Allofit /Allofit -S IT Alloclassic Acetabular Cup System

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1 Allofit /Allofit -S IT Alloclassic Acetabular Cup System Surgical Technique Primary Stability and Simple Application _ _ST_Allofit.indd :07:27 Uhr

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3 The Allofit /Allofit -S IT Alloclassic Cup System Surgical Technique 3 Surgical Technique Allofit/Allofit-S IT Alloclassic Cup System Component Sizing Information 4 Preoperative Planning 5 Surgical Technique 6 Surgical Approach 6 Acetabular Reaming 6 Provisional Shell Insertion and Alignment 8 Implant Insertion 10 Screw Insertion 12 Provisional Liner Insertion and Trial Range of Motion 13 Polar Hole Plug Insertion 14 Liner Insertion 14 Liner Removal 17 Implants 20 Allofit IT and Allofit-S IT Shells 20 HA Allofit IT and Allofit-S IT Shells 21 Longevity Highly Crosslinked Polyethylene Liners Neutral 22 Longevity Highly Crosslinked Polyethylene Liners Elevated 23 BIOLOX * delta Ceramic-on-Ceramic Taper Liners 24 Metasul Metal-on-Metal Taper Liners 25 Cancellous Bone Screws 26 Instruments 27 Allofit Base Instruments 27 IT Liner Instruments 28 Provisional Shells 29 IT Provisional Liners, Neutral 30 IT Provisional Liners, Elevated 31 Screw Instruments 32 Poly Liner Thickness Chart 34 Shell and Liner Sizing Chart 36 *BIOLOX is a trademark of CeramTec AG _ _ST_Allofit.indd :07:45 Uhr

4 4 The Allofit /Allofit -S IT Alloclassic Cup System Surgical Technique Component Sizing Information The Allofit IT Implant Shell has a press-fit of 2 mm compared to the acetabular reamer already built in the design. An oversize of 1 mm over the reamer is built in the provisional shells to assess stability of the component (Fig. 1). In most cases, using the same nominal size for the acetabular reamer, provisional shell and Allofit IT Shell provides sufficient primary stability. Provisional Shells and Shell Implants are labeled with the exterior size and a corresponding letter code (e.g. 54/JJ). The matching Provisional Liners and Liner Implants are identified by the matching letter code and head diameter (e.g. JJ/28, JJ/32 or JJ/36). Acetabular Reamer Labeled 54 mm Measures 54 mm Provisional Shell Labeled 54 mm Measures 55 mm Fig. 1 Implant Shell Labeled 54 mm Measures 56 mm _ _ST_Allofit.indd :07:47 Uhr

5 The Allofit /Allofit -S IT Alloclassic Cup System Surgical Technique 5 Preoperative Planning X-ray templates are available for preoperative planning. Together with a current X-ray overview of the pelvis, these are a practical aid for planning the surgical procedure. 0 cm 54/JJ -Number Allofit IT Allofit-S IT /KK -Number Allofit IT Allofit-S IT The aim of preoperative planning is to determine the most favourable position of the implant and its approximate size, and anticipate potential surgical complications. A load-bearing, stable acetabular floor and solid lateral bony tissue are desirable. An extensively preserved osseous circumference of the acetabulum is a prerequisite for primary stability of the cup. In cases of acetabular dysplasia, preoperative planning helps in deciding whether the implant bed must be supported by using bone grafts. The center of rotation should approximate physio logical conditions as closely as possible. The inclination of the cup should form an angle of to the pelvic horizontal line. A cup template of appropriate size is placed between the acetabular roof and teardrop figure, which serve as a reference to determine the shell diameter. The cup should be placed in an anteversion of intraoperatively. However, it should be kept in mind that the correct cup orientation also depends on other factors (e.g. femoral implant position). Fig. 2 0 cm 0 cm Magnification 1.15:1 58/LL Allofit IT/Allofit -S IT Shell, Uncemented Lit. No Ed. 5/2009 WL -Number Allofit IT Allofit-S IT /NN -Number Allofit IT Allofit-S IT H /$090501E09+ 64/OO 0 cm 0 cm This reference number must correspond to that of the prosthesis to be implanted All rights reserved, Zimmer GmbH, CH-8404 Winterthur, Switzerland 60/MM -Number Allofit IT Allofit-S IT Number Allofit IT Allofit-S IT _ _ST_Allofit.indd :07:48 Uhr

