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
Center&of&rotation&
Collateral&ligaments&
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
#3 #4
Clinical'Cases:Pilot'Study'
#5 6
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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Dejardin case Graftys and 15 implant
Older patient Abby
Post op
Day one
LONG TERM