EOTTS with HyProCure: Myths & Misconceptions

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HyProCure is an extra-osseous talotarsal stabilization device used for flexible talotarsal dislocation. There are many perceived myths and misconceptions that are addressed in this presentation.

Learn more at www.GraMedica.com or www.HyProCure.com.

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EOTTS with HyProCure: Myths & Misconceptions

  1. 1. HyProCure® Myths & Misconceptions
  2. 2. Separating fact from fiction
  3. 3. 3 Myth & Misconception #1 HyProCure® can only be used in children, not adults.
  4. 4. Not true. 4
  5. 5. Here’s why: 5
  6. 6. It is true that 6
  7. 7. the birth of extra-articular talotarsal stabilization stemmed as an alternative over arthrodesis procedures in pediatric patients. (Chambers, 1946) 7
  8. 8. The first generation arthroereisis devices were made of high-grade medical plastics/silicone and were theorized to be “too weak” for adults so they were only used in pediatric patients. (Subotnick 1974/Valenti 1976/Giannini 1985/Viladot 1992) 8
  9. 9. The second generation of arthroereisis devices, made of medical grade titanium, lead to the acceptance of use in adults. 9
  10. 10. The only problem was that up to 40% of the 2nd generation titanium arthroereisis devices had to be removed. (Needleman 2005/Schon 2007) 10
  11. 11. There had to be a better solution. That solution is HyProCure® 11
  12. 12. HyProCure® was created with a better anatomic fit and biomechanical function. This has dropped the removal rate to 6%. 12
  13. 13. HyProCure® is routinely used in adults of every activity level. 13
  14. 14. Myth & Misconception #2 HyProCure® can only be used in adults, not children. 14
  15. 15. Not true. 15
  16. 16. Here’s why: 16
  17. 17. HyProCure® has been successfully used, when indicated, in pediatric patients as young as three years of age. 17
  18. 18. What other options are there to truly stabilize the talus on the tarsal mechanism? 18
  19. 19. The chamber forming the sinus tarsi is ossified by three years of age and is therefore strong enough to withstand the interaction with HyProCure®. 19
  20. 20. Myth & Misconception #3 HyProCure® blocks/limits talotarsal motion. 20
  21. 21. Not true. 21
  22. 22. Here’s why: 22
  23. 23. HyProCure® stabilizes the anterior superior edge of the posterior talar facet at the cruciate pivot point of talotarsal motion. 23
  24. 24. The talus glides over HyProCure® which prevents the anterior-medial-sagittal plane dislocation of the talus on the tarsal mechanism. 24
  25. 25. HyProCure® transforms a “negative” obliterated sinus tarsi into a “positive” open sinus tarsi. 25
  26. 26. Myth & Misconception #4 HyProCure® is just another arthroereisis, bone-blocking device. 26
  27. 27. Not true. 27
  28. 28. Here’s why: 28
  29. 29. Arthroereisis devices act as an anterior extension of the lateral process to block talar motion. 29
  30. 30. HyProCure’s® shape and position within the sinus tarsi is completely different from the cylindrical and conical shapes of the arthroereisis devices. 30
  31. 31. Comparison Lateral Arthroereisis Device Placement HyProCure® Bisection of the talus 31
  32. 32. Myth & Misconception #5 HyProCure® is indicated for “flat” feet. 32
  33. 33. Not necessarily true. 33
  34. 34. Here’s why: 34
  35. 35. HyProCure® stabilizes the talus on the tarsal mechanism. It “fixes” talotarsal displacement. 35 U.S.A. Food & Drug Administration – 510(k)
  36. 36. A “flat” foot (pes planovalgus) is a generic term and has a wide range of perceived meanings. (is it flexible, semi-flexible, or rigid?) 36
  37. 37. Components of a “flat” foot include: l lower than normal calcaneal inclination angle l navicular drop l elevated 1st ray l increased talar declination angle l talar second metatarsal angle >16 (AP view) 37
  38. 38. HyProCure® can, in a foot with a reducible talotarsal dislocation, normalize the: talar second metatarsal angle talar declination angle navicular height (Graham 2011) 38
  39. 39. HOWEVER HyProCure® has no effect on the calcaneal inclination angle. 39 Surgical Treatment of Hyperpronation Using An Extraosseous Talotarsal Stabilization Device: Radiographic Outcomes in 70 Adult Patients, Journal of Foot & Ankle Surger, 51(5):548-555, 2012
  40. 40. HyProCure® will not and cannot correct a pathologic calcaneal inclination angle 40
  41. 41. HyProCure® stabilizes the medial column on the lateral column of the foot. Think about the implications of a stable medial column. 41
  42. 42. Myth & Misconception #6 HyProCure® is contra-indicated in a high-arched pes cavus foot. 42
  43. 43. Not necessarily true. 43
  44. 44. Here’s why: 44
  45. 45. A “high” arch is the result of a higher than normal calcaneal inclination angle. 45
  46. 46. BUT it is possible to still have talotarsal dislocation in a high arched foot resulting in excessive medial column motion on the lateral column. 46
  47. 47. The talus can still dislocate off the tarsal mechanism and cause many similar cumulative traumatic disorders that are seen in a lower than normal arched foot. 47
  48. 48. Since HyProCure® has no effect on the calcaneal inclination angle, it can still be used in “high” arched feet. 48 Surgical Treatment of Hyperpronation Using An Extraosseous Talotarsal Stabilization Device: Radiographic Outcomes in 70 Adult Patients, Journal of Foot & Ankle Surger, 51(5):548-555, 2012