6 6 The Allofit /Allofit -S IT Alloclassic Cup System Surgical Technique Surgical Technique Surgical Approach The Allofit IT Cup can be implanted using a variety of surgical approaches. The specific approach depends on the surgeon s preference and therefore may differ from the procedure shown below. A clean and clear exposure of the acetabulum is a prerequisite for successful implantation. The capsule is excised in its entire circumference so that reamers can be easily introduced. All fibrous, cartilaginous and bony structures preventing the preparation of the acetabulum must be removed. Fig. 3a Acetabular Reaming The acetabulum is reamed based on its size and prepared in 2 mm steps. The aim is to create an anatomically shaped acetabular implant bed so that the cup is gripped by bone on all sides and anchored in well-vascularized bone. This establishes the prerequisites for primary and secondary stability. Note: Take extra care to avoid eccentric reaming by holding the reamer steady. Note: Reaming must be minimal to preserve bone stock and the morphology of the acetabulum. In a flat acetabulum, first ream the central acetabular floor with a relatively small reamer. Then ream to the depth established in preoperative planning (Fig. 3a) _ _ST_Allofit.indd :07:48 Uhr

7 The Allofit /Allofit -S IT Alloclassic Cup System Surgical Technique 7 In a normal acetabulum, deepening is not required. Once the necessary depth has been reached, progressively ream the acetabulum by applying constant pressure, angling each reamer at approximately 40 to the longitudinal axis of the body to create a hemispheri -cal implant bed (Fig. 3b). Continue reaming in this direction until the necessary depth has been reached and 50 60% of the acetabular roof has been reamed to vascularized bone. The anterior and posterior acetabular roof must remain stable and solid. The reaming process is completed when these conditions are met. To obtain an implant bed being as symmetrical as possible and to avoid thermal necrosis, the final reaming should be performed manually. The reamer is inserted to a depth where its equator is entirely covered by bone; this does not apply to dysplastic acetabuli, for which an additional implant bed must be created. Fig. 3b _ _ST_Allofit.indd :07:49 Uhr

8 8 The Allofit /Allofit -S IT Alloclassic Cup System Surgical Technique Provisional Shell Insertion and Alignment Surgical judgment is used to define proper fit for press-fitting to avoid fracturing of the acetabulum. Assess bone quality and determine the appropriate implant size and type. Note: The diameter of the Provisional Shell is 1 mm larger than the labeled size and the acetabular reamer. Place the Ball Head Hex Driver through the opening and into the locking screw at the tip of the Inserter. Place the selected size Provisional Shell over the tip of the Inserter. While holding the Provisional Shell in place, securely thread the Locking Screw completely into the polar hole of the Provisional Shell (Fig. 4). Fig. 4 Provisional Shell assembly If using the straight Inserter, directly thread the tip into the polar hole of the Provisional Shell. Ensure that the patient is in the correct position. Attach the Positioning Guide to the Inserter and tighten the Positioning Bar. To achieve of inclination and of anteversion, in the supine patient position align the Positioning Guide parallel to the longitudinal body axis and the Positioning Bar vertical (Fig. 5a + 5b). Fig. 5a Supine position, A/P view Fig. 5b Supine position, top view _ _ST_Allofit.indd :07:50 Uhr

