Joint Implant Surgery & Research Foundation
 

Study Group

Tissue Sparing ImplantTM (TSITM) Total Hip Stem Designs

tissue-sparin-img

Links to JISRF Publications:

Books
TSITM References
Slide Presentations

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

 

You will need the Adobe Flash Player to view these videos. Get Adobe Flash Player

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 Mackel, Audley, MD, Cleveland, OH, USA
Berend, Keith, MD, Columbus, OH, USA Mahoney, Ormonde M., MD, Athens, GA
Brazil, Declan, PhD, NSW, Au Manktelow, Andrew, PHD, Nottingham, England
Bruce, Warwick, MD, NSW, Au McCarthy, Joseph, MD, Boston, MA, USA
Bryant, Charles, MD, Oklahoma City, OK, USA McPherson, Ed, MD, LA, CA, USA
Cameron, Hugh, MD, Toronto, Canada McTighe, Timothy, Dr. H.S. (hc), Chagrin falls, OH, USA
Campbell, David, MD, South Australia, Au Morrison, J. Craig, MD, Nashville, TN
Chadha, Harbinder S., MD, San Diego, CA, USA Nevins, Russell, MD, Las Vegas, NV, USA
Christie, Michael, MD, Nashville, TN Parvizi, Javad, MD, Philadelphia, PA
Clarke, Ian, PhD, Loma Linda, CA, USA Ponder, Corey, MD, Edmond, OK, USA
Clyburn, Terry, MD, Houston, TX, USA Reddick, Bradley, D.O., Oklahoma City, OK, USA
DeBoer, David, MD, Nashville, TN Rubin, Lee, MD, Providence, RI, USA
Donaldson, Thomas, MD, Loma Linda, CA, USA Samuels, Lewis, MD, Canada
Drinkwater, Chris, MD, Rochester, NY, USA Schmidt, Frank, MD, Cody, WY
Froimson, Mark, MD, Cleveland, OH, USA Schutte, H. Del, MD, Charleston, SC, USA
German, Robert A., M.D., Oklahoma City, OK, USA Scott, David F., MD, Spokane, WA, USA
Goldberg, Victor, MD, Cleveland, OH, USA Smith, Evert, PHD, Bristol, England
Hannoford, Peter, MD, NSW, Au Snyder, Daniel C., MD, Newton, MA, USA
Harrison, John, MD, NSW, Au Stulberg, S. David, MD, Chicago, IL, USA
Hitt, Dr. Kirby D., MD, Temple, TX Swank, Mike, MD, Cincinnati, OH, USA
Hodrick, Jeffery T., MD, Nashville, TN Sydney, Sam, MD, Baltimore, MD, USA
Jones, Richard E., MD, Dallas, TX, USA Tkach, Tom, MD, Oklahoma City, OK, USA
Keggi, John, MD, Waterbury, CT, USA Trick, Larry, MD, San Antonio, TX, USA
Keggi, Kristaps, MD, Waterbury, CT, USA Turnbull, Allen, MD, NSW, Au
Kennon, Robert, MD, Waterbury, CT, USA van der Rijt, Adrian, MD, Wagga Wagga, Au
Keppler, Louis, MD, Cleveland, OH, USA Vaughn, Bradley, MD, Raleigh, NC, USA
Kreuzer, Stefan, MD, Houston, TX Walter, Brad, MD, Thomasville, GA, USA
Kyle, Richard, MD, Minneapolis, MN, USA Whitewell, Duncan, MD, Oxford, England
Kudrna, James, MD, PhD, Glenview, IL, USA Woodgate, Ian, MD, NSW, Au
Leslie, Chris, MD, Columbia, MO, USA  
Liebelt, Ralph, MD, Durham, NC, USA  
Lombardi, Adolph, MD, Columbus, OH, USA  
Low, Warren, M.D., Oklahoma City, OK, USA  

 

Each participant received a Certificate of Membership from the Executive Director of JISRF.

certificate-membership-img

Results

Arc and Msa Steam Design

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.

cfp-pipino-stem-img

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.

proxima-mayo-img

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

Newest Design Concept: TSI<sup>TM</sup> 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.

Design and technique1 Design and technique
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.

additional-cadaver-studies-img

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.

collaboration-worldwide-img1

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.

remodeling-stimulus-img1 remodeling-stimulus-img

Evaluations of instrumentation, trial stems and final implants have been carried out successfully.

Poast-op l woodgate Intra-op stem anterior-approach-img

posterior-approach-img

intra-operative-img

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.

t-back-for-adsditional-img sagital-slot-img

 

Total Hip Stem Classification System

June 2014

Total Hip Stem Classification System

   
The Science Behind a Short (Neck Preserving) Curved Stem Total Hip Replacement

July 2014

Short Stems in Total Hip Arthroplasty

   
Optimizing Modular Tapers for Total Hip Arthroplasty

July 2014

Optimizing Modular Tapers for Total Hip Arthroplasty

   
The Science Behind a Short (Neck Preserving) Curved Stem Total Hip Replacement

June 2014

The Science Behind a Short (Neck Preserving) Curved Stem Total Hip Replacement

   
Taper Issues in Total Hip Arthroplasty ICJR 2014-Australia

February 2014

Taper Issues in Total Hip Arthroplasty (THA)

