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Friday, June 15, 2018 · 12:11 p.m. · 19m 59s
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so if there's any year questions from the floor might be a it is more fun here that we passed around
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um what's that the first question you score the um having after place these in the shoulder and also
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hit at tending to go ratify the padded because of
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the where to the articulation adjacent to collection
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and with regard to resist air 'cause they're important fact with regard to
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the indications for the process faces but also have a lottery
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a good outcome for the passion up how that's great
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actually were designed um the process is designed eventually need to be replaced ah
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we all know that it actually cartilage on metal whereby darker to results with
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these guys my card six seven years would question that we use
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and you're the plastics and approximate radius all the time uh an answer rather joints so i'll
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designed ah to eventually wear out it's a modular prosthesis that we will
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um be able to deliver to taurus are the plastic at at some point time so
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it's got can i ask you a question about you know the uh actual to sigh
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of that the articulation basically everybody's talking about either dart thrower sort induction motion
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should be articulating surface on that i may arthur plastic worked over wrist implants
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be designed differently there's ways in which to reverse engineer things
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to have any more like a a a orientated
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to have the orientation the articulation being not the planes of flexion extension or younger deviation
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how did you design articulating surface in would you recommend that other people alter
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the design of the articulating surface orientation in taurus replacements on sure well
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obviously with the rest we speak the rest is if it's a single joint there is is a compilation of eight pounds moving independently with
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respect to each other so to try to develop a restored the plastic give you back all those joints isn't possible so we're not
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simplifying it into a single joint and i don't think that you could design a single joint to completely emulate
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the rest so with that as a prelude idea was let's allow the rest have as much
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um make carpal motion or dark promotions we can only knows since the net carpal joints does
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allow the dart rumours motion and in fact if in isolation can give you doctors motion
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we built this wrist the design of the both prostheses off of actual human um uh rests
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emulating a an average of twenty five rest to build the design of
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the of the just a component as well as the reciprocal um
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radio i'm sorry mate carpal proximal uh as it happened if you will so that's
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this was i want one follow up on it is interesting to look at your your design
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uh it looks like you've replaced the portion of the staple it in your in your design
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and it's very close to the the uh traps early in should be easy
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ah yeah we know from the shark procedure that if you take out the distal half a skateboard
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you get excellent big carpal motion actually much more bigger promotion to normalise
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their uh what is the rationale for stating that radio side
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sure well it's actually the rationale as to simulate eight just a skateboard actively so that that is a truck it's
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good for it so we we've essentially taking out the distal third about forty percent of escape for if
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when looking at the p. i. r. c. if it all seems to be the same plan
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but of course that's very bowler and and looking at our intention analysis of the total
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ah there's absolutely no punishment on that on that just a piece having said that
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our total differs from our proximal radio carpal handy we've smooth the edges of that take it back
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a little bit more completely agree with you for some reason really push that out before
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question yeah i have a question um did you ever tried to convert a p. c. r. which
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is the follow on going as you tried is enough for some loony with your technique
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i'll we have not done that any p. c. r. to having our to plastics as yet
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do you think that's possible i think it's it's possible you'd have a lot of
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uh obviously a ligament changes over the approximate cut back to me things will
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change tremendously over the last several years it's been place i think it might
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be difficult to get the same like that sounds right but not impossible
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yeah
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right i'm very very interesting uh regarding um the um after blast of surpluses
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i've whole always had that kind of the same a problem with the uh upper extremities
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one is that uh uh they're really not comparable to lower extremities i mean
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a a traditional force in lower extremities it it it's a it's a
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by itself is totally stubble laces uh um the effortless test
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and and and many of the things that we know and that we
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do uh are trying to make what we know uh from uh
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joint replacement in uh in me and uh and uh and and uh
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and it but that there i i really think they're not similar so it's uh
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it's maybe it's a good idea to kind of uh i think outside of go would
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you could you ask your panel question place your question ah sorry and um
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the the question is that um that um regarding you really you really um stress out the the
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importance of a soft tissue uh when uh when you doing a restart to persist but uh
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you didn't talk too much about uh how to um
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fix that or uh improve that regarding um when when you
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going at at the at the uh for example under
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dorsal production an uh a fixed and the ligaments or or
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uh how to balance tendons and and stuff dishes
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yeah i i think that the the most important thing is to preserve your bowler capsule
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as you're doing it releases and as you're going around the side don't
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go too far don't realise your your to your palmer capsule
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yeah i yeah i have to you do your approach then you don't you want respect not known to be able to get your implants in
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but you don't want to over stuff generally speaking to preserve evil or capsule there's enough there's enough support there
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to get things to generally speaking instability is not the problem it's status so that you don't
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wanna over tighten the dorsal capsule there's some cases i mean i'd even repair it
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but i also want to make sure that my that my extensive tendons are able to flex if you watched all
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of the the images that we saw here today there's some
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limitation of course of flexion in almost every patient
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but the starting it neutral a lot of what they do is inflection this motion
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so as long as you're not tight here they can still function quite well
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if you've got a prosthesis and you're putting it in and you really can't you struggling to get it in
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on title one of the things that you do to be i would make
