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Hello!

I am shadowing a podiatric surgeon and I have some questions about one of the procedures he does.

The surgeon does Hyprocure implants. After researching this device specifically, I was curious about the need for removal of the device. The surgeon I'm following thinks it's a terrible idea to ever have the device removed (he seemed kind of upset when I asked him about it...), but based on everything I've read and learned so far about these devices, I'm not sure why.

I know that the interosseous ligament is cut before the device is put in, but, does this really cause any complications if the device is removed? I thought the interosseous ligament doesn't prevent overpronation of the foot.

The podiatrist also told me that removal of the device will lead to arthritis. Wouldn't a patient have the same risk for arthritis as before, as in, if they had never gotten the implant?

Any advice is much appreciated! (and I already read all the previous threads I could find on the hyprocure specifically).

 

Hi Footses2,

HyProCure subtalar arthroereisis prostheses require removal in approximately 5% of cases for various reasons and cause some ongoing discomfort in around 15% of cases. One of my colleagues had trouble extricating this device from a patient but generally they can be effectively removed if required. I believe the HyProCure arthroereisis passes through the interosseous ligament and when removed, the ligament tissue remains functional. I have not had any patients experience subtalar arthropathy or instability following such extrication. Others may have differing experiences.

Andrew Kingsford (F.A.C.P.S.)

 

I agree with Andrew that circa 5% of HyproCure implants may require removal. In order to correctly implant the device the IOL is indeed cut. Failure to do so will likely cause difficulty with correct insertion and placement of the device. Unlike other devices, HyproCure is inserted more deeply into the canalis tarsi. The device functions not from blocking STJ pronation but from a re-alignment of the STJ axis. Some believe the IOL should not be severed but this does not seem to cause any adverse effects. The ligament is then wrapped around the threaded portion of the implant upon insertion.

An arthroereisis can be used in isolation when indicated. Other times there may have to be ancillary procedures performed. Like any other procedure a successful outcome is predicated on correct execution and familiarity with the device.

I am not aware of any outcome studies that corroborate the impression that removal of the implant is responsible for arthritis. The implant does not violate any joint.