Pro: o: I Immed ediate W e Weight Be Bear aring ng with H - PowerPoint PPT Presentation

OSET Pro: o: I Immed ediate W e Weight Be Bear aring ng with H HTO: A Gam A ame Cha e Changer er Thomas M. DeBerardino, MD Professor of Orthopaedic Surgery, Baylor College of Medicine Co-Director, Baylor-San Antonio, Texas Sports Medicine Fellowship The San Antonio Orthopaedic Group Medical Director, BRIO

Disclosure • The following relationships with commercial interests related to this presentation existed during the past 12 months: • Research support: MTF and Arthrex • Consultant: Arthrex, MTF • Dr. DeBerardino does not intend to discuss the use of any off-label use/unapproved use of drugs or devices

Goals of Talk: • Discuss safety and efficacy of iBalance HTO implant • Early weight bearing study • Highlight new technology for guided or free-hand iBalance HTO

Goals of HTO • Realign extremity • Decrease pain • Improve overall function • Restore mechanical environment • Decrease force on ligaments & grafts

HTO Indications • Unicompartmental arthritis • Varus Deformities • Cartilage Restoration Procedures • Meniscus Transplantation • Osteochondral transplantation • Cartiform • Bio- Cartilage

Decades of Opening Wedge Osteotomies

It is All About the Hinge Pin • The hinge pin technique reduces drastically the risk of lateral cortex fracture • Stress homogenization in the area of the drill hole • Avoids locally high stress concentrations in the region of the sharp cutting notch • Definitive TRUE VALGUS ostoeotomy

Freehand Technique

Guide Pin, Cannulated Drill, and Hinge Pin

Hinge Pin Guide Pinned in Place

Making the Cut European cut

HTO FreeCut- Still Protect N-V structures!

FreeCut Guide

Open Osteotomy Desired Distance

Implant Placement

Secure, Quickset, Close

Recent Case

Hinge Pin Placement

Protected Osteotomy Cut

Completed HTO Cut and Opening Jig

Peek Fasteners Placed

Guided FreeHand vs FreeCut- An Option for All

Recent Clinical Trial • Scordino LE, DeBerardino TM. Surgical treatment of osteoarthritis in the middle-aged athlete: new horizons in high tibial osteotomies. Sports Med Arthrosc. 2013 Mar;21(1):47-51

Hypothesis • Time to full weight bearing will be significantly reduced in group allowed to bear weight as tolerated and healing will not be compromised

Block Randomization: Two Treatment Arms • Group I • Group II • TTWB 6 wk • WBAT • Pain ≤ 3 • Off narcotics Standard HTO using the PEEK iBalance implant with Osferion and ACP ROM locked brace 6 wk

Outcome Measures • 1 0 Outcome Measures • Time to FWB • Healing on Radiographs • 2 0 Outcome Measures • WOMAC • Hematoma, Bleeding • Pain & Medication Use

Data Points WOMAC, Pain and Medication, PRE OP Radiographs 1 WK Pain and Medication, Radiographs 6 WK WOMAC, Pain and Medication, Radiographs WOMAC, Pain and Medication, 12 WK Radiographs WOMAC, Pain and Medication, 6 MONTH Radiographs

All patients undergoing HTO from my practice N=40 Excluded 2 language barrier, 1 did not enroll Enrolled N=37 Withdrew: 1 workers comp, 1 fracture- subchondral cyst N=35 Early Toe Touch N=18 N=17 Group 2 Group 1

Time to D/C of Crutches Days Until Full Weight Bearing 45 40 42 days* (42- Average 12 days* (2-21) post-op in 35 56) the early group before no crutches 30 needed 25 20 15 10 5 0 Rapid WB Delayed *significantly different, p < 0.05

Summary: Key Highlights • Growing need for knee realignment and joint preservation procedures • HTO evolved from “freehand procedure” to guided, predictable/reproducible procedure

Conclusions: iBalance HTO Game Changer • No increased complications • Slope, correction maintained • Early weight bearing appears safe and efficacious for HTO “Invisible” PEEK Standard Bulky • No difference +/- ACLR iBalance, OsFerion, ACP Hardware

Take Home Points- iBalance HTO • iBalance HTO remains best in class option for OWHTO • Only system that obtains true valgus slope maintaining osteotomy • Hinge Pin is the key • Safe, reproducible, maintainable results. LOW morbidity • Standard biplanar alignment guide is really freehand jigged bony cut • Hinge Pin & FreeCut guides are newest option for surgeons based on personal preference

Thank You Questions?