9 The Allofit /Allofit -S IT Alloclassic Cup System Surgical Technique 9 In the lateral patient position the Positioning Guide is also aligned parallel to the longitudinal body axis and the Positioning Bar is pointing horizontally in a 90 angle to the longitudinal body axis in ventral direction (Fig. 5c + 5d). With the Provisional Shell in the appropriate alignment, use a mallet on the Inserter to impact it (Fig. 6). Stability is carefully tested under pulling, tilting and rotating loads. Fig. 5c Lateral position, A/P view If the Provisional Shell does not have a sufficient fixation base, the acetabulum must be adequately deepened with the last reamer used, after which the stability of the trial shell is checked again. If the Provisional Shell is not seated firmly enough even with sufficient osseous enclosure, choose the next largest trial implant. The Provisional Shell has fenestrations to assess proper cup seating inside the acetabulum. After stability has been assessed and the implant size has been determined, the Provisional Shell is removed from the acetabulum. Fig. 5d Lateral position, top view Fig. 6 Provisional Shell insertion _ _ST_Allofit.indd :07:52 Uhr

10 10 The Allofit /Allofit -S IT Alloclassic Cup System Surgical Technique Implant Insertion Note: The nominal size of the definitive shell should match the last reamer used; a press-fit of 2 mm is built into the design of the shell. Oversizing and selection of a larger implant than prereamed is only advisable for soft bone, as the risk of pelvic fracture would be increased. Place the Ball Head Hex Driver through the opening and into the locking screw at the tip of the Impactor. Place the selected size implant over the tip of the Inserter. While holding the implant in place, securely thread the locking screw into the polar hole of the implant (Fig. 7). Impaction will be applied primarily to the dome of the implant, therefore it is important to fully seat the shell on the Inserter. Fig. 7 Implant Shell assembly If screw fixation is foreseen, it is necessary to assemble the Allofit-S IT Shell to the Offset Inserter in a way that allows to position the shell accordingly in the acetabulum with regards to the screw hole position. A small groove on the face of the shell indicates the middle of the screw hole area for easier orientation during impaction. Ensure that the patient is in the correct position. Attach the Positioning Guide to the Inserter and tighten the Positioning Bar. Fig. 8a Supine position, A/P view To achieve of inclination and of anteversion, in the supine patient position align the Positioning Guide parallel to the longitudinal body axis and the Positioning Bar vertical (Fig. 8a + 8b). Fig. 8b Supine position, top view _ _ST_Allofit.indd :07:54 Uhr

11 The Allofit /Allofit -S IT Alloclassic Cup System Surgical Technique 11 In the lateral patient position the Positioning Guide is also aligned parallel to the longitudinal body axis and the Positioning Bar is pointing horizontally in a 90 angle to the longitudinal body axis in ventral direction (Fig. 8c + 8d). With the final implant connected to the Shell Inserter, introduce the shell into the prepared acetabulum. Note: The potential for neurologic and vascular injury can be minimized if the posterior quadrants are used for transacetabular screw placement. 1 The Allofit-S IT Shell should be positioned to allow screw placement in the posterior superior and/or posterior inferior quadrants of the acetabulum. Fig. 8c Lateral position, A/P view Any soft tissue which remains between the bone and the implant should be removed. It is important to align the shell before tapping in and maintain the selected setting direction. With the implant in the appropriate position and alignment, use a mallet on the Inserter to impact the shell (Fig. 9). The impact required to safely seat the implant is dictated by the bone quality. When the shell is fully seated, turn the Ball Head Hex Driver counterclockwise to loosen the attachment screw on the Inserter. Then remove the Inserter. Fig. 8d Lateral position, top view The Control Hook can be used to check whether the implant was driven to the acetabular floor. Fig. 9 Shell insertion 1 Wasielewski RC, Cooperstein LA, Kruger MP, Rubash HE. Acetabular anatomy and the trans -acetabular fixation of screws in total hip arthroplasty. J Bone Joint Surg. 1990: 72-A (4); _ _ST_Allofit.indd :07:56 Uhr