   
The Science Behind A Short Curved Stem Total Hip Replacement

February 2014

The Science Behind A Short Curved Stem Total Hip Replacement

   
Metal Ion Levels in a Stable Modular Junction

October 2013

Metal Ion Levels in a Stable Modular Junction

   
Cementless Stem Selection and Options JISRF Stem Classification System

September 2013

Cementless Stem Selection and Options "JISRF Stem Classification System"

- Presented at the ICJR 2013 2nd Annual Anterior Hip Course

   
"Neck-Sparing" Total Hip Arthroplasty

February 2013

"Neck-Sparing" Total Hip Arthroplasty

   
northwestern-img

October 2012

Effect of Optimizing Bone-Implant Contact on Hip Offset and Anteversion with Three Contemporary Uncemented Short Metaphyseal-Engaging Implants

 
Analysis of Neck Sparing (TSI) Versus Conventional Cementless Stem

October 2012

Analysis of Neck Sparing (TSI) Versus Conventional Cementless Stem

 
clinical-surgical-img

October 2012

The First 1,200 U.S.A. (May 2010 - May 2012)
Short Curved Neck Sparing Stems - Clinical Surgical Observations

 
curved-neck-stabilized-stems-img

October 2012

The First 1,200 (1,790) U.S. Short Curved Neck Stabilized Stems

 
JISRF - A Classification System for Short Stem Uncemented Total Hip Arthroplasty

October 2012

JISRF - A Classification System for Short Stem Uncemented Total Hip Arthroplasty

 
jisrf-classification-system-img

October 2012

JISRF Classification System for Short Stem Uncemented THA

 
Design Considerations for a Short Curved Neck Sparing Total Hip Stem With a Modular Neck: Tissue Sparing Implant™ (TSI)

September 2012

Design Considerations for a Short Curved Neck Sparing Total Hip Stem With a Modular Neck: Tissue Sparing Implant™ (TSI)

   
early-experience-img

September 2012

Early Experience with MSATM Neck Sparing Stem Via Anterolateral Approach

 
Neck Sparing Total Hip Arthroplasty In The Osteoporosis Patient

May 2012

Neck Sparing Total Hip Arthroplasty In The Osteoporosis Patient

 
Design Rationale And Early Clinical/Surgical Observations With A Tissue Sparing Stem For THA In Osteoarthritis

April 2012

Design Rationale And Early Clinical/Surgical Observations With A Tissue Sparing Stem For THA In Osteoarthritis

 
A Classification System For Short Stem Uncemented THA

April 2012

A Classification System For Short Stem Uncemented THA

 
The First 1,225 Short Curved Neck Sparing Stems - Clinical Surgical Observations

April 2012

The First 1,225 Short Curved Neck Sparing Stems - Clinical Surgical Observations

 
Predicting Errors in Offset Templating for Total Hip Arthroplasty

April 2012

Predicting Errors in Offset Templating for Total Hip Arthroplasty

 
Tissue Sparing ImplantTM (TSITM) Total Hip Arthroplasty Study Group

January 2012

Tissue Sparing ImplantTM (TSITM) Total Hip Arthroplasty Study Group

 
Surgeon Interview on Current Trends in THA

October 2011

Surgeon Interview on Current Trends in THA

 
FEA Analysis of Neck Sparing Versus Conventional Cementless Stem

October 2011

FEA Analysis of Neck Sparing Versus Conventional Cementless Stem

 
Design Rationale and Early Clinical / Surgical Observations with a Short Curved Tissue Sparing Hip Implant "The Apex ARCTM Stem"

October 2011

pdf Design Rationale and Early Clinical / Surgical Observations with a Short Curved Tissue Sparing Hip Implant "The Apex ARCTM Stem"

 
Early Learning Experience with a Neck Stabilized THA Stem for Treating Osteoarthritis

September 15, 2011

Early Learning Experience with a Neck Stabilized THA Stem for Treating Osteoarthritis

 
Interesting THA Case from Down Under

August 15, 2011

Interesting THA Case from Down Under

 
case-report-img

August 10, 2011

JISRF Case Report - ARCTM Stem, Dr. Charles Bryant - Surgeon

 
June 9, 2011 Update News

June 9, 2011

Update News

 
Short Stems for THA

May 2011

Short Stems for THA

 
Advantage of Proximal Modularity

May 10, 2011

Advantage of Proximal Modularity

 
Comparison of A Short Stemless- and A Conventional Stemmed Total Hip Protheses in Young Patients

May 2011

Comparison of A Short Stemless- and A Conventional Stemmed Total Hip Protheses in Young Patients

 
FEA Analysis of TSITM Neck Stabilization Stem

November 2010

FEA Analysis of TSITM Neck Stabilization Stem

   
Neck Sparing Total Hip Arthroplasty - Lessons Learned

May 2010

IOWACA Poster Exhibit "Neck Sparing Total Hip Arthroplasty - Lessons Learned"

 
design-rationale-img

July 2010

The Design Rationale of the ARCTM Stem

   
FEM of a Bone Preserving Implant TSITM (Tissue Sparing Implant)

2008

FEM of a Bone Preserving Implant TSITM (Tissue Sparing Implant)

 

March 2008

AAOS Poster Exhibit "A New Approach To Neck Sparing THA Stem"

 

You will need the Adobe Reader to view and print these documents.Get Adobe Reader

Loading
» Read more
» Read more
Facebook Twitter YouTube
Bookmark and Share
Your Practice Online