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A-1169 Biomechanics and Clinical Results of MidCarpal Hemi-Arthroplasty
Scott W Wolfe, New York, USA
Friday, June 15, 2018 · 11:53 a.m. · 17m 12s
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already
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i saw the next twenty minutes or so or explore some of they are critical a clinical and
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an early can imac results of the rest uh any art the plastic that we've developed
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um it's designed to emulate the mid carpal joint for a number of reasons which i'll get into
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i'd like exactly extensive team contest gators i've worked with over the years uh including
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a and especially triggers go with whom i sure they yeah kappa delta word
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for the uh basic science research when in the development of this prosthesis um
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and also our motion else's teams both in london and uh here in about that here and you're there in new york
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uh that well we continue to do some of this uh research and uh a great
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packer who's implant it at the first twenty two of these prostheses in london
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beginning in two thousand eleven uh try and i are going vendors of the uh can
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maddox make our plan are the plastic so we have an obvious a conflict there
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uh it's been implanted in europe in canada and australia it does have the c. e. mark
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uh it is um uh able to be used everywhere except united states where no
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ways to me are the past is f. d. a. approved at this time
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so the wrong question when we look at these issues restart the past is why not restarted the cyst
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uh jim struck on the p. i. f. s. s. h. meeting in argentina uh last year two years ago
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uh has argued that restored to pieces was still the
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most dependable procedure for a wrist arthritis indeed restart
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reduces has been a shit demonstrated show more reliable pain relief then restart the plastic with your complications
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well systematic reviews of a taurus start the plastic demonstrate variable range of motion
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data and survival data at a higher cost than our to pieces
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several studies however show the given a preference patients which used to
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retain wrist motion especially those who slack arthritis were generally engaged
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in a high performance activities and uh who are uh in the midpoint of their careers
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a quality adjusted life analysis life your analysis by kevin chunk showed
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wrist arctic blast you is actually extremely cost effective procedure
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was starkly indicated only inflammatory conditions um a fantasy as an was tempered by a
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uh by this report showing revision rate in rheumatoid patients about the fifty per cent
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all traditional solutions for slack arthritis um as we've up
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as we've all been told or are those palliative
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a blade of or limited restored produces options however and if the uh if r. i. t. team
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can turn off the sound that would be good 'cause i don't need sound here um
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however for quarter fusion approximate rocker back to me both sacrifice the mid couple joint
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at the expense of range of motion normal kinda maddox and performance of functional tasks
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the holy grail from restart the past you'd be to achieve comparable
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results as we do and other major restored the plastics
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many iterations as of restart the plastics we heard earlier by fred include the for generations and
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my generation's maybe a little different than his generations but we start with the silicone prosthesis
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uh the second generation could put on the ball and socket a
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up a design to the fixer rotation the third generation
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i include all of these uh featuring bony and growth ellipsoid articulation
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is and just all screwed fixation of the copper component
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well my fourth generation includes new bearing surfaces uh in
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shapes not articulated designs and having arthur plastics
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several reviews a taurus are the plastic feature a high complication of error rates
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it recently almost all surround the distal component fixation and for
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many reasons that we've heard over the preceding several talks
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design changes over the past decade it markedly improve survival rates and outcomes
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and increasing numbers of these are being implanted for slack and asked your thread is
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large series of third generation implants demonstrate survival rates upwards of ninety percent with high
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satisfaction and patient laid out come scores across both inflammatory and non inflammatory conditions
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similarly the few series that we have an articulated implants also demonstrate
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very satisfactory results but with very short a followup intervals
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unfortunately complication rate stubbornly persist across all major series in over recorder or patients
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including that's disturbing report of high rates perry prosthetic loosen sees a generation three prosthesis
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but the others did not attribute this to polyethylene debris eh advice close observation
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it's important to know the patients prix operator emotion predicts their
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post op range emotion after total restart the plastic
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major motion is not statistically improve by any total restored the policy in any public series
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and the systematic review show that only one series exceeded the functional rage emotion that was
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published by paul uh fred and by uh any palmer over three decades ago
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so in this collector gonna metric study out of writing to interest are that
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was to show to demonstrate a highly restricted sir conduction motion envelope
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with a predominantly by axial axis of flexion extension and maybe on the deviation
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as opposed to the doctors accessible motion of normal rests the video on your left
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demonstrates and the sound can be off of possible demonstrates also conduction and if you in your mind's eye look
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at the long axis of that motion it is in the dark drawing axis of radio extension tourist function
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oh well her cultural r. s. hadn't made carpal a blade of perceive your p. r. c.
