Tissue Sparing ImplantTM (TSITM) Total Hip Stem Designs
Links to JISRF Publications:
Videos
December 2013
MSA™ Femoral Neck Preserving Hip Arthroplasty Stem - Operative Technique
May 2011
Single Anterior Incision THA Using a Tissue Sparing Implant
November 2010
Mini-Symposium on Neck Sparing Total Hip Arthroplasty - Lessons Learned
November 2010
Tissue Sparing Total Hip Surgery & Hip Society Award Paper on Acetabular Component Positioning
Master Surgeons Interview: Keppler, MD; A Mackel, MD; Rubash, MD
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Participants
The following is the list of participants in JISRF's Study Group on Tissue Sparing ImplantTM Total Hip Stem Designs. This will be an ongoing study and findings will be added to the results below as they become available.
Daniel C. Allison, MD, Los Angeles, CA, USA |
Jalil, Redouane, MD, Paris, Fr |
Berend, Keith, MD, Columbus, OH, USA |
Mackel, Audley, MD, Cleveland, OH, USA |
Brazil, Declan, PhD, NSW, Au |
Mahoney, Ormonde M., MD, Athens, GA |
Bruce, Warwick, MD, NSW, Au |
Manktelow, Andrew, PHD, Nottingham, England |
Bryant, Charles, MD, Oklahoma City, OK, USA |
McCarthy, Joseph, MD, Boston, MA, USA |
Cameron, Hugh, MD, Toronto, Canada |
McPherson, Ed, MD, LA, CA, USA |
Campbell, David, MD, South Australia, Au |
McTighe, Timothy, Dr. H.S. (hc), Chagrin falls, OH, USA |
Chadha, Harbinder S., MD, San Diego, CA, USA |
Morrison, J. Craig, MD, Nashville, TN |
Christie, Michael, MD, Nashville, TN |
Nevins, Russell, MD, Las Vegas, NV, USA |
Clarke, Ian, PhD, Loma Linda, CA, USA |
Parvizi, Javad, MD, Philadelphia, PA |
Clyburn, Terry, MD, Houston, TX, USA |
Ponder, Corey, MD, Edmond, OK, USA |
DeBoer, David, MD, Nashville, TN |
Reddick, Bradley, D.O., Oklahoma City, OK, USA |
Donaldson, Thomas, MD, Loma Linda, CA, USA |
Rubin, Lee, MD, Providence, RI, USA |
Drinkwater, Chris, MD, Rochester, NY, USA |
Samuels, Lewis, MD, Canada |
Froimson, Mark, MD, Cleveland, OH, USA |
Schmidt, Frank, MD, Cody, WY |
German, Robert A., M.D., Oklahoma City, OK, USA |
Schutte, H. Del, MD, Charleston, SC, USA |
Goldberg, Victor, MD, Cleveland, OH, USA |
Scott, David F., MD, Spokane, WA, USA |
Hannoford, Peter, MD, NSW, Au |
Smith, Evert, PHD, Bristol, England |
Harrison, John, MD, NSW, Au |
Snyder, Daniel C., MD, Newton, MA, USA |
Hitt, Dr. Kirby D., MD, Temple, TX |
Stulberg, S. David, MD, Chicago, IL, USA |
Hodrick, Jeffery T., MD, Nashville, TN |
Swank, Mike, MD, Cincinnati, OH, USA |
Jones, Richard E., MD, Dallas, TX, USA |
Sydney, Sam, MD, Baltimore, MD, USA |
Keggi, John, MD, Waterbury, CT, USA |
Tkach, Tom, MD, Oklahoma City, OK, USA |
Keggi, Kristaps, MD, Waterbury, CT, USA |
Trick, Larry, MD, San Antonio, TX, USA |
Kennon, Robert, MD, Waterbury, CT, USA |
Turnbull, Allen, MD, NSW, Au |
Keppler, Louis, MD, Cleveland, OH, USA |
van der Rijt, Adrian, MD, Wagga Wagga, Au |
Kreuzer, Stefan, MD, Houston, TX |
Vaughn, Bradley, MD, Raleigh, NC, USA |
Kyle, Richard, MD, Minneapolis, MN, USA |
Walter, Brad, MD, Thomasville, GA, USA |
Kudrna, James, MD, PhD, Glenview, IL, USA |
Whitewell, Duncan, MD, Oxford, England |
Leslie, Chris, MD, Columbia, MO, USA |
Woodgate, Ian, MD, NSW, Au |
Liebelt, Ralph, MD, Durham, NC, USA |
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Lombardi, Adolph, MD, Columbus, OH, USA |
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Low, Warren, M.D., Oklahoma City, OK, USA |
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Each participant received a Certificate of Membership from the Executive Director of JISRF.
