The HyProCure® Extra-Osseous Fixation Device: TaloTarsal Stabilization that Works
HyProCure® offers a superior option in the treatment of flexible talotarsal joint dislocation, for patients ages three and up. Unlike any other talotarsal mechanism stabilization device, HyProCure® has inherent advantages that make this minimally invasive procedure the ideal solution for the vast majority patients from all walks of life.
This stent’s advanced design utilizes both the sinus and canalis portions of the sinus tarsi, yielding the best anatomical fit and biomechanical correction. These factors contribute to the low removal rate and high patient satisfaction, which in turns translates into great professional success for the physician.
Perhaps most importantly, HyProCure® has more peer-reviewed published literature to support its claims than any other device on the market. Links to abstracts of the published literature can be found in our Library section.
Below are points that will help explain the dramatic breakthrough that HyProCure® represents:
- The HyProCure® talotarsal fixation device is a self-seating/positioning implant which is not drilled or screwed into the bone. Rather, it is simply placed inside the space where the ligaments and fibrous tissues will hold it in place by filling its threads and ridges during the healing process. Older generation implants do not work this way, which causes complications and limitations in their use.
- The design of HyProCure® has three different distinct sections:
- A threaded inner/medial section; this sections locks the device into the canalis portion of the sinus tarsi. The threads will purchase into the interosseous ligament which helps to reduce backing-out of the implant.
- A tapered middle section; this is the portion that comes in contact with the lateral aspect of the talus and blocks the implant from going any deeper. It takes the guesswork out of the procedure. With other implants it becomes a game of “Is it in too far or not far enough?”
- The outer larger diameter is smooth and is what actually leads to the prevention of the obliteration (partial/full) of the sinus tarsi. It is very important that this part of the implant has no threads since the lateral process of the talus will come in contact with the implant. Other implants have threads that are very sharp and may lead to damage to this portion of the talus and the sulcus on the calcaneus.
- Due to its unique shape, HyProCure® utilizes both the canalis (deeper inner portion) and sinus (wider outer portion) portions of the sinus tarsi. Other subtalar implants are inserted with a slightly
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different orientation, and call for the lateral portion of the stent to be about 1 cm from the lateral wall of the calcaneus. The problem with this placement is that the implant sits in the middle part of the sinus tarsi, the most unstable portion. The other implants only minimally enter the canalis portion. The lateral (outer) wall of the talus hits against the outer portion of the implant causing micro-motion that can further lead to pistoning or displacement of the implant. This can cause pain and the implant may need to be removed. If these other implants are seated too deep into the sinus tarsi there will be under-correction because the lateral process of the talus will still obliterate the sinus tarsi. If the implant is too superficial then it isn’t locked into the canalis portion of the sinus tarsi. The lateral process of the talus will hit up against the implant thousands of times a day and may eventually come lose or piston, leading to pain and further failure of the implant.
- This implant does have a canula for guide-wire insertion but its use is completely optional as it is not a required step in the HyProCure® procedure. Other implants require the use of a guide wire for insertion to make sure that the implant is actually placed into the correct location and to avoid misplacement. The HyProCure® stent, however, can only be inserted into the sinus tarsi because of its anatomical design. It would be extremely difficult and highly unlikely to insert it into any other location and therefore the use of a guidewire is optional.
- The instrumentation of the system is very different from the rest. The sizing of the implant has been simplified. The trial sizers were designed to mimic the shape of the implant driver with the implant attached. The end is the shape of the HyProCure® stent without the threads. This sizer is quite simply inserted into the sinus tarsi until it won’t go in any farther. Once inserted, the forefoot is loaded and the rearfoot is inspected for eversion. If there is greater than three (3) degrees of eversion then the next larger size is inserted until the desired 3-4 degrees is achieved. With other implant systems, a trial implant is inserted into the sinus tarsi with its full thread causing trauma to the internal structures, then the foot is loaded again, and then the trial implant must be removed and the next one inserted. Again, this is very, very traumatic to those tissues and it’s also very time-consuming. Finally, with other implants, when the desired implant size is determined and inserted into the sinus tarsi, there is usually under-correction precisely due to the trauma to the area from the previous sizing repetitions.
- The technique for inserting the HyProCure® stent involves one lateral incision, while some other implant systems call for a second medial incision. This leads to needles trauma to the inner ankle and other potential complications.
- Other implant systems also have dilators or probes to stretch out the interosseous ligament. The surgeon is instructed to push this into the sinus tarsi until there is tenting on the medial side of the ankle. As mentioned above, this punctures the deltoid ligament and can potentially lead to complications post-operatively.
- Finally, the post-op course is different, we allow patients to weight-bear to tolerance without a cast. Patients can move to a new, supportive sneaker as soon the immediate post-op bandage is removed. The use of a surgical type shoe is not required; if anything, a soft sandal type of footwear like “Crocs” is preferable to wear right after surgery. A surgical shoe will make the patient walk “flat-footed” and there is no room to compensate for the pain in the area. By allowing them to walk with the soft sandals or a sneaker, they will be able to turn their foot slightly inward to take off some of the pressure from the surgical area.