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Which Hip Stem to Choose and Why - An Evidence Based Approach by Dr. Anoop Jhurani
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Which Hip Stem to Choose and Why - An Evidence Based Approach by Dr. Anoop Jhurani
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Segment:0 .
ANOOP JHURANI: Hello, friends. The aim of this video is to share the choice of the hip implant in our patient who needs hip replacement surgery. There are various type of hip implants in the market, and all the companies promote their hip implants. But our choice has to be based on scientific judgment, which in turn is dependent on patients, demographics, bone quality, and, most importantly, battle and autonomy.
ANOOP JHURANI: So the purpose of this video is to show various types of hip implants, discuss what is the right implant for the kind of patient that you have. And all this is based on published evidence and registry data. The purpose of this video is not to promote any one type of implant, but to promote the principle and philosophy of thinking as to how we should choose our hip implant.
ANOOP JHURANI: I strongly encourage you to template your hips on a X-ray. That is true size. You should have a marker here and these days you have software which tells us the right dimension of the implants that we can template or X-rays. So if we have this X-ray it's the true size X-ray and ideally you can do a software templating or you can do templating like this.
ANOOP JHURANI: So you know that this is a 52 cut, you have a 30 year drop line and you have a lesser trochanteric line and your cup has just to be lateral to the entire teardrop line and 45 degrees to the hip drop line. So roughly, this cup, say, is 52 and that's the center of rotation of the hip. And then you have compared to the stem to the center of rotation of the hip there.
ANOOP JHURANI: And the purpose of integrating the stem is to see the right size, the left cut and the right offset. So once you've completed your hip correctly, we have to choose our implant. And the oldest implant that has been there is the cemented hip. And all the current implants are supposed to match the success of cemented hip, which has lasted more than forty years in some type of implants.
ANOOP JHURANI: Now, cemented hips have traditionally done very well, especially in elderly people. And, a cemented hip, well-polished, paper has shown to have excellent long term data. And this is the elderly patient. you can see we have done a cemented hip. The cup is at 45 degree inclination, about 20 degrees and inverted, good cementing throughout, more than 2 millimeters into the ilium ischium and the pubis bone through the holes and the complete bite out of cement on the femoral side.
ANOOP JHURANI: But if we look at the registry data very carefully, the Australian industry data or the British registry data, in younger patients less than 55, at 15 years the rate of loosening on the acetabular side, especially is higher. So what that means is that in younger patients who are very active, use their hips, the rate of failure on the acetabular side is higher as compared to the uncemented. So earlier the registry data was showing that cemented hips do the best,
ANOOP JHURANI: but at 15 years we are seeing that the hybrid and the uncemented hips are doing better. Now what that means is that in younger patients, less than 55 on the socket side, the uncemented cup is better because it is a press fix fixation and when the bone grows, then it is likely to last longer. So in younger patients, without being biased, just judging all the registry data and long term scientific literature, it's recommended now to use uncemented hips in younger patients, especially on the socket side where the bone is good
ANOOP JHURANI: and once you get press for fixation, you are likely to last, the cup is likely to last longer. So for the cemented hips, we all know that a tapered design, highly polished, has really done very well. This is an exemplorary design. It's very good long term data. On the femoral side, it's got excellent track record and it subsides a little and really stabilizes and gives excellent long term results.
ANOOP JHURANI: Now, in a younger patient, when you do need to revise a cemented hip system, that is a big operation because it will most likely need an extended trochanter osteotomy or a longer operation. Not just to remove the stem, but also to remove the cement. And in turn, that takes out some bit of cancellous bone. So even in young patients, on the acetabular and on the femoral side, we should choose uncemented stems.
ANOOP JHURANI: Now, what kind of uncemented stems? There are two types of uncemented stems. Either they're proximally coated, like this one where the port is proximal or they are fully coated like the Corail stem, which is fully coated. Now, let's understand the scientific difference between these two. In a younger patient,
ANOOP JHURANI: the younger patient like let's say this one, uncemented socket, good press fixation and this can take a larger 32 or a 36mm head, though for 36 heads we should avoid metal heads for fixation. If we're using a 36 head, we should preferably use a ceramic head. For a metal head, 28 or 32 is good enough. We can use a longer head, larger head and we have a proximally coated stem like this one. This is an Accolade which takes excellent fixation.