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you can see is a predominantly straight up and down
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long axis flexion extension range of motion with very little read only the asian of couple
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researcher several centres it's ever say the couple motions of throwing
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hammering encircled actions occur predominate in the couple joint
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as shown by this video by shower more tone of the macabre joint is inclined
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we know bleak access that enables the dart throwing mo a daughter motion
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and is contained within a nearly as a tab other socket of uh oh let me take a minute on this this
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um diagram this comes from some research the train i did
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and shows a very similar egg shaped lips of um
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of sir conduction if i can get this to work yes and again the long
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axis of this is essentially the arteries motion from radio extension to on reflection
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oh that motion is contained within a nearly
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i'm nearly as a tab other socket and that's that make our bills
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right this isn't nearly as a traveller socket made up of kept
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take him a and this beautiful mccorkle joint nearly as a tab
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either socket constrained by a horse alaska talent if you will
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and for some reason you had or so last attack them over skate fracture quite
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troll and uh and the uh dorsal labour m. of the mccorkle joint
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so what then is the rationale for wrist america plastic
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with the current limitations in given the known limitations that just a component we possibly the proximal having are
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the plastic would provide pain relief and improve range emotion without the concern for component listening religion
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and bryan adams publish short term follow up with greater couple hammers blasting twenty six trust
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using only the proximal component of universal to breast prosthesis
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specific rage emotion data wasn't reported and there were a few complications uh including
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a button of the cavity in a in a few their patients
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shortly thereafter ready call publish another series rate a couple hammers applies to using the proximal component their
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emotion with the maestro prosthesis but also noted uh high complication rate and subsequently abandoned the procedure
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so what then is the rationale for another rest any or the plastic will this case
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it's admit carpal having our trip last and i think that's it a distinct difference
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current third generation designs eliminate the mid carpal joint by replacing the radio carpal tonight with
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the by actual design which eliminates that oblique axis of the big carpal joint
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given the star rated complications in motion last tourist nanny or the plastic designs that sacrifice destroyed
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a design change it preserves and enables maker promotion seem logical
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so to thousands well we poppers encouraging one year results of a novel the couple
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him hard the past in nine patients by substituting arthritic proximal corpora row
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make our plan northwest you re creates an an atomic it
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more in a timex interpretation and i would just parenthetically
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i think from all of our presentations you can see that there is no an atomic server rotation it's it's it's a several
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sectors of rotation that need to be allowed throughout all of
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these complex motions while preserving bony and soft tissue integrity
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by looking at sparing procedure the procedure was technically straightforward demonstrated no early complications
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notably range emotion was significantly improved as were the dash and the male scores
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well these results were maintain any two thousand seventeen publication of that same cohort published
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with an average of four year outcomes in the journal of an surgery
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we wrote twenty patients radio corporate right is an average age of fifty one years
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into a prospective single surgeon trial between october two thousand eleven and may have to doesn't thirteen
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patients were evaluated restraint emotion grip strength passion male scores
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are for your outcomes demonstrated the range of motion increase significantly from prix are devised
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by thirty three degrees in fact extension and ten degrees may donor deviation
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well patient outcomes course both using the mayo and the dash improve significantly
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grip strength also infer from fourteen to twenty one kilograms which was significant
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three patients had a manipulation under anastasia um first deafness and one
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of these patients when on ultimately to a restaurant produces
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two of our patients converted to total restored the plastic for our survival rate was eighty percent at seven years
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our first patient performance spring of two thousand eleven in london seven years ago still
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plays golf several days a week and as a dash score of zero
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so in conclusion that card linear the past leads to improvements
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in all our come parameters with no limitations of activity
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it's a first replacing for slack or reserve person or slackers
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procedure that demonstrates improve range emotion over property values
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it's fair complication profiles comparable to other surgical options for slack worst
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and lastly conversion to total restart the past you will be facilitated by new modular design
