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A-1301 Total joint prosthesis
Maarten van Nuffel, Belgium
Wednesday, June 13, 2018 · 4:48 p.m. · 14m 48s
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the owners to meet the most motivated participants of this afternoon um so i'll be
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talking about uh the total joint archer posted in the d. o. j.
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um uh there is there but they're gonna be there's gonna be some overlap between uh my talk on the previous
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speaker that try to keep to the minimum um so if we've already covered that if you haven't actually
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the two j. joint for truth ever several uh reasons you can uh do not ah posted by
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every second part uh with a like a direct procedure was perfect open g. procedure i sorry
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um or you can um put in uh and and important to replace
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the older hat and there are several different types of implants
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um have to dig that i didn't get any colour from a bluish checker to talk
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about the the uh implantable or to promote to have nothing to declare about that
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so the problem with these are topless the boat dock and uh so
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pick up and you is that you create actually in in stable
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a distal older stump um and that might look good on a a non a load
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bearing an an x. ray but ones use your give the patients something to lift
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you see that the uh the still almost dump real uh
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give a bony conflict with the distal uh a radius
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and then um we've already covered the uh older had replacements um they do have their
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uh indication i'm not here to say that you shouldn't the um put them in
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um but the problem is there are known constrain their unknown linked so it means that
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all the stability comes from the soft tissues around it so if you're soft issue
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is not good um because of the previous condition and you have to be a damage because you have to put in an implant
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uh that is or is that there is a instability m. part of
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these patients will have some instability which is not symptomatic habits
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um i'm a great deal of these patients may continue to
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have problems with instability uh causing them to uh
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keep having a pain even if you put in a sigmoid much uh a
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replacement as well but you have a known linked uh but total uh
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uh go to uh implement i don't have any experience with that kind of implant um so then you go to the next
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stage uh how are you going going to revise these failing or
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this still problematic or symptomatic uh wrists um so the
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first technique described uh mostly by saddam's where to put in and telegraphed offenders so big chunk of tandem
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um put it over the older had uh the older stump and then try to stay buys
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it well those procedures don't have the best track record um some place series published
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um reasonable results but all the model of the patients were perfect um and then the other option is a one
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bone forum which is a a a quite the important a limitation of the uh uh mobility of the
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patient of course and it has a a severe complication rate mostly non union as well so then the other
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option um has designed mostly by the we shake it isn't didn't a total d. o. j. implant
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so it's a total your abode uh replacing the the overhead and sing with much and it's amy constraint
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um there's a discussion about what this constraint insane constraint a completely
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constraint implant would be that the uh implant itself can just
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uh i do as much motion as the joint should do we should be
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let's say that if the if the amp that would be able to outside of
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the body just move a hundred eighty degree then it would be completely constraint
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you should take out the implant and you put it together you swirl it around it can uh rotate the
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three hundred and sixty degree so that's and say me constraints there is some constraint but the implant itself
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he's not limiting all of the motion once implemented and of course it's
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linked and it's a bipolar construct just so the uh radio component
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and with the caption lot rotates around the polyethylene a ball and the ball itself rotates around the stem
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there is a possibility of some a long to do migration which obviously obviously needs during precipitation
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a small degree of english and and the rotation to i can accommodate for a wrist movement
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uh when putting any brown thing um as already mentioned by the previous speaker would one of the biggest problems
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is a conflict with the accents attendance over the uh implement it's very close to the easy you tendon
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and one of the most uh complaints after the imprint they uh after
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the operation is that the patients have p. c. you tonight is
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so which you need to do is uh make a taps or a rectangular flap only based
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you have to make it all the way to the second extensive compartment so it has to be quite long
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four centimetres white and you flip it over to your side as a as assertions you're sitting on the other side and
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at the end of the operation you put it on the need easy you over the implant so you see
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i think it does work yeah so this one here the impound is in place here
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is the easy you ten if you allow you just closed it an excellent
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you would put the easy tendon immediately against the metal in the polyethylene whereas if you put the uh
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written like a flat on the need to ease you your covering the implants and protecting the uh tenants
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all the attention points concerning the radial a component don't put it to the study um if you
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put it to the study it will have a bony conflicts with the uh carpal bones
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and especially liking model lose disease um uh of muddling deformity it's better to be
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put it more approximately uh and so you really have to check during operation
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uh on fuel scoop if your position is okay avoid um
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a door soul tilting of the uh implants otherwise the the whole construct
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will uh be put in a in a in the mel position
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and also avoid the regular protruding screws and that's the thing we learned
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as well as the other and uh and and several the surgeons you're using the implant
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is that in the beginning we did like we uh have full word in all
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the a. o. manuals if you have a cortical screw you put it through
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until the uh the endpoint comes out on the other side if you do this they
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uh and up in the first extensive compartment then you created the convent disease um
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so you're actually so should look more like this but you don't have screws protruding through the radio cortex
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and then the last uh that tips and tricks part is about the older stem um if you use this as
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a revision after all the implants you may need to respect quite a lot of this still all ma
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um to be able to put in the the important because the distal all like can be damaged um
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after implanting or after removing the the the the the previous employment
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and make sure that your stem is of adequate length
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um i think that describe that you you need a a proximal
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amount of at least eleven centimetres you can still put in
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uh and and implant but you need a lot of length in the stem
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because have three seen before there's a lot of loading all the fiscal
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all now there's a lot of roadrunner your weight bearing all the weight
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goes through uh through the distal on also you need to have