ANOOP JHURANI: Now earlier uncemented stem, like the AML was cylindrical and they used to cause anti stem pain. Now currently all the uncemented designs are paper, so they are tapered this way. That is, they don't fix distally, they fix proximally, they only feel distally. So what's important for us to understand is that the fixation is proximal and not distal. We don't want to give a press fix distally because that may cause anti stem pain and difficulty in removal when we are doing a revision.
ANOOP JHURANI: So all these stems take fixation proximally. That's one thing. Second thing is they are tapered here also for nowadays they don't cause any trochanteric fractures. So they are tapered on the trochanter and they take very good fixation proximally here and distally they only fill, so that's important. And when we need to remove, we need to remove without the extended trochanter goes largely because we only need to break the bond between the bone and the edge of the cord here proximally and the stem will come out and like a fully coated stem Corail in which the cord is in the full length of the stem.
ANOOP JHURANI: So this is a Corail stem and it is fully coated. So what that means is that the cord is vital to the excess cord. And if we need to do the remove this, we may need to do a extended trochanter osteotomy. Sometimes it may come out, but mostly we need to extend it to help reverse charge me to remove a Corail stem. So friends, there are two types of uncemented primary stems, proximally coated and fully coated.
ANOOP JHURANI: We should probably use mostly the proximally coated stem and not the fully coated stem and in an elderly patient with poor bone quality, we may use a fully coated stem in a patient that mostly won't need a revisit. Second, most important, for younger patients, we should choose a proximally coated stem with both offsets available; the high offset and the standard offset and we need to template it on an ex ray.
ANOOP JHURANI: The offset is high or is standard and we need to put it so that the offset is maintained. The biomechanics of the hip has to be recreated in terms of offset and leg length. Now let's understand the pattern and autonomy of the femur. Now, the femur from the greater trochanter into the lesser trochanter is a wedge. And that is why all the primary stems are wedge shaped, because they hold in the good bit of physeal bone, which is a wedge between the greater trochanter and the lesser trochanter.
ANOOP JHURANI: So wedge holes in a wedge provides rotational stability and that is why we don't need distal fixation. We need proximal fixation with a wedge holding on to the primary wedge shaped bone between the greater trochanter and the lesser trochanter. Now, when this wedge is disturbed between the greater trochanter and the lesser trochanter, below the lesser trochanter, the femur is a cone.
ANOOP JHURANI: And so when this primary area is disturbed, we need a conical stem. Before we come to that, we need to understand. Another thing between the primary and the revision stems, that is the S from stem. Now, in a displasia case like this one, dysplasia is a condition where there is abnormal development of the socket and the head. There is a tight femur, there is a small socket.
ANOOP JHURANI: The socket is reverted, the neck is highly anti-verted. So basically you are dealing with a small sized bone on the femur, on the socket and aversion issues. And in this, the right is every tooth is the eslamist stem in which the sleeve is separate and the stem perforation is separate. So what is happening is that we take a small cemented cup, get it near the teardrop, and then put a sleeve and extend those independent of the sleeve so you can rotate the version in any way you like because the version is not normal.
ANOOP JHURANI: There is a huge anti-version on the femoral side, so Edstrom is an excellent stem for dysplasia and this is the way to execute it. Now let's go to our next pattern on to me, which is the revision situation and the commonest problem that we have in our country is a failed hip test or a failed ostion move, and the way to handle this is that, as you know, a primary fixation area that is the wedge is lost.
ANOOP JHURANI: So this area between the greater trochanter and the lesser trochanter, which is the wedge, is lost. So we should not choose a primary stem for these cases. Now, the stem that is available to us or the area that's available to us is below the lesser trochanter and that is a cone. And hence we need to prepare our femur like a cone and put in the mother of all revision stems.
