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Case Spotlight: Hardware and varus deformity | Bryan Huber, MD

This case is an example of a patient with a significant varus deformity in addition to retained hardware from a previous ACL repair. This patient had been in pain for ~15 years and had a low activity level due to the disease progression.

Patient History

Product: iTotal CR
Gender: Male
Age: 50
Pre-op ROM: 5-120˚
Deformity/Indication: 10˚ varus deformity
Other issues: Retained hardware from prior ACL repair

Why Conformis?

Conformis was the right choice for this patient for two reasons:

  1. With larger preoperative angular deformities and flexion contractures, both greater than 15˚, I would consider a Conformis PS implant
  2. The additional bone preservation with Conformis implants combined with improved post-op kinematic function result in higher levels of success on more demanding young patients

Conformis Plan

The iView review is an integral part of the pre-op preparation. My key observations for this case were:

  • Lateral resection is above 7mm: Since the LL is ~10mm at the 10˚ and there is medial tibial bone loss, a conservative approach on the tibial side is warranted, thus a -2mm initial resection is my plan.
  • Retained hardware in the tibia will have to be removed due to interference with the Tibial tray. Note: Conformis provides additional imagery with the iView for these cses as seen below.
  • Significant osteophytes present which will have to be removed intra-op prior to performing any releases to ensure proper soft tissue balancing.

Tibial images
 

Femoral images

Notable Condition

During the process of designing the implants, hardware was discovered. Hardware is not incorporated into the design of the iJigs or implants. It is assumed that interfering hardware will be addressed during surgery.

Intraoperative Details

Surgical Technique: Measured Resection
Tibial Resection: -2mm
Slope: 10˚
Femoral Resection: Planned 0mm
Distal Offset: 0.9mm
Final Poly: 6-B
Patella: 41mm

Post-op Results

Surgery Performed by:

Bryan Huber, MD
Mansfield Orthopaedics
Copley Hospital
Morrisville, VT
Conformis user since 2009

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