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Lb0431 b prostop


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Lb0431 b prostop

  1. 1. ProStop Instrumentation Set (AR-4200S) includes: ProStop Arthroereisis Instrumentation Case AR-4200C ProStop Arthroereisis Driver, 3.5 mm AR-4201 Tear Drop Handle AR-2001 ProStop Arthroereisis Guide Pin, qty. 2 AR-4202 ProStop Starter Dilator, 4.75 mm AR-4203D ProStop Arthroereisis Sizer, 7 mm AR-4203-07 ProStop Arthroereisis Sizer, 8 mm AR-4203-08 ProStop Arthroereisis Sizer, 9 mm AR-4203-09 ProStop Arthroereisis Sizer, 10 mm AR-4203-10 ProStop Arthroereisis Sizer, 11 mm AR-4203-11 ProStop Arthroereisis Sizer, 12 mm AR-4203-12 ProStop Arthroereisis Extraction Tamp AR-4205 Implants: ProStop Arthroereisis Implant, 7 mm x 12 mm AR-4207-12 ProStop Arthroereisis Implant, 8 mm x 14 mm AR-4208-14 ProStop Arthroereisis Implant, 9 mm x 14 mm AR-4209-14 ProStop Arthroereisis Implant, 10 mm x 14 mm AR-4210-14 ProStop Arthroereisis Implant, 11 mm x 16 mm AR-4211-16 ProStop Arthroereisis Implant, 12 mm x 16 mm AR-4212-16 Accessories: ProStop Dilator, 8 mm AR-4203D-08 ProStop Dilator, 9 mm AR-4203D-09 ProStop Dilator, 10 mm AR-4203D-10 ProStop Dilator, 11 mm AR-4203D-11 ProStop Dilator, 12 mm AR-4203D-12
  2. 2. Overview The Arthrex ProStop Arthroereisis Subtalar Implant is intended to assist in treating the hyperpronated foot by stabilizing the subtalar joint. It is intended to block for- ward, downward, and medial displacement of the talus, thereby limiting excessive eversion of the hindfoot. Examples include: - Posterior tibial tendon dysfunction with flexible deformity - Symptomatic acquired flatfoot treatment in children and adolescents - Symptomatic congenital flexible flatfoot - Tarsal coalitions when resected associated with a flatfoot deformity ProStop technique - Paralytic flatfoot The ProStop titanium subtalar implant is also designed to be used as an adjunct in conjunction with other corrective procedures, including posterior tibial tendon reconstruction, FDL tendon transfers and the medial displacement calcaneal osteotomy. Using a small incision and blunt guidewire, the ProStop is inserted into the tarsal canal, between the calcaneus and talus. The conical shape of the ProStop mimics tarsal canal anatomy for improved fit and resistance to implant migration, while the soft thread design supports better implant to bone contact. The color-coded and laser marked instrumentation is easy to use and comes with trial sizers on their own shaft. The concave back end offers the surgeon easier access with a guidewire in the event the implant requires removal. Scientific Rationale In recent years, numerous scientific investigations have shown promising results with arthroereisis. These include biomechanical and clinical studies from both the orthopaedic and podiatric literature. Biomechanically, sinus tarsi implants have been shown to improve arch mechanics and alignment while clinically they have enhanced the results of flatfoot correction. Pre-op Biomechanical Clinical 1. Vora AM, et al. JBJS, August 2006 4. Needleman RL. Foot Ankle Intl., January 2006 2. Arangio GA et al. Clin Biomech, October 2004 5. Gutierrez PR, Foot Ankle Intl., November 2005 3. Husain ZS and Fallat, LM, J. 6. Nelson et al. J Foot Ankle Surg., May 2004 Foot Ankle Surg., November 2002 ProStop Features & Benefits: • Better Fit Contour of the titanium implant supports the anatomy of the tarsal canal Post-op • Safer Soft threads are easier on bone • Concave Back Allows easy guide pin access • Straightforward Instrumentation One piece color-coded trial implants support easy and accurate placement Adjunct Arthrex Surgical Solutions for Posterior Tibial Tendon Dysfunction • Trim-iTTm Screw System for the calcaneal osteotomy (a) • Variety of Arthrex suture anchors for PTT repair (c) • Bio-TenodesisTM Screw System for FDL Tendon Transfer (b) • LPS plate for Cotton Osteotomy (d) a b c d
  3. 3. Surgical Technique 1 2 Incision should be made in the “soft spot” just proximal Bluntly dissect the subcutaneous tissues into the tarsal to the anterior process of the calcaneus. Make the canal with a small hemostat to create a pathway for the incision along the course of the nerve to avoid inadvertent guidewire. transection of the superficial branch of the peroneal nerve. Alternatively, an incision along the skin lines can be used. In this case, care should be taken to protect the underlying nerve. 3 4 Insert the guidewire through the tarsal canal. This wire passes Insert the trial sizer over the guidewire. about 15 degrees off the perpendicular to the sagittal plane going from anterolateral to posteromedial. The surgeon should aim for the sustentaculum talus medially. The guidewire will tent the skin medially and a 1-3 mm incision can be made here to permit clamping of the protruding wire. The wire will exit below the posterior tibial tendon. Note: medial incision is not necessary unless the surgeon is planning on performing an FDL tendon transfer after insertion of the ProStop.
