Esperienza e primi risultati nei sistemi protesici custom made. Dott. Fernando Marcucci L. Buonocore, M.Greggi, E.D Antonio, N.

Transcription

1 Esperienza e primi risultati nei sistemi protesici custom made Dott. Fernando Marcucci L. Buonocore, M.Greggi, E.D Antonio, N. Cuozzo

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3 What about TruMatch? TruMatch is a patient specific instrumentation for primary TKA based on SIGMA HP system TruMatch cutting blocks are manufactured In USA, by DePuy-Synthes Realized on CT scan imaging TruMatch instrumentation is disposable and delivered sterilized

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5 ACCURATE PREOPERATIVE PLANNING VARUS/VALGUS CORRECTION PATELLAR OFFSET CORRECTION TKA BEFORE TRUMATCH PROSTHETIC IMPLANT SIZING ROTATION DEFECTS CORRECTION EVALUATION OF FLEXION-EXTENSION GAP

6 HIGHER INFECTION RISK MORE STRESS FOR THE PATIENT BLOOD LOSS INCREASED LONGER SURGICAL TIME

7 Intra-Op Efficienies Efficienies Intra-Op Flexion/Extension instability Osteotomia da scivolamento TIBIAL CREST PLANNING TKA BEFORE TRUMATCH Surgical workflow efficiency femoral prep ORworkflow VALGUS PREFERENCES VARUS Surgical efficiency tibial prep EXTRAROTATION del Distal Femur resection distance relative to the condilo laterale Avoid LCL releasefemorale Accurate preoperative planning OSTEOTOMIES My experience landmark (10 mm) CT SCAN Attention to popliteus tendon damaging Patient proposal review When between sizes do you External rotation landmark fornormally the Case number Additional Femur resection due knee to flexion Prefer Distal later approach in valgus component (Epicondylar Axis) up or down sizing? ( Down size) femoral Check the stability of cutting Size contracture mm) During this step the(0surgeon could Side Value the opportunity toand perform lateral masks using the femoral change condyle preselected preferences slide osteotomies Proximal tibial resection landmark using tibial «SHAKE» External rotation angle relative to themechanical surgical Choose Limit Shift implant APimplant tolike prevent andtoadapt the implants a landmark (how many degrees?) sartorial review axis (lower condyle) system femoral notch (3 mm) Specific focus on the use ies I USUALLY PREFER 3 DEGREES FROM WHITESIDE S LINE of tibial cutting block to avoid(ps,cr,cs) TECHNIQUE Femoral component SURGICAL 2nd choice external rotation landmark COULD YOU Proximal tibial resection distance relative to The alignment manufacturing aresimply ready for wrong or flex-extension landmark (4 mm) if 1st is not detectable Accettable Limit to Flex implant to NMR instability the shipment CHECK THE LINES (Whiteside s Line) notch Tibial component (Fixed bearing, prevent femoral (degree) Dopo release il distance Addictional proximal tibial resection efficiency bial prep femoral prep My choices to correct due tothebeashipped rotating plate) Resection guides will in 35 CT SCAN SUGGEST GOOD compartimento laterale Femoral sizing references and AP flexion patella overloading or(2mm) patella 90 apositioning couple of weeks and ready to using use WITH AN AVERAGE position Distal femur resection landmark è lasso in flessione references Down) «BAJA» and collateral(anterior varus/valgus 2,85 DEGREES balancing, Posterior slope to proximal tibia (2 degree) Poly component type stabilized mechanical axisslide (most distal condyle) are angle the OSTEOTOMIES and TIBIAL CREST osteotomy

8 TIBIAL POSITIONING I ALWAYS PREFER THE «CURVE ON CURVE» POSITIONING MATCHING THE ANTERIOR PROFILE OF TIBIAL IMPLANT ON ANTERIOR CORTICAL BONE MORE THAN 35 CT SCAN POST- OPERATIVE CONTROL SUGGEST A CORRECT POSITIONING

9 TIBIAL POSITIONING Instability after TRUMATCH is a rare event When it happens is more frequently due to wrong intraoperative chooses or errors in surgical practice Stability is still easily recoverable by replacing only PE component

10 OUR EXPERIENCE AVERAGE TIME Surgery (Skin to Skin): 43:00 min Femoral Distal Cut: Sizing Femur: Tibial Alignment an Resec.: 02:23 min 01:41 min 06:53 min

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12 Our experience 150 cases TM since 04/07/ cases LCS since 04/07/ cases SIGMA since 04/07/2011

13 OUR EXPERIENCE LCS 150 cases Age 62 Gender Weight Varus/Valgus Functional requirement >Women 76,3 Kg >Varus High Asa Asa 1,6

14 OUR EXPERIENCE SIGMA 150 cases Age 73,2 Gender Weight Varus/Valgus Functional Requirement >Women 79,6 Kg >Varus Medium/High Asa Asa 1,8

15 OUR EXPERIENCE TM 150 cases Age 79,3 Gender Weight Varus/Valgus Functional Requirement >Women 87,4 Kg >Varus Medium/High Asa Asa 2,6

16 OUR EXPERIENCE TM LCS SIGMA NOTCHING FLEXION CONTRACTURE EXTENSION LAG VARUS OVERCORRECTION VALGUS OVERCORRECTION

17 LCS SIGMA TM Blood Transfusion 58 U 54U 16U Haemoglobin Value Post operative pain-killer drugs management 822 U 736 U 329 U Mean Hospital Stay 5,3 d 5,5 d 4,1 d

18 CONCLUSIONS REDUCED BLOOD LOSS AND BLEEDING SHORTER SURGICAL TIME LESSER PAIN AND EDEMA REDUCED INFECTION CASES NO MALALIGNMENT SHORTER HOSPITAL STAY OPPORTUNITY TO PERFORM TKA IN PATIENTS WITH INCREASED ASA

19 124 X-Ray post-operative control confirm 5 from surgeon preferences in VARUS/VALGUS 8 Computer-Assisted cut control confirm the same gap in flexion and extension

20 WHO? Patients older than 70 years Standard functional requirement Immediate result No good clinical conditions (ASA ) Jehovah s Witnesses BMI

21 WHY CONCLUSIONI TRUMATCH?

22 GRAZIE

23 Esperienza e primi risultati nei sistemi protesici custom made Dott. Fernando Marcucci L. Buonocore, M.Greggi, E.D Antonio, N. Cuozzo