Dr. Tahsin Beyzadeoglu

Transkript

1 AYAK BİLEĞİ YÜZEY ARTROPLASTİSİ Dr. Tahsin Beyzadeoglu

2 ENDİKASYONLAR Lokalize, geniş instabil osteokondral lezyon veya OCD sekelleri Post-travmatik dejeneratif lezyon veya nekrozl Stabil veya rekonstrükte edilebilir stabilitesi olan ayak bileği Diğer konvansiyonel yöntemler iflas etmiş veya etmesi bekleniyorsa İleride artordez veya artroplasti adayı olacağı düşünülen hastalarda

3 HASTA SEÇİMİ Talar domda lokalize lezyon olmalı Hasta beklentisi ağrının geçmesini ve fonksiyonun ilerlemesi olmalı Hasta yaşı rölatif bir kontrendikasyondur (artrodez, artroplasti) Hastanın sağlıklı olması, tedavi sürecine uyumlu olması

4 KESİN KONTRENDİKASYONLAR Yaygın talus nekrozu, belirgin kemik demineralizasyonu veya yetersiz kemik stoğu Belirgin cilt, yumuşak doku veya nörolojik problem İnflamtuar veya Romatoid Artrit, Aktif Enfeksiyon, Sepsis Bilinen Cobalt-Chrome alerjisi

5 RÖLATİF KONTRENDİKASYONLAR Takip sürecine uyumsuz hasta Osteoporoz Kemik iyileşmesine etkili metabolik bozukluk Vücudun başka yerinde enfeksiyon Lateral bağların olmaması, kronik instabilite Yaygın tibiotalar dejenerasyon Belirgin dizilim bozukluğu

6 RÖLATİF KONTRENDİKASYONLAR Takip sürecine uyumsuz hasta Osteoporoz Kemik iyileşmesine etkili metabolik bozukluk Vücudun başka yerinde enfeksiyon Lateral bağların olmaması, kronik instabilite Yaygın tibiotalar dejenerasyon Belirgin dizilim bozukluğu

7 PREOP DİKKAT! Lezyon büyüklüğü ve radyolojik olarak dizilim Nörovasküler durum ve yumuşak doku örtünümü Lokalizasyon ve buna uygun cerrahi yaklaşım şekli

8 Ürün Cobalt Chrome Component Plasma Spray Undersurface Titanium Fixation Component 20mm Diameter 14 Different Convexities with Asymmetrical Curvatures

9 CERRAHİ TEKNİK Prof. C. Niek van Dijk

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26 Anterior Posterior Medial Lateral

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36 The metallic implantation technique appears to be a promising treatment option for ODs of the medial talar dome after failed primary treatment The clinical and radiologic results of 1-year follow-up are encouraging Osteochondral Defects of the Medial Talar Dome. Reilingh, ML, van Bergen CJ, van Dijk CN. Techniques in Foot & Ankle Surgery: March Volume 11 - Issue 1 - p

37 Reilingh et al 2012 Prospective case series of 15 patients with a clinical follow-up of 1 year. All patients had failed prior surgical treatment. Median AOFAS improved from 69 (range, 42-75) to 87 (range, ) (P = 0.001). Pain improved from 56.6 ± 13.4 to 73.6 ± 22.1 (P = 0.001). Function improved from 64.2 ± 13.0 to 82.8 ± 15.7 (P < 0.001). Sports improved from 29.1 ± 19.6 to 48.3 ± 31.7 (P = 0.005). QoL improved from 17.3 ± 13.9 to 46.3 ± 26.2 (P < 0.001).

