TATE ELBOW Randy Acker DVM

End stage cartilage loss

Stem Cells?

Elbow Arthritis   Many new options

  PAUL   Unloading

  Replacements   CUE   Wendleberg   John Innes   Iowa   TATE

  Watch and wait   Design evolution

  Joint replacement – long term results only get worse

  Kyon total hip and ten years (cement)

Design Evolution   What we have learned – what is next

  TPLO and TTA

  TATE Elbow   Five years

  End stage elbow   Mill and drill

  Excited about implants for younger patients

  Human: elbow, ankle, and knee

Progress

The Problem   Elbow dysplasia

  Common   Current treatments often fail leading to progressive

OA

  Tate

Napkin to implant Concept

Ulnar nerve Deep digital flexor only Sensory branch Triceps medial head

Unlinked Systems (cemented)

Linked Systems (cemented) Chancrin, 1989, France

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Surgical Technique

Surgical Technique

Positioning - Stabilization

Surgical Technique

Articular Surfaces Preparation

Milling

Surgical Technique

Surgical Technique

Surgical Technique

Range of Motion

+/- debridement If impingement

TATE Pilot study   Perioperative complications

  Fractures, dislocations, other

  Morbidity   Cook – temper your excitement until you put it in a

clinical case

  Some projects were scrapped instantly

  Repeatability

  Technical ease

Clinical'Cases:'Pilot'Study'

#1 #2

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Clinical'Cases:Pilot'Study'

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Pilot study   Drop the ulnar ostectomy

  Instruments   COR Device, arm support, MEO guide

  Courses

Case Selection   Owner has tried other treatments and feels the

patient is in pain

  Global cartilage loss

  Most are chronic elbow dysplasia cases

  Some malunions and subluxations   Humeral malunions

  Not for old fractures if the mill does not remove the bone

Implant limitations

TATE pre-operative evaluation

Digital Templating – Orthoview

Post-op Radiographs

Post-op Radiographs

Alignment in the frontal

plane: Varus/valgus

Reduction of the MEO

Radioulnar component

centered on the ulna

Difficult case

Post op

TATE Elbow™ – Functional outcome

Summary TATE Elbow™ - RLA

 Primary surgeon   30 cases – Sun Valley Animal Center   No explants or fusions   Longest case 40 months

 Assistant surgeon   20 cases   One amputation   One fracture – repaired   One MRSA – currently on antibiotics

Survival study   Six patients have died of other causes at up to 38

months later

  Average age is ten average weight is 70 #

  No premature explants

  Histomorphometry being done

Bone ingrowth

Radiographic evaluation

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On the workbench   Surgical simplification

  Alignment plate   MEO cutting tool

  Bone ingrowth R-U component   Hollow segmented post

  Soften constraints   HA coating

  Medial compartment replacement

  Radial head – three component

Floating radial head   Young dogs

  Confidence you have with a hip replacement

  Each moving part increases your failure chances

Prototype to production

Younger dogs   Dr. Moore

  TPLO to TKA

  Morbidity hip vses. knee

  Periarticular injections   Ropivicaine   Torridol   Morphine   Decadron

Unicompartmental   Where we started

  Will it prevent medial collapse and lateral compartment disease

  You only get one surgery on our patients

Medial epicondylar osteotomy

Locking alignment plate

Over milling

Over milling caused by collapse

Results of changes

Trabeculae on HA coated femoral stem

Unlinked Systems (cemented)

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Older patient Abby

Post op

Day one

LONG TERM