Trumatch - Dr Fernando Marcucci

Esperienza e primi risultati nei sistemi
protesici custom made
Dott. Fernando Marcucci
L. Buonocore, M.Greggi, E.D’Antonio,
N. Cuozzo
What about TruMatch?
• TruMatch is a patient specific instrumentation
for primary TKA based on SIGMA HP system
• TruMatch cutting blocks are manufactured
In USA, by DePuy-Synthes
• Realized on CT scan imaging
• TruMatch instrumentation is disposable
and delivered sterilized
ACCURATE PREOPERATIVE PLANNING
VARUS/VALGUS CORRECTION
PATELLAR OFFSET CORRECTION
TKA
BEFORE
TRUMATCH
PROSTHETIC IMPLANT SIZING
ROTATION DEFECTS CORRECTION
EVALUATION OF FLEXION-EXTENSION GAP
• HIGHER INFECTION RISK
• MORE STRESS FOR THE PATIENT
• BLOOD LOSS INCREASED
LONGER SURGICAL TIME
Intra-Op Efficienies
Efficienies
Intra-Op
Flexion/Extension
instability
Osteotomia
da
scivolamento
TIBIAL
CREST
PLANNING
TKA
BEFORE
TRUMATCH
Surgical
workflow
efficiency – femoral
prep
ORworkflow
VALGUS PREFERENCES
•• VARUS
Surgical
efficiency
tibial prep
EXTRAROTATION
•del
Distal
Femur
resection
distance
relative
to
the
condilo
laterale
Avoid
LCL releasefemorale
•Accurate
preoperative
planning
OSTEOTOMIES
My
experience
landmark
(10 mm)
CT SCAN
Attention
to popliteus
tendon
damaging
• Patient
proposal
review
• When between
sizes
do you
•External
rotation
landmark
fornormally
the
Case
number
• Additional
Femur resection
due knee
to flexion
Prefer Distal
later approach
in valgus
component
(Epicondylar
Axis)
up or
down
sizing
?
(
Down
size)
•femoral
Check
the
stability
of
cutting
Size
contracture
mm)
• During this
step the(0surgeon
could
Side
Value the
opportunity
toand
perform lateral
masks
using
the
femoral
change condyle
preselected
preferences
slide osteotomies
• Proximal
tibial resection
landmark
using
tibial
«SHAKE»
•External
rotation
angle
relative
to
themechanical
surgical
••Choose
Limit
Shift
implant
APimplant
tolike
prevent
andtoadapt
the
implants
a
landmark (how many degrees ?)
sartorial
review
axis
(lower
condyle)
system
femoral
notch
(3 mm)
• Specific
focus
on
the
use
ies
•I USUALLY PREFER
3 DEGREES FROM
WHITESIDE’S LINE
of tibial cutting
block to avoid(PS,CR,CS) TECHNIQUE
•Femoral
component
SURGICAL
•2nd
choice
external
rotation
landmark
COULD
••YOU
Proximal
tibial
resection
distance
relative to
• The alignment
manufacturing
areSIMPLY
ready
for
wrong
or flex-extension
landmark
(4
mm)
if •1st
is not detectable
Accettable
Limit to Flex implant to
NMR
instability the
shipment
CHECK
THE
LINES
(Whiteside’s
Line) notch
•Tibial
component
(Fixed
bearing,
prevent
femoral
(degree)
Dopo
“release”
il distance
• Addictional
proximal
tibial resection
efficiency
bial
prep – femoral prep
••My
choices
to
correct
due
tothebeAshipped
rotating
plate)
Resection
guides
will
in
35
CT
SCAN
SUGGEST
GOOD
compartimento
laterale
•Femoral
sizing
references
and AP
flexion
patella
overloading
or(2mm)
patella
90°
aPOSITIONING
couple
of weeks
and
ready
to using
use
WITH
AN
AVERAGE
• position
Distal
femur
resection
landmark
è
lasso
in
flessione
references
Down)
«BAJA» and
collateral(Anterior
varus/valgus
2,85
DEGREES
• balancing,
Posterior
slope
to
proximal
tibia
(2 degree)
•Poly
component
type
stabilized
mechanical
axisSLIDE
(most
distal
condyle)
are angle
the
OSTEOTOMIES
and
TIBIAL CREST osteotomy
TIBIAL POSITIONING
• I ALWAYS PREFER THE
«CURVE ON CURVE» POSITIONING
• MATCHING THE ANTERIOR PROFILE
OF TIBIAL IMPLANT ON ANTERIOR
CORTICAL BONE
• MORE THAN 35 CT SCAN
POST- OPERATIVE CONTROL
SUGGEST A CORRECT POSITIONING
TIBIAL POSITIONING
Instability after TRUMATCH is a rare event
When it happens is more frequently due to
wrong intraoperative chooses or errors in surgical
practice
Stability is still easily recoverable by replacing only
PE component
OUR EXPERIENCE
AVERAGE TIME
Surgery (Skin to Skin):
43:00 min
Femoral Distal Cut:
Sizing Femur:
Tibial Alignment an Resec.:
02:23 min
01:41 min
06:53 min
Our experience
150 cases TM since 04/07/2011
150 cases LCS since 04/07/2011
150 cases SIGMA since 04/07/2011
OUR EXPERIENCE
LCS
Age
150 cases
62
Gender
>Women
Weight
76,3 Kg
Varus/Valgus
>Varus
Functional requirement
Asa
High
Asa 1,6
OUR EXPERIENCE
SIGMA
Age
150 cases
73,2
Gender
>Women
Weight
79,6 Kg
Varus/Valgus
>Varus
Functional Requirement
Asa
Medium/High
Asa 1,8
OUR EXPERIENCE
TM
Age
150 cases
79,3
Gender
>Women
Weight
87,4 Kg
Varus/Valgus
>Varus
Functional Requirement
Asa
Medium/High
Asa 2,6
OUR EXPERIENCE
TM
LCS
SIGMA
NOTCHING
0
2
1
FLEXION
CONTRACTURE
3
5
7
EXTENSION LAG
0
0
2
VARUS
OVERCORRECTION
0
5
4
VALGUS
OVERCORRECTION
0
1
2
LCS
SIGMA
TM
58 U
54U
16U
Haemoglobin
Value
8.9
8.6
10.4
Post operative
pain-killer
drugs
management
822 U
736 U
329 U
Mean
Hospital Stay
5,3 d
5,5 d
4,1 d
Blood
Transfusion
CONCLUSIONS
• REDUCED BLOOD LOSS AND BLEEDING
• SHORTER SURGICAL TIME
• LESSER PAIN AND EDEMA
• REDUCED INFECTION CASES
• NO MALALIGNMENT
• SHORTER HOSPITAL STAY
• OPPORTUNITY TO PERFORM TKA IN PATIENTS WITH
INCREASED ASA
124 X-Ray post-operative control confirm
from surgeon preferences in VARUS/VALGUS
8 Computer-Assisted cut control confirm the
same gap in flexion and extension
5°
WHO?
• Patients older than 70 years
• Standard functional
requirement
• Immediate result
• No good clinical conditions
(ASA )
• Jehovah’s Witnesses
• BMI 
WHYCONCLUSIONI
TRUMATCH ?
GRAZIE
Esperienza e primi risultati nei sistemi
protesici custom made
Dott. Fernando Marcucci
L. Buonocore, M.Greggi, E.D’Antonio,
N. Cuozzo