Hemi Cap

[SPK]

I was just watching Channel 9 news and they mentioned a break-through with regards to people who have suffered cartillage damage and run the risk of Arthritis.

Apparently it's something called a 'Hemi cap'. It works by having a tiny screw with a chrome top inserted into the bottom of the Femur so that the joint moves freely and without the bone on bone.

Picture a stainless steel enlarged thumb-tac with a large and flat top.

Has anyone heard anything about it?

I'd be pretty interested in hearing about it's sucess rate.

[SPK]

OK, I've found a bit more information about it.

Chrome bones to help old joints
18:00 AEST Sat Sep 10 2005
By Sheryl Taylor


Living with knee or shoulder pain from cartilage damage is a major problem for young and middle-aged people. Even though they suffer pain, difficulty running and even walking, they've been difficult to treat.

“Most treatments would have been traditionally to restrict your activities, lose weight, take anti-inflammatories and stop running,” says Dr Michael Neil, from Sydney’s St Vincent's Clinic.

Joint replacement is often considered too extreme for this age group, but now a new device called a hemiCAP, is set to revolutionise cartilage repair.

“It's a bit like having a filling in a tooth,” Dr Neil explains.

In a day-only procedure, the damaged area is filled by inserting a titanium screw, connected to a chrome cap.

Dr Neil says when the HemiCAP is in position you can see that its perfectly-smooth metal cap sits flush with the bone. Each one is matched individually to the anatomy of each patients knee, and after an overnight stay, patients can walk on it straight away.

One of the first Australian patients to undergo the procedure, Lisa Maguire, says she was used to have terrible pain with her knee. A nurse on her feet 10 hours a day, she had even started to miss work.

“It was terrible, I was quite miserable with it because the swelling would come up every week to 10 days,” she says.

She had one night in hospital after Dr Neil operated on her, and 12 weeks later she's now, with very little need for physiotherapy, back at the gym.

“I've got full flexibility in [my knee] now,” she says. "I'm really happy, it's been great.”

Doctors say preserving the ‘whole joint’ is more important than ever now that people are living longer. So it's important for a joint to last for a long time.

Another patient to receive the new device, Annie Lord, used to walk five kilometres every day and was a passionate ballroom dancer. Then her knee gave way.

“I had to stop,” she says. “I literally had to stop my ballroom dancing and the walking".

She was on daily pain killers and anti-inflammatory medication. But now, after receiving the HemiCAP has no pain and needs no medication whatsoever.

“I highly recommend it,” she says. “It’s changed my life.”

Doctors say there are thousands of Australians who will benefit from this new device, not just those with sport injuries, but anyone who has localised cartilage damage.

It's being used initially for knees, but in the US, it has successfully treated shoulders and hips in a small number of cases.

“It's an ingenious device,” Dr Neil adds. “I think its going to revolutionise a lot of problem for patients we couldn't previously treat.”

Courtesy of ninemsn.com (http://news.ninemsn.com.au/article.aspx?id=61989)

[SPK]

And here is a bit more from the Official Website;http://www.arthrosurface.com/products.asp

Arthrosurface HemiCAP

The Arthrosurface HemiCAP™ system is a surgical method for the treatment of localized cartilage lesions and defects in the major joints. This system is comprised of three elements; a three-dimensional mapping technology, a set of instruments to map and prepare the damaged area and a cobalt-chrome and titanium implant. The CAP™ system precisely aligns the surface of the implant to the contours of the patient's articular cartilage surface, thus filling the defect and restoring a smooth and continuous articular surface. The CAP™ system has been developed so that it can be utilized via minimal access surgical techniques.

The HemiCAP™ Instrument Set enables the surgeon to accurately place the implant and precisely map the curves of the articular surface, in real-time, under direct or arthroscopic visualization, with no angle-induced errors or magnification errors that might exist with MRI, or X-ray imaging techniques.

The HemiCAP™ system is intended to provide an effective interim means for managing pain and disability in the middle-aged patient until a total joint replacement treatment option becomes more necessary, and is part of a clinical treatment strategy to help avoid early-age-revision scenarios. The prosthetic may also provide a treatment option for the older patient who may not tolerate the morbidity of a total joint replacement procedure.

The HemiCAP™ implants and instruments are designed to remove a minimal amount of bone stock, preserve functional structures and tissues, and allow for an uncomplicated removal in the event of revision.

Courtesy of Arthrosurface (http://www.arthrosurface.com/products.asp)

[SPK]

And last, but not least;http://www.arthrosurface.com/patients_cap.asp

Introduction to the HemiCAP

The Arthrosurface HemiCAP™ (Contoured Articular Prosthetic) Resurfacing System is a surgical method for the treatment of localized lesions and defects in the major joints. This system is comprised of three elements; a mapping technique, a set of instruments to prepare the damaged area and place the resurfacing prosthesis, and the HemiCAP™ implant. The CAP™ system precisely aligns the surface of the implant to the contours of the patient's articular cartilage surface, thus filling the defect and restoring a smooth and continuous articular surface. The CAP™ system has been developed so that it can be utilized via minimal access surgical techniques.

One component of the HemiCAP™ system is a set of reusable instruments that are used to map and prepare the defect sites for receipt of the implant. The HemiCAP™ implants come in a variety of sizes and curvature profiles designed for the different surface anatomies. Arthrosurface continues to design products and development marketing strategies to address other painful joints of the body.

