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Osteoarthritis of the Lisfranc Joint Christian Kinast Munic Germany

Dr. Christian Kinast (ORTHOPEDIC CENTER ARABELLAPARK MUNICH, OZA, Germany) at ArthroParis 2014: Osteoarthritis of the Lisfranc Joint

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Dr. Kinast lectured from 27.-28.06.2014 in 5th International Symposium of Surgical and Biological Treatments in Orthopaedics, Sports Medicine and Distal Extremity Pathologies im CNIT in Paris: Foot and Ankle II (Live surgical, scientific discussions, meet the experts): “Trauma of the Lower Extremity”: Osteoarthritis of the Lisfranc Joints Associated foot deformities with atraumatic Lisfranc osteoarthritis pes planovalgus hallux valgus or skew foot deformities hallux valgus with pes planovalgus pes cavus in-situ without deformities Secondary flatfoot due to short metatarsus and secondary Lisfranc osteoarthitis Lisfranc correction arthrodesis TKA total knee arthroplasty Atraumatic Lisfranc osteoarthritis with hypermobile metatarsus primus varus MRI helps to visualise the extent of arthritic changes Arthrex Mini Joint Distractor Distraction of the Lisfranc joint Bonesaving preparation for the arthrodesis Lapidus Plate; Quickfix Can. Screws 4.0, 3.0, 2.4 mm; Double-Compression Plate Double Compression Plate bonegrafting from calcaneus Double Compression Plates Double compression due to oblong hole manual bending of middle portion 3.5 mm locking and non-locking screws 2, 3 and 4 holes 20, 25 und 30 mm lengths Lisfranc Plates 3 locking holes, 1 compression hole Compression along the lisfranc ligament CT allow visualization of lisfranc joint during healing process 3 Sizes: Small, Medium, Large QuickFix Cannulated Screws + Lisfranc Plate Lapidus Plate + Compression Staples Flatfoot with peritalar subluxation and Lisfranc atraumatic subluxation Calcaneus Step-Plate; H-Plate Plate (Evans); Headless Compression Screw Lisfranc Arthrodesis Rehabilitation 2 weeks valved cast 4 - 6 weeks closed cast Week 7 – 10 increased weight baring CT scan week 10 - 12 ( difficult to read ) Week 11-12 full weight bearing Conclusion Identify the underlying deformity of the foot in atraumatic Lisfranc osteoarthritis pes planovalgus with peritalar subluxation / Lisfranc subluxation hallux valgus or skew foot deformities hallux valgus with pes planovalgus pes cavus in-situ without deformities postraumatic osteoarthritis rheumatoid arthritis neuro-osteo-arthropathy Arthrex Implants Lapidus Plate Lisfranc Plate Arthrex Headless Compression Screws Quickfix Cannulated Screws 2.4, 3.0, 4.0mm Compression Staples Double Compression Plate Calcaneus StepPlate H-Plate (Evans) contact: Dr. med. Christian Kinast ORTHOPEDIC CENTER ARABELLAPARK MUNICH Englschalkinger Str. 12 / 3rd floor D-81925 Munich T: +49 89 / 9 99 09 78 – 0 F: +49 89 / 9 99 09 78 – 77 E: [email protected] I: www.oza-m.de facebook: www.facebook.com/oza.muenchen

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Page 1: Dr. Christian Kinast (ORTHOPEDIC CENTER ARABELLAPARK MUNICH, OZA, Germany) at ArthroParis 2014: Osteoarthritis of the Lisfranc Joint

Osteoarthritis of the Lisfranc Joint

Christian KinastMunic Germany

Page 2: Dr. Christian Kinast (ORTHOPEDIC CENTER ARABELLAPARK MUNICH, OZA, Germany) at ArthroParis 2014: Osteoarthritis of the Lisfranc Joint

Associated foot deformities with atraumatic Lisfranc osteoarthritis

pes planovalgus hallux valgus or skew foot deformities hallux valgus with pes planovalgus pes cavus in-situ without deformities

Foot Ankle Int 2007 28: 482Hong Geun Jung, Mark S. Myerson and Lew C. SchonSpectrum of Operative Treatments and Clinical Outcomes for Atraumatic Osteoarthritis of the Tarsometatarsal Joints

Page 3: Dr. Christian Kinast (ORTHOPEDIC CENTER ARABELLAPARK MUNICH, OZA, Germany) at ArthroParis 2014: Osteoarthritis of the Lisfranc Joint

Secondary flatfoot due to short metatarsus and secondary Lisfranc osteoarthitis

ST. I

Page 4: Dr. Christian Kinast (ORTHOPEDIC CENTER ARABELLAPARK MUNICH, OZA, Germany) at ArthroParis 2014: Osteoarthritis of the Lisfranc Joint

