Douglas A. Dennis, M.D. Adjunct Professor, Dept. of Biomedical - - PowerPoint PPT Presentation
STR TRUC UCTUR TURAL B L BONE ONE ALLOGR LLOGRAFT FT HAS B S BEEN EEN REPLA LACED B BY Y MOD MODULA ULAR ME META TAPHYS HYSEAL L SLE LEEVES IN IN REVI VISION ON TK TKA Douglas A. Dennis, M.D. Adjunct Professor, Dept. of
STR TRUC UCTUR TURAL B L BONE ONE ALLOGR LLOGRAFT FT HAS B S BEEN EEN REPLA LACED B BY Y MOD MODULA ULAR ME META TAPHYS HYSEAL L SLE LEEVES IN IN REVI VISION ON TK TKA
Douglas A. Dennis, M.D.
Adjunct Professor, Dept. of Biomedical Engineering, University of Tennessee Adjunct Professor of Bioengineering University of Denver Assistant Clinical Professor, Dept. of Orthopedics University of Colorado School of Medicine
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uy / / Innom nnomed ed / / Wolt
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Labo borato atory R Resear earch ch S Suppo pport rt
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Porter er A Adven entis ist H t Hosp
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Owner ership I hip Int nteres erest: t: J Joint int Vue ue
REVISI REVISION ON TK TKA: A: Fix Fixat ation Op ion Options ions
Thre
Condyles les
taphysi ysis
Diaphy hysis is
1. 2.
LA LARGE GE TYPE 2B 2B & & 3 3 DE DEFE FECT CTS
Wha
What To t To Do
↓ Condyl
Suppor upport
Fi
Fixa xati tion
sed
↑ Str
tress sses On s On Ste tems ms
REVISI REVISION ON TK TKA: A: Fix Fixat ation Op ion Options ions
Metaph
taphyseal F eal Fixat ation ion
aphy hyseal Sleev l Sleeves Or Or C Cones
Me
Meta taphys hyseal Augme ugment ntati tions
emoral l & Tibial D ial Defec fects
Step D Des esig ign
– Prog
ssive ve Metap taphyseal al Loa
ding
– + Bone
Respo ponse se
Precis ecise B e Bone Pr Prep eparatio ion
– Metap
taphyseal al Broa
hing ng
Vario
Various Si Size zes
Fem
emoral & l & Tibial ial
Ma
Mate Wi With A Any Le ny Level Of Of Const straint
PS → VVC → Hin inge
Pa
Part rtial O ial Or Full Po l Poro rous Coat atin ing
Modular S
ar Stem A m Attach tachmen ment t (Reco commen mended ed)
Ream IM
m IM Cana nal
and O Or Po Power wer
termines es S Stem D m Diameter eter
Broa
h Meta taphys hysis
Size ze U Until il Rigid id F Fixat atio ion
Re
Resect ect Art Artic icula lar Surface rface
Gr
Graft C t Cavi vita tary D y Defects ts
FE FEMOR MORAL S L SLE LEEVES
Pr
Provid ide F Fixat atio ion & & C Chosen en Siz ize Det e Determines Jo Joint Lin ine
⇧ Size =
= Mor More D Dist stal Joi
Line
itia ially lly I Inser ert Sma Smalle ller Sl Sleev eve e / Bone R Resec ectio ions
al R Reducti ction / / Determ termine e Desir ire J Join int L Lin ine L Lev evel el
arger Sl Sleev eve e To G Gain R Rigid id Fix ixation & & Des Desired Jo Joint Lin ine
HEMA HEMATOGEN ENOUS MSSA S MSSA: 2 2-STA TAGE
Help
elpfu ful I l In Cases es Req equirin iring C Corr rrectiv ive e Distal F al Fem emoral O l Osteo teotomy
Add
dditional Fi Fixation / / Bridges Ost s Osteotomy
78 ⧬ 18 Months S
Months S/P /P OR ORIF Inte IF Intercond
ylar Fx Fx
Nonuni
Nonunion
/ Sagi gitta ttal S Spl plit
2 Year
ears S/ S/P P Distal F l Fem
lacement W With Sl Sleev eve
Note Sl
Sleev eve e Trab rabeculat latio ion
Courtesy J
sy James s Dow
MD
Watte tters, Denni nnis, et al l J Arthr throplas asty ty 2017 17
116 R
Revi visi sion TK TKA
152
52 Metaphysea eal Sl l Sleev eves es
1 Fem emoral / l / 111 11 Tibial al
Mean
an F F/U D Dura ratio ion: 5 5.3 Y 3 Year ears
2 – 9.6 Y 6 Year ears
Type pe 2 2A - Femur ur 3 Type pe 2 2B - Femur ur 34 Type pe 3 3 - Femur ur 4 Type pe 2 2A - Ti Tibia 5 Type pe 2 2B - Ti Tibia 89 Type pe 3 3 - Ti Tibia 17
0.9 0.95 1 12 24 36 48 60 Percent Not Revised Time (months)
Sle leeve e Surviv ivorshi hip Curve
Survivorship - All Cause Revision of Metaphyseal Sleeve Revision for Asceptic Loosening of Metaphyseal Sleeve
97.8% Survivorship @ 5.3 Yrs
Me
Meta taphys hyseal Fi Fixa xati tion
Offers Addi dditi tiona
nhanc nceme ments In ts In Prosthe
sis Fi s Fixa xati tion
Large ge Type Type 2 2B & & 3 Defects ts
Me
Meta taphys hyseal S Sleeves
recis cise Bo e Bone Pre repar aratio ation
iate e ↑ Fi Fixa xati tion
ble Fi Fixa xati tion
In Compl
x Fixa xati tion
ses