AUTOBLOQUANTE AUTOBLOQUANTE. Product Rationale Surgical Technique

Transcription

1 AUTOBLOQUANTE AUTOBLOQUANTE Product Rationale Surgical Technique

2 AUTOBLOQUANTE The Product of Long-Term Clinical Experience The AUTOBLOQUANTE femoral component is a direct descendant of the original straight self-locking stem designed in the 1970s by Professor ME Müller. A range of sizes helps the surgeon to achieve a closer anatomical match for patients including those with a narrow femoral canal. Longitudinal groves are designed to increase the surface area of the stem in contact with the cement without compromising extraction in revision scenarios. The intramedullary portion of the stem is grit-blasted to allow cement fixation. The neck is polished to reduce the potential for wear should cup impingement occur and features reduced geometry: designed for stability and range-of-motion. 1 DePuy Synthes AUTOBLOQUANTE Product Rationale & Surgical Technique

3 Material Specification The AUTOBLOQUANTE stem is made from a High Nitrogen Stainless steel alloy (i.e. M30NW) conforming to ASTM F1586 & ISO Further, the stem supports a 12/14 taper that is compatible with all DePuy Synthes 12/14 heads indicated for total hip arthroplasty, offering metal-on-polyethylene, ceramic-on-polyethylene and ceramic-on-ceramic bearing options to the surgeon. AUTOBLOQUANTE Product Rationale & Surgical Technique DePuy Synthes 2

4 Pre-Operative Planning Preoperative planning is an important initial step in the THR surgical procedure. It helps the surgical team to evaluate the patient s anatomy, identify and pre-empt any intra-operative difficulties that may occur before the commencement of the surgical procedure. Figure 1 Note: Care should be taken when positioning the patient for X-ray to ensure the femoral neck is parallel to the horizontal when the patient is supine and this is accomplished by internally rotating the affected leg by 15 degrees. The selection of the appropriate implant to match the patient s anatomy is facilitated by the use of pre-operative X-ray templates. The AUTOBLOQUANTE THR system has a complete range of femoral X-ray templates featuring both an AP and ML view with a scale magnification of 115%. Each template contains a series of holes on the AP view that represent the femoral head centre of each of the available head offsets. These templates are to be used in conjunction with X-rays that clearly demonstrate the acetabular configuration and the endosteal and periosteal contours of the femoral head, neck and femur. To restore leg length and natural head position, the femoral axis and natural head centre are set using key anatomical landmarks such as the greater and lesser trochanters, the femoral shaft and the pelvic tear drop; as per standard X-ray templating techniques. The AUTOBLOQUANTE X-ray template is then positioned on the AP radiograph, such that the implant s centre line overlays the long axis of the femur. The AP view provides the surgeon with the primary means of determining the dimensions of the femoral canal and the largest stem template that fills the proximal femur should be selected. With the template positioned accurately, the centre of rotation of the head should overlay the centre of the femoral head. The most appropriate offset that replicates the natural head centre should then be marked through the corresponding hole in the template. The Lateral (ML) view also reveals the femoral curvature and provides opportunity for further verification/confirmation that the selected size is correct, whist revealing any anatomical anomalies. Figure 2 Note: A 20 mm gap should be left from the distal tip of the selected implant template to accommodate the cement restrictor. The corresponding neck resection level is then noted in relation to key anatomical landmarks (e.g. greater and lesser trochanters) to enable its position to be identified intraoperatively. 3 DePuy Synthes AUTOBLOQUANTE Product Rationale & Surgical Technique

5 Femoral Canal Preparation Once adequate exposure of the femur has been achieved, a slot is prepared in the resected femoral neck, at of anteversion, using the Anteversion Osteotome (Figure 3). This will provide a directional guide for the anteversion of the first rasp Figure 3 The medullary canal is then probed to confirm its axis, and cleared using a long curette (Figure 4). Alternatively, the T-Handle, IM Initiator and Müller Awl Reamer provided may also be used to open the medullary canal. Figure 4 AUTOBLOQUANTE Product Rationale & Surgical Technique DePuy Synthes 4

6 Broaching The smallest broach is attached to the Broach Handle and Anterversion Axis assembly. The broach is then introduced into the medullary cavity, maintaining of anteversion, in line with the slot previously prepared (Figure 5). The size of broach is progressively increased until the final broach, corresponding to the previously templated implant size, is seated at the pre-determined neck resection level and is completely stable within the femur. The Broach Handle is now removed leaving the final broach in situ. Figure 5 Trial Reduction The appropriate trial head is attached to the neck of the rasp, and the hip is reduced to assess impingement and joint stability through a full range of motion (Figure 6). If necessary, neck length may be adjusted by selecting the appropriate trial head option. Following satisfactory trial reduction, the trial implant is removed. Figure 6 5 DePuy Synthes AUTOBLOQUANTE Product Rationale & Surgical Technique

