LUMiC. Surgical Technique

Transcription

1 LUMiC Surgical Technique

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3 LUMiC Surgical Technique LUMiC is developed in cooperation with Prof. Dr. A.H.M. Taminiau and Dr. P.D.S. Dijkstra, LUMC Leiden, The Netherlands. Table of contents Surgical Technique...5 Implants...13 Instruments...15 Note: The described surgical technique is the suggested treatment for the uncomplicated procedure. In the fi nal analysis the preferred treatment is that which addresses the needs of the individual patient. Copyright Information: Copyright: Cepthar, ACCIS, ACS, DiaLoc, EcoFit, BethaLoc, Load Shift, implafix, implavit, implatan and implacross are registered trademarks of implantcast GmbH. The use and copy of the content of this brochure are only allowed with prior written permisson of implantcast GmbH.

4 LUMiC Cup Insert options for MUTARS LUMiC Inner-Ø LUMiC Cup implacross PE insert 15 neutral 0 mm implacross PE insert 15 offset 4 mm ACCIS insert 15 Size /44 36/44 42/44 Size /48 36/48 46/48 Size /52 36/52 50/52 4

5 Positioning The patient is positioned on the contra lateral side. The pelvic should be free to move foreand backwards during operation. The chest is supported anterior and posterior in a ¾ posterior posture. fi gure 1 Resection Resect according to the preoperative planning (fi g. 2). fi gure 2 Push the drill guide under pressure in the space between the iliac blades (fi g. 3). Use X-ray or CAS to make sure not to perforate the iliac blades. An accurate starting point is crucial for the next steps in the procedure. The drill guide is calibrated to determine the stem length. fi gure 3 5

6 The K-wire is placed in the drill guide and gently tapped in with use of a mallet. The K-wire should reach the cortical bone in the upper iliac region for good fi xation. fi gure 4 Remove the drill guide (fi g. 5). fi gure 5 Connect the handle for modular stem reamer with the LUMiC stem reamer of the previously determined length and diameter and pull it over the K-wire (fi g. 6). In case of using the cemented stems prepare the bone with the modular reamer Ø10mm in the respective length. fi gure 6 6

7 Ream until the end of the reamer is fl ush with the resection level (fi g. 7a & 7b). Remove the reamer. Manual reaming is preferred. fi gure 7a fi gure 7b Attach the trial stem with the same length as the previously used reamer to the LUMiC stem impactor. Make sure the LUMiC stem impactor is attached securely to the stem. Implant the trial stem into the reamed canal. Make sure the fi n slots are aligned in the right position (fi g.8). fi gure 8 Remove the LUMiC stem impactor (fi g.9). fi gure 9 7

8 Fix the fi n chisel to the canulated shell impactor (fi g.10). In case of a 65mm trial stem use the 65mm fi n adapter, in case of a 75mm trial stem use the 75mm fi n adapter. There is no adapter needed for the 85mm trial stem. fi gure 10 Gently hammer the fi n chisel through slots until it stops (fi g.11). Move the fi n chisel only axial. Avoid bending loads, otherwise the fi n blades could break. Remove all components except the trial stem. Connect the chosen trial cup and the trial stem with the LUMiC screw (fi g.12a). The cup postitioner can be used. Perform a trial reposition to check the length and soft tissue tensioning. The LUMiC cup can be rotated in 5 degree increments in order to prevent luxation. In order to adjust the rotation for optimal stability, fi rst the proximal femur replacement should be performed. fi gure 11 fi gure 12a fi gure 12b 8

9 Remove all components. The trial stem is removed with the help of the LUMiC disassembling adapter (fi g. 13). fi gure 13 The fi nal stem can optionally be implanted with the use of the K-wire (fi g.14). fi gure 14 Connect the fi nal stem with the LUMiC stem impactor and put the stem over the k-wire (fi g. 15). For fi nal impaction remove the k-wire and connect the canulated shell impactor with the LUMiC impactor adapter. After the stem is impacted half way remove the K-wire to prevent it from clamping. fi gure 15 9

10 Make sure the stem has a proper primary fi xation. It should have full bone contact for optimal stability (fi g. 16a). Take care of the correct position of the fi ns. RIGHT WRONG fi gure 16a fi gure 16b Fix the desired LUMiC cup to the stem with the help of the LUMiC cup inserter (fi g.17). The cup positioner can be used to adjust the position. Optionally the alignment guide can also be used. A second trial reduction can be performed. Fix the screw with the use of the hex screw driver and use a trial insert. fi gure 17 fi gure 18 10

11 Finally fi x the screw with the counter lever (fi g. 18).Fix the counter screw in the same manner. fi gure 19 The insert is positioned with the insert impactor. To re-attach soft tissue and muscles the attachment tube can be used. Drill a hole in the Iliac bone and fi x the attachment tube to the bone with use of none resorbable sutures. fi gure 20 fi gure 21 fi gure 22 11

