Hey guys, been an awesome day fixing hallux limitus with joint implant, the Arthrosurface.
I have two awesome videos to share with you.
Two patients today back to back, one had surgery six years ago with me with the arthrosurface.
She wants to make the other side even today.
And the other one is a new patient for arthrosurface.
You can see the pathology of hallux rigidus as well as see how the implant is put in and
how it's gonna make a difference for the patient.
You'll see immediate increase range of motion and you'll see some of the pathomechanics
behind this hallux rigidus deformity and disease of the joint and how it looks like in the
actual joint.
Warning, these are actual surgery pictures so if you are squeamish please do not continue.
Left foot now.
This is the clinical presentation, again the bump on top, limited range of motion, it's
not moving.
She's under anesthesia right now and I also blocked her, so watch this,
it stops, the skin stops right
about here, it stops right about there, it's not moving.
After surgery we want to get about 90 degrees or close to it, that's the goal.
That's what I wanna be.
Right now it's down here, I want to go ahead and bring that big toe up to about this high
by the time I'm done with the surgery.
I'll go ahead, clean this out same as a lot of patients, again it's stuck right here,
it hurts with every step we're gonna go ahead and fix it.
Let's do it.
We still see a lot of this junk right here, a lot of the inflamed tissue, inflamed cartilage,
we'll go ahead and clean this up, in the next shot you'll see all this cleaned out and the
joint moving correctly now.
So right now guys we have the implants in place, seated in place correctly now I'm just
gonna clean up aggressively and get this joint moving.
This is patient number two, you see that big bump is gone right here and it's all cleaned
out, the arthrosurface implant is in.
The metatarsal is right here, we're right in front the metatarsal, on the x-ray and
we see that.
The base of the proximal phalanx has been cleaned out too very aggressively.
So now when I put it back together again, it's just gonna move where we want it to be
without jamming or causing any kind of problems.
Right here again it's nice and smooth as you can see from the side we're gonna look down
at it we're about -- I can get it to 90 degrees on the table right now.
Realistically, you'll probably settle in right about there but that's 90 degrees right now, that's
a good starting point versus before. So again this is arthrosurface you could take a look
at it, there's no jamming in there, implant's in place, movement is perfect at this point,
nice and smooth, no jamming, nothing holding it back.
Again we'll gonna take a look at this again one more time on this view, no jamming.
Again we don't need this to walk anymore we're gonna use what nature intended but look at
that, we're going up right here, the joint is in good condition.
Arthrosurface number two for the day.
Arthrosurface closed now.
Now we've been fully closed, look, the range of motion is perfect, gliding perfectly normal,
her toes looking really good right here.
Range of motion is perfect, we'll gonna go on the side and look up and down the range
of motion we have close to 90, that's what I want again.
Again, this is the range of motion that we want.
Okay, again, range of motion that we want.
She's gonna be able to walk with this without pain, without restriction, this is the arthrosurface
implant and we're good to go.
Well, grossed out yet?
That is one patient.
The second patient will be coming up very soon.
Again the second patient I did her left foot about six years ago and she's in for the
right foot today.
She's very happy with the left foot done six years ago, no pain and she's able to go about
all her activities.
The next patient is actually also 76 years old, very active, very athletic, very good
shape, excellent bone stock so she's a great candidate for this implant because -- well
she had it six years ago and it was perfect on the other foot and she just wants the other
side taken care of.
So enjoy and see the outcome.
We're gonna move it, it's not moving, it's jamming, a lot of pain.
We did her other foot, you can't see it but the other foot is moving very well.
I did her other foot about 6 years ago
and she's doing great and we'll gonna make this even.
We're gonna do the arthrosurface implant, again, this is gonna go here
we're gonna look at the intraop photos, pictures, videos, and some post-op.
We'll go from there, thank you.
This is down to the joint, this is the first MPJ inside, the same patient last time
you see there's a big loss of cartilage right about here
so again this is the osteophyte or the arthritis I see on top,
the joint is very irregular. This is cartilage, very minimal part,
there is no cartilage right here.
And then over here we have some loose fracture fragments right about here.
These are all loose. This is bone that's loose in the joint that's causing a lot of pain.
Now we're gonna go ahead and resurface this thing with arthrosurface and
we'll go on from there. Thanks.
The range of motion immediately after surgery, we still have the 90 degrees right here,
the joint has no impinging, we see the nice range of motion here, there's no crepitus,
no impinging and we're about 90 degrees right about here, that's what I want,
close to 90 degrees at least.
But that's the amount of degrees I want of dorsiflexion right after the surgery.
Again, here you go, range of motion, no crepitus, very nice and smooth.
No bone on bone. We're looking good.
You've seen those videos about the actual surgeries I've done today
for hallux limitus with the arthrosurface implant.
Here is a little bit of what it looks like on in a cartoon method
in a cartoon right here you see, that's hallux rigidus, I've explained to the patient
so many times that I took off some of the marks but basically a bone spur is in
the first toe joint and is very, very narrowed.
A normal first toe joint will actually be nice and smooth around --
nice and smooth right about here, okay.
Some of the older implants look like this, it's called a silicone implant,
they will put a silicone implant in between this space called a spacer
so that's what that looks like.
Now this is an older poster so I don't have the arthrosurface on here
but basically the arthrosurface is putting a -- we're resurfacing this joint right here
so we take all this off all this is taken off, all the bone spurson top are taken off
but we also put that implant right about here
so this is replaced, this is not replaced.
When I'm in surgery most of this cartilage is intact.
So it doesn't make sense to damage this for the sake of fixing a joint
when this is the joint that's bad.
So the arthrosurface is actually the first implant that's come out
addressing this problem and I've been very happy with it, the patients have done really well.
So again this is called a Hemi implant it goes right about here in this area
and there's a stem that comes in where this implant pops right into.
That's why patients are able to walk right away.
So the results have been excellent and read more about it,
come visit us at www.NaplesPodiatrist.com and give us a call (239) 430 3668.
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