7 Femoral Stem Insertion A Cement Restrictor is introduced to a depth of 2 cm beyond the tip of the stem. The Hardinge Cement Restrictor has an introducer featuring markings to help gauge depth relative to stem length. Pulse lavage should be used to clear debris from the medullary canal before drying with a swab (that may be dry or pre-soaked with epinephrine or hydrogen peroxide). A bone cement such as SMARTSET HV Bone Cement can now be injected into the femur in a retrograde manner using a cement gun, before being pressurised using a proximal femoral seal, to ensure the femoral cavity is filled. The Femoral Stem Impactor, Stem Handle and definitive stem are assembled (Figures 7 and 8) and the definitive stem is advanced into the femoral canal in line with the long axis of the femur. Figure 7 Once the stem is fully seated, any excess cement is removed. Pressure is maintained on the stem until cement polymerisation is complete. The joint is irrigated and cleared of debris. Figure 8 AUTOBLOQUANTE Product Rationale & Surgical Technique DePuy Synthes 6

8 Femoral Head Impaction Once the cement is fully set, a further trial reduction is performed. The appropriate trial head is placed on the neck of the stem and the hip is reduced to carry out a final assessment of joint stability and range of movement. The trial head is then removed and the neck of the prosthesis is irrigated and thoroughly dried to ensure that the taper is free of debris or liquid. The corresponding, definitive DePuy Synthes 12/14 femoral head is placed on the taper and lightly tapped home, using the Head Impactor (Figure 9). The hip is reduced and the wound is closed. Rehabilitation guidelines should follow normal clinical practice. Figure 9 7 DePuy Synthes AUTOBLOQUANTE Product Rationale & Surgical Technique

9 Technical Specification B C D 135 A Size A Stem Length (mm) B Offset w/head (mm) C Leg Length Adjustment w/head (mm) D Neck Length (mm) AUTOBLOQUANTE Product Rationale & Surgical Technique DePuy Synthes 8

10 Ordering Information Femoral Implants AUTOBLOQUANTE Standard Stems L85900 AUTOBLOQUANTE Standard Size 7.5 L85901 AUTOBLOQUANTE Standard Size 10 L85902 AUTOBLOQUANTE Standard Size L85903 AUTOBLOQUANTE Standard Size 12.5 L85904 AUTOBLOQUANTE Standard Size L85905 AUTOBLOQUANTE Standard Size 15 L85906 AUTOBLOQUANTE Standard Size ARTICUL/EZE Femoral Heads ARTICUL/EZE Head CoCr 28 mm ARTICUL/EZE Head CoCr 28 mm ARTICUL/EZE Head CoCr 28 mm ARTICUL/EZE Head CoCr 28 mm +12 All 12/14 heads available in the DePuy Synthes portfolio are compatible with the AUTOBLOQUANTE Stem The 12/14 ceramic BIOLOX femoral heads are also available for use with AUTOBLOQUANTE on request Femoral Instruments Femoral Head Impactor A3670 Femoral Stem Impactor L85975 Standard Stem Handle L44571 Anterversion Axis L95060 Rasp Handle L85930 Rasp Size 7.5 L85931 Rasp Size 10 L85932 Rasp Size 11.5 L85933 Rasp Size 12.5 L85934 Rasp Size L85935 Rasp Size 15 L85936 Rasp Size ARTICUL/EZE Trial Head 28 mm +1.5* ARTICUL/EZE Trial Head 28 mm +5* ARTICUL/EZE Trial Head 28 mm +8.5* ARTICUL/EZE Trial Head 28 mm +12* L85960 Trial Head 28 mm +1.5** L85961 Trial Head 28 mm +5** L85962 Trial Head 28 mm +8.5** L85963 Trial Head 28 mm +12** L85964 Trial Head 28 mm +15.5** * for use with definitive implants ** for use with rasps 9 DePuy Synthes AUTOBLOQUANTE Product Rationale & Surgical Technique

11 Femoral Implants Femoral Instruments (Cont.) Anteversion Osteotome Medium Müller Awl Reamer with Hudson End T-Handle IM Initiator Hardinge Cement Restrictor Introducer Long X-ray Templates Cement Accessories Empty Bowl with Spatula SMARTSET HV Bone Cement 40g Hardinge Cement Restrictor AUTOBLOQUANTE Product Rationale & Surgical Technique DePuy Synthes 10

12 The third party trademarks used herein are the trademarks of their respective owners. This publication is not intended for distribution in the USA. Johnson & Johnson Medical Limited PO BOX 1988, Simpson Parkway, Livingston, West Lothian, EH54 0AB, United Kingdom. Incorporated and registered in Scotland under company number SC DePuy France S.A.S. 7 Allée Irène Joliot Curie Saint Priest France Tel: +33 (0) Fax: +33 (0) DePuy Orthopaedics, Inc. 700 Orthopaedic Drive Warsaw, IN USA Tel: +1 (800) Fax: +1 (574) depuysynthes.com DePuy International Ltd St Anthony s Road Leeds LS11 8DT England Tel: +44 (0) DePuy (Ireland) Loughbeg Ringaskiddy Co. Cork Ireland Tel: Fax: DePuy International Ltd Trading as DePuy CMW Cornford Road Blackpool FY4 4QQ Lancashire England Tel: + 44 (0) Fax: + 44 (0) Johnson & Johnson Medical Limited All rights reserved. CA#DSEM/JRC/1216/0726 Issued: 03/17