LPS SYSTEM POCKET GUIDE

Transcription

1 LPS SYSTEM POCKET GUIDE Implants Procedural Uses Instruments & Trials L P S Limb Preservation System

2 L P S Limb Preservation System The purpose of this document is to review the LPS (Limb Preservation System) and provide details for material composition, dimensional characteristics, the use of the implant components and some examples of how the components are assembled to address various surgical needs. The LPS instruments are reviewed to provide information regarding their use. A checklist of other instruments and/or implants that are integrated for the procedural uses is also covered.

3 IMPLANTS Proximal Femoral Body Replacement Components... 4 Segmental Components... 6 Total Femoral Segmental Component... 8 Intercalary Segmental Component... 8 Distal Femoral Replacement Components Stem Extension Components Proximal Tibial Replacement Component MBT Revision Tray LPS Universal Tibial Hinge Insert Bearing S-ROM NOILES Rotating Hinge Femoral Component Metaphyseal Sleeves Implants 3

4 PROXIMAL FEMORAL BODY REPLACEMENT COMPONENTS Standard Body Style Offset 38 mm Body Height 70 mm (using +1.5 mm head) Trochanteric Build-Up Body Style 4

5 MATERIAL Titanium alloy with POROCOAT Porous Coating FEATURES Standard and trochanteric build-up styles Neutral and 15 degrees (left and right) Suture holes Anti-rotation tabs 90 mm minimum resection 70 mm body + 20 mm stem collar (to the mm head center) 38 mm offset (using a +1.5 mm head) ARTICUL/EZE neck taper 135 degree neck/shaft angle Female component taper USE Replaces proximal femoral bone Mates with segmental components, total femoral segmental components, LPS stem extension components, and universal metaphyseal sleeves PROXIMAL FEMORAL BODY REPLACEMENT COMPONENTS Ordering Information Cat. No. Description Standard Body, Neutral Trochanter Body, Neutral Standard Body, Left, 15 Degrees Trochanter Body, Left, 15 Degrees Standard Body, Right, 15 Degrees Trochanter Body, Right, 15 Degrees 5

6 SEGMENTAL COMPONENTS Length 6

7 MATERIAL Titanium alloy FEATURES 25, 30, 35, 40, 45, 65, 85, 105 and 125 mm lengths One male and one female taper Anti-rotation tabs and slots USE Connectors of the LPS System. Mates with all LPS components, including the LPS femoral to sleeve adapter Replaces missing shaft bone in 5 mm increments to adjust leg length SEGMENTAL COMPONENTS Ordering Information Cat. No. Description mm length mm length mm length mm length mm length mm length mm length mm length mm length 7

8 TOTAL FEMORAL SEGMENTAL COMPONENT 55 mm Length INTERCALARY SEGMENTAL COMPONENT 55 mm Length 8

9 MATERIAL Titanium alloy FEATURES 55 mm length Two male tapers Anti-rotation slots USE Needed for total femoral replacement construct Replaces missing shaft bone Mates with segmental, proximal femoral or distal femoral components TOTAL FEMORAL SEGMENTAL COMPONENT Ordering Information Cat. No. Description mm length MATERIAL Titanium alloy FEATURES 55 mm length Two female tapers Anti-rotation tabs USE Replaces midshaft bone Connects with segmental components and LPS stem extensions INTERCALARY SEGMENTAL COMPONENT Ordering Information Cat. No. Description mm length 9

10 DISTAL FEMORAL REPLACEMENT COMPONENTS X-small 60 mm Height XX-small 50 mm Height 66 mm M/L, X-small 56 mm M/L, XX-small mm A/P, X-small 48 mm A/P, XX-small

11 MATERIAL Cobalt Chrome alloy FEATURES 70/80 mm minimum resection 50/60 mm component height to articular surface + 20 mm stem collar when using LPS stems 50/60 mm minimum resection when using metaphyseal sleeves Utilizes SIGMA Patella Female taper with anti-rotation tabs Anatomic (right and left) X-small and XX-small size for soft tissue closure Cobalt Chrome hinge pin allows for easy insertion with secure locking (packaged with the femur) USE Replaces missing distal femur Compatible with segmental components, total segmental components, LPS stem extensions, and universal metaphyseal sleeves Assembles with the LPS Universal Tibial Hinge insert bearing to connect with the MBT Revision Tray or the LPS proximal tibial replacement components Load share design between hinge pin bushings and plateau bearing surface Allows for 5 degrees of hyperextension and 140 degrees of flexion Intended for cemented use only Femoral component and tibial insert must match size for size DISTAL FEMORAL REPLACEMENT COMPONENTS Ordering Information Cat. No. Description Left, XX-small Right, XX-small Left, X-small Right, X-small PFC SIGMA Patella Components and Misc. Replacement Components mm 3-Peg Round/Dome Patella mm 3-Peg Round/Dome Patella mm 3-Peg Round/Dome Patella mm 3-Peg Round/Dome Patella Distal femoral poly bumper replacement XX-small replacement hinge pin X-small/small replacement hinge pin 11

12 STEM EXTENSION COMPONENTS 20 mm Collar Height Bevel Stem Length 12

13 MATERIAL Cobalt Chrome alloy FEATURES Cemented and porous options Straight (100 and 125 mm) and bowed (150 and 200 mm) All stems have a porous collar, 20 mm height Male taper with anti-rotation slots Proximal stem bevel for enhanced fit Porous stems utilize POROCOAT Porous Coating with bullet tip Cemented stems have flutes for enhanced cement fixation Trials are 0.5 mm undersized relative to the implant Cemented Stems Porous Stems 9-17 mm diameters (1 mm increments) 100, 125, 150 and 200 mm lengths* mm diameters (1 mm increments) 100, 125, 150 and 200 mm lengths* *See pages 14 and 15 for details USE Provides fixation into remaining host bone Stems mate with segmental, intercalary, proximal femoral, distal femoral and proximal tibial replacement components 13

14 CEMENTED STEMS (STRAIGHT) Ordering Information Cat. No. Description mm diameter x 100 mm length mm diameter x 100 mm length mm diameter x 100 mm length mm diameter x 100 mm length mm diameter x 125 mm length mm diameter x 125 mm length mm diameter x 125 mm length mm diameter x 125 mm length mm diameter x 125 mm length mm diameter x 125 mm length POROUS STEMS (STRAIGHT) Ordering Information Cat. No. Description mm diameter x 100 mm length mm diameter x 100 mm length mm diameter x 100 mm length mm diameter x 100 mm length mm diameter x 125 mm length mm diameter x 125 mm length mm diameter x 125 mm length mm diameter x 125 mm length mm diameter x