Results
Tissue Sparing ImplantTM (TSITM) Total Hip Stem Designs
There is a current trend towards using short stems for Total Hip Arthroplasty (THA). This is exciting because there is a distinct advantage in preserving bone and soft tissue. Minimal utilization of bone stock is vital given the fact that revision hip surgery may be required in the future.
Preclinical tests such as mechanical fatigue, finite element analysis and photo-elastic techniques are used to design bone conserving stems that can be effective and potentially increase long term outcomes as compared to some of the conventional femoral stems. There is growing interest from total hip surgeons that this procedure is a more conservative approach to current re-surfacing designs and techniques by preserving more soft tissue and bone in the acetabulum.
Historically, surgeons such as Freeman, Whiteside and Pipino identified the mechanical advantage of retaining the femoral neck. Freeman and Whiteside have advocated conventional stem length where as, Pipino has been a strong advocate of short curved stems. Pipino has argued for tissue (hard & soft) preservation for a number of years and is now beginning to be recognized for his 20 plus years of solid work.
A number of bone conserving hip joints have been developed and have been used instead of conventional femoral stems. First generation stems include Munting, Weber- Huggler Thrust Plate, Stratech, Spiron, Spotorno and the Mayo.
Second generation stems such as the Silent, Proxima, McMinn, Proximal Epiphyseal Replacement (PER), CFP (Pipino) are now in use.
The risk of some short stems is perforation of the cortical bone, stress shielding and bone loss with a faith driven belief in some that metaphyseal fit and fill alone will suffice for stability ignoring the hoop and mechanical strength of the proximal neck and superior (intact) digital fossa bone flowing in to the greater trochanter.
The Newest Design Concept: TSITM Stems
The MSATM and ARCTM Stems have been designed with a unique lateral T-back design to maximize torsional stability and ease of insertion. A modular neck is used with this new stem design allowing fine tuning of joint mechanics including version length and offset and the potential ability to check on cup alignment to stem more accurately. A novel proximal conical flare provides for off loading of compressive forces stimulating the medial calcar.
Since this is a curved stem design there is significant protection of the lateral soft tissue structures along with less bone removal. Keeping the lateral bone and soft tissues intact provides a natural barrier to migration of particular debris, less blood loss and less force required to rehab the hip.
A choice of bearing surface may be used providing versatility over the limitations of hip resurfacing, (currently limited to MOM).
Development of TSITM Stem Design and Technique
Doctors John Keggi, Kristaps Keggi, and Louis Keppler reviewing surgical technique at Yale Medical University Cadaver Laboratory.
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Design and technique clearly demonstrate tissue preserving benefits of the TSITM Stem |
Additional Cadaver Studies
Additional studies recently performed by Dr. Sam Sidney, at The Anatomy Board University of Maryland, confirmed the previous cadaver work.
Collaboration Worldwide
The work involved has been a worldwide effort from FEA modeling, engineering, review of x-rays, design review, development of surgical techniques and clinical evaluation.
Hundreds of x-rays were review both in Australia, Canada and the United States. Participating in this process acknowledgment goes out Doctors Peter Hannaford, John Harrison, Allen Turnbull, Ian Woodgate of Australia, Hugh U. Cameron, of Canada, Louis Keppler, John Keggi, Kristaps J. Keggi, Robert Kennon, and S. David Stulberg from the United States.
FEA modeling was performed by three different scientist. Declan Brazil, PhD from Australia, Kevin Ong, PhD from Exponent, Philadelphia, PA and Edward Cheal, PhD, Omnilife Science, Raynham, MA.
