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Anatomic Stem Evolution in Nordprothese: Augmenting Surgical Precision

Explore the evolution and benefits of Nordprothese A2 anatomical stem for hip surgeries, emphasizing improved metaphysal contact, reduced stress shielding, and optimal alignment techniques. Learn about special cases and clinical follow-ups.

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Anatomic Stem Evolution in Nordprothese: Augmenting Surgical Precision

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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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