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i'm a very long uh support um and be careful after the after
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a previous shorting hostile to me mum lots of patients nowadays
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we have a persistent older pain may have had an older shorting cost you to me this little
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take the the the obscure to me side becomes very sporadic so sometimes it's very very hard
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to get the reappeared real through your birth through and even get your stem through
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um if it's if they all still to me has been done quite
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the study you may even consider respecting that additional part of both
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of course is to proximal yeah you can't restrict the whole part but
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uh that's sometimes an uh an should during implantation as well
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so we started out in two thousand and ten using this implant only for a very very difficult disaster cases
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um that was we saw that the early uh uh the results were quite encouraging
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we start also use them in the division cases um before we used uh
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uh the other types of implants um and also the one which was a pull
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from the market and they all came back for revision or so we use
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this as a division then because the uh results kept being quite wrist i'm
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encouraging we even started to use it in a primary better as well
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um so this is a a case example i guiding is
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a sixties yelling to doesn't don't for a a partial
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uh this little or a section at the f. c. c. repair i did well for ten years so off the ten years he came back
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again paying on the older side looking at an implant down and uh
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he was afterwards quite happy you sees a range of motion um
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there and a more difficult cases actually the youngest patient in our series this girl was born in
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an nineteen ninety so she's um she has a model than a deformity
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he was twenty four when she would present that with a uh so fake up a new procedure
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persistent pain and you can really imagine there's a bony conflict between the
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distal alma and the uh the uh the still radius um
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she is is now doing fine with the prestigious although we have to admit i'm
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in have been doing heavy activities she still feels some pain uh butts
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i think that's she's far better off with the implant and with the suffix up
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and you procedure um so if you look at our a patient a series
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um we excluded the the though the shorter a term fall
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up so then we ended up with thirty four patients
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uh we don't mean age of a forty eight um mostly female patients actually
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didn't mean follow past five years um the range of motion actually it's
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seldom or never you can maybe never say never but most of the time the range of motion isn't a problem so they
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all are quite for a i have a very good range of
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motion the role supple but that all a happy um
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some still complain of uh especially the uh is you tonight is but
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we considered fifty not the thirty four to be perfect they
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had no visible complaints and all of the primary implants that actually
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in that uh a group you see their data the dash
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uh and uh uh a visual unlike score for pain was a a a improving uh
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was was yeah well decreasing so improving and that the grip force was also improving
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um most of these patients were operated before like i mentioned uh already
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uh on average they already had two other procedures before they got the uh the link to implant
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um you can already see that the most of the uh
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the techniques mentioned before are already done on these patients
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uh of course it's not on complications free implant and like i said
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uh if your screws are to radio a protruding through radially you create a kind
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of the caravans disease um so that was the most uh often revision
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uh operation we need to do is change the screws for shorter ones um
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the interesting thing is that you can try to um it's change the screws of the radio component
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without completely is assembling the uh important especially if you only need to uh have one screw
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uh it changed uh it's even possible to uh keep the
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the implant in fact uh one patient choose to remove
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the uh of the uh the the implant because she had kept having easy you tend to notice even
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uh extensively get warm uh ten you notice so we at the
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end of the day it was removed she knows where's um
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uh on a permanent splint for a heavy activity of heavy duty activities uh but sixty percent
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of these patients keep complaining about some pain endured a around the e. c. u.
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um of course the skimp on doesn't protect you from all that uh pick problems in the rest of the joint
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so uh some of these patients on the rent a additional
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procedures uh for actually changes in the greater copper joint
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as well one developed the finger fraction complexion i couldn't find that in the early church and uh neither
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uh i wouldn't be lot club with short of it's related to the impound or just the guy bit to purchase disease or a woman um
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uh interesting it we didn't have any lose means any infections any c. or p. s. but probably we should adopt a at
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yet we don't have it yet if the a followup goes longer uh every uh our
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implanting more of these implants probably a real i encountered these so these you
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pictures you've seen before the uh short there's a screws are a better this is the patient to a bit
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recurrence the nurse invitees and ended up with a removable the implant and
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then you get a situation more or less like a direct procedure
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um but of course with a lot of a soft tissue damage um the
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patients who uh kept having complaints of radio carpal uh obscured arthritis
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uh ended up with a partial or full a wrist a fusion um
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so more and more people are reporting on the better results of these implants
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um it started out as a small case series uh
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for patients ten patients but now it's getting
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bigger and a bigger so that is more memories site in this uh in this implant
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and this is a quite a a very recent uh article in the american journal fun surgery
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uh but the reported on a fifty two implants uh interesting
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these people had a a lot of well off
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quite a lot of uh fractures infections and a septic loosening which we didn't see a so
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much so you had three division and to complete removal of the uh implants um
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uh practically for me they also the review of the complications reporting the digits your
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uh where you see that their current study is actually one of the uh uh one which
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reported most explains and revisions of the oval the implants compared to the other ones
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so in conclusion in the medium tour we think it's a reliable solution for difficult cases
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not for everybody with a little bit of a little uh other side with pain
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uh there are some complications most of them are quite manageable or even preventable and if you
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really need to do a section it's still feasible but it's not a perfect results
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and then the indications maybe they will expand in the future if we had implants like these
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