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DIANA implants

Frequently asked questions

Is 'DIANA' a sacroiliac screw?

No: With the DIANA method a hollow threaded implant is inserted between the bones of the SI-Joint, to keep the ilial and the sacral bone separated from each other until bony fusion is performed. Under the theory of distraction-interposition, relative laxity of the ligament-bone relationships is likely to be improved by cautious redistraction against the resistance of the underlying ligament tension,  upon which the technique relies.  Though we believe the early pain relief results because the bone surfaces are separated slightly and that the ligaments will guide the pelvic relationships to a position closer to their original nondiseased state, the hypotheses need to be tested.  Though clinical results are very encouraging and suggest this effect, there is much work to do to demonstrate the actual method of the promising clinical results.

The hollow threaded implant looks like an interbody cage. Can standard cages be used?

Yes, but this will not lead to success.  During the development of the DIANA technique and implant system, the first attempts of distracting the joint were done with available standard cages and without special instruments or the use of radiologic landmarks.  The use of intraoperative imaging and an understanding of the patientâ's special anatomy allows an approach to this difficult area with a greater confidence and safety than any cage method. The actual instruments respect the fact that the sacral bone is softer by asymetrical cutting. The implant is mainly seated and fixed in the hard ilial bone. For this purpose the implant is equipped with a distally self cutting thread, which is continued proximally as a solid thread with an anti-subsidence shoulder.

Is there a need to remove the implant after fusion? 

No. The titanium implant is filled during and after insertion with bone graft. The special disign allows for lasting ingrowth. It serves only to maintain the distraction until bony fusion is completed. Removal of the implant would not weaken the achieved fusion, since the implant is NOT the fusion method. Once the fusion is solid the implant could be removed, but we never do. A need to remove would only be in cases of nonunion or  infection.

Can the implant be revised, if needed?

The anatomy is ordinarily preserved if the implant must be removed, and a new slightly larger implant can be inserted, reestablishing tension.  The procedure was developed to be intuitive and reproducible in a primary circumstance but also to preserve anatomy and revision options, in the event that revision surgery is necessary. Cautious design has allowed options to the surgeon, and under the effects of improved medical and surgical support, the revision situation should heal.

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