ANOOP JHURANI: That's a Wagner. So we have to prepare it like a cone and put in a cone. So a cone goes in a cone because the area below the lesser trochanter in the femur is a cone. And hence we need to put a conical stem into the femur for good press fixation distally. Now the fixation is distal. so all these stems are distally fixing because the proximal area is not normal.
ANOOP JHURANI: But there is excellent long term data over 30 years, very, very, very few case reports of the stem breaking, excellent stem and comes in sizes 14, are very good for our kind of patients, gives excellent rotational stability because of these fins and also has these two holes for tying of the trochanter. This is sometimes compared to a solution stem, but they are not the same. There are a lot of differences between these two stems.
ANOOP JHURANI: Now the Wagner stem is titanium, the Solution stem is cobalt chromium, the Wagner stem is conical, the Solution stem is cylindrical. The Wagner stem is great blasted, the Solution stem is fully edged coated. The Wagner stem gives excellent rotational stability while Solution stem does not because it's a cylinder going into a cone. So, and there are some case reports of solution breaking below size 11.
ANOOP JHURANI: So we very, very cautious of using Solution below 11. Our primary choice for a revision or a primary complex case is a Wagner stem for the advantages that I would like to re-emphasize. It's a cone, it's titanium with same modulus of elasticity as bone, gives excellent rotational control because of the fins, great ease of preparation. When the cone is disturbed, that is when the area between the lesser, below the lesser trochanter is disturbed,
ANOOP JHURANI: and the femur is ballooned out or the anatomy is disturbed, in a complex revision situation, we may need a modular stem. And all modular systems are been designed based on the mother of all revision stems. That's a Wagner. So what it essentially means is that when you have a situation like this, the femur is ballooned out and the anatomy is abnormal, then you need a modular stem. Now modular stem you need to broach proximally depending on how much is the width of or the dimension of the proximal canal, and then separate distally depending on what is the dimension of the distal canal.
ANOOP JHURANI: Essentially you're preparing the proximal and the distal parts separately, depending on the width of the canal. So in a Wagner STEM cell, for example, you know that it is 14 and it tapers down to 12, but it may not be in complex pattern inotomy. So if the proximal femur is ballooned out is larger, you may need a 16 or 18 cone proximally and distally, the stem may still be 12, and when you have a situation where the proximal canal is ballooned out or is bigger and the distal canal is thinner, you need a modular stem.
ANOOP JHURANI: So you need to prepare your proximal cone 16 or 18 or 20, whatever that is, and distally 12 or 14, whatever the canal dimension is and that is the advantage of a modular stem. Being careful that there are some reports of breakage of the stem at modular junction and some reports of cruenosis or corrosion at the modular junction. More modularity, more the junctions, more the chances of corrosion.
ANOOP JHURANI: So try and use a Wagner in most cases. In cases where there is a metaphyseal, diaphyseal mismatch, that is the time to use a modular stem. And last but not the least is, in hip revision surgery, we may have to use complex situations or tumor prostheses. So in a case like this where this will operate at four times and the proximal bone is completely sclerotic, you cannot put any kind of implant into it,
ANOOP JHURANI: a proximal femur tumor. Prostheses like this one may be a great fill out now, what that means is that you're replacing the proximal femur and cementing or using an uncemented stem to complete your reconstruction and tying your trochanter around the holes in the final implant. So, friends, let's go to a summary now. Choice of hip implants should be based on scientific judgment. Patient's age, body mass index, bone quality, osteoporosis, canal dimension and better anotomy.
ANOOP JHURANI: For any good primary case,
ANOOP JHURANI: simple case in elderly patients, probably a cemented hip would do very well. In young patients, there is very good evidence now that uncemented hips last longer because the fixation is better and the head size increases, so the range of movement is better. In primary cases, we should choose proximally coated stems like the Accolade where the fixation is proximal, and even when you revise, you don't need to do an extended tochantric osteotomy.
