Hallux rigidus und limitus sind Erkrankungen, die zu erheblichen Beeinträchtigungen führen und von denen in der Regel ältere Menschen betroffen sind. Unter Umständen können sie jedoch auch bei jüngeren Patienten auftreten. Die Phalanx-Hemiprothese AnaToemic ist eine ideale Option, wenn ein gelenkschonender Eingriff anstatt einer Arthrodese sowie eine unmittelbare Verbesserung der Beweglichkeit gewünscht sind.

Foot and Ankle

Trauma Lower Extremities

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Foot and Ankle: Next Generation in Foot and Ankle Technology 2023

Kris DiNucci, DPM, (Scottsdale, AZ) uses a Mini TightRope® suture FT and an AnaToemic® implant for correction of a Hallux Limitus with a large intermetatarsal angle.

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AnaToemic® 1st MTP Hemi Implant with Hallux Valgus Correction Using the Mini TightRope® FT Anchor

A standard incision through the subcutaneous tissue. Once I get to the capsule, most of the time I'll be performing a linear capsulotomy of the first MTP joint and releasing all of the structures around the base of the proximal phalanx to allow for adequate exposure. Following this, I will expose the medial eminence of the first metatarsal. If it's hypertrophied, I'll resect it. We will save that for later use. As I'll discuss here, you can see the base of the proximal phalanx, where it has eroded of its articular cartilage and is degenerative. I then perform a lateral release where the adductor tendon is released off of its insertion in the base of the proximal phalanx. In patients that have a concomitant valgus deformity with arthrosis of the first MTP joint. I'll also release the deep transverse metatarsal ligament. The base of the proximal phalanx is then exposed with either homemade retractors or a bone clamp. Resection of the proximal phalanx is then performed with a sagittal saw. I prefer to do minimal resection, as you As you can always go back and remove additional bone, but if it's too excessive resection, you will not have good implant seating. I will use a guide wire of a 0.0 45K wire initially, to see if the placement of this is central within the base of the proximal phalanx. I'll use my flora scan to see if it's properly placed. Then I will use the 2.8mm k wire. You can see there's three laser lines. You go all the way to the third laser line to allow for proper placement of this guide wire. Once that guide wire is in place, you use a trial sizer and you see which size is appropriately placed. 17 to 23 millimeter sizes are available. This is the reamer that will ream the base of the proximal phalanx flush. The guide wire is then removed and following this, the trial prosthesis. This patient has a 21.5mm trial. Place it through its range of motion following placement and look fluoroscopic or radiographically to see the seating on the base of the proximal phalanx. And it looks anatomic in its alignment at this point. Removal of the trial prosthesis is then performed after range of motion assessment. Once this has been removed and irrigation is then performed. Now the gouge is then placed to allow the flare at the base of the prosthesis to be seated. The prosthesis is then placed, and then the mallet is then used to seat the implant into the base of the proximal phalanx. I then look at the fluoroscopic imaging of the placement of the implant, and the implant looks anatomic, and its placement hits the margins of the proximal phalanx well. You can see there's significant increase in the first intermetatarsal angle, which would normally be reduced with an osteotomy or a arthrodesis or possible non osteotomy techniques, which is what we're going to do at this time with use of a mini TightRope ft anchor. The guidewire is then placed at the proximal first metatarsal obliquely to the base of the second metatarsal. Fluoroscopic imaging confirms proper placement at the base of the second metatarsal laterally. The 4.5 over drill is then performed through the base of the first metatarsal, just purchasing that medial cortex of the second metatarsal, as you can see on this image. The guidewire is then removed and a tap is in place. The entire length of the placement of the anchor to the base of the second metatarsal. The anchor is an inserted medially to the base of the second metatarsal. As you get to the end of the turns a few quarter turns, you feel it's firm. You remove the suture and as you can see, this is a bioabsorbable anchor that does not show up on X-ray. But you can see the handle which does show up on the floor. Scan a few turns in the handles, able to be removed. The cinch mechanism allows for the button to be seated against the first metatarsal, prior to seating the button against the metatarsal. The medial eminence bone has been more sliced, and is packed to fill that hole into the first metatarsal tarsal medially. Once the button has been seated against the first metatarsal, the suture is pulled directly out in line with the anchor in the base of the second metatarsal, to properly reduce the deformity and tighten the cinch mechanism. A few tie hand ties and the anchor is completely seated. Now you can see you have reduced the first metatarsal angle. The halix remains in a mild amount of valgus position, so at this point I do not cut the suture. Here's a radiograph showing reduction of the first intermetatarsal angle. Irrigation is then performed and capsular closure is then performed with two zero FiberWire. Now once the closure has been performed, you've maintained your motion of the first MTP joint, at least 50 degrees of dorsiflexion, 30 of plantar flexion, and the halix is sitting in neutral due to the medial plication of the first empty capsule and reduction of the deformity with the Ft anchor.

The Arthrex® AnaToemic® Hemi-Prosthesis is placed in the proximal phalanx of the great toe for Hallux Limitus or Hallux Rigidus.

A general overview including the relevant steps of an Arthrex surgical technique. These animations always include a voice-over explaining the process.

Eine allgemeine Übersicht, einschließlich der relevanten Schritte einer Arthrex Operationsanleitung. Diese Animationen enthalten immer Voice-Overs, die den Prozess erklären.