Lisfranc correction arthrodesis TKA

59 y fem playing badminton again

ST.I

Page 5: Dr. Christian Kinast (ORTHOPEDIC CENTER ARABELLAPARK MUNICH, OZA, Germany) at ArthroParis 2014: Osteoarthritis of the Lisfranc Joint

Atraumatic Lisfranc osteoarthritiswith hypermobile metatarsus primus varus

MRI helps to visualise the extent of arthritic changes

Page 6: Dr. Christian Kinast (ORTHOPEDIC CENTER ARABELLAPARK MUNICH, OZA, Germany) at ArthroParis 2014: Osteoarthritis of the Lisfranc Joint

Arthrex Mini Joint Distractor

• Distraction of the Lisfranc joint • Bonesaving preparation for the arthrodesis

Page 7: Dr. Christian Kinast (ORTHOPEDIC CENTER ARABELLAPARK MUNICH, OZA, Germany) at ArthroParis 2014: Osteoarthritis of the Lisfranc Joint

Lapidus Plate; Quickfix Can. Screws 4.0, 3.0, 2.4 mm; Double-Compression Plate

bonegraftingfrom calcaneus

Double Compression Plate

Page 8: Dr. Christian Kinast (ORTHOPEDIC CENTER ARABELLAPARK MUNICH, OZA, Germany) at ArthroParis 2014: Osteoarthritis of the Lisfranc Joint

Double Compression Plates

• Double compression due to - oblong hole- manual bending of middle portion

• 3.5 mm locking and non-locking screws• 2, 3 and 4 holes• 20, 25 und 30 mm lengths

Page 9: Dr. Christian Kinast (ORTHOPEDIC CENTER ARABELLAPARK MUNICH, OZA, Germany) at ArthroParis 2014: Osteoarthritis of the Lisfranc Joint

Lisfranc Plates

• 3 locking holes, 1 compression hole• Compression along the lisfranc lig.• Allow visualization of lisfranc joint

during healing process • 3 Sizes: Small, Medium, Large

Page 10: Dr. Christian Kinast (ORTHOPEDIC CENTER ARABELLAPARK MUNICH, OZA, Germany) at ArthroParis 2014: Osteoarthritis of the Lisfranc Joint

QuickFix Cannulated Screws + Lisfranc Plate

Hö.A

Page 11: Dr. Christian Kinast (ORTHOPEDIC CENTER ARABELLAPARK MUNICH, OZA, Germany) at ArthroParis 2014: Osteoarthritis of the Lisfranc Joint

Lapidus Plate + Compression Staples

CT control

Ha.E

Page 12: Dr. Christian Kinast (ORTHOPEDIC CENTER ARABELLAPARK MUNICH, OZA, Germany) at ArthroParis 2014: Osteoarthritis of the Lisfranc Joint

Flatfoot with peritalar subluxation and Lisfranc atraumatic subluxationCalcaneus StepPlate; H-Plate Plate (Evans); Headless Compression Screw

Page 13: Dr. Christian Kinast (ORTHOPEDIC CENTER ARABELLAPARK MUNICH, OZA, Germany) at ArthroParis 2014: Osteoarthritis of the Lisfranc Joint

Lisfranc Arthrodesis Rehabilitation

2 weeks valved cast 4 - 6 weeks closed cast Week 7 – 10 increased weight baring CT scan week 10 - 12 ( difficult to read ) Week 11-12 full weight bearing

Page 14: Dr. Christian Kinast (ORTHOPEDIC CENTER ARABELLAPARK MUNICH, OZA, Germany) at ArthroParis 2014: Osteoarthritis of the Lisfranc Joint

Conclusion

Identify the underlying deformity of the foot in atraumatic Lisfranc osteoarthritis

pes planovalgus with peritalar subluxation / Lisfranc subluxation hallux valgus or skew foot deformities hallux valgus with pes planovalgus pes cavus in-situ without deformities postraumatic osteoarthritis rheumatoid arthritis neuro-osteo-arthropathy

Page 15: Dr. Christian Kinast (ORTHOPEDIC CENTER ARABELLAPARK MUNICH, OZA, Germany) at ArthroParis 2014: Osteoarthritis of the Lisfranc Joint

Arthrex Implants

Lapidus Plate Lisfranc Plate Arthrex Headless Compression Screws Quickfix Cannulated Screws 2.4, 3.0, 4.0mm Compression Staples Double Compression Plate Calcaneus StepPlate H-Plate (Evans)

Page 16: Dr. Christian Kinast (ORTHOPEDIC CENTER ARABELLAPARK MUNICH, OZA, Germany) at ArthroParis 2014: Osteoarthritis of the Lisfranc Joint

Thank you for your attention.

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