38 This prospective case report is the first clinical report of a metal implant for OCDs of the talus and gives an insight into the surgical technique and clinical follow-up. The metallic implantation technique appears to be a promising treatment for osteochondral defects of the medial talar dome after failed primary treatment. van Bergen CJ, Reilingh ML, van Dijk CN. Tertiary osteochondral defect of the talus treated by a novel contoured metal implant. Knee Surg Sports Traumatol Arthrosc Jun;19(6):

39 Van Bergen et al year old female with OCD 2 previous arthroscopies on ankle Followed for 2 years post implantation Pain scores: walking improved from 8 to 0; running from 10 to 1 Foot and Ankle score improved on 4 of 5 subscales RTS Korfball at 1 year AOFAS improved to 90 at 2 years Radiographs showed implant in position, no signs of osteolysis or progression of degeneration

40 van Bergen CJ, Reilingh ML, van Dijk CN. Tertiary osteochondral defect of the talus treated by a novel contoured metal implant. Knee Surg Sports Traumatol Arthrosc Jun;19(6):

41 The metallic implantation technique appears to be promising treatment option for osteochondral defects of the medial talar dome after failed primary treatment Novel metal implantation technique for secondary osteochondral defects of the medial talar dome-one year results of a prospective study. Van Bergan CJA, Reilingh M,L van Dijk CN. Fuβ & Sprunggelenk 10: ,2012.

42 Van Bergen et al patients followed for 12.1+/- 1 months Mean age 38 years (20-60 yrs) Mean lesion size 15.7+/- 2.9mm x /- 1.8mm x 9.2 +/- 3.1mm 13- Stage 3; 1- stage 3; 1 unstaged Pain at rest, walking, running and stair climbing improved sig. (p<0.05) AOFAS, FAOS pain, function, sports, QOL improved sig. (p<0.05) There were no signs of prosthetic loosening or progressive degenerative changes on any of the postoperative radiographs

43 focal resurfacing with a metallic implant appears to hold promise as a means to restore more quasi-physiologic contact mechanics in ankles with a large talar osteochondral defect, appreciably reducing biomechanical aberrations presumed to be responsible for whole-joint cartilage degeneration. Anderson D, Tochigi Y, Rudert J, Vaseenon T, Bron T, Amendola A. Effect of Implantation Accuracy on Ankle Contact Mechanics with a Metallic Focal Resurfacing Implant. JBJS Am, 2010 June,

44 Anderson et al cadaver ankles with created 15mm osteochondral defect contact stresses measured before and after implantation FEA for effect of implant height, post axis rotation and varus/valgus tilt Untreated defect: 20% reduction in contact area, 40% increase in peak contact stress, shift in location Resurfacing recovered 90% of contact area, same elevated contact stress 0.25 mm proud = 220% of peak contact stress in intact Kinematics were restored

45 our study shows that accurate and reproducible implantation of this novel metallic implant can be achieved, preventing excessive prosthetic pressure. The results suggest that the implant can be used clinically in a safe way, but the effectiveness and safety of this treatment option should be evaluated in a clinical study. van Bergen CJ, Zengerink M, Blankevoort L, van Sterkenburg MN, van Oldenrijk J, van Dijk CN. Novel metallic implantation technique for osteochondral defects of the medial talar dome. Acta Orthop Aug;81(4):

46 van Bergen CJ, Zengerink M, Blankevoort L, van Sterkenburg MN, van Oldenrijk J, van Dijk CN. Novel metallic implantation technique for osteochondral defects of the medial talar dome. Acta Orthop Aug;81(4):

47 The metallic implantation technique seems to be a promising treatment for secondary osteochondral defects of the talus. Ooij B, Kaas L, Reilingh ML, van Dijk CM. Osteochondral defects of the talus: surgical treatment and rehabilitation. Archivio di Ortopedia e Reumatologia. 2010, Volume 121, Number 4, Pages 17-18

48 Ooij et al patients prospective study followed for 2 years AOFAS scores improved from 70 (42-75) before surgery to 86 (58-100) at 1 year, and 90 (87-90) at 2 years follow-up (p < 0.05) There were no clinical or radiographic complications.

49 Ooij B, Kaas L, Reilingh ML, van Dijk CM. Osteochondral defects of the talus: surgical treatment and rehabilitation. Archivio di Ortopedia e Reumatologia. 2010, Volume 121, Number 4, Pages 17-18

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53 OLGU SUNUMU 51 / K Temizlik personeli Sol ayak bileği medial talar lezyon 2010 da artroskopik mikrokırık Eylül 2011 de opere yüzey artroplastisi Postop 2. yıl, AOFAS , aktif çalışıyor

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66 TEŞEKKÜRLER Dr. Tahsin Beyzadeoglu