12 12 The Allofit /Allofit -S IT Alloclassic Cup System Surgical Technique Screw Insertion Carefully following these steps for screw insertion can help to minimize screw push through or torque out after initial implantation. For additional screw fixation, position the Flexible Drill and the corresponding Drill Guide in the selected screw hole, and drill a pilot hole (Fig. 10). For sclerotic bone, it may be helpful to tap the screw hole. Use the Depth Gauge to measure the depth of the screw hole. Then select the appropriate length screw and use a Hex Head Driver to insert it into the selected screw hole (Fig. 11). Evaluate the bone quality, and avoid overtightening the screws. Place additional screws as necessary. Fig. 10 Drilling Srew Holes Note: Screws cannot be inserted into the polar hole at the dome of the shell. Note: The screws must be fully screwed in. Projecting screw heads can cause difficulties for correct fitting of the liner. Note: Avoid screw placement through the shell into the anterior inferior and anterior superior quadrant of the acetabulum to prevent injury to the neurovascular structures. Fig. 11 Screw insertion Optional Screw Hole Plugs If desired, insert Screw Hole Plugs in all unused screw holes. Place the plug on a Hex Head Driver or use the Screw Hole Plug Inserter in combination with the Ball Head Hex Driver to insert the Screw Hole Plugs. Properly align the geometries of the plug and screw hole. When correctly inserted, the plug will be slightly inset to avoid contact with the liner (Fig. 12). Note: No excessive force should be applied to the Screw Hole Plug, as damage may occur to its thread. Fig. 12 Screw Hole Plug insertion _ _ST_Allofit.indd :07:57 Uhr

13 The Allofit /Allofit -S IT Alloclassic Cup System Surgical Technique 13 Provisional Liner Insertion and Trial Range of Motion After preparing the femoral implant bed, select the Provisional Liner size that matches the letter code of the previously selected implant shell. The selected shell will be identified through a size and a letter code (e.g.54/jj). There are different inner diameter liners avail able for each shell size. The Provisional Liner is identified by a letter code matching the shell diameter and inner diameter (e.g. JJ/36). Fig. 13 Provisional Liner insertion Only elevated Provisional Liners have antirotational tabs, neutral Provisional Liners don t. Use a Hex Head Driver to insert the Provisional Locking Screw (golden c-ring) through the polar hole of the Provisional Liner. The smallest liners in head sizes 28, 32, 36 and 40 mm (DD/28, FF/32, HH/36 and JJ/40) do not have a Locking Screw and seat with a peg feature. Insert the Provisional Liner into the implanted shell. Note: Do not impact the Provisional Liner as damage may occur. Use a Hex Head Driver to thread the Provisional Locking Screw through the polar hole of the Provisional Liner (Fig. 13). Check stability and Range of Motion. When the appropriate liner selection is confirmed by a trial reduction, remove the Provisional Locking Screw and remove the Provisional Liner. When using elevated provisionals, mark the final position of the elevated portion on the face of the shell or the acetabular bone after trial reduction _ _ST_Allofit.indd :07:57 Uhr

14 14 The Allofit /Allofit -S IT Alloclassic Cup System Surgical Technique Polar Hole Plug Insertion If desired, the dome hole can be closed with a plug. Place the Polar plug on the Polar Hole Plug Inserter (Fig. 14). Properly align the geometries of the plug and dome hole before threading it into place. Make sure that the Polar Plug is fully seated. Note: No excessive force should be applied to the polar plug, as damage may occur to its thread. Fig. 14 Polar Hole Plug Insertion Liner Insertion The correlation between shell and liner size is indicated using letter codes on both components. Choose the liner with the same letter code as the implanted shell and the desired femoral head size. Hard-bearing liners should be inserted using the Liner Insertion Tool. Poly - eth ylene liners can be inserted by hand or using the Liner Insertion Tool. Assembly of Liner Insertion Tool Insert the suction tip onto the shaft of the instrument up to the etch line. Ensure that the shaft is bottomed out in the suction tip. Saline or water can be used to lubricate the shaft of the instrument for easier assembly of the Suction Cup. Note: Do not impact the Liner Insertion Tool. This warning is indicated on the instrument using the following symbol: BIOLOX delta Ceramic or Metasul Metal-on-Metal Liner Attach the Liner Insertion Tool to the liner. Make sure that the inner surface of the implanted shell as well as the liner surface is intact, clean and dry. Also inspect the shell to ensure that no damage occurred to the taper, dome hole plugs or screw hole plugs _ _ST_Allofit.indd :07:58 Uhr

