1. UPDATE IN EOA 65 AC 2013 Dr: Khaled F Ebido Ortho specialist AL Hada Hospital

2. Biomechanical Biomechanical and Clinical Evaluations of a Porous Tantalum Implant for the Treatment of Early-Stage Osteonecrosis

3. What is the tantalum?

4. Trabecular Metal Material resembles trabecular bone The mechanical and physical properties of bone Highly porous, structural biomaterial enables rapid and extensive bone infiltration

5. Trabecular Metal Technology Used clinically since 1997 75-80% porous, permeability similar to bone Enables osteoconduction and fixation High strength and ductility Elasticity similar to bone Intrinsically high friction and stability

6. The Trabecular Metal Osteonecrosis Intervention Implant System Reduce pain and slow the progress of the disease in stage I or stage II osteonecrosis of the femoral head may delay or prevent the need for THA in many patients.

7. Osteonecrosis Intervention Implant System  Structurally support the necrotic segment of the femoral head.  Interrupt the interface between healthy and necrotic bone  The high coefficient of friction and ingrowth potential of Trabecular Metal Material.  The flexibility of the material allows for more normal physiological loading of the femoral head and neck and allows new bone formation.  The implant may be used with or without bone graft.

9. Since the late 1960s, numerous articles have been published on the clinical outcomes of various techniques that have been used for the treatment of femoral head osteonecrosis. One of the most comprehensive papers was by Mont et al. Mont et al. concluded that core decompression is clinically beneficial for patients with early-stage (precollapse) osteonecrosis and reported that the overall rate of success following the treatment of stage-II disease was 65% after a mean duration of follow-up of thirty months.

10.  The early clinical results associated with the porous tantalum implant were encouraging in terms of the survival, the clinical outcomes (as reflected by increased Harris hip scores),and the lack of device-related clinical complications.  Radiographic analysis showed that -no instances of abnormal bone density -no evidence of implant loosening -no evidence of radiolucent lines.

12.  These findings indicate that initial stability is achieved with the threaded end of the implant and that the bone- matched elastic modulus of porous tantalum reduces the potential for physiologically abnormal stress in thesurrounding bone.

13. Arthroplasty

14. Bilateral simultaneous TKR in patients with severe articular deformities using PSI technique Purpose to evaluate short term outcome of patient specific instrument. Operative time was shorter as comparaed to cohort of TKR using C I. Short term outcome satisfactory for severe cases of articular deformitis that could be contraindicated for conventional techniqe.

15. Acetabular fractures in the elderly  An alternative mangment strategy is to perform a total hip repl. At the same time of internal fixation.  The early results of this strategy suggest it is well tolerated by the patient and leads to a more rapid and reliable return to mobility Paul culpan

16. Modified Dunn, s osteotomy in mangement of SCFE

17. Salvage of failed fixation of intercondylar fractures of the humerous using ulno-humeral fixation After removal of the humeral fixation, patient regained a satisfactory range of elbow movement of an avarage of 80 dgree after an avarage of 12 weeks A.moharam

18. Sports

19. Lelli test for ACL function