ANOOP JHURANI: On dysplasia cases,
ANOOP JHURANI: we should use a strong type of stem there, we can dial out, a stem independent of the sleeve into the right version. In complex primary or revision situations we choose to use the mother of all revision stems sets of Wagner; titanium, grid blasted, excellent rotational stability, works in most revision situations. Solution; not a great stem because it's cobalt chromium, very stiff and leads to stress shielding
ANOOP JHURANI: also. There is considerable evidence to that. Modular stem where there is a metaphyseal/diaphyseal mismatch and metaphyseal is ballooned out, you need to prepare your metaphyseal separately. And last but not the least, a tumor prostheses if indicated, when you have complete proximal bone loss. So friends, I hope this video will help you choose the right type of hip implant, especially in the femur side.
ANOOP JHURANI: We have concentrated on the femur side. In the next video, we'll tell you about the acetabular side but the right type of femoral implant in your patient based on registry data and scientific evidence. Let me reemphasize this is not to promote any one type of implant, but to promote the practice and philosophy of hip replacement surgery. Thank you very much.
Segment:0 .
ANOOP JHURANI: Hello, friends. The aim of this video is to share the choice of the hip implant in our patient who needs hip replacement surgery. There are various type of hip implants in the market, and all the companies promote their hip implants. But our choice has to be based on scientific judgment, which in turn is dependent on patients, demographics, bone quality, and, most importantly, battle and autonomy.
ANOOP JHURANI: So the purpose of this video is to show various types of hip implants, discuss what is the right implant for the kind of patient that you have. And all this is based on published evidence and registry data. The purpose of this video is not to promote any one type of implant, but to promote the principle and philosophy of thinking as to how we should choose our hip implant.
ANOOP JHURANI: I strongly encourage you to template your hips on a X-ray. That is true size. You should have a marker here and these days you have software which tells us the right dimension of the implants that we can template or X-rays. So if we have this X-ray it's the true size X-ray and ideally you can do a software templating or you can do templating like this.
ANOOP JHURANI: So you know that this is a 52 cut, you have a 30 year drop line and you have a lesser trochanteric line and your cup has just to be lateral to the entire teardrop line and 45 degrees to the hip drop line. So roughly, this cup, say, is 52 and that's the center of rotation of the hip. And then you have compared to the stem to the center of rotation of the hip there.
ANOOP JHURANI: And the purpose of integrating the stem is to see the right size, the left cut and the right offset. So once you've completed your hip correctly, we have to choose our implant. And the oldest implant that has been there is the cemented hip. And all the current implants are supposed to match the success of cemented hip, which has lasted more than forty years in some type of implants.
ANOOP JHURANI: Now, cemented hips have traditionally done very well, especially in elderly people. And, a cemented hip, well-polished, paper has shown to have excellent long term data. And this is the elderly patient. you can see we have done a cemented hip. The cup is at 45 degree inclination, about 20 degrees and inverted, good cementing throughout, more than 2 millimeters into the ilium ischium and the pubis bone through the holes and the complete bite out of cement on the femoral side.
ANOOP JHURANI: But if we look at the registry data very carefully, the Australian industry data or the British registry data, in younger patients less than 55, at 15 years the rate of loosening on the acetabular side, especially is higher. So what that means is that in younger patients who are very active, use their hips, the rate of failure on the acetabular side is higher as compared to the uncemented. So earlier the registry data was showing that cemented hips do the best,
ANOOP JHURANI: but at 15 years we are seeing that the hybrid and the uncemented hips are doing better. Now what that means is that in younger patients, less than 55 on the socket side, the uncemented cup is better because it is a press fix fixation and when the bone grows, then it is likely to last longer. So in younger patients, without being biased, just judging all the registry data and long term scientific literature, it's recommended now to use uncemented hips in younger patients, especially on the socket side where the bone is good
ANOOP JHURANI: and once you get press for fixation, you are likely to last, the cup is likely to last longer. So for the cemented hips, we all know that a tapered design, highly polished, has really done very well. This is an exemplorary design. It's very good long term data. On the femoral side, it's got excellent track record and it subsides a little and really stabilizes and gives excellent long term results.