15 The Allofit /Allofit -S IT Alloclassic Cup System Surgical Technique 15 Insert the liner into the shell (Fig. 15). After correct positioning, remove the Liner Insertion Tool after lifting up on the Interior Rod to release the vacuum. Select the correct size Hard Bearing Rim Impactor, that matches the implant head size. Align the pins on the Universal Handle with the keyhole slot on the underside of the Rim Impactor. Push it onto the handle and twist it in either direction to lock it in place. Fig. 15 Hard-bearing Liner alignment Center either the Metasul or BIOLOX delta Liner by rocking the Impactor Handle prior to impaction. This will decrease the likelihood of incorrect liner seating. Palpate and visually check the perimeter of the shell to ensure that the liner is not canted. Firmly strike the Universal Handle once with a mallet to fully seat the liner (Fig. 16). Verify that the liner is properly seated. When fully inserted, it should be flush to the face of the shell. Note: Larger sized Metasul and BIOLOX delta Liners may be more difficult to handle given their weight. Fig. 16 Hard-bearing Liner impaction _ _ST_Allofit.indd :07:59 Uhr

16 16 The Allofit /Allofit -S IT Alloclassic Cup System Surgical Technique Polyethylene Liner Place the final polyethylene liner into the implanted shell. Make sure that the inner surface of the shell as well as the liner surface is intact, clean and dry and that the anti-rotation tabs on the liner are aligned with the scallops on the shell (Fig. 17). When using elevated liners, ensure that the elevated portion is in the correct position prior to impacting the liner. Fig. 17 Polyethylene Liner alignment After correct positioning, remove the Liner Insertion Tool after lifting up on the Interior Rod to release the vacuum. Note: Before impaction, the polyethylene liner will not be flush with the rim of the shell. Note: Smaller inner diameter liners (e.g. 22 mm) may not fully disengage from the Liner Insertion Tool. Select the correct size Dome Impactor and attach it to the Universal Handle by aligning the pins on the Universal Handle with the keyhole slot on the underside of the Dome Impactor. Push it onto the handle and twist it in either direction to lock it in place. Then place the Dome Impactor on the liner and firmly strike the Universal Handle with a mallet until the liner is fully seated (Fig. 18). Verify that the liner is properly seated by palpating at the rim. When fully inserted, it should be flush to the face of the shell (Fig. 19). If additional elevated liner seating verification is desired, gently move the elevated portion of the liner to ensure that it is locked into place. Fig. 18 Polyethylene Liner impaction Fig. 19 Final Polyethylene Liner position Final Reduction After implantation of the femoral component perform a final reduction and assess range of motion, hip stability, and limb length to determine the final neck length of the femoral head _ _ST_Allofit.indd :08:00 Uhr

17 The Allofit /Allofit -S IT Alloclassic Cup System Surgical Technique 17 Liner Removal If removal of a liner is necessary, use appropriate disassembly devices to remove the liner. Once the acetabular shell taper ridges have been deformed through assembly of a hard bearing Liner (BIOLOX delta or Metasul Liner), the shell should not be used with another hard bearing liner. The safety and effectiveness of the taper locking mechanism has not been established for multiple hard bearing liner insertions. Following removal of a liner, clean and inspect the shell for damage prior to assembly of a new liner. In the case of revisions after possible breakage of ceramic components it is recommended to use a Ceramic-on- Poly eth ylene pairing in the case of liner revision, or a Ceramic-on-Ceramic articulation in case of replacing the shell completely. It is not recommended to use Metal-on- Polyethylene or Metal-on-Metal Pairings in these cases, because left over ceramic third-body particles may cause greater wear of the bearing surface 2. After removing a liner, assess the stability and positioning of the newly positioned liner and cup through trial reduction. 2 Matziolis G, Perka C, Disch A. Massive metallosis after revision of a fractured ceramic head onto a metal head. Arch Orthop Trauma Surg. 2003: 123; _ _ST_Allofit.indd :08:00 Uhr

