The Top Ten Innovations In Podiatry

Brian McCurdy, Senior Editor

   With the Prophecy guides, the manufacturer Wright Medical says one can start surgical planning by loading preoperative computed tomography (CT) or magnetic resonance image (MRI) scans into a computer. Based on surgeon preferences, the company says the knee aligns with unobscured anatomic landmarks without invasion of the tibial canal. The guides result from the information that surgeons provide. The company says with the guides, one can determine the following information before surgery: alignment and rotation, implant size and anterior/posterior femoral placement.

   Christopher Hyer, DPM, has been using the Prophecy guides for two years. He says there are no other systems available that allow physicians to visualize the operative anatomy for total ankle replacement before surgery.

   “This technology allows you to really perform the surgery in the virtual world before you ever get to the OR,” says Dr. Hyer, a Fellow of the American College of Foot and Ankle Surgeons. “You are able to visualize the unique anatomy and pathology specific to that individual case.”

   In comparison to performing a traditional total ankle replacement, Dr. Hyer says with the Prophecy guides, one can make decisions about implant sizing and positioning of the tibial tray, the number of stems, and the size of polyethylene space and the talar component before surgery. As he notes, this saves time and adds considerably to the efficiency in the OR. Dr. Hyer says the Prophecy guides also allow one to create patient specific cut guides to allow for precise implant placement.

   Wright Medical notes that the Prophecy Pre-Operative Navigation Guides are completely extramedullary and may reduce blood loss and the incidence of pulmonary emboli. The company notes that the simplified ankle replacement process results in several simplified steps for OR staff: reduced tourniquet time; a reduced hospital sterilization process due to reduced instrument requirements; and less training for hospital staff.

   Dr. Hyer adds a caveat that the technology requires a specific CT imaging protocol and its turnaround is about four weeks for the workup and computer simulation. However, he says this lead time is often not an issue in regard to total ankle replacement surgery. Dr. Hyer also notes that sometimes the CT images are compromised by preexisting hardware, which he says could adversely affect the ability of this templating protocol.

Tenex Health TX (Tenex Health). With the Fasciotomy and Surgical Tenotomy Technique in the Tenex Health TX, surgeons can use ultrasound technology to identify and debride pain-generating pathologic soft tissue in tendons and musculoskeletal structures of the foot and ankle, according to the manufacturer Tenex Health. The company says the Tenex Health TX uses the TX1 Tissue Removal System to address the lateral and medial epicondyle, the patellar tendon, the rotator cuff, the plantar fascia and the Achilles tendon.

   Bob Baravarian, DPM, uses the TX1 ultrasound tissue debridement system for fasciosis, tendinosis and small loose bone pieces, calling it “great for plantar fascia and Achilles pain including insertional pain.”

   Dr. Baravarian, the Chief of Podiatric Foot and Ankle Surgery at the Santa Monica UCLA Medical Center and Orthopedic Hospital, notes that the product removes the chronic scar tissue and increases blood to the region for healing in a percutaneous manner. He adds that it is minimally invasive with no downtime for patients, who will wear a boot for two weeks after the procedure.

   The company notes that Tenex Health TX is minimally invasive. It maintains that one can perform the technique with a local anesthetic and the treatment is done in 15 minutes or less with a fast recovery.

Manos (Thayer Intellectual Properties). Plantar fasciotomy surgery can be truly minimally invasive thanks to a device that uses small entry and exit points, and results in no scarring.

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