ANOOP JHURANI: Now, in a younger patient, when you do need to revise a cemented hip system, that is a big operation because it will most likely need an extended trochanter osteotomy or a longer operation. Not just to remove the stem, but also to remove the cement. And in turn, that takes out some bit of cancellous bone. So even in young patients, on the acetabular and on the femoral side, we should choose uncemented stems.
ANOOP JHURANI: Now, what kind of uncemented stems? There are two types of uncemented stems. Either they're proximally coated, like this one where the port is proximal or they are fully coated like the Corail stem, which is fully coated. Now, let's understand the scientific difference between these two. In a younger patient,
ANOOP JHURANI: the younger patient like let's say this one, uncemented socket, good press fixation and this can take a larger 32 or a 36mm head, though for 36 heads we should avoid metal heads for fixation. If we're using a 36 head, we should preferably use a ceramic head. For a metal head, 28 or 32 is good enough. We can use a longer head, larger head and we have a proximally coated stem like this one. This is an Accolade which takes excellent fixation.
ANOOP JHURANI: Now earlier uncemented stem, like the AML was cylindrical and they used to cause anti stem pain. Now currently all the uncemented designs are paper, so they are tapered this way. That is, they don't fix distally, they fix proximally, they only feel distally. So what's important for us to understand is that the fixation is proximal and not distal. We don't want to give a press fix distally because that may cause anti stem pain and difficulty in removal when we are doing a revision.
ANOOP JHURANI: So all these stems take fixation proximally. That's one thing. Second thing is they are tapered here also for nowadays they don't cause any trochanteric fractures. So they are tapered on the trochanter and they take very good fixation proximally here and distally they only fill, so that's important. And when we need to remove, we need to remove without the extended trochanter goes largely because we only need to break the bond between the bone and the edge of the cord here proximally and the stem will come out and like a fully coated stem Corail in which the cord is in the full length of the stem.
ANOOP JHURANI: So this is a Corail stem and it is fully coated. So what that means is that the cord is vital to the excess cord. And if we need to do the remove this, we may need to do a extended trochanter osteotomy. Sometimes it may come out, but mostly we need to extend it to help reverse charge me to remove a Corail stem. So friends, there are two types of uncemented primary stems, proximally coated and fully coated.
ANOOP JHURANI: We should probably use mostly the proximally coated stem and not the fully coated stem and in an elderly patient with poor bone quality, we may use a fully coated stem in a patient that mostly won't need a revisit. Second, most important, for younger patients, we should choose a proximally coated stem with both offsets available; the high offset and the standard offset and we need to template it on an ex ray.
ANOOP JHURANI: The offset is high or is standard and we need to put it so that the offset is maintained. The biomechanics of the hip has to be recreated in terms of offset and leg length. Now let's understand the pattern and autonomy of the femur. Now, the femur from the greater trochanter into the lesser trochanter is a wedge. And that is why all the primary stems are wedge shaped, because they hold in the good bit of physeal bone, which is a wedge between the greater trochanter and the lesser trochanter.
ANOOP JHURANI: So wedge holes in a wedge provides rotational stability and that is why we don't need distal fixation. We need proximal fixation with a wedge holding on to the primary wedge shaped bone between the greater trochanter and the lesser trochanter. Now, when this wedge is disturbed between the greater trochanter and the lesser trochanter, below the lesser trochanter, the femur is a cone.
ANOOP JHURANI: And so when this primary area is disturbed, we need a conical stem. Before we come to that, we need to understand. Another thing between the primary and the revision stems, that is the S from stem. Now, in a displasia case like this one, dysplasia is a condition where there is abnormal development of the socket and the head. There is a tight femur, there is a small socket.
