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Does anyone have any opinions on hyprocure

Discussion in 'Foot Surgery' started by bartypb, May 9, 2009.

  1. bartypb

    bartypb Active Member

    Members do not see these Ads. Sign Up.
    Hi there I keep hearing about HYPERCURE - a quick surgical procedure that involves putting a titanium screw into the sinus tarsi to reduce excess subtalar pronation, triplaner movement.

    Does anyone out there have experience of this, Pros/Cons or any opinions welcome


  2. Griff

    Griff Moderator

  3. drsarbes

    drsarbes Well-Known Member

    Hi Marc:

    The Hyprocure is not a procedure but a type of implant for subtalar arthroereisis.

    The first of these, and the one I still use, was the MBA STJ Arthroereisis. The MBA is a symmetrical implant whereas the newer designs are more conical in shape. The Hyprocure ( I did meet the developer for this 3 or 4 years ago, I believe he is from Michigan) is more of a classic headed screw design.

    In addition to new implant design, absorbable implants have also been developed.

    I have implanted many of these, both types and for both pediatric flexible pes valgo planus and for adult progressive PTTD.

    If you have some specific questions I'll do my best to answer them for you.

  4. drsarbes

    drsarbes Well-Known Member

    I read Emma Supples' bio.
    Can anyone tell me if she has a DPM degree?
    If not, how did she manage to do a Surgical Residency in Detroit?
    Just wondering.
  5. Paul Jones DPM

    Paul Jones DPM Welcome New Poster

    This is a STJ implant made by Gramedica.com. Affectionately name the HyProCure, It has quick found its way into my practice. 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.
  6. lgs

    lgs Active Member

  7. Paul Jones DPM

    Paul Jones DPM Welcome New Poster

    Don't know that she has a DPM degree, as she practices in England. As for a residency, her bio says she attended the Master Surgeon's Seminar in Detroit, Michigan. This is a hands on training program put on by the Gramedica International Implant Institute of Gramedica grahamiii.com

  8. apple

    apple Welcome New Poster

    sorry to resurrect such an old post but what was it that was going wrong before you attended the masters training course?

    several months down the line, has anyone else got any opinions on this surgery?


  9. drsarbes

    drsarbes Well-Known Member

    I think we should.

    First, I can no longer find Emma Supples BIO stating she had a residency in Detroit.
    Second, the one that I can find now states she is a fellow of the COLLEGE OF PODIATRIC SURGEONS.
    Unless this is a UK association, to the best of my knowledge, there is no such organization.

    Third, as to Hyprocure; I read Dr. Jones' last post; I'd like to know how the HyproCure is different than the dozen or so STJA implants out there. I cannot find any evidence that this implant design can or does anymore than the others, certainly does not diminish the need for ancillary procedures when indicated, including a tight Soleus-gastroc complex.
    The main difference that I can find is that it is marketed better.

    I used the new Biomet design several times and found it almost identical to the MBA design, however the biomet was recalled to due one of the 117 that were implanted breaking. Hmmmmm. Most likely an obese patient or the wrong size or both.

    I have found that the ONLY time it can be done stand alone with predictable results is when:
    1. Flexible pes planus (fully reducible)
    2. at least 5 degrees DF at the ankle with Knee extended
    3. Normal Muscle strength
    4. No accessory Navicular


  10. anDRe

    anDRe Active Member


    Within Europe, only Spain and the UK allow non-registered medical practitioners to undertake foot and ankle surgical procedures. In the UK, a number of chiropodists were employing local anaesthetic techniques in the mid 1960s, learnt during service in the Royal Army Medical Corp. Under guidance from American podiatrists, individuals with a background in the conservative treatment of foot disorders commenced training in nail and hammer toe surgery in the early 1970s.Within 20 years, it was determined that over 22,500 procedures a year were being performed by podiatric surgeons in the UK.To become a podiatric surgeon, practitioners undertake a 3-year degree course in Podiatric Medicine, and complete a minimum 1-year post-registration year before commencing a Master's degree course in the Theory of Podiatric Surgery. Subsequently, they complete an Objective Assessment of Professional Skills Test. A minimum of 2 years in supervised training posts in NHS departments of podiatric surgery follows to gain experience in foot surgery. Further practical examinations in clinical diagnosis and surgical treatment planning are completed before the final Fellowship examination when candidates must perform a comprehensive range of foot surgery on a number of patients. Once awarded Fellowship of the Faculty of Podiatric Surgery (FCPodS), the surgeon is entitled to apply for specialist registrar posts in the NHS. At the end of 3-year specialist registrar posts, the surgeon submits a log book to the Faculty of Podiatric Surgery for the award of the Certificate of Completion in Podiatric Surgical Training (CCPST). The CCPST allows the podiatric surgeon to apply for consultant podiatric surgeon posts in the NHS. All such posts are awarded by an appointment panel. The minimum training period for UK podiatric surgeons is 9 years.
  11. drsarbes

    drsarbes Well-Known Member

    Thanks Andre.

    Is there a "college of Podiatric Surgeons" in the UK or Spain?

    What is the scope of practice for Podiatric Surgeons in the UK. Forefoot, midfoot, rearfoot, ankle, osseous, amputations......

    For one trained in the USA, it all seems a bit confusing.