All modeling demonstrated favorable bone remodeling and fatigue characteristics of this novel device.
Evaluations of instrumentation, trial stems and final implants have been carried out successfully.
Design and technique have provided for a simple stem design (five sizes) with novel features that offer significant implant-to-bone stability, ease of surgical approach, reproducible techniques, and impressive short term clinical outcomes.
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June 2014
Total Hip Stem Classification System |
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July 2014
Short Stems in Total Hip Arthroplasty |
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July 2014
Optimizing Modular Tapers for Total Hip Arthroplasty |
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June 2014
The Science Behind a Short (Neck Preserving) Curved Stem Total Hip Replacement |
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February 2014
Taper Issues in Total Hip Arthroplasty (THA) |
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February 2014
The Science Behind A Short Curved Stem Total Hip Replacement |
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October 2013
Metal Ion Levels in a Stable Modular Junction |
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September 2013
Cementless Stem Selection and Options "JISRF Stem Classification System"
- Presented at the ICJR 2013 2nd Annual Anterior Hip Course |
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February 2013
"Neck-Sparing" Total Hip Arthroplasty |
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October 2012
Effect of Optimizing Bone-Implant Contact on Hip Offset and Anteversion with Three Contemporary Uncemented Short Metaphyseal-Engaging Implants |
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October 2012
Analysis of Neck Sparing (TSI) Versus Conventional Cementless Stem |
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October 2012
The First 1,200 U.S.A. (May 2010 - May 2012)
Short Curved Neck Sparing Stems
- Clinical Surgical Observations |
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October 2012
The First 1,200 (1,790) U.S. Short Curved Neck Stabilized Stems |
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October 2012
JISRF - A Classification System for Short Stem Uncemented Total Hip Arthroplasty |
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October 2012
JISRF Classification System for Short Stem Uncemented THA |
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September 2012
Design Considerations for a Short Curved Neck Sparing Total Hip Stem With a Modular Neck: Tissue Sparing Implant™ (TSI) |
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September 2012
Early Experience with MSATM Neck Sparing Stem Via Anterolateral Approach |
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May 2012
Neck Sparing Total Hip Arthroplasty In The Osteoporosis Patient |
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April 2012
Design Rationale And Early Clinical/Surgical Observations With A Tissue Sparing Stem For THA In Osteoarthritis |
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April 2012
A Classification System For Short Stem Uncemented THA |
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April 2012
The First 1,225 Short Curved Neck Sparing Stems - Clinical Surgical Observations |
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April 2012
Predicting Errors in Offset Templating for Total Hip Arthroplasty |
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January 2012
Tissue Sparing ImplantTM (TSITM) Total Hip Arthroplasty Study Group |
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October 2011
Surgeon Interview on Current Trends in THA |
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October 2011
FEA Analysis of Neck Sparing Versus Conventional Cementless Stem |
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October 2011
Design Rationale and Early Clinical / Surgical Observations with a Short Curved Tissue Sparing Hip Implant "The Apex ARCTM Stem" |
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September 15, 2011
Early Learning Experience with a Neck Stabilized THA Stem for Treating Osteoarthritis |
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August 15, 2011
Interesting THA Case from Down Under |
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August 10, 2011
JISRF Case Report - ARCTM Stem, Dr. Charles Bryant - Surgeon |
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June 9, 2011
Update News |
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May 2011
Short Stems for THA |
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May 10, 2011
Advantage of Proximal Modularity |
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May 2011
Comparison of A Short Stemless- and A Conventional Stemmed Total Hip Protheses in Young Patients |
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November 2010
FEA Analysis of TSITM Neck Stabilization Stem |
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May 2010
IOWACA Poster Exhibit "Neck Sparing Total Hip Arthroplasty - Lessons Learned" |
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July 2010
The Design Rationale of the ARCTM Stem |
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2008
FEM of a Bone Preserving Implant TSITM (Tissue Sparing Implant) |
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March 2008
AAOS Poster Exhibit "A New Approach To Neck Sparing THA Stem" |
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