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with the introduction of the mid carpal tunnel restart the busty hopefully into those nineteen
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oh
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so the second part this presentation concerns are ongoing can imac analyses of couple
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motion in cohort of patients with the maker planning our trip last
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so the question is what are the canon x. of the kinetics
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as you saw off two slides ago this is our motion analysis laboratory use nine cameras like in a
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gait analysis laboratory and examine those same um markers
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that are uh exterior on the patients wrist
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as a bill showed
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a couple of our uh
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couple of our uh uh publications uh using this technology um
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we previously demonstrated restriction of restraint or deviation by splitting
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let knowledge a significant loss of coupled motion body decker minute performance in both
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hammering and are throwing two functional activities are highly dependent on coupled motion
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so when this we spotted the rest to totally prevented restrained emotion here's a uh again if you could turn the sound down
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huh
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which will say see tires this is
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his ability
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to hit the nail on the head with a hammer is substantially impair
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and that was shown statistically i'm not only hammering but also under thrown in another study results we demonstrated the
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coupling it functional performance in the same battery of activities was diminished when compared to healthy uh subjects
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saying and that was so for confusion and p. r. c. patients
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were given the same battery diminished functional activities diminished coupling
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saying and shimmy across the atlantic show the exact same thing uh in
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patients with a bow for confusion and a p. r. c.
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and we as bill sites was showing have started to look at
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i'm quite right specific tasks you can see on the airline is
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the black wind of normal sir contraction on the inner line
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um are some up in the normal range some of the normal sir conduction registering activities on the far side
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are the restricted range emotion that we see in a total restart the plastic and yet there
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sir conduction and the purple dots allows the performance of both bartering hammering seen
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in the blue and the red lines so task specific quadrants of motion
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purpose or study was to quantitatively evaluate can american functional test performance in the course of subjects
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within a couple of years the plastic and to compare their can
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maddox and functional test performance before confusion in pure c.
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our prophecies where that make our one hard plastic we preserve task specific quadrants of motion
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and wrist kinda maxim functional test performance in that group would be more
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similar to help the rest when compared to pierce even for confusion
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so we use that three motion capture data collected without ten uh
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cameras i drink as performance using the previously described marker set
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our previous subscribe marker set and actually twelve camera motion
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capture system are tested are drawing hammering answer conduction
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data is actually collected identical lab across the uh atlantic here in uh in the u. k.
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and then transferred over to the u. s. a. where we did the analysis using kinetic
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pacman path like which is a some of the angular displacements throughout the functional
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task motion sir conduction envelope which is a circumscribed area motion and uh kinetic packed
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length along that entire perimeter in any orientation the major axes sure coupling axes
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so here's subject to was right in a dominant h. forty seven six years post a couple having our to plastic
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so there's or
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i there's are a couple motion with the wrist a couple hundred the
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plastic this happens to be a wrist fusion as one might imagine
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there's no no coupling at all everything here's fingers
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not for that so the left wrist as a four thirty says you can see a circumscribed sir
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conduction envelope but the um range emotion the kinetic path length both activities falls well within that
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same the subject for
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and in comparison there's a normal patients
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back to our normal circuit action on the left or
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and sorry
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this is a station just ah six years post because landmarks the class three facts extension radio or deviation
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ah
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oh
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it's so he continues to play on to go alright so
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inclusion this is data collected only on five subjects so far it's an ongoing study
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our early data supports our processes one from a couple hundred the plaster that we do maintain couple motion answer conduction
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we have our commotion path like which is diminished over normal but the quadrant specific motion paths are
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preserved um we will be compare saying comparing them with our four core and appear see patients
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and thank you very much for your tension and critically think it with
