PRODUCT RATIONALE & SURGICAL TECHNIQUE

Transcription

1 This publication is not intended for distribution in the USA. PRODUCT RATIONALE & SURGICAL TECHNIQUE

2 THE PRODUCT OF LONG-TERM CLINICAL EXPERIENCE The TRILOC cemented UHMWPE cup is a direct descendant of Prof ME Müller s 1970 s design. Circumferential grooves increase surface area for enhanced cement contact while polar-equatorial grooves provide rotational stability. An X-ray marker wire allows post-operative assessment of position. 1 DePuy Synthes TRILOC Product Rationale and Surgical Technique

3 PRE-OPERATIVE TEMPLATING The primary goal of total hip arthroplasty is the anatomic reconstruction of the hip joint, resulting in favourable prosthetic joint load and function. Mechanically, the goals are to create a stable articulation with an optimised range of motion, restore biomechanics for muscular efficiency and equalise limb lengths. Meeting these goals begins with a thorough analysis of the hip with comparison to the contralateral side in anteroposterior (A/P) and lateral projections. Clear AP and lateral radiographs should be available prior to intervention. TRILOC templates, available in 115% magnification, allow assessment of the most likely size of cup to be implanted. The cup should be placed so that the head centre is as near to the anatomical position as possible and the most inferior part of the cup should normally be at the level of the bottom of the teardrop. The radiographs should clearly demonstrate the acetabular configuration and the endosteal and periosteal contours of the femoral head, neck and proximal femur (Figure 1). Frequently, the affected hip is fixed in external rotation, which leads one to underestimate the amount of offset present. In this situation it may be helpful to template the normal hip. Take into consideration any anatomical anomaly, dysplasia, previous fracture or leg length discrepancy. It is important to note that the template is a guide only. The final implant size and position will be determined intraoperatively. Figure 1 Properly positioned acetabular template TRILOC Product Rationale and Surgical Technique DePuy Synthes 2

4 CUP POSITIONING Peer reviewed publications highlight the importance of acetabular component positioning in relation to short and long term outcomes during total hip arthroplasty for all types of bearing materials. 1-5 Cup positioning should be varied to optimise fixation, range of motion, dislocation resistance and to minimise the likelihood of subluxation, impingement and edge loading. This may be assessed during pre-operative planning, acetabular preparation and cup trialling. Sub-optimal component positioning may lead to edge loading, dislocation, increased wear, and polyethylene fracture. 1-5 The target cup inclination (as measured on radiographs) should be 45 taking into account local soft tissue and anatomic landmarks. The target cup anteversion (as measured on radiographs) should be taking into account local soft tissue and anatomic landmarks. 3 DePuy Synthes TRILOC Product Rationale and Surgical Technique

5 ACETABULAR PREPARATION The capsule is excised from around the acetabulum and a curette is used to clear any remaining soft tissues and osteophytes from the rim and bed of the acetabulum. The acetabulum is then progressively reamed, beginning with the smallest diameter hemispherical reamer, to remove the articular cartilage and any medial osteophytes. Reaming is stopped when healthy, bleeding subchondral bone is exposed and a symmetrical, hemispherical dome is achieved. The reamers should be introduced in 45 of abduction (Figure 1) and 15 of anteversion. Note: If the posterior approach is employed, it should be remembered that this position puts the pelvis in approximately 20 of anteversion which must be compensated for during acetabular reaming and cup placement. 45 Multiple drill holes are made in the roof of the acetabulum using the Acetabular Prep Drill provided to encourage penetration of the cement into these keyholes and the interstices of the bone. Note: Care should be taken to avoid breaching the medial wall of the acetabulum. The edges of the drill holes are smoothed and any debris is removed using a small curette. TRIAL SIZING A trial cup that corresponds in diameter to the final acetabular reamer is screwed to the handle provided and used to confirm the diameter of the acetabulum (Figure 2). Figure 2 TRILOC Product Rationale and Surgical Technique DePuy Synthes 4

6 CUP IMPLANTATION Use pulse or continuous lavage within the acetabulum to remove fat and debris from the cancellous bone interface. Employ suction and dry swabs to clean and dry the bone surface (Figure 3). When the acetabular surface is dry and the bone surface is open, pack the socket with swabs. These will prevent blood clots adhering to the bone and leave the surface ready for cement introduction. Screw either the Neutral Alignment Guide or the Standard Alignment Guide to the two-piece Inserter provided. The definitive cup is then placed on this assembly for steering into position later (Figure 4). Note: The diameter of the definitive cup is normally 4 mm less in diameter than the final acetabular reamer. This ensures a sufficient and consistent thickness of cement mantle. Figure 3 Cement is introduced into the keyholes and the bed of acetabulum and the cup is inserted. The cup should be introduced in 45 of abduction (using the two-piece Inserter provided) and 15 of anteversion (Figure 4). Note: Cup orientation in the patient depends on patient position. The alignment guides do not allow for variation in patient position with respect to the operating table and it should be noted that patient orientation can vary throughout the procedure. 45 The Alignment Guide is unscrewed and replaced by the 28 mm Pusher provided while pressurisation and cup position are maintained throughout cement polymerisation (Figure 5). Figure 4 Once the cement is fully polymerised, the rim of the acetabulum is carefully cleared of all cement debris and the cup is covered with a clean swab to protect it during preparation of the femur. Figure 5 5 DePuy Synthes TRILOC Product Rationale and Surgical Technique