  4. 4. 5 6 Initial assessment should check eversion of the calcaneus. If AP intra-op image: implant/sizer should not be medial to too much eversion is present, increase the diameter of the the midline of the talar neck. Once the proper insertion trial sizer and then reassess. distance has been visualized on fluoro, confirm distance using the laser marks on the driver and compare against the skin line. The lateral edge of the implant should be at or just medial to the lateral side of the talus. 7 8 Insert the implant using the driver from the instrument set. Procedure complete. It is suggested to maintain the foot in an everted position while disengaging the screw driver. To confirm final placement, check with fluoroscopy. If satisfactory, then remove the guidewire.
  5. 5. Arthrex, Inc. 1370 Creekside Boulevard, Naples, Florida 34108-1945 • USA Tel: 239-643-5553 • Fax: 239-598-5534 • Web site: Arthrex GmbH Liebigstrasse 13, 85757 Karlsfeld/Munich • Germany Tel: +49-8131-59570 • Fax: +49-8131-5957-565 Arthrex Iberoamérica 1370 Creekside Boulevard, Naples, Florida 34108-1945 • USA Tel: 954-447-6815 • Fax: 954-447-6814 Arthrex S.A.S. 5 Avenue Pierre et Marie Curie, 59260 Lezennes • France Tel: +33-3-20-05-72-72 • Fax: +33-3-20-05-72-70 Arthrex Canada Lasswell Medical Co., Ltd., 405 Industrial Drive, Unit 21, Milton, Ontario • Canada L9T 5B1 Tel: 905-876-4604 • Fax: 905-876-1004 • Toll-Free: 1-800-224-0302 Arthrex GesmbH Triesterstrasse 10/1 • 2351 Wiener Neudorf • Austria Tel: +43-2236-89-33-50-0 • Fax: +43-2236-89-33-50-10 Arthrex BvbA Technologiepark Satenrozen, Satenrozen 1a, 2550 Kontich • Belgium Tel: +32-3-2169199 • Fax: +32-3-2162059 Arthrex Ltd. Unit 16, President Buildings, Savile Street East, Sheffield S4 7UQ • England Tel: +44-114-2767788 • Fax: +44-114-2767744 Arthrex Hellas - Medical Instruments SA 103, Ethnikis Antistasseos str., N. Psichico 154 51 Athens • Greece Tel: +30-210-8079980 • Fax: +30-210-8000379 Arthrex Sverige AB Turbinvägen 9, 131 60 Nacka • Sweden Tel: +46-8-556 744 40 • Fax: +46-8-556 744 41 Arthrex Korea Rosedale Building #1137, 724 Sooseo-dong, Gangnam-gu, Seoul 135-744 • Korea Tel: +82-2-3413-3033 • Fax: +82-2-3413-3035 Arthrex Mexico, S.A. de C.V. Insurgentes Sur 600 Mezanine, Col. Del Valle Mexico D.F. 03100 • Mexico Tel: +52-55-91722820 • Fax: +52-55-56-87-64-72 Arthrex Swiss AG Müllerenstrasse 3, 8604 Volketswil • Switzerland Tel: +41-43-399-45-20 • Fax: +41-43-399-45-29 ©Copyright Arthrex Inc., 2007. All rights reserved. LB0431B