  12. Steve:

    I just wrote an article for Podiatry Today Magazine (scheduled to be published in April 2011), "Biomechanics of Subtalar Joint Arthroereisis Implants" which included a mention of the Hyprocure implant. I would be interested in your thoughts on the article when it is published.:drinks
  13. drsarbes

    drsarbes Well-Known Member

    Hi Kevin:
    I would be my pleasure.
    I just received the February edition but I don't see it there, must be the next one.
  14. April 2011....in two more issues.
  15. bob

    bob Active Member

    Hello Steve,

    There is a 'college of podiatry, faculty of podiatric surgery' in the UK. Emma Supple has completed her fellowship as far as I know. As far as scope of practice goes - it is all of the above. Podiatric Surgeons in the UK can and do operate on 'the foot and associated structures'. They are regulated by the Health Professions Council (although currently as 'podiatrists', this has no bearing on their scope of practice and they will be held to task for all manner of problems encountered in the surgical arena) and almost all work within our national health service (NHS). Similar to the US, podiatric surgeons' practice varies vastly from practitioner to practitioner, but the vast majority will only provide a surgical service to patients (so no callus and corn debridement or toenail cutting, etc...).

    I entirely agree with your comments regarding the hyprocure arthroeresis by the way. In the few that I have used, I have performed other procedures to accompany the arthroeresis. If you are to use an arthroeresis within the NHS in the UK, your local NHS organisation will prossibly point you in the direction of the following document before they agree to spend the money on the kit, etc... :
  16. anDRe

    anDRe Active Member


    In the UK Podiatric surgeons specialise in invasive foot surgery. The scope of practice is defined as "surgery of the foot and associated structures". The majority of work reflects the frequency of foot pathology presenting in the UK, most commonly digital and forefoot surgery, as well as mid foot and rearfoot surgery including triple arthrodeses, ankle stabilisations and Achilles tendon lengthenings/repairs.

    The role of the College of Podiatric Surgery is to promote, develop and govern podiatric surgery training and practice. To this end it will also work closely with the College of Podiatrists Professional Conduct Committee, Industrial Relations Committee, Professional Indemnity Committee and Faculties of Podiatric Medicine and Management.

    The Faculty is an elected body of 8 representatives taken from the membership of the Faculty of Podiatric Surgery. Elections are held annually and once elected, members of the Board can remain on the Board for a minimum period of 3 years before standing down for at least a year.

    Surgery Board, College of Podiatrists

    The Board is chaired by the Dean of Faculty who is elected by the Board. There are also representatives from the podiatric surgery training grades, at the pre-surgical training and Specialist registrar level.

    The Board meets three times per year and is fully supported by the secretariat of the College of Podiatrists including the Director of Education and the Post Graduate Education Officer. The Board meetings are open to all members of the Faculty on application to the secretariat, though sections of the meeting will be confidential.
  17. NewsBot

    NewsBot The Admin that posts the news.

    Stabilization of Joint Forces of the Subtalar Complex via HyProCure Sinus Tarsi Stent
    Michael E. Graham, Rachit Parikh, Vijay Goel, Devdatt Mhatre, Aaron Matyas
    JAPMA September/October 2011 vol. 101 no. 5 390-399
  18. So much here I want to know more about.

    What is "stabilisation" exactly? What is a "hyperpronated foot"? What is "excessive talar subluxation", or indeed talar subluxation in general? What is an axial load? What is the proper distribution of one?
  19. timharmey

    timharmey Active Member

    Does anyone know of a surgeon who perfoms this op on the N.H.S
  20. I think Graham Mann does.
  21. timharmey

    timharmey Active Member

    Thanks ,I have a patient who has been recommended the op but refused by a commisioning committee but looking at the nice guidelines if I can locate someone with a record on the N.H.S we might get some joy , where does he work?
  22. Ryan McCallum

    Ryan McCallum Active Member

    I would be amazed if a surgeon performed this procedure (or any other) just because someone else has recommended it to a patient.

    We have performed a number of subtalar arthroresis procedures but do not perform them regularly (or at all really now) and never without concomitant procedures. We tend to favour alternative procedures.

    I personally think the procedure when performed in isolation is a bit of a waste of time. In a case where a sinus tarsi implant would be sufficuient by itself, the patient is likely to respond excellently to a pair of foot orthoses. Just my opinion.

  23. Makes sense to me. If an arthroesis is an internal orthotic...
  24. timharmey

    timharmey Active Member

    Thanks Ryan ,I will have a grumpy lady sitting in front of me , not a new experince, thinking she is being denied a life changing op due to cost.It would be good to offer her a NHS alternative .I do feel with this patient there is a bit of pass the parcel going on but at least i can say to her I tried to find her an alternative.The patient was offered the op before but denied this due to cost issues , or so the surgeon who tried to arrange her care thinks , she has then been sent to me to see by her GP to see if her care can be arranged elsewhere.
  25. Freeman

    Freeman Active Member

  26. Carl

    Carl Welcome New Poster

    This is what I'd like to know too. I contacted Charing Cross hospital in London and their team under Dr. Barlow-Kersley apparently do Hyprocure operations funded by the NHS

    But I'd like to know if there are any others and what their credentials are. My patient has extremely pronated feet and it's completely inhibiting his life
  27. Rebecca Graham

    Rebecca Graham Welcome New Poster

    I've had this procedure 12 months ago. Been in absolute agony ever since. Having it removed in 2 weeks
  28. Lindsay DeRose

    Lindsay DeRose Welcome New Poster

    Dr. Arbes,
    If it is okay, I would like to pick you brain on Hyprocure. I had bilateral MIS bunion surgery almost 7 weeks ago. Things are healing well and I am progressing to athletic shoes with carbon fiber inserts. The problem is that it did not address all of my pain. I’m attaching a few files…..my ankle still rotates, causing pain in my ankles, knees, and hips. I think the bunion surgery is successful (fingers crossed), but I need do something else in the future. I’ve already tried conservative (PT, orthotics/custom orthotics), etc. Thank you for your time!

    Also, I had bunions for about 12 years with no pain/issues. During my pregnancy my feet fell apart….I thought that the bunion surgery would repair the misalignment, but the misalignment begins more proximally than I thought realized.


    Attached Files:


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