The HyProCure system:
Talar tarsal stabilization that works
HyProCure truly offers a superior option in the treatment of hyperpronation for any patient with a flexible flat foot ages four and up. Unlike any other sinus tarsi stabilization device, HyProCure has inherent advantages that make this minimally invasive procedure the ideal solution for the vast majority of flexible flat foot 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.
Below are points that will help explain the dramatic breakthrough that HyProCure represents.
1. The HyProCure Sinus Tarsi Stent 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. Furthermore, these other implants' instructions want the lateral portion of the stent to be about 1 cm from the lateral wall of the calcaneus. The problem with this is that the implant will sit in the middle part of the sinus tarsi. The sinus tarsi is made up of the deeper canalis portion and the outer sinus portion. Since the other implants are smaller in length they will only minimally enter the canalis portion. The lateral (outer) wall of the talus will hit against the outer portion of the implant causing micro-motion that can further lead to pistoning or displacement of the implant. This will cause pain and the implant will then need to be removed. If these other implants are seated too deep into the sinus tarsi, then 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.
2. The design of the HyProCure Sinus Tarsi Implant has three different distinct sections.
- The inner/medial portion is threaded; the purpose of this is to lock the implant into the canalis portion of the sinus tarsi. The threads will purchase into the interosseous ligament that helps to reduce backing out of the implant.
- The middle section is tapered; this is very important since this is the part 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?" then intra-op films need to be taken to visualize the location of the implant.
- 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.
3. 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 being 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 only optional.
4. The overall length of the HyProCure stent is longer than other implants. This is very important because it fills in the sinus better to give better correction with less of a chance for it to back all the way out. Also, there is a much larger range of sizes with the HyProCure stent than with any the other implant system. This allows for more accurate correction to be achieved with better results for the patient
5. The instrumentation of the system is very different from the rest. The sizing of the implant has been simplified. At the end of the trial sizer 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 more and the forefoot is loaded and the rearfoot is inspected for it’s eversion. If there is greater than three (3) degrees of eversion then the next larger size is inserted until the desired 1-3 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, when the desired implant 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.
6. The technique for inserting the HyProCure stent involves one lateral incision, while another implant system calls for a second medial incision. This leads to needles trauma to the inner ankle and other potential complications.
7. 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.
8. Finally, the post-op course is different, we allow patients to weight-bear to tolerance without a cast. We also recommend the use of a sneaker as soon as possible and for the patient not to wear a surgical type shoe. If anything, a soft sandal type of footwear like "Crocs" is preferable to wear intially right after surgery. The reason for this is that the 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.