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sure you actually can get a prosthesis and your discuss reason technical
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what seymour use new practised sure right like you're in the last
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section of right hand give very very elegant talk on
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this and and uh one of the things you can just take a little bit more bone off the radio side
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it doesn't take much to to to be able to loosen things up in our current systems you have
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to have enough bone to be able to get your central peg into the into the kappa take
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so i try never to take more than five millimetres a bone off the cap take yeah perhaps will have me
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and then make sure that you have so lovely prepare green broach well
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the radius to get your tray fully seated when you see
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some scalping and loosening or listen sees around the
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the trade means that implant is not adequately seated within that have says and say guess trash building
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is the end any resorts to a point where you get good fixation more approximately but that usually stops
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we have a question from from that i have a question about the i think the mole check that the metal on
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metal articulation given the furor at the moment in the shape of the plastic will we've got to metal metal
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was obviously low to the rest a lot less where there's no doubt that
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for engineers producing a perfect match a metal articulation is a significant challenge
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have you noticed any problem sort of increase global and local each remote so i've every look for them or is it
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an issue you think so i'm quite i don't have extensive experience in the use of process promo that uh
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a mock solomon and some of have a great pack was also mention before they have extensive experience in that um
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so i but i i think i have actually done some studies on that uh but i i can't quite the result
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what are some of the the british and some of the south african said we're not
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quite sure if it's a pretty morbid condition with regard to cut about crime
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maybe i interact quest to do the ghost area when the second one day test the m. p.
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or this out i think we're gonna do but we were just just be careful they yeah
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maybe in terms of metal on metal one thing i can comment on is is is that a
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lot of them or they hate implants has really uh the radius of the of the head
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yeah and it's usually the uh the larger head have had problems other than metal on
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metal that have gone back thirty years or so that i've done extremely well
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that also noted design change that ten years ago that problem started to occur
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whether or not that's gonna be a problem oh tech um i think because the smaller radius of curvature
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it's mark to be a problem but anything can happen but it definitely was a design change
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i i liked asset prof with um about your um make
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apple ham yeah for plastic distilled put them on inspiration
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s. saxony unmatched and maybe i'm a catholic seasons in a
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cafe as well and the second question is um
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uh is an advantage of using the big apple hand me over say
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a radio couples fusion like uh an s. l. fusion thanks
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um uh we don't know whether or not the prosthesis can be implanted with slack three disease
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from empirical standpoint you would suggest that it should not because you would
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then be putting metal on bone which doesn't were well how however
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clearly many patients over six or seven years of lost the colours
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well so we really don't know the answer that we were careful in this series to do
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are drastically for each one to be sure that the cat carded surface was okay
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uh and and so we know that these did not have cartilage damage to begin second
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question i think that's true there's choice you can you could do it um
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radio staple than a fusion if you prefer and i i think that's a great option
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technical challenges abound with that as a gregor shown others of shown
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to get that articulation as tab murphy well exactly right
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depending on the primordial uh injury or disease so um it's a great operation but has to be done technically perfectly
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yeah it or we probably won't get into that now but it did question
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i'm sorry that i have the first to comment on and then to the next
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i have a lot of experience with the multi corporate boston some with promotion
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first for the metal metal uh the admission the older patients
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and they're the slight elevation of both for him and cobalt but uh um that's uh about the
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same level that's a of the room a lot and that's the the new york plus this
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uh that there is one report from finland as a uh with
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the patient the having problems with the net and metal so
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i think any any kind of artificial articulation will have the problem with where
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and that was a good commented that may be of the ten years you will not have a problem with where
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and i cannot understand the the uh that that would be
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the reality uh we have to prepare for a a
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continued problem because this is a mechanic they was putting the bit biological them
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and that's uh the brings me to another common with it
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for the uh articles that have to think about how to fix
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it because that's the first and then long term particularly since
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and he eh in the start the boss the uh have a lot to learn from heap surgeons
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so four there's not uh not been in the articulation is with the
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for example file equal sling bulletin and against the phone call
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or seven which is uh it seems to be a very good or declarations in the hips
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yeah then the comments on that uh which surfaces to use on
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the foregoing fixation um what populations for the future okay
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oh and terms or calculations for the future and i like i i agree that you
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know for a post it you have a hard across like polyethylene obstacle bach row
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i i i think that i uh haven't looked at and not too recently uh there's some studies were people are using
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stainless steel articulation theorist imply so i think that would be a problem you know i think that you know
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i think that great so a history says in terms of the uh things are used after observing their the
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amount of energy uh in that curve could very well the fractional component about on metal on metal
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are and that's an area which told after being measured you know are how much frictions occurring
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all with him points and so that maybe we're a bit for all be what's going on there
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you got about ten twenty percent squeaking of total compliance probably probably
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would have the same colour problem occurring in rest or uh
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manufacturing probably it's a lot harder for record what for a ceramics because we have to be very tight tolerances
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or a button and hips that they are typically uh you know it's a
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ball socket really tight tolerances they were ceramics for the u. n. e.