7 ORDERING INFORMATION Instruments Implants Acetabular Prep Drill L95470 Handle L95596 Inserter (two-piece) L95444 Trial 44 mm L95446 Trial 46 mm L95448 Trial 48 mm L95450 Trial 50 mm L95452 Trial 52 mm L95454 Trial 54 mm L95456 Trial 56 mm L95458 Trial 58 mm L95580 Neutral Alignment Guide L95578 Standard Alignment Guide L mm Pusher L mm Pusher QUICKSET Acetabular Grater Head 46 mm QUICKSET Acetabular Grater Head 48 mm QUICKSET Acetabular Grater Head 50 mm QUICKSET Acetabular Grater Head 52 mm QUICKSET Acetabular Grater Head 54 mm QUICKSET Acetabular Grater Head 56 mm QUICKSET Acetabular Grater Head 58 mm QUICKSET Acetabular Grater Head 60 mm QUICKSET Acetabular Grater Head 62 mm QUICKSET Acetabular Grater Head 64 mm QUICKSET Acetabular Grater Head 66 mm EZ Clean Grater Handle mm, Ø44 mm mm, Ø46 mm mm, Ø48 mm mm, Ø50 mm mm, Ø52 mm mm, Ø54 mm mm, Ø56 mm mm, Ø58 mm mm, Ø44 mm mm, Ø46 mm mm, Ø48 mm mm, Ø50 mm mm, Ø52 mm mm, Ø54 mm mm, Ø56 mm mm, Ø58 mm DePuy CMW Bone Cement SMARTSET GHV Gentamicin 20g SMARTSET GHV Gentamicin 40g DePuy CMW 2 Gentamicin 20g DePuy CMW 2 Gentamicin 40g SMARTSET HV 20g SMARTSET HV 40g DePuy CMW 2 20g DePuy CMW 2 40g Cement Accessories X-Ray Templates Pressuriser Handle Long Acetabular Pressuriser 5 x 45 mm Acetabular Pressuriser 5 x 52 mm Acetabular Pressuriser 5 x 55 mm Acetabular Pressuriser 5 x 60 mm Acetabular Pressuriser 5 x 65 mm Open Mixing Bowl SMARTMIX Bowl X-Ray Templates TRILOC Product Rationale and Surgical Technique DePuy Synthes 6

8 References 1. Williams S, Leslie I, Isaac G, Jin Z, Ingham E, Fisher J. Tribology and wear of metal-on-metal hip prostheses: influence of cup angle and head position. J Bone Joint Surg. 2008;90A(Suppl 3): Udomkiat P, Dorr LD, Wan Z. Cementless hemispheric porous-coated sockets implanted with press-fit technique without screws: average ten-year follow-up. J Bone Joint Surg. 2002;84A: Schmalzried TP, Guttmann D, Grecula M, Amstutz H. The relationship between the design, position, and articular wear of acetabular components inserted without cement and the development of pelvic osteolysis. J Bone Joint Surg.1994;76A: Kennedy JG, Rogers WB, Soffee KE, et al. Effect of acetabular component orientation on recurrent dislocation, pelvic osteolysis, polyethylene wear and component migration. J Arthroplasty 1998;13: Prudhommeaux F, Hamadouche M, Nevelos J, et al. Wear of alumina-on-alumina total hip arthroplasty at a mean 11-year followup. Clin Orthop Relat Res. 2000; 397:113. DePuy Orthopaedics EMEA is a trading division of DePuy International Limited. Registered Office: St. Anthony s Road, Leeds LS11 8DT, England Registered in England No DePuy Orthopaedics, Inc. 700 Orthopaedic Drive Warsaw, IN USA Tel: +1 (800) Fax: +1 (574) Summit Medical Ltd. Bourton On The Water Industrial Park Bourton On The Water Cheltenham Gloucestershire GL54 2HQ 0086 DePuy France S.A.S. 7 Allée Irène Joliot Curie Saint Priest France Tel: +33 (0) Fax: +33 (0) DePuy International Ltd St Anthony s Road Leeds LS11 8DT England Tel: +44 (0) Fax: +44 (0) DePuy International Ltd Trading as DePuy CMW Cornford Road Blackpool FY4 4QQ Lancashire England Tel: + 44 (0) Fax: + 44 (0) DePuy Ireland Loughbeg Ringaskiddy Co. Cork Ireland Tel: Fax: Fax: +33 (0) DePuy International Ltd. and DePuy Orthopaedics, Inc All rights reserved. depuysynthes.com DPEM/ORT/1013/ Issued: 11/13