12 Combine the 2M-head of the respective size with the desired ic-head. For this use the assembling aid. ic-head and 2M-head will be combined by turning the threadof the assembling aid. With the head impactor and some slightly strokes the combined heads can be fi xed on the taper of the femoral stem. 12

13 Implants MUTARS LUMiC cup incl. safety screw Mat.: implatan ; TiAl 6 V 4 acc. to ISO mm mm mm S MUTARS LUMiC cup HA incl. safety screw Mat.: implatan ; TiAl 6 V 4 acc. to ISO with HA-coating acc. to ISO mm mm mm MUTARS LUMiC stem cementless HA Mat.: implatan ; TiAl 6 V 4 acc. to ISO with HA-coating acc. to ISO x65mm x75mm x85mm x65mm x75mm x85mm MUTARS LUMiC stem cemented Mat.: implavit ; CoCrMo acc. to ISO x65mm x75mm x85mm MUTARS LUMiC screw Mat.: implatan ; TiAl 6 V 4 acc. to ISO M 6x28mm 13

14 Implants ACCIS -insert 15 Mat.: implavit ; CoCrMo casting alloy acc. to ISO with TiNbN-coating /44mm /48mm /52mm implacross PE-insert 15 neutral 0mm Mat.: implacross ; crosslinked UHMW-PE /44mm /48mm /52mm implacross PE-insert 15 Offset 4mm Mat.: implacross ; crosslinked UHMW-PE /44mm /48mm /52mm 2M implacross E head Mat.: implacross E; crosslinked UHMW-PE with Vitamin E Ø 28/42 mm Ø 28/46 mm Ø 32/50 mm ic-head CoCrMo Mat.: implavit, CoCrMo acc. to ISO ; taper 12/ mm, S mm, M mm, L mm, S mm, M mm, L mm, XL ic-head titanium Mat.: implatan, TiAl 6 V 4 acc. to ISO with TiN-coating; taper 12/ mm, S mm, M mm, L mm, XL 14

15 Instruments MUTARS LUMiC container 1 top MUTARS LUMiC container 1 bottom MUTARS LUMiC container MUTARS 2M trial LUMIC Container 15

16 Instruments ACCIS trial insert 15 container 16

17 Instruments ic T-handle Zimmer-Jakobs ic-pin extractor MUTARS LUMiC stem impactor MUTARS LUMiC trial cup Ø 50mm Ø 54mm Ø 56mm trial head snap taper 12/14mm Ø 36mm S Ø 36mm M Ø 36mm L Ø 36mm XL trial liner 15 neutral 0mm /44 mm /48 mm /52 mm trial liner 15 offset 4mm /44 mm /48 mm /52 mm MUTARS LUMiC cup positioner Inlay 44 mm Inlay 48 mm Inlay 52 mm MUTARS LUMiC trial screw M6x28mm

18 Instruments MUTARS LUMiC trial stem x 65 mm x 75 mm x 85 mm MUTARS LUMiC trial stem x 65 mm x 75 mm x 85 mm shell impactor canulated MUTARS LUMiC fin chisel mm mm positioner PE-inlay Ø 32 mm Ø 36 mm MUTARS LUMiC fin chisel adapter mm mm MUTARS LUMiC drill guide MUTARS LUMiC handle for modular stem reamer guide wire 3,2/350 mm with 15mm threaded MUTARS LUMiC stem reamer x 65 mm x 75 mm x 85 mm MUTARS LUMiC stem reamer x 65 mm x 75 mm x 85 mm 18

19 Instruments trial insert extractor ic-adapter outside A/O / inside ic canulated hexagon screw driver with t-handle 5mm hip cup alignment guide left/right MUTARS LUMiC counter instrument MUTARS LUMIC cup inserter MUTARS LUMiC impactor adapter MUTARS LUMiC disassembling adapter ball probe 240mm

20 Instruments trial liner /39 mm /44 mm /48 mm /52 mm ACCIS inlay positioner /39 mm /44 mm /48 mm /52 mm ACCIS cup impactor without rim mm mm mm mm 20

21 Instruments ic head assembling tool M trial head /42mm /46mm /50mm or head impactor trial head snap taper 12/14mm Ø 28 mm S Ø 28 mm M Ø 28 mm L Ø 28 mm XL Ø 32 mm S Ø 32 mm M Ø 32 mm L Ø 32 mm XL 21

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24 your local distributor implantcast GmbH Lüneburger Schanze Buxtehude Germany phone: fax: internet: LUMICOPE *+E1ICLUMICOPE++* *+$$E1IC *