18 18 The Allofit /Allofit -S IT Alloclassic Cup System Surgical Technique BIOLOX delta Ceramic or Metasul Metal-on-Metal Liner Attach the Liner Removal Tip to the Universal Handle by aligning the pins on the Universal Handle with the keyhole slot on the underside of the Removal Tip. Push it onto the handle and twist it in either direction to lock it in place. Fix the Liner Insertion Tool into the articulation surface of the liner and activate the vacuum. Then place the Liner Removal Tip onto the edge of the metal shell in a 90 angle to the shell s face. Strike the Universal Handle with a mallet to dislodge the liner from the shell (Fig. 20). Pull out the Liner Insertion Tool to remove the liner. Note: The Liner Removal Tip should not contact the liner during impaction. Fig. 20 Hard-bearing Liner removal Polyethylene Liner Use a 3.2 or 3.5mm Drill Bit to drill a hole into the polyethylene. Be careful to avoid drilling over a screw or screw hole. Thread a non-self tapping bone screw into the hole and remove the liner (Fig. 21). The use of a second bone screw on the opposite side of the shell may be necessary to lift the liner out of the shell. Special care should be taken not to lever against the polyethylene locking mechanism or taper region on the shell. Fig. 21 Polyethylene Liner removal _ _ST_Allofit.indd :08:01 Uhr

19 The Allofit /Allofit -S IT Alloclassic Cup System Surgical Technique _ _ST_Allofit.indd :08:01 Uhr

20 20 The Allofit /Allofit -S IT Alloclassic Cup System Surgical Technique Implants Allofit IT and Allofit -S IT Shells Pole Plug M8 Protasul -Ti Material Allofit IT Shell uncemented Protasul -Ti Material Allofit -S IT Shell uncemented Protasul -Ti Material Quantity Size* 42/DD /EE /FF /GG /HH /II /JJ /KK /LL /MM /NN /OO /PP /QU Size* 42/DD /EE /FF /GG /HH /II /JJ /KK /LL /MM /NN /OO /PP /QU /RR /SS /TT Screw Hole Plugs Protasul -Ti Material Quantity * Letter code indicates the correct Liner size _ _ST_Allofit.indd :08:06 Uhr

21 The Allofit /Allofit -S IT Alloclassic Cup System Surgical Technique 21 HA Allofit IT and Allofit -S IT Shells HA Allofit IT Shell uncemented Protasul -Ti Material/HAC HA Allofit -S IT Shell uncemented Protasul -Ti Material/HAC Size* 42/DD /EE /FF /GG /HH /II /JJ /KK /LL /MM /NN /OO /PP /QU Size* 42/DD /EE /FF /GG /HH /II /JJ /KK /LL /MM /NN /OO /PP /QU /RR /SS /TT * Letter code indicates the correct Liner size _ _ST_Allofit.indd :08:06 Uhr

22 22 The Allofit /Allofit -S IT Alloclassic Cup System Surgical Technique Longevity Highly Crosslinked Polyethylene Liners Neutral* Longevity Neutral PE Liners Longevity PE EO x 28 mm x 32 mm x 36 mm x 40 mm Size** x mm Size** x mm Size** x mm Size** x mm EE FF GG HH II JJ KK LL MM NN OO PP QU GG HH II JJ KK LL MM NN OO PP QU RR SS TT II JJ KK LL MM NN OO PP QU RR SS TT KK LL MM NN OO PP QU RR SS TT * For femoral head compatibility, please refer to ** Letter code indicates the correct Shell size _ _ST_Allofit.indd :08:07 Uhr

23 The Allofit /Allofit -S IT Alloclassic Cup System Surgical Technique 23 Longevity Highly Crosslinked Polyethylene Liners Elevated* Longevity Elevated PE Liners Longevity PE EO x 22 mm x 28 mm x 32 mm x 36 mm Size** x mm DD EE FF Size** x mm EE FF GG HH II JJ KK LL MM NN OO PP QU Size** x mm GG HH II JJ KK LL MM NN OO PP QU RR SS TT Size** x mm II JJ KK LL MM NN OO PP QU RR SS TT * For femoral head compatibility, please refer to ** Letter code indicates the correct Shell size _ _ST_Allofit.indd :08:12 Uhr

