Pro: o: I Immed ediate W e Weight Be Bear aring ng with H - - PowerPoint PPT Presentation

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Pro: o: I Immed ediate W e Weight Be Bear aring ng with H - - PowerPoint PPT Presentation

Jan 04, 2023 230 likes •588 views

OSET Pro: o: I Immed ediate W e Weight Be Bear aring ng with H HTO: A Gam A ame Cha e Changer er Thomas M. DeBerardino, MD Professor of Orthopaedic Surgery, Baylor College of Medicine Co-Director, Baylor-San Antonio, Texas Sports

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Pro:

  • : I

Immed ediate W e Weight Be Bear aring ng with H HTO: A A Gam ame Cha e Changer er

Thomas M. DeBerardino, MD Professor of Orthopaedic Surgery, Baylor College of Medicine Co-Director, Baylor-San Antonio, Texas Sports Medicine Fellowship The San Antonio Orthopaedic Group Medical Director, BRIO

OSET

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Disclosure

  • The following relationships with commercial interests related to this

presentation existed during the past 12 months:

  • Research support: MTF and Arthrex
  • Consultant: Arthrex, MTF
  • Dr. DeBerardino does not intend to discuss the use of any off-label

use/unapproved use of drugs or devices

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Goals of Talk:

  • Discuss safety and efficacy
  • f iBalance HTO implant
  • Early weight bearing study
  • Highlight new technology

for guided or free-hand iBalance HTO

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Goals of HTO

  • Realign extremity
  • Decrease pain
  • Improve overall function
  • Restore mechanical

environment

  • Decrease force on ligaments

& grafts

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HTO Indications

  • Unicompartmental arthritis
  • Varus Deformities
  • Cartilage Restoration Procedures
  • Meniscus Transplantation
  • Osteochondral transplantation
  • Cartiform
  • Bio- Cartilage
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Decades of Opening Wedge Osteotomies

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It is All About the Hinge Pin

  • The hinge pin technique reduces

drastically the risk of lateral cortex fracture

  • Stress homogenization in the

area of the drill hole

  • Avoids locally high stress

concentrations in the region of the sharp cutting notch

  • Definitive TRUE VALGUS
  • stoeotomy
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Freehand Technique

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Guide Pin, Cannulated Drill, and Hinge Pin

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Hinge Pin Guide Pinned in Place

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Making the Cut

European cut

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HTO FreeCut- Still Protect N-V structures!

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FreeCut Guide

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Open Osteotomy Desired Distance

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Implant Placement

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Secure, Quickset, Close

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Recent Case

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Hinge Pin Placement

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Protected Osteotomy Cut

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Completed HTO Cut and Opening Jig

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Peek Fasteners Placed

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Guided FreeHand vs FreeCut- An Option for All

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Recent Clinical Trial

  • Scordino LE, DeBerardino TM. Surgical treatment of
  • steoarthritis in the middle-aged athlete: new horizons in

high tibial osteotomies. Sports Med Arthrosc. 2013 Mar;21(1):47-51

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Hypothesis

  • Time to full weight bearing will be significantly

reduced in group allowed to bear weight as tolerated and healing will not be compromised

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Block Randomization: Two Treatment Arms

  • Group I
  • TTWB 6 wk
  • Group II
  • WBAT
  • Pain ≤ 3
  • Off narcotics

Standard HTO using the PEEK iBalance implant with Osferion and ACP ROM locked brace 6 wk

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Outcome Measures

  • 10 Outcome Measures
  • Time to FWB
  • Healing on Radiographs
  • 20 Outcome Measures
  • WOMAC
  • Hematoma, Bleeding
  • Pain & Medication Use
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1 WK 6 WK 12 WK 6 MONTH PRE OP

WOMAC, Pain and Medication, Radiographs Pain and Medication, Radiographs WOMAC, Pain and Medication, Radiographs WOMAC, Pain and Medication, Radiographs WOMAC, Pain and Medication, Radiographs

Data Points

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All patients undergoing HTO from my practice N=40 Excluded 2 language barrier, 1 did not enroll Enrolled N=37

Toe Touch N=17

Withdrew:

1 workers comp, 1 fracture- subchondral cyst

N=35

Early N=18

Group 2 Group 1

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Time to D/C of Crutches

5 10 15 20 25 30 35 40 45

Rapid WB Delayed

Days Until Full Weight Bearing

Average 12 days* (2-21) post-op in the early group before no crutches needed 42 days* (42- 56) *significantly different, p < 0.05

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Summary: Key Highlights

  • Growing need for knee realignment and joint

preservation procedures

  • HTO evolved from “freehand procedure” to

guided, predictable/reproducible procedure

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Conclusions: iBalance HTO Game Changer

  • No increased

complications

  • Slope, correction

maintained

  • Early weight bearing

appears safe and efficacious for HTO

  • No difference +/- ACLR

Standard Bulky Hardware

“Invisible” PEEK iBalance, OsFerion, ACP

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Take Home Points- iBalance HTO

  • iBalance HTO remains best in class option for OWHTO
  • Only system that obtains true valgus slope maintaining
  • steotomy
  • Hinge Pin is the key
  • Safe, reproducible, maintainable results. LOW morbidity
  • Standard biplanar alignment guide is really freehand

jigged bony cut

  • Hinge Pin & FreeCut guides are newest option for

surgeons based on personal preference

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Questions?

Thank You