
and with the maturity you other large range of solution
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uh to fit properly so joint almost four hundred a a
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configuration but of course we don't use such important uh
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amount so that thinks it is that the tactics instrumentation set is uh
00:04:16
specific for the proximal on the style uh implant and it's it has been
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designed for adults all approach the surgical technique must be very precise
00:04:28
a yielding a dollar sign approach with a splitting of the extra shot and and
00:04:34
it's we we do a a bone cut perpendicular due to the axes
00:04:38
wheels of been a central in a major are hirsch shaft
00:04:43
to have a well uh orientated still faces bottom bit definitely daily and
00:04:48
we do a bone rejection and then we put the stamp
00:04:51
and after introducing the the trial stamp we can
00:04:55
choose the proper size of the house sickness
00:04:59
on the other witness of the joint in order to get a good but uh attention of the soft issues
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then uh uh which acts as a dinner does this affect your rings upper shooter and it's necessary
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to have a good day to know disease if they have the recorder 'cause the excess and tendon
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it's not necessary to reattach the central sleep of this
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doesn't and and just close it to a
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flaps of the tent and i checking of the uh dinner does this effect is very important
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but uh pretty meant it's imitate active mobile edition
00:05:36
we just only most of those but we strapping with to the objects and a finger under does that's being
00:05:43
during the night to see here the result after two weeks
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this is a result of our series twenty two cases a mean h. c. c. four
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euros mainly was to arthritis a soda on force finger on the four up
00:05:59
i mean for that at least twenty foreman says thirty four months as in the
00:06:03
in the main and tail with the that the painted decrease a lot
00:06:08
the range of motion was fifty eight degrees zero when no blame plane
00:06:13
user laying on we out for a revision street in our
00:06:16
lives is i'm the one who still fight room over there is
00:06:20
also just recently published another a report about this uh prostheses
00:06:26
with a lot bigger uh it's a series but short a follow up
00:06:32
uh and the result ah quite the same no you implant is early on
00:06:37
a few revision you to to noises on sonic before meet this is a tough stand our uh
00:06:43
the results uh what we can expect to patient as
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you see here slight deviation will still arthritis
00:06:51
when you see the result after three years and very good the uh the uh function
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and very good the motion as well and that you know that t. r. as being correct
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about this deviation we have focus our study
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on a settee five cases was deviation at least of five degrees
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and we have seems that after a follow up of two
00:07:16
point six euros the post op deviation was corrected
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we to one point four degrees and the range of motion was sixty one degrees we had
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three revision to turn allies is on one fusion due
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to instability of the imprint interface think when you
00:07:33
see on these example here of that after three euros we uh maintain is a good uh
00:07:41
rex session of the empire let's go let's see now for that kept flex a a
00:07:47
implants which is a recipe see implants with three competence made of chrome about
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and that uh always a titanium of coated on the suffice they are three sizes
00:07:58
on street eight of the put it in a component z. m. pen
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can be a a place with a doll solar palm our approach
00:08:06
and uh the first publication my shingle a uh when it with the shop for up to
00:08:12
twelve months ten patients you see that pain relief is good range of motion for
00:08:17
fifty one degrees no migration and to revisit fourteen races and you see
00:08:21
here that uh the the press disease a real uh resurfacing
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and they were also another uh uh results uh reports
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uh same uh a team oh fifty patients huh
00:08:35
a ways a short for a possible pain relief is okay
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and a range of motion fifty fifty six degrees
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no revision five no uh immigration five revision ten arises and collateral ligament trip
00:08:48
what is the evidence for this uh more you are implant if you look at the literature
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you can see that's a range of motion of this imprint are quite good comparing to the silicon implant
00:08:59
or also comparing to to be recommended in term of for for up off of course it's it's short
00:09:07
so far but was a complication rate is ah quite low and
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you know our uh experience we have compared the results
00:09:17
uh you know quite same series of was to arthritis in the
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uh with silicon implant your cabin implant and tactics implant
00:09:25
and you can see here as they are same uh the same age same number of patients same for uh
00:09:31
and we see here with the tech t. seem pen somalia rampant we happen
00:09:35
bitter pain relief beta range of motion and bitter a score of function
00:09:41
we have a little bit more uh a rehabilitation uh comparing has the silicon implants
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so what do we expect with the modularity as safe meter to achieve
00:09:54
anatomy colour joint onto choice the size of each still face
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to get the uh the the good the human changing and
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push each position of a rotation axes we get
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a result which are any form are pretty to bear in term of pain relief
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mobility which are more than fifty degrees at least uh uh up
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to sixty degrees and there is a low complication worked
00:10:20
uh oh no revision right index finger on t. i. p.
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deviation are no more a contract indication for opera best
00:10:30
what are the drawback of modularity we have not resolves the
00:10:34
non specific issue of p. i. p. address the
00:10:37
justice basting teen they are swan neck deformity eighteen percent in our series
00:10:42
twelve person is those or should we was attacked is plus disease
00:10:46
and very pretty to was a vacation as well are still they are twenty seven percent thirty nine posts
00:10:53
of course we have a shortfall of so far with this implant
00:10:57
on what will be the result was a long time
00:11:00
what would be is a loosening a a right we don't know what would be the wearing
00:11:05
of the three or four component which time we don't know but with this implant
00:11:10
it's very easy to change the inlay a particular so face
00:11:16
uh if there is a problem so this is there an advantage
00:11:21
so more your imprint indication they are a very large you can see here we have
00:11:27
a treated this nation what on the index was attacked his finger on them
00:11:31
medium a finger with a calf exterior and the results
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is the same after a a six six weeks you can see the motion is quite the same
00:11:44
it can be a specific uh indication for each implant for example
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take this could be a good choice in case of failure
00:11:52
for previous implant when rose deformity all been knows
00:11:56
and the cat facts implant could be just a resurfacing impairment
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if uh we uh see liking that that case that's a preparation of the major activity could
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