  49. 49. What other options do you have? Observation? Special shoes? Arch supports? Rearfoot reconstructive surgery? 49
  50. 50. Myth & Misconception #7 Cutting the structures within t he sinus tarsi is devastating and will lead to long-term complications. 50
  51. 51. Not true. 51
  52. 52. Here’s why: 52
  53. 53. The talus has more ligamentous attachments than any other bone in the foot. 53
  54. 54. The talus is firmly connected to the tibia, fibula, calcaneus and navicular. 54
  55. 55. The interosseous talocalcaneal ligament is not “functioning” in patients diagnosed with talotarsal dislocation. 55
  56. 56. HyProCure® replaces the function of the interosseous talocalcaneal ligament. 56
  57. 57. During the EOTTS procedure with HyProCure® the interosseous TC ligament is only cut and NOT removed. The cut ends will heal back together around the threads of HyProCure® anchoring HyProCure® into the medial canalis tarsi. 57
  58. 58. Even if HyProCure® had to be removed at a later date, the ends of the ligament would again heal. Ligaments are like skin, in that they repair themselves. 58
  59. 59. Myth & Misconception #8 HyProCure® is “screwed” into bone. 59
  60. 60. Not true. 60
  61. 61. Here’s why: 61
  62. 62. HyProCure® is simply pushed into place. 62
  63. 63. We suggest that once HyProCure® is advanced as deep as possible into the sinus tarsi to give it a few clock-wise spins. This only assists in wrapping the ligamentous tissues around the threads. 63
  64. 64. EOTTS with HyProCure® is a soft tissue procedure only. The threads do not engage into the osseous chamber of the sinus tarsi. HyProCure® will not tighten like a screw. 64
  65. 65. Myth & Misconception #9 If placed into a child’s foot HyProCure® will have to be changed when the child becomes an adult. 65
  66. 66. Most likely, not true. 66
  67. 67. Here’s why: 67
  68. 68. The osseous chamber creating the sinus tarsi is formed by 3 years of age, as we learned earlier. At that point, the talus and calcaneus will grow peripherally and the overall sinus tarsi diameter stays the same size. 68
  69. 69. The most common adult sizes are 7 and 6 therefore if a size 7 or 6 HyProCure® is placed into a child’s foot they already have one of the most common adult sizes. 69
  70. 70. Obviously, this is not a guarantee and it is possible that HyProCure® will have to be revised. 70
  71. 71. Myth & Misconception #10 You should wait until the child becomes an adult to insert HyProCure® 71
  72. 72. Not true. 72
  73. 73. Here’s why: 73
  74. 74. The sooner the talotarsal mechanism is stabilized with HyProCure®the better. Every step taken with talotarsal dislocation leads to cumulative traumatic disorders. 74
  75. 75. Think about all the various foot disorders that occur as a result of years of excessive repeated forces: first ray deformities plantar fasciopathy tarsal tunnel syndrome posterior tibial neuropathy posterior tibial tendon dysfunction adult acquire flat foot 75
  76. 76. We don’t wait to balance the tires on our car until we have 50,000 miles on them. 76
  77. 77. The benefit to risk analysis shows that it is better to internally stabilize the talus on the tarsal mechanism with HyProCure® than to: do nothing/observe try to wear a shoe insert perform rearfoot reconstructive surgery 77
  78. 78. Myth & Misconception #11 HyProCure® will end up destroying the sinus tarsi and lead to arthritis long-term. 78
  79. 79. Not true. 79
  80. 80. Here’s why: 80
  81. 81. HyProCure® is extra-osseous and extra-articular. 81
  82. 82. There is no cartilage in the sinus tarsi. 82
  83. 83. HyProCure® is not placed into the “subtalar joint.” 83
  84. 84. So how could it possibly lead to arthritis? 84
  85. 85. Arthritis is a disease within a joint usually due to chronic excessive motion which leads to a chronic inflammatory reactionthat eventually destroys the cartilage within the joint. 85
  86. 86. This occurs with talotarsal dislocation. 86
  87. 87. So here are the facts: 87
  88. 88. HyProCure® can be used in both adults and children with flexible reducible talotarsal dislocation. 88
  89. 89. HyProCure® does not block or restrict motion. It restores the normal amount of talotarsal motion. 89
  90. 90. HyProCure® is not an arthroereisis device. It is an extra-osseous talotarsal stabilization (EOTTS) device. It does not block the lateral process of the talus. Instead, the talus glides over and is stabilized by HyProCure® . 90
  91. 91. HyProCure® is indicated for reducible talotarsal dislocation regardless of the calcaneal inclination angle (high or low arch). 91
  92. 92. HyProCure® is pushed, not screwed, into its final position. 92
  93. 93. HyProCure® replaces the function of the interosseous talocalcaneal ligaments. 93
  94. 94. HyProCure® should be inserted as soon as reducible talotarsal dislocation is diagnosed (three years old and older) to help prevent the devastating cumulative traumatic disorders that WILL adversely affect not only the foot and ankle but the rest of the body. 94
  95. 95. “Changing Lives, One Step at a Time” For more information please visit: www.HyProCure.com On-line training www.HyProCuredoctors.com

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