MAÏA® (Lépine) CMC 1 Prosthesis · 2015. 10. 5. · 4,8 1,6 0 10 20 30 40 50 60 70 80...
Transcript of MAÏA® (Lépine) CMC 1 Prosthesis · 2015. 10. 5. · 4,8 1,6 0 10 20 30 40 50 60 70 80...
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MAÏA® (Lépine) CMC 1 Prosthesis Didier FONTÈS (Sports Clinic of Paris -‐ France)
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The design of the Prosthesis
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The MAÏA® Prosthesis (Groupe Lépine)
The implants
The technical m
aterial
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The Surgical Technique
The Surgical Procedure for MAÏA Prosthesis implatation
Exposure, prepara?on and impac?on of the press-‐fit cup Prepara?on, impac?on of the defini?ve stem, reduc?on
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Important tips and tricks during implantation of the Maïa® prosthesis
§ Perfect centering of the cup (+/-‐ Rx control)
§ Preserve trapezium walls during milling
§ Polyethylene cup must overtake Tz surface aLer impac?on
§ Right tension with 2 mm axial piston during try
§ APL tendon dorsaliza?on during capsular closing
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Our personal indications and contra-indications
§ Eaton I-‐II-‐III class or Badia class II-‐III, resistant to codified medical R
§ No STT symptoma?c arthri?s
§ Trapezium height > 5 mm
§ No dominant hand of heavy laborers
§ No work compensa?on nore previous prosthesis
§ Z deformity is not a CI
Eaton Classifica?on
04/02/12 10:48
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Series - References
1. Analyse du confort post-‐opératoire et des résultats fonc?onnels précoces dans le traitement de la rhizarthrose. Etude prospec?ve et compara?ve trapézectomie-‐interposi?on vs prothèse MAIA -‐ Thèse de Médecine 2010: Thomas Jager (dir. De Thèse Gilles Dautel)
2. La prothèse trapézométacarpienne Maïa dans la rhizarthrose – Revue de 100 prothèses à plus de 3 ans – J. Teissier (Chir de la Main 2011)
3. Intérêt et mise au point d’un essai de résistance en fa?que mécanique du col d’une prothèse trapézo-‐métacarpienne. Applica?on à la prothèse Maïa – T. Aslanian (Chir de la Main 2011)
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Post-operative Assessment
Clinical assessment
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Post-operative Assessment
Radiological assessment
Protrusion of the cup
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Clinical Results at short follow-up (6 months versus Tzectomy)
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§ M1 lengthening +3,4mm
§ Sublux reduc?on 1 cm
§ Good centering in 80% cases § Osseous integra?on in 64%
(no cup protrusion, good angular stability, no peri prosthe?c bright space)
§ 2% mobiliza?on (1 necessity of a Tzectomy)
Radiological Results at short follow-up (6 months versus Tzectomy)
Good clinical func?on Bad clinical func?on => Tzectomy
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71,3
22,2
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Very sa?sfied Sa?sfied medium sa?sfied bad result
Subjec8ve Sa8sfac8on
Results at follow up > 4 years (J. Tessier – 100 prosthesis)
93,6 % global sa?sfac?on
95,6% of survival probability at 4 years follow up
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Results at follow up > 4 years (J. Tessier – 100 prosthesis)
9,7 2
Males : 9,4 Kg / 9,3 Kg
Females: 5,3 Kg / 5,5 Kg
Clinical evalua?on
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Results at follow up > 4 years (J. Tessier – 100 prosthesis)
Radiological evalua?on
§ Cup osteolysis seam 17,4%
§ Around M1 stem 8,2%
(no clinical consequence)
§ Peri prosthe?c ossifica?ons (frequent but not symptoma?c /
arc of mo?on)
§ Cup protrusion 3,2% § Cup mobiliza?on 4,7%
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Results at follow up > 4 years (J. Tessier – 100 prosthesis)
Complica?ons
§ 3 removal of the prosthesis § 1 disloca?on (close
reduc?on) § 4 Sudeck dystrophy
syndromes § 2 de Quervain tenosynovi?s § 1 cup unsealing § 1 trauma?c Tz fracture
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Advantages of MAÏA® PROSTHESIS
§ Large indica?ons (small Trapezium) § Large panel of configura?ons § Quick pain free func?on recovery § Rare disloca?ons (reten?ve cups) § Z deformity and 1st column length can
be corrected § In case of failure, Trapezectomy =
simple alterna?ve
Our Preferred treatment of Eaton class II-‐III CMC 1 ArthriEs