Extra-Osseous TaloTarsal Stabilization (EOTTS)

Arthroereisis vs HyProCure®

There is a difference.Don’t be fooled.

Arthroereisis

• First of all it is pronounced

r-throw-ear-e-sis

– “operative limiting of the motion in a joint that is abnormally mobile from paralysis.”

Dorlands Medical Dictionary

“operative limiting of the motion in a joint that is abnormally mobile from paralysis”

• limiting of motion • in a joint (an articulation; the place of union or junction

between two or more bones of the skeleton, especially a junction that admits of more or less motion of one or more bones)

• that is abnormally mobile• from paralysis (loss or impairment of motor function in a part

due to lesion of the neural or muscular mechanism)

Arthroereisis

Arthroereisis

This is a procedure to “block” or limit joint motion.

J Bone Joint Surg Am. 1928;10:261-267.G. NOVÉ-JOSSERAND

Subtalar Joint Arthroereisis

This is a procedure to either block/limit or lift up the lateral process of the talus.

Subtalar Joint Arthroereisis

Prior to STJ arthroereisis this was the only other option.

Subtalar Joint Arthroereisis

This technique is focused on lifting and/or blocking the lateral process of the talus.

Plantar view of talus

Subtalar Joint Arthroereisis

The goal is to stop the anterior progression of lateral process by some method within the outer half of the sinus tarsi.

Arthroereisis

Historically , it was performed but cutting and inserting a bone graft into the calcaneus in front of the lateral process.

Long-term Results?

These methods usually failed due to the forces acting on the bone graft material and also since the bone remodeled and therefore failed to restrict lateral process motion.

Evolution of Subtalar Arthroereisis

Later, “newer” materials were used intra-osseously and inter-osseously to restrict talocalcaneal motion.

Arthroereisis Implements

Arthroereisis devices act solely within the

lateral half of the tarsal sinus.

Subtalar Arthroereisis

The end result usually lead to failure due to: – Its poor anatomic design – limitation in material– inadequate biomechanical function

Subtalar ArthroereisisExtra-Osseous Devices.

Due to the previously described limitations and need for something better combined with improved biomaterials, the first extra-osseous titanium device was inserted into the lateral portion of the sinus tarsi.

Subtalar Arthroereisis

• This device was a titanium version with enhancements of a polymer device.

• However, they were still placed in the same spot and had the same function- lateral arthroereisis

Arthroereisis Placement

This device is inserted so that the tip “touched” the bisection of the talus. These are placed in a lateral-to-medial orientation.

Function

This device acts as an anterior extension of the lateral process of the talus.

Talar Supination

There is no limitation of supinatory motion as the talus supinates.

Talar Pronation

As the talus moves from a supinated to pronated position the anterior extension of the talus hits against the posterior aspect of the anterior facet to block further pronation.

Lateral Arthroereisis Devices

Longer term results showed about a 40% removal rate due to device loosening along with other factors.

Subtalar Arthroereisis Device Evolution

• The device had a cylindrical design.• It should be noted that the outer sinus

tarsi shaped is conical not cylindrical. • Newer devices were designed with that in

mind as well as other features with ways to make device removal easier.

Subtalar Arthroereisis

Unfortunately, the new designs did little to decrease the overall removal rate.

Now its time to learn about a major evolutionary leap.

Extra-Osseous TaloTarsal Stabilization with HyProCure®.

Arthroereisis implants act here.

HyProCure® is not an arthroereisis device.

Arthroereisis implants act here.

HyProCure® stabilizes the talotarsal mechanism here.

Do you see the difference?

If not, go back and take another look.

HyProCure® is a talotarsal fixation device.

That is how HyProCure ® is classified with the

Food & Drug Administration.

Arthroereisis Implants

HyProCure® does not act as an anterior extension of the lateral process.

This is where arthroereisis devices are

placed.

This is where HyProCure® is

placed.

HyProCure® is placed deeper into the sinus tarsi.

HyProCure® transforms the abnormal “negative” sinus tarsi space into the normal “positive” space.

HyProCure® is medially anchored by the tissues within the canalis portion of the sinus tarsi.

Tissues within the canalis grow and adhere onto the threads to lock HyProCure in

place.

HyProCure® does not block or limit motion.

The leading edge of arthroereisis devices

come into contact with the calcaneus here.

Top view of the calcaneus

HyProCure internally stabilizes the talus at

the cruciate pivot point here.

HyProCure® stabilizes the talus at the cruciate pivot point to restore the talotarsal

axis of motion back to normal.

See the difference?It may not seem so different but it is the difference

between success and failure.

Normal amount of pronation and supination is still available.

HyProCure® stabilizes the talus on the tarsal mechanism while still allowing the normal

range of motion to occur.

If a wire, staple or screw is used to stabilize the talotarsal mechanism, there will be a complete

limitation of motion.

This is different from arthroereisis devices that

abruptly stops talar motion or arthrodesis which completely eliminates talotarsal motion.

Because of the unique anatomic design combined with the

improved biomechanic function, HyProCure® has a significant

less chance for removal.

Arthroereisis devices are like an octagonal tire.

It kind of works and is better than no tire.

Just doesn’t work so good and doesn’t last too long.

On the other hand…

HyProCure® is like putting a round tire on your car.

You’ve heard the saying

“form follows function”?

A round tire is meant to roll.

HyProCure® is designed to stabilize the talus while still allowing the

normal functions to occur.

This presents a revolutionary breakthrough.

It is a paradigm “shifter”.

It works.

Significantly lower removal rate.(nearly 6% compared to nearly 40%)

Just makes sense.

Leads to better outcomes.

Many are fooled into believing that HyProCure® is

“just another arthroereisis device”…

IT IS NOT!

HyProCure’s effect can benefit not only

the foot but it can lead to improvement

up the MSK chain.

HyProCure® truly “fixes” one thing…

TaloTarsal Dislocation

Dislocation- “the displacement of any part, more especially of a bone”-Dorlands.

TaloTarsal Dislocation (TTD)

This is the pathologic displacement (removal from the normal position) of the talus on the tarsal mechanism.

TTD

Does not “fix” itself

TTD

It is a progressive disease…it only gets worse and the signs and symptoms are far reaching.

TTD

This is an internal deformity occurring above the calcaneal (heel bone) and above the bottom of the foot.

Internal deformity = Internal Solution

HyProCure®

www.HyProCure.com