24 24 The Allofit /Allofit -S IT Alloclassic Cup System Surgical Technique BIOLOX delta Ceramic-on-Ceramic Taper Liners* BIOLOX delta Ceramic-on-Ceramic Taper Liners Alumina Matrix Composite x 28 mm x 32 mm x 36 mm x 40 mm Size** x mm Size** x mm Size** x mm Size** x mm EE FF GG HH GG HH II JJ II JJ KK LL MM NN OO PP QU RR SS TT KK LL MM NN OO PP QU RR SS TT * For femoral head compatibility, please refer to ** Letter code indicates the correct Shell size _ _ST_Allofit.indd :08:13 Uhr

25 The Allofit /Allofit -S IT Alloclassic Cup System Surgical Technique 25 Metasul Metal-on-Metal Taper Liners* Metasul Metal-on-Metal Taper Liners Protasul -21 WF High carbon CoCrMo Alloy x 28 mm x 32 mm x 36 mm x 40 mm Size** x mm Size** x mm Size** x mm Size** x mm DD EE FF GG FF GG HH II HH II JJ KK LL MM NN OO PP QU RR SS TT JJ KK LL MM NN OO PP QU RR SS TT * For femoral head compatibility, please refer to ** Letter code indicates the correct Shell size _ _ST_Allofit.indd :08:15 Uhr

26 26 The Allofit /Allofit -S IT Alloclassic Cup System Surgical Technique Cancellous Bone Screws Countersunk Cancellous Bone Screw x 6.5 mm Protasul -64WF Material not sterile Length 15 mm mm mm mm mm mm mm mm mm mm mm * 80 mm * Countersunk Cancellous Bone Screw x 6.5 mm Tivanium Material Length 15 mm mm mm mm mm mm mm mm mm * 80 mm * * On request _ _ST_Allofit.indd :08:16 Uhr

27 The Allofit /Allofit -S IT Alloclassic Cup System Surgical Technique 27 Instruments Allofit Base Instruments Allofit Base Instrument Case (empty) Tray Cover Allofit Straight Shell Impactor Positioning Guide Control Hook 5633 Allofit Offset Impactor Positioning Bar for Setting Instrument for Pole Plug, straight Screw Hole Plug Instrument Setting Instrument for Pole Plug, curved Ball Hex Driver _ _ST_Allofit.indd :08:19 Uhr

28 28 The Allofit /Allofit -S IT Alloclassic Cup System Surgical Technique IT Liner Instruments IT Hard-Bearing Liner Case (empty) Tray Cover Straight Universal Handle Hard-Bearing Rim Impactors Size in mm Curved Universal Handle Liner Insertion Tool Dome Impactors Size in mm Disposable Suction Cup Hard-Bearing Liner Removal Tip _ _ST_Allofit.indd :08:30 Uhr

29 The Allofit /Allofit -S IT Alloclassic Cup System Surgical Technique 29 Provisional Shells Provisional Shell Case (empty) Tray Cover Provisional Shells Size in mm _ _ST_Allofit.indd :08:33 Uhr

30 30 The Allofit /Allofit -S IT Alloclassic Cup System Surgical Technique IT Provisional Liners IT Provisional Liner Case (empty) Tray Cover Locking Screw Provisional Liners, Neutral x 28 mm x 32 mm x 36 mm x 40 mm Size** x mm DD EE FF GG HH II JJ KK LL MM NN OO PP QU Size** x mm FF GG HH II JJ KK LL MM NN OO PP QU RR SS TT Size** x mm HH II JJ KK LL MM NN OO PP QU RR SS TT Size** x mm JJ KK LL MM NN OO PP QU RR SS TT ** Letter code indicates the correct Shell size _ _ST_Allofit.indd :08:37 Uhr