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AnaToemic® Hemi-Prosthesis

The base of the proximal phalanx is resected with a sagittal saw. The guidewire is then placed centrally into the base of the proximal phalanx. The sizer is used over the guidewire to find the appropriate sized implant. The hand reamer is then used to prepare the base of the proximal phalanx for the final implant. Trial implants are available in the set, and the appropriate size should be placed to check range of motion with the implant in place. Once the size of the implant has been determined, the punch is used to prepare the proximal phalanx for the stem of the implant. The implant is then impacted into the proximal phalanx until flush with the bone. The final implant will allow the halex a full pain free range of motion.

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AnaToemic ® Phalangeal Prosthesis

1st MTP Joint Hemi-Arthroplasty Utilizing The AnaToemic® Prosthesis

First MTP joint hemiarthroplasty utilizing the anatomic prosthesis with Doctor Franz Lancedale. Indication for the Arthrex anatomic prosthesis in Hill-Sachs rigidus with pain and restricted range of motion. Using the anatomic hemi prosthesis, you can avoid the disadvantages of other common used procedures like arthrodesis or the scaler procedure. Using the anatomic hemi prosthesis, you can avoid weakness of the Hill-Sachs and transfer lesions of the second MTP joint like. We find it common very often in the scaler procedure, and there is full range of motion. There is no there are no lesions of the IP joint one like in the Arthrodesis. There is a very good cosmesis, a good range of motion and no shortening of the helix. The AnaToemic hemi prosthesis is indicated for the treatment of grade three and four helix rigidus, as specified by Viner. The approach to surgery is made through either a medial or dorsal medial skin incision. Using a scalpel, make a sharp detachment of the capsule from both the metatarsal head and the base of the phalanx. Take care not to damage the dorsomedial neurovascular bundle. Osteophyte removal and or colectomy may be performed at this point. Resect 2 to 3mm from the base of the proximal phalanx with a micro sagittal saw. Take care to preserve the planter plate and short flexor tendon or fhb, as this attachment is important for proper function of the toe. Using a strong bone clamp or Hohmann retractors on the proximal phalanx, the metatarsophalangeal joint is dislocated to enable sufficient access to the proximal phalanx. If the joint is too tight, Tied another 1 to 2mm may be resected using an oscillating saw. This should be done with care, as excessive shortening of the phalanx can lead to laxity of the joint and component loosening. Determine the implant size with the sizing gauge. The gauge should not be bigger than the surface of the proximal phalanx. In patients with soft bone, templating should be done along the dorsal cortex to avoid subsidence of the implant. Drill a 2.8mm guide pin through the central hole of the gauge. This may be done either perpendicular to the surface of the proximal phalanx, or elevated five degrees, to aim in a slightly better direction. Use the appropriately sized AnaToemic reamer for a controlled final resection of the phalanx, and for creation of a perfectly smooth mating surface for the implant. The amount of the resection can be checked at the laser marks of the wire, which are spaced two millimeters apart. Ensure that the fhb is preserved throughout the guide. Pin is Pin is removed, the trial implant is inserted and the joint is reduced. The alignment and bone contact between the implant and the proximal phalanx are checked while applying slight traction to the toe. Check the distance between metatarsal head and the prosthesis. There should be a gap of 5 to 6mm. The sizing gauges are 1.5mm thick and may be stacked to estimate joint resection. The range of motion should also be evaluated at this point. Additional osteophytes are removed and the head is shaped for ideal interfacing with the surface of the implant. The passive range of motion should be at least 70 degrees. In many cases, a colectomy is performed to achieve this range of motion. This is one of the key advantages to resurfacing the phalanx compared to resurfacing the metatarsal head. Remove the trial implant. The medullary space of the phalanx is prepared for the implant by inserting the punch to the laser line. In soft bone, only 50% of tip should be inserted to guarantee a tight fit of the stem of the prosthesis. The final implant is inserted. The cobalt chrome AnaToemic hemi prosthesis is highly polished on the joint side, and grip blasted on the bone mating side. The implant is only 2.4mm thick and is available in five different sizes 17, 18.5, 20, 21.5, and 23 millimeter. The prosthesis is fixed to bone with a notched tooth that provides phalangeal stability without excessive bone removal. The range of motion alignment and the distance between the metatarsal head and the implant are confirmed. When closing the wound. No capsule orifice should be performed. Post op protocol. Patients may fully weight, bear immediately in a postoperative shoe, and are encouraged to keep the foot elevated for 7 to 10 days. Postoperatively. Sutures are removed between 12 to 14 days. A post-operative physiotherapy regimen after suture removal should focus on first MTP, dorsiflexion, and a normal gait pattern. The postoperative program should continue for at least four months to prevent scarring and stiffness. Patients are followed at two weeks, six weeks, three months, six months, one year, and two years postoperatively with radiographs at six weeks, one year and two years. For information on the Arthrex Surgical Skills Training program, contact Arthrex or visit the Arthrex website at Arthrex.

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Videos - OP-Anleitung (2)

AnaToemic® 1st MTP Hemi Implant with Hallux Valgus Correction Using the Mini TightRope® FT Anchor

1st MTP Joint Hemi-Arthroplasty Utilizing The AnaToemic® Prosthesis

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Foot and Ankle: Next Generation in Foot and Ankle Technology 2023

Operationsanleitungen (1)

AnaToemic ® Phalangeal Prosthesis

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AnaToemic® Hemi-Prosthesis