ANOOP JHURANI: The socket is reverted, the neck is highly anti-verted. So basically you are dealing with a small sized bone on the femur, on the socket and aversion issues. And in this, the right is every tooth is the eslamist stem in which the sleeve is separate and the stem perforation is separate. So what is happening is that we take a small cemented cup, get it near the teardrop, and then put a sleeve and extend those independent of the sleeve so you can rotate the version in any way you like because the version is not normal.
ANOOP JHURANI: There is a huge anti-version on the femoral side, so Edstrom is an excellent stem for dysplasia and this is the way to execute it. Now let's go to our next pattern on to me, which is the revision situation and the commonest problem that we have in our country is a failed hip test or a failed ostion move, and the way to handle this is that, as you know, a primary fixation area that is the wedge is lost.
ANOOP JHURANI: So this area between the greater trochanter and the lesser trochanter, which is the wedge, is lost. So we should not choose a primary stem for these cases. Now, the stem that is available to us or the area that's available to us is below the lesser trochanter and that is a cone. And hence we need to prepare our femur like a cone and put in the mother of all revision stems.
ANOOP JHURANI: That's a Wagner. So we have to prepare it like a cone and put in a cone. So a cone goes in a cone because the area below the lesser trochanter in the femur is a cone. And hence we need to put a conical stem into the femur for good press fixation distally. Now the fixation is distal. so all these stems are distally fixing because the proximal area is not normal.
ANOOP JHURANI: But there is excellent long term data over 30 years, very, very, very few case reports of the stem breaking, excellent stem and comes in sizes 14, are very good for our kind of patients, gives excellent rotational stability because of these fins and also has these two holes for tying of the trochanter. This is sometimes compared to a solution stem, but they are not the same. There are a lot of differences between these two stems.
ANOOP JHURANI: Now the Wagner stem is titanium, the Solution stem is cobalt chromium, the Wagner stem is conical, the Solution stem is cylindrical. The Wagner stem is great blasted, the Solution stem is fully edged coated. The Wagner stem gives excellent rotational stability while Solution stem does not because it's a cylinder going into a cone. So, and there are some case reports of solution breaking below size 11.
ANOOP JHURANI: So we very, very cautious of using Solution below 11. Our primary choice for a revision or a primary complex case is a Wagner stem for the advantages that I would like to re-emphasize. It's a cone, it's titanium with same modulus of elasticity as bone, gives excellent rotational control because of the fins, great ease of preparation. When the cone is disturbed, that is when the area between the lesser, below the lesser trochanter is disturbed,
ANOOP JHURANI: and the femur is ballooned out or the anatomy is disturbed, in a complex revision situation, we may need a modular stem. And all modular systems are been designed based on the mother of all revision stems. That's a Wagner. So what it essentially means is that when you have a situation like this, the femur is ballooned out and the anatomy is abnormal, then you need a modular stem. Now modular stem you need to broach proximally depending on how much is the width of or the dimension of the proximal canal, and then separate distally depending on what is the dimension of the distal canal.
ANOOP JHURANI: Essentially you're preparing the proximal and the distal parts separately, depending on the width of the canal. So in a Wagner STEM cell, for example, you know that it is 14 and it tapers down to 12, but it may not be in complex pattern inotomy. So if the proximal femur is ballooned out is larger, you may need a 16 or 18 cone proximally and distally, the stem may still be 12, and when you have a situation where the proximal canal is ballooned out or is bigger and the distal canal is thinner, you need a modular stem.
ANOOP JHURANI: So you need to prepare your proximal cone 16 or 18 or 20, whatever that is, and distally 12 or 14, whatever the canal dimension is and that is the advantage of a modular stem. Being careful that there are some reports of breakage of the stem at modular junction and some reports of cruenosis or corrosion at the modular junction. More modularity, more the junctions, more the chances of corrosion.
