Can The HyProCure Implant Provide The Answer For Hyperpronation?

By Robi Garthwait, Contributing Editor

For DPMs dealing with the common condition of hyperpronation, the HyProCure Sinus Tarsi Implant may be one of the more intriguing treatment options to date.
Composed of medical grade titanium, the implant serves as an internal orthotic that essentially turns the negative space of the sinus tarsi into a positive space, according to the implant’s manufacturer Gramedica.
Gramedica says the HyProCure implant is stronger than bone and requires one small incision for insertion without the need for casting after the procedure. Paul Clint Jones, DPM, has successfully implanted the HyProCure device in about 20 patients since 2006. “I have used the older generation products and none of them are able to be used and tolerated the way HyProCure is,” states Dr. Jones, who practices in Spokane, Wa., and Kellogg, Idaho.

A Closer Look At Key Benefits

While medication, physical therapy and orthotics can address the symptoms of hyperpronation, Gramedica says these treatment options do not target the underlying cause. Historically, the use of implants to target the problem has also been problematic.
“The older generation of STJ implants has a poor track record of not being tolerated and having to be removed in the adult population,” notes Dr. Jones. “(The) end result is having to do more aggressive procedures with increased risk, protracted convalescence and pain to the patient.”
Using the HyProCure implant enables surgeons to avoid these issues, according to Dr. Jones. Gramedica maintains that surgeons have successfully used the HyProCure design since 2004 to realign the talus on the calcaneus.
For Dr. Jones, one of the key benefits of the HyProCure is that it “addresses the apex of the deformity of the foot.” He says this allows for a broader spectrum of indications. Dr. Jones also points out that surgeons can use the implant to treat both adults and pediatric patients.
The company says the ease of insertion makes the HyProCure stent an attractive option for practitioners. A 1.5- to 2.0-cm incision over the sinus tarsi is usually all that is necessary to implant the device. The goal of the procedure is to achieve 1 to 3 degrees of rearfoot eversion and the stent is available in several sizes to achieve this goal, according to Gramedica.
In addition, Gramedica says the implant will not wear out, patients are usually back in regular shoes within one week of surgery and there are no limits to activities once the implant is inserted and healing has occurred.

Some Caveats To Keep In Mind
Gramedica notes there are potential complications with this procedure. One rare complication that surgeons have observed is “sprained ankle syndrome,” due to the new stretch being placed on the outer ankle ligaments. The company says this may be a temporary symptom that will likely dissipate. However, if the ligaments do not adjust to the new positioning, Gramedica says this may require removal of the implant.
Depending on the amount of correction one achieves with the implant, postoperative pain may also be present. Anti-inflammatory medication is recommended for six to eight weeks after the procedure to reduce discomfort, according to Gramedica.

Final Notes
Overall, Dr. Jones says the design of the HyProCure implant and the ease of the procedure facilitates optimal results.
“This product bridges the need to deliver the best service to my patients while minimizing the worry that I could have done something more,” emphasizes Dr. Jones.



I have just recently started using the HyProCure implant in a few of my patients. Within 2 weeks post operative, the patients are pain free in their original chief complaint areas (PT Tendonitis and Achilles Tendonitis) with a minor amount of residual post operative pain. The immediate post operative results in resting calcaneal stance position are amazing. The classic flatfoot signs are greatly reduced. I have seen reduction in "too many toes sign", increased medial longitudinal arch height, decreased talar head prominence medially, and even elevation of the dorsal medial eminence in some bunions to more dorsally. I am very encouraged by what I have seen so far. Post operative pain management is best managed with a course of steroids immediately after surgery though to help reduce the bone swelling associated with the "trauma" of the surgery itself. The benefits of the steroids far outweigh the risks of their usage for 1 weeks time. NSAIDs can be started the week the steroids are finished. I believe the steroids provide a larger decrease in bone edema then by conventional NSAIDs.

Thus far, it is an excellent product that can produce great results when the appropriate patient is selected. As with any procedure, it too has its indications and limitations. Chose wisely.

This has been the same results I have seen. Historically, the first generation STJ implants are an adjunct procedure, especially in the adult. Concomitantly, lengthening of the Achilles Complex, PT tendon advancement, Medial Cuneiform opening wedge osteotomy, etc. are performed. Conversely,the HyProCure, frequently, is performed as a stand alone procedure. I always notify the patient of potential for further need of additional procedures, but with the understanding that I will attempt to do the isolated procedure first. I rarely have to return for the additional procedures. Even the Gastroc-Soleal Equinus does not tend to be a problem. I have had a case where the implant reduced the talar declination such that it revealed a flattened talar dome and induced an osseous equinus and required subsequent removal of the implant. This certainly has been the exception. The nice thing about the implant is it addresses both regions of motion that can occur in the Subtalar Joint. This being the sinus tarsi and the sinus canalis respectively. The first generation of implants (STA-PEG, MBA, STJ, Conical, Valenti, Kalix, Villadot, etc.) only function at the sinus tarsi, allowing compensatory translation at the sinus canalis, a resultant elongation of the medial column. This equates to failure or less-than-desired result to the patient and surgeon. Studies have also shown, 40% of the time, the first generation implants having to be remove from the adult patient due to pain. This is due to the weightbearing "Door Stop" effect of the implants. The HyProCure, on the other hand, does not have this problem, as its placement has a "Shear Pin" effect, limiting pronatory motion of the peritalar joints without direct weightbearing on the implant. My oldest patient so far is 91. The patient came to the office requesting the implant and luckily was a candidate. The patient is currently a year plus with the implant. The HyProCure, certainly, is not for everybody, but I have been pleasantly surprised with the low rate of complications and the patients tolerance to the implant. The one problem I have encountered with fellow doctors is the impression that this is just another STJ Arthroeresis implant. Admittedly, I originally felt the same, but prior to my attending the training course, every one I put in, I had to remove due to displacement or patient complaint. I dismissed it as the implant was not what it claimed to be and tabled further use. Following the completion of the Master's Training Course, I found I had the same results as those claimed by Gramedica, of a 5% removal rate. This implant certainly deserves a second look by the profession. This is a surgery and results I confidently share with my patients.

Can anyone tell me what CPT code you are using for this procedure???? Thank you!

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