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THE A2 ANNIVERSARY

THE A2 ANNIVERSARY. THE ANATOMIC STEM : A 2. NORDPROTHESE Pôle Prothétique de St.Saulve Drs: JM.DELOBELLE R.ELHAGE P.LESAGE. A2 :anatomic 2. Born in France in October 18th. 2004 188 CASES PRIMARY SURGERY: 179 SECOND OPERATION: 9. A2 ANATOMICAL STEM.

zephania-camacho
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THE A2 ANNIVERSARY

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  1. THE A2 ANNIVERSARY NORDPROTHESE

  2. THE ANATOMIC STEM : A 2 NORDPROTHESE Pôle Prothétique de St.Saulve Drs: JM.DELOBELLE R.ELHAGE P.LESAGE NORDPROTHESE

  3. A2 :anatomic 2 • Born in France in October 18th. 2004 • 188 CASES • PRIMARY SURGERY: 179 • SECOND OPERATION: 9 NORDPROTHESE

  4. A2 ANATOMICAL STEM Evolution from the ABG2 to the A2 • INCREASE THE METAPHYSAL CONTACT • LIMITED THE DISTAL STRESS SHIELDING NORDPROTHESE

  5. VERY ANATOMIC NORDPROTHESE

  6. Surgical approach . • MIS two incisions : 16 Cases • MIS Postero-lateral : 111 Cases • Postero-lateral : 61 Cases NORDPROTHESE

  7. MIS 2 incisions :Interesting, but don’t forget the legal-medical aspect NORDPROTHESE

  8. MALE: 80 • FEMALE: 108 • AGE: From 22 to 87 YEARS Average: 65.33 • WEIGHT: From 47 to 147 Kg • SIZE: From 149 cm to 193 cm • FOLLOW-UP: FIRST CASE 10.18.2004 FROM ONE YEAR TO TWO MONTHS NORDPROTHESE

  9. BONUS OF THE NEW INSTUMENTATION NORDPROTHESE

  10. The instrumentation 2 • I use systematically: • The planification • The bone cut • The zimmer’s reamer • The alignment tip ( only the size 9mm ) • I use in 75% of the hips, the ABG’s reamer NORDPROTHESE

  11. FOURS SOLUTIONS TO DECREASE AN EVENTUAL VARUS • ONE : TROCHANTERIC PREPARATION • TWO : ABG’S REAMER • THREE : THE TIP ALIGNEMENT • FOUR : A GOOD IMPACTOR NORDPROTHESE

  12. DECREASE THE TROCHANTERIC IMPINGEMENT NORDPROTHESE

  13. IN THE 75% I USED THE ABG’S REAMERI want to decrease the risk of distal contact and to increase the alignment NORDPROTHESE

  14. THE TIP- ALIGNEMENT : 9mm NORDPROTHESE

  15. CHECK THE INTRODUCTION OF THE STEM NORDPROTHESE

  16. SIZE OF THE STEMS NORDPROTHESE

  17. Thesize of the stem increases with the learning curve . NORDPROTHESE

  18. The offsett decreases with the experience of the surgeon NORDPROTHESE

  19. VARUS / VALGUS ! • VARUS : 12 % • VALGUS : 3 % • THE RIGHT POSITION OF THE STEM INCREASES WITH EXPERIENCE . NORDPROTHESE

  20. METAPHYSAL FILLING • OVERSIZE • Without the bone at the calcar • 4% of the cases • NOT ENOUGH • Danger of varus • 7% of the cases • CORRECT FILLING • 89% of the cases MIS X 2 Y+1 6/6/6 NORDPROTHESE

  21. SPECIAL INDICATIONS . NORDPROTHESE

  22. SPECIAL CASE 1 NORDPROTHESE

  23. SPECIAL CASE 2 NORDPROTHESE

  24. SPECIAL CASE 3 M+4 NORDPROTHESE

  25. SPECIAL CASE 4 NORDPROTHESE

  26. SPECIAL CASE 5 THIGH PAIN ABG Y + 3 CIMENTED NORDPROTHESE

  27. SPECIAL CASE 6 NORDPROTHESE

  28. POST.OPSPECIAL CASE 6 MALE 56 YEARS OLD THIRD REVISION NORDPROTHESE

  29. BREAST CANCER NORDPROTHESE

  30. DWARFISH . SIZE :1 28/0 CUP:52 NORDPROTHESE

  31. ALCOHOL NORDPROTHESE

  32. BORDER-LINE CASE M+5 PAIN:0 NORDPROTHESE

  33. OPERATIVE COMPLICATIONS DURING A M.I.S. TWO INCISIONS • Only one failure during a M.I.S. two incisions , I kept the two incisions, but I fixed a revision stem to increase the stability NORDPROTHESE

  34. CLINICAL RESULT OF THIS CASE NORDPROTHESE

  35. Post operative complication: case 1 • Mrs Ca… case number 16 : • After MIS 2 incisions the leg’s lenght was too large , 3 cm too much , I performed a new intervention at J+3 • with a smaller stem 7/+3.5 by 6/-3.5 . • And a new osteotomy of the neck . NORDPROTHESE

  36. Y+1 : 6/6/5 NORDPROTHESE

  37. Post operative complication:case 2 • Mr. DU…. Number 26 : Instability after only 6 days without accident . • New stem one size bigger 8 9 • New cup with a double mobility . NORDPROTHESE

  38. Y+1 : 6/6/6 NORDPROTHESE

  39. Post operative complication: case 3Instability . • Mr. HER…. Number 74 : • After a M.I.S. POSTERIOR, the instability of the hip was probably due to the fact that the stem was too small. The size 9 has been put out and I fixed a stem 10 with ciment . Size 11 or 12 were not avalaible !!! • P.S : it was a M.I.S. 2 incisions in the other hip !! NORDPROTHESE

  40. M+8 : 6/6/6 NORDPROTHESE

  41. Fragility of the calcar , Mrs. LE..number :69 • Two months after the surgery • Probably one little crack during surgery. • Clinical follow up : MDA : 6/5/5 HARRIS : 95 80 years old NORDPROTHESE

  42. Clinical follow up : 6/5/5 6/5/5 NORDPROTHESE

  43. AN OTHER SIMILAR CASE NORDPROTHESE

  44. CLINICAL FOLLOW UP 6/6/6 NORDPROTHESE

  45. Mrs. DIEUDO… number 10579 years old broken , after a slice (M+2) NORDPROTHESE

  46. M+3 : 6/6/6 NORDPROTHESE

  47. CLINICAL FOLLOW-UP • Too short follow-up for a real analysis. • No thigh pain . • except with two M.I.S. 2 incisions, with an abnormal sensibility on the femoro-cutaneus nerve. • Satisfaction of the patients about 100 %. NORDPROTHESE

  48. RADIOLOGICAL FOLLOW-UP • VARUS : 12 % of the cases, specially at the beginning of my personal experience. • VALGUS : 3 % of the cases. • WITHOUT DISTAL BONE CONTACT : 85 % NORDPROTHESE

  49. 85 % NORDPROTHESE

  50. ADAPTATION BONE / STEMAFTER 6 MONTHS • OVERSIZED STEM : 4 % • UNDERSIZED : 7 % • NORMAL : 89 % • 3 FRACTURES : two subsiding of the stem! one slice. • No mobilisation of the stem at the radiological follow up and a good osteo integration. NORDPROTHESE

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