Description

The HemiCAP™ implant is a rounded, cap-like implant made from a cobalt chrome alloy with a central post on the implanted, or bone side. Cobalt chrome is a material that has been used in total joint reconstruction devices for over two decades. This material has proven to provide a safe, effective and strong weight-bearing surface in joints. This metal alloy exhibits lubricious qualities very similar to articular cartilage when implanted in a joint. The fixation component that looks like a screw is made of Titanium, another material that has been used in Orthopedics for decades.

The HemiCAP™ surgical procedure begins the same way as all arthroscopic procedures. Two or more small access incisions are made in order to access the joint. One of the access holes is used to insert the arthroscope which is like a small telescope. This is inserted into a cannula or tube which is used to protect the arthroscope and also allow for a saline fluid to flow into the joint. The second hole or portal is used to introduce different instruments during the operation. When an articular defect is confirmed, the central axis in the middle of the defect is located and a component that looks like a screw is implanted to establish the mechanism for anchoring the resurfacing implant. Using this first component as a central axis, several specially designed instruments are introduced to map the contours of the patient's articular cartilage surrounding the defect and to prepare the tissue in and around the defect itself for the resurfacing implant. Once the site is prepared, the HemiCAP™ resurfacing implant is brought into position and seated.


Shoulder


Hip


Knee

Courtesy of Arthrosurface (http://www.arthrosurface.com/patients_cap.asp)

[injuryupdate]

Haven't had any experience with patients getting one of these, but my initial impression would be that:

(1) It wouldn't work for someone with widespread degenerative change in the joint. You couldn't put an artificial segment in and leave degenerative joint elsewhere - you'd have to go for a total joint replacement.
(2) For an ACUTE localised area of degenerative change, it would still be better to wait or use microfracture technique because a lot of these lesions get better without needed highly invasive sugrery.
(3) For a very localised chronic lesion, this procedure may work. However, we are talking a fairly small percentage of degenerative joint problems.

[hhh]

Maybe OK for OCD

[Paul t]

Not sure I understand. I saw the news report also & was considering this surgery. I am a 27 year old male with osteoarthritis in the knee, in your opinion would this surgery be suitable / successful?

[Leonie]

which is the American company this treatment comes from. I also have osteo-arthritis in my knee and I have asked whether this surgery is suitable for it.

Hopefully I will get a reply soon.

[Unregistered]

I don't know where it comes from but I would like to know of a Gold Coast/ Brisbane specialist who does the operation.

[Unregistered]

I don't know where it comes from but I would like to know of a Gold Coast/ Brisbane specialist who does the operation.If you go to the http://www.arthrosurface.com (as above) you will find that for Australia the following list of surgeons...

sorry no one on the Gold Coast...

Dr Lindsay Laird MD - New Castle, NSW, Australia

Professor Michael Neil - Darlinghurst - Sydney, NSW

Dr Bruce Caldwell MD - Sydney, NSW

Dr Mark M Perko Dr - Sydney, NSW

Dr Daniel Biggs Dr - Sydney, NSW

Dr Simon Tan Dr - Sydney, NSW

Dr Robert Drummond MD - Sydney, NSW

Dr, Robert Genat - Fremantle, Western Australia

Dr Ian M Davison MD - Nowra, NSW

Dr John Ireland MD - Sydney, NSW

Dr Chris Pullen MD - East Melbourne, Victoria

Dr John M ODonnell MD - Richmond, VIC

Dr Richard N de Steiger MD - Parkville, Victoria

[injuryupdate]

Of interest, in the above list the subspecialties of some of the surgeons are:

Neil - hip and knee
Caldwell - primarily knee
Perko - upper limb
Biggs - shoulder and knee
O'Donnell - hip and knee

[Unregistered]

Does anyone know of the projected long term outcomes for this device if used in patients in their early thirties? Are you able to run on it after the procedure and could you still play sport?

[injuryupdate]

Not sure about it, but long-term results are going to be inversely related to the amount of activity undertaken (in terms of absolute load). That is, whatever the shelf life of the Hemicap, it is going to be less if you run on it compared to if you only walk.

[urpbloke@aol.com]

been looking at hemi-cap on the site and trying to find somone in the uk who practises it. my surgeon isnt familiar with it.

[Kai]

A friend of a friend had the Arthrosurface Hemicap device implanted in his shoulder. The shoulder bothered him terribly for the last three years and was getting ready for a total replacement till he found out about this device. The surgery was in December and the doctor indicated his shoulder was further gone that origionally thought and required major clean-up. By early January, his shoulder was feeling better than is has for over five to seven years. He is allready scheduling to have the other shoulder done within the next six months. At this point he is extremely happy with it. Prior to the surgery he talked to several other patients, one who had surgery on his great toe with the hemicap and one with the shoulder.

It appears that those who have had the surgery become true belivers.

[Shiama]

I just received the HemiCap in my left knee in the form of a "combo" 3 months ago. A combo simply means I have more than one surface capped in the same knee. I am an extremely active 47 year old female. I had suffered a serious sports injury in high school and had recon surgery then. This would be my third surgery on this knee. My knee, especially the patella, was in my surgeon's words..."trashed"! from all the years of wear and tear, arthritis, spurs...etc. I am so excited with how my knee feels now and feel it was the right option for me. I plan to be back on the tennis court in the spring.