31 The Allofit /Allofit -S IT Alloclassic Cup System Surgical Technique 31 Provisional Liners, Elevated x 22 mm x 28 mm x 32 mm x 36 mm Size** x mm Size** x mm Size** x mm Size** x mm DD EE FF EE FF GG HH II JJ KK LL MM NN OO PP QU GG HH II JJ KK LL MM NN OO PP QU RR SS TT II JJ KK LL MM NN OO PP QU RR SS TT ** Letter code indicates the correct Shell size _ _ST_Allofit.indd :08:38 Uhr

32 32 The Allofit /Allofit -S IT Alloclassic Cup System Surgical Technique Screw Instruments Screw Instrument Case (empty) Tray Cover mm Straight Drill Guide 5913 T-Handle Guiding Hook 5174 Flexible Shaft Gauge for Screws Screw Forceps Drill Bit Size mm mm mm mm Depth Gauge 7936 Screw Caddy mm Straight Screwdriver mm Tap Angular Gear 7799* 3.5 mm Cardan Hex Screw Driver * On request _ _ST_Allofit.indd :08:42 Uhr

33 The Allofit /Allofit -S IT Alloclassic Cup System Surgical Technique _ _ST_Allofit.indd :08:43 Uhr

34 34 The Allofit /Allofit -S IT Alloclassic Cup System Surgical Technique Poly Liner Thickness Chart Neutral Elevated Head Size (mm) Shell Size (mm) Liner Size Pole (mm) 45 (mm) Chamfer (mm) neutral elevated DD EE FF EE FF GG HH II JJ KK LL MM NN OO PP QU GG HH II JJ KK LL MM NN OO PP QU RR SS TT _ _ST_Allofit.indd :08:45 Uhr

35 The Allofit /Allofit -S IT Alloclassic Cup System Surgical Technique 35 Head Size (mm) Shell Size (mm) Liner Size Pole (mm) 45 (mm) Chamfer (mm) neutral elevated II JJ KK LL MM NN OO PP QU RR SS TT KK LL MM NN OO PP QU RR SS TT _ _ST_Allofit.indd :08:46 Uhr

36 36 The Allofit /Allofit -S IT Alloclassic Cup System Surgical Technique Shell and Liner Sizing Chart Shell Size [mm] Allofit IT DD EE FF GG HH II JJ KK LL MM NN OO PP QU Allofit -S IT DD EE FF GG HH II JJ KK LL MM NN OO PP QU RR SS TT Longevity Highly Crosslinked Polyethylene Liners BIOLOX delta Composite Ceramic Liners Metasul Metal Liners x 28 mm neutral x 32 mm neutral x 36 mm neutral x 40 mm neutral x 22 mm elevated x 28 mm elevated x 32 mm elevated x 36 mm elevated x 28 mm neutral x 32 mm neutral x 36 mm neutral x 40 mm neutral x 28 mm neutral x 32 mm neutral x 36 mm neutral x 40 mm neutral _ _ST_Allofit.indd :08:46 Uhr

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40 Disclaimer This document is intended exclusively for physicians and is not intended for laypersons. Information on the products and procedures contained in this document is of a general nature and does not represent and does not constitute medical advice or recommendations. Because this information does not purport to constitute any diagnostic or therapeutic statement with regard to any individual medical case, each patient must be examined and advised individually, and this document does not replace the need for such examination and/or advice in whole or in part. Information contained in this document was gathered and compiled by medical experts and qualified Zimmer personnel. The information contained herein is accurate to the best knowledge of Zimmer and of those experts and personnel involved in its compilation. However, Zimmer does not assume any liability for the accuracy, completeness or quality of the information in this document, and Zimmer is not liable for any losses, tangible or intangible, that may be caused by the use of this information. Please refer to package insert for complete product information, including contraindications, warnings, precautions, and adverse effects by Zimmer GmbH Printed in Switzerland Subject to change without notice Contact your Zimmer representative or visit us at Lit. No Ed. 09/2010 ZHUB +H /$100901I10Y _ _ST_Allofit.indd :09:12 Uhr

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