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A-1300 DRUJ implant arthroplasty: a review
Grey Giddins , UK
Wednesday, June 13, 2018 · 4:39 p.m. · 08m 40s
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see corner or use any of the back you'll be more comfortable sitting at euro seriously better my talk if you do
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um for the rest of you looking that you see why you so stand up there they are you know stand up
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go you could do was stare that way cannot lovely everyone for the backing come down to sit there are lots of seats down here
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have a strange and then you can either the back come down
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to the seats that's lovely joy this tool much more
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there's still plenty of seats down here if you wanna come
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they left they left that they deal would be boring you see okay um so i'm talking about d.
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r. u. j. r. trip last either be a little bit of crossover with the next speaker
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but i'm looking at um so what we did on a systematic review the outcomes
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all these all surpluses this is what we published um last yeah
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um i did this work with um lawrence molten as you can
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imagine he did most of the work i'm taking the cubicles
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um so this is a systematic review and we looked and we did a wide number of searches
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in a standard man as you'd expect looking at implant also posse the d. r. u. j.
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we wanted a minimum of five implants in the reports um with some functional and out comes in a
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minimum one year follow up now for those of you attuned to loading also posse one year
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follow what really is nothing and you don't really learn a great deal to you get to about
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five to ten years so we have to be cut listen to that and we excluded
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by mechanical the studies and we excluded silicon implants is uh not really used now
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so they're all the papers and one of the things we did do was we tried to
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contact all of the all of the is it written these papers to get further information
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particularly if there was multiple papers and i would particularly say how how fully shekel was
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um who's describe his act is implied he was very helpful providing information that was i
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and they were just to clarify some crossover between papers seventy whatever does ask
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you about information of a paper you published do send them reply
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so this is the number papers we looked at so we started before london six papers
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um and then we whittled it down to twenty nine that we thought was looking at um and
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since then we are updated this and there were three more papers we've included in this review
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so with primarily talking about oh my head replacement will have me also plus to the d. r. u. j.
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so we looked at fifteen studies that with three hundred and eighty five implants it seems a reasonable number
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quite a range of implants we used to have it be event uh first choice
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um strikingly the pains goes willow average or any one point nine so that looks pretty successful and the
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radio the occupation was reasonable and for most people was a more than functional range of motion
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there were complications they want to take the hide the big case complication
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is we're current instability now uh since we did this study rex we've
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got to this instability the d. r. u. j. bit but that
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they're all unstable okay so don't convince yourself that this stable than all of these
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an l. surprise or unstable they just in the a symptomatic unstable range for
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most of them um so we go to that you'd ever get in almost ability
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with these so don't think you do at the last speaker highlighted that
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assessing this clinically is not reliable but you can measure it in if you measure it you find
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it's always true so we've looked at quite a number we've yet to find one that's stable
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and then all sorts of other complications you'd expect and this is the one we worry about long to um
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revision are we gonna be i migrate putting these in and then the younger people here are gonna be taking them out and revising
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them and having problems in twenty years and we really don't know
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that yet though and so far it looks reasonably optimistic
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revision rate isn't high but then the followup isn't very long um
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not very long that range um but not high any about nine percent now course as door these vision rates
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we don't know how many patients were still very symptomatic but didn't want more surgery they'd had enough
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pa studio huge a replacement that we're a small number of these put in now
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to my knowledge this is no longer on the market so it's really for historically interest
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unless someone i someone knows better than i do that with just two papers
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twenty three implants no revisions good range of motion um but very short term studies
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quite why was removed is on clay uh by that always makes you worry
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and then the total d. r. u. j. replacement uh most of
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which is based on louis shack is working his impart
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um so there was a fifteen studies there um three hundred and twenty five in ponce similar
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numbers basically the second percy says six of them have come from his working group
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and of course you always wonder about that but i if you look
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at his website on the c. allows patients to report their experience
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and i think he's um tried report this in and on his way
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there was some duplication so we try to take those out
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the pace goes were little higher but still pretty good in this is tape they put
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in for more complex group of patients and the four major motion was good
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they had complications the biggest complication there is e. c. u. ten tonight it's
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um i'm not one of these in so i can't comment on that but um i
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don't think is my understanding they know quite exactly why or how to address that
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i think the big problem here is the worry about nice me 'cause it
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this implant loosens there's been a lot of bone taken away and
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it's not clear how well though do long term so this is a
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saudis later percy says is you will hear more the next will
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they reported number visions a lower vision rate um but the shorter follow up
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so really in summary this is not high quality studies
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sadly and that place a lot of hands of it doesn't mean we can't learn useful information
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um but we have to respect the level of quality of this
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it's heterogeneous group we don't have a uniform group or without
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implants are similar designs to be the heavy also prostitutes
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so in conclusion i think we can say they're a good short to medium term was outstanding cut and outcomes
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but there are small numbers of implants and save all seven hundred thirty three reported but
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we know that many thousands of input into a lot of these have not been
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putting we probably should be putting these into implant registers to make sure we get a better handle
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on this long to um so we don't know the long term results at the moment
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they're on i. r. c. t.s and we need to look at because studies better down
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purpose opinion what is what i do think this is one of the best reason implants in has a lot of input lots in
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but i'll be very please when i do put the main so i think that when you have a case it
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needs it i think for the heavy also plus the at that you can be pretty confident will do well
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and it will last reasonably well in the short to medium to save file like very much
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couple question when some more is coming appear to be good for the questions
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what is the main inclusion proof the humour at four plus the like you the
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the the the total that proposed elected map does when you put in
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what what to choose well i haven't put the tape cleans wanna differs the next to last week
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from that for the um having also plus the i think it's when they've got a
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and they were destroyed joint so it's an arthritic joint that like in any other offers a
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joint p. i. p. joint in the hip you got they some easy solution um and
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then i think the implant works well that i would be concerned if they're very unstable but that is rag my experience
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