ANOOP JHURANI: So try and use a Wagner in most cases. In cases where there is a metaphyseal, diaphyseal mismatch, that is the time to use a modular stem. And last but not the least is, in hip revision surgery, we may have to use complex situations or tumor prostheses. So in a case like this where this will operate at four times and the proximal bone is completely sclerotic, you cannot put any kind of implant into it,
ANOOP JHURANI: a proximal femur tumor. Prostheses like this one may be a great fill out now, what that means is that you're replacing the proximal femur and cementing or using an uncemented stem to complete your reconstruction and tying your trochanter around the holes in the final implant. So, friends, let's go to a summary now. Choice of hip implants should be based on scientific judgment. Patient's age, body mass index, bone quality, osteoporosis, canal dimension and better anotomy.
ANOOP JHURANI: For any good primary case,
ANOOP JHURANI: simple case in elderly patients, probably a cemented hip would do very well. In young patients, there is very good evidence now that uncemented hips last longer because the fixation is better and the head size increases, so the range of movement is better. In primary cases, we should choose proximally coated stems like the Accolade where the fixation is proximal, and even when you revise, you don't need to do an extended tochantric osteotomy.
ANOOP JHURANI: On dysplasia cases,
ANOOP JHURANI: we should use a strong type of stem there, we can dial out, a stem independent of the sleeve into the right version. In complex primary or revision situations we choose to use the mother of all revision stems sets of Wagner; titanium, grid blasted, excellent rotational stability, works in most revision situations. Solution; not a great stem because it's cobalt chromium, very stiff and leads to stress shielding
ANOOP JHURANI: also. There is considerable evidence to that. Modular stem where there is a metaphyseal/diaphyseal mismatch and metaphyseal is ballooned out, you need to prepare your metaphyseal separately. And last but not the least, a tumor prostheses if indicated, when you have complete proximal bone loss. So friends, I hope this video will help you choose the right type of hip implant, especially in the femur side.
ANOOP JHURANI: We have concentrated on the femur side. In the next video, we'll tell you about the acetabular side but the right type of femoral implant in your patient based on registry data and scientific evidence. Let me reemphasize this is not to promote any one type of implant, but to promote the practice and philosophy of hip replacement surgery. Thank you very much.
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Form Title Accessibility and Keyboard Shortcuts
The cadmore media player is a professional video and audio player experience designed to deliver media as well as relevant transcript, segmentation, and metadata. On the screen is a traditional html video player with buttons such as play, pause, forward, captioning, language and play speed selection and more. Adjacent to the video player are generally tabs, one of which shows a scrolling transcript of the video and the other shows any segmentation of the media, sometimes referred to as chapters. At the top of the video is a menu bar containing an Explore button and Tools button. The Explore button allows you to dig deeper into the video by opening up an explore dialog which contains tabs for a visual navigation of the video using thumbnails, an about tab which contains rich metadata about the media, a segments tab which contains further information about the video, and a related tab which contains links to other media related to this media. The tools button opens a menu with options for sharing the media on social media, creating bookmarking links, creating embed codes for your website, generating citations, and more.
Keyboard Shortcuts
Keyboard shortcuts only work while you are in forms mode. By entering forms mode, you will be able to quickly access portions of the media player with single key commands.
Spacebar: Play/Pause Toggle
I: Info Menu,
O: Tools Menu
T: Transcript Tab,
S: Segments Tab
F: Forward 15,
R: Rewind 15
L: Languages,
P: Playspeed
M: Mute Toggle,
V: Volume Bar
N: Video Only Toggle,
B: Full Screen Toggle
C: Captions Toggle
Escape: Closes dialogs and menus / Exits Player
Z: Next Transcript Chapter
X: Previous Transcript Chapter
Q: Next Transcript Paragraph
W: Previous Transcript Paragraph
Entire Media
Segment(s)
Custom Clip
Start At:
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Embed Size
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You Size - Responsive
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We Size - Responsive
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Picture Overlay Popup
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400 x 225
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512 x 288
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400 x 700
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768 x 1024
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1024 x 512
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1280 x 608
Form Title Cite
No citation provided.
Info
Segments
Related
Thumbnails
Exit Clip Mode
You have requested to see a portion of the video outside of the clip.
Click OK to switch to the full video or click if you would like to stay inside the clip. You can always go back to the clip with Tools and Clip Mode