Reply:Article 1 (
Article 2 (
Following are my responses to the questions and comments from Drs. Hatch and Tower regarding the 2 articles (
1
, 2
).Article 1 (1)
- 1.The primary point was that only 6% of the cases resulted in a permanent removal and 9 cases required a revision. If you want to add the numbers together to show how many patients required additional surgery that is fine; however, the ultimate failure rate would not be 14% as the additional cases were successful after the revision.
- 2.The pivot point is the same as the axis point of the subtalar joint. This was shown in my article published in 2011 (3).
- 3.I assume that you are inferring that HyProCure® is the object that is placed on both sides of the pivot point, 180° to each other. The medial threaded portion of the HyProCure® has no effect to the talotarsal joint motion. The true stabilizer is the central conical smooth section. The “head” of the HyProCure® device serves only as an additional area for tissue on-growth to prevent device displacement. HyProCure®, if sized correctly and positioned accurately, will not block all motion.
Article 2 (2)
- 1.The reference to Farabeuf was taken from EFS Chamber's article (4).
- 2.If you cut skin, it heals. If you cut tendon, it heals. If you cut bone, it heals. If you cut a ligament, it heals. I have no scientific peer reviewed published studies on the healing rate of the interosseous ligament. When I have had to go back into the sinus tarsi for implant removal or revision the ligament had reanastomosed. The cutting of the interosseous ligament, for many, is simply preposterous and one of the biggest “sins” of sinus tarsi implant surgery, yet to cut the medial band of the plantar fascia is quite acceptable and to completely remove the contents of the sinus tarsi for a patient with chronic sinus tarsitis is also very acceptable. The interosseous ligament is one of many talotarsal ligaments whose function is to prevent the displacement of the talus on the calcaneus. The interosseous ligament is not “doing its job” in patients with talotarsal displacement. The sinus tarsi implant replaces the function of the interosseous ligament.
- 3.The threaded portion of the HyProCure® device does not limit any motion of the talus on the calcaneus. The real stabilizer is the smooth conical portion. It is specifically this middle section of the HyProCure® that prevents the anterior displacement of the talus. The threaded portion only serves as an anchor to allow tissue on-growth to resist device displacement.
- 4.Wilhelm Henke and Friedrich Gustav Jakob Henle were anatomists in the 1800s who published many works on anatomy including talotarsal motion. They have been referenced by the forefathers of foot and ankle surgery.
Please see the Additional Sources at the end of this letter.
References
- Extraosseous talotarsal stabilization using HyProcure® in adults: a 5-year retrospective follow-up.J Foot Ankle Surg. 2012; 51: 23-29
- Extraosseous talotarsal stabilization devices: a new classification system.J Foot Ankle Surg. 2012; 51: 613-619
- Stabilization of joint forces of the subtalar complex via HyProcure sinus tarsi stent.J Am Podiatr Med Assoc. 2011; 101: 390-399
- An operation for the correction of flexible flatfeet of adolescents.West J Surg Obstet Gynecol. 1946; 54: 77-86
Additional Sources
Bergmann E, Bruns P, Mikuliez J. A System of Practical Surgery, Vol III, New York, Lea Brothers p. 751–768, 1904.
Cunningham DJ. Manual of Practical Anatomy, 2nd ed, Vol 1, p. 324, Pentland, London, 1896.
Henke FGJ. Handbuch der Anatomie und Mechanik der Gelenke mit Rucksicht auf Luxationen und Contracturen. D.F.Winter, X, Leipsig u. Heidelberg, Germany, 1863.
Henke. W Die Contracturen der Fusswurzel. Zeitschrift fur ration Med, 3rd ed, Vol II, p. 177, Leipzig und Heidelberg, Reihe, 1859.
Henle FGJ. Handbuch der systemischen Anatomie des Menschen, III, Braunschweig, 1871.
Lorenz. Die Lehre vom erworbenen Plattfusse, Stuttgart, Verlag Von Ferdinand Enke, 1883.
Lovett RW, Cotton FJ. Some practical points in the anatomy of the foot. J Bone Joint Surg 298–315, 1898.
Article info
Publication history
Published online: July 01, 2013
Identification
Copyright
© 2013 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.
ScienceDirect
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- Extraosseous Talotarsal Stabilization Using HyProCure® in Adults: A 5-year Retrospective Follow-upThe Journal of Foot and Ankle SurgeryVol. 51Issue 1
- PreviewThe purpose of this retrospective study was to determine long-term functional outcomes and device tolerance achieved in adult patients who chose to undergo an extraosseous talotarsal stabilization procedure HyProCure® for the treatment of flexible talotarsal joint deformity. Eighty-three adult patients participated in this study. Postoperative subjective assessment of device performance was evaluated using Maryland Foot Scores, which were collected at a mean follow-up period of 51 months. The mean postoperative Maryland Foot Score was 88 out of 100; postoperatively, 52% of cases reported complete alleviation of foot pain, 69% of cases had no limitations on their foot functional abilities, and 80% of cases reported complete satisfaction with the appearance of their feet.
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- Extraosseous Talotarsal StabilizationThe Journal of Foot and Ankle SurgeryVol. 52Issue 5
- PreviewWe appreciated Dr Graham et al's 2 recent articles on arthroereisis [Graham ME, Jawrani NT, Chikka A. Extraosseous talotarsal stabilization using HyProCure® in adults: a 5-year retrospective follow-up. J Foot Ankle Surg 51(1):23–29, 2012; Graham ME, Jawrani NT. Extraosseous talotarsal stabilization devices: a new classification system. J Foot Ankle Surg 51(5):613–619, 2012]. Articles and research are needed to validate collective findings that this is an important procedure for flexible flatfoot and talotarsal dislocation.
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- Extraosseous Talotarsal Stabilization Devices: A New Classification SystemThe Journal of Foot and Ankle SurgeryVol. 51Issue 5
- PreviewDisplacement of the articular facets of talus on the tarsal mechanism, or partial talotarsal dislocation, is a condition seen in children, adult, and geriatric populations. A characteristic of this pathologic condition is a prolonged period of and excessive amount of pronation (hyperpronation) on weightbearing. The ill effects of this condition may lead to a multitude of other foot pathologies and to pathologies associated with the proximal lower extremity musculoskeletal structures. A variety of conservative and operative treatment options have been used to eliminate or minimize hyperpronation.
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