Name: 1st MTP Joint Hemi-Arthroplasty Utilizing The AnaToemic® Prosthesis
Uploaded: 2008-04-30T00:00:00Z
Channel: Arthrex

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DVD-1109 | A | 1st MTP Joint Hemi-Arthroplasty Utilizing The AnaToemic® Prosthesis

Franz Landsiedl

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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.

Procedure

AnaToemic-Hemiprothese

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

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