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my guess is you're probably not gonna end up and ceramics for the uh the rest unless you really have starting problem so where
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oh and it's all of the particle that and i think that people would
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start reporting wearer of it that they are seen very much polyethylene
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in a wrist implants or other appliances that are not measuring smaller particles those are
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the small small particles are really cause no problems in hips and knees
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and so i would advocate that people look at very small of particles are beginning breast implants
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yeah we were built to publishes a a two case reports
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and of revision so we're sort of come to us
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ah where the big bill had both metal particles as well as as well as polyethylene particles
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causing such a device that the patients presented with carpal tunnel syndrome
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in both had very limited motion both wrists were severely over stuff
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i like to ask a question packet of frederick just to get my chances
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that what you think about the forces that you have talked about
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are you are to there's a suggestion is that there's more low to the second or third mccorkle
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why do people put screws into where would be the equivalent of the second and the fourth and put a stop the third
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why not put two screws to the second or third why not change that design
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or that that's just that's a leading suggestion what do you think about the things that you
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have found about the forces should be used corporal
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components be designed differently to improve fixation
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any ideas when i cannot answer this question i think a decent needs
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a a a simulation that the uh and that and then i
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see so to know we for these uh improved is this the fixation
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but the the problem of uh many of uh the trustees
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it just an idea how did how do this better question
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oh sorry uh_huh yep okay uh avenues and uh the uh got a bore sweden
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a question the we have a serial around a hundred and sixty remotes nothing plastics
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and uh we can see yeah uh we use and see yeah in their own twenty percent yeah
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in both the the couple a common component and the wreckage component uh
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integrate is component specially radially uh have a boat push pieces
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it would be a income and so is it a a question of uh mel
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position or is it uh uh the material uh we sit and not uh
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it is uh it has the same as the l. s. d. c. c. s.
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the bow or what what the views and suggestions or maybe suggestions for
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how could be changed uh this stems for compliance with bone the out i think one of the
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things that we need to learn for make it colleagues is the fit in foo concept together
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a good the provisional stability at the time of the initial surgery and then i put in my time at
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and then the other thing was uh which which is the questions gonna ask the panel that uh
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in italy rehabilitation flies so we know that uh with a hip replacement if you have that
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and on cemented prosthesis you don't just go ahead and do you know walk marathon on it
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you you tend to sort of take it pretty slow to try get the offices integration
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so so i think those things are important and um when they're what aspect is we don't actually doing
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many risk replies internet cracked the side is technical challenges to be i would optimised the positioning it
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and over the prosthesis and make sure that we're loading so i think we really need to keep focusing on most those details
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any other comments yeah i think the the when you see these a
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rail ah ah reception around like the tree would be on the
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rail holding or the owners sign it's usually because the tray is
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not adequately incorporated in the taps as if it's sitting proud
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sitting too for distal is not being supported you going to get stress shielding of the bone directly around it
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any goes down to the point where the standards well fixed and it stops
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so you'll see you'll see user option but you won't necessarily see loosening
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but i think that can be avoided by means of making sure the tray
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is fully seated with any the taxes of the radius at times or
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i want to comment about the key passing the major advance for the guy and
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he has decreased a lot of the loosening is a ceramic on ceramic actually
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and uh so i think the particle please and lot of proving that the slices in our intense
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what does have very last question thank you i just want to point old
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so that the proximal room compared to me is a very good solution
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and uh uh you mentioned soapy recover bomb that's it the person says
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in my experience i have turned euros experience with these
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posters is on my youngest is eleven your balls
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and i have no problem on the warm breeze or i see
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your troubling should be also very important point to look good
00:19:48
thank you thank you i think we might close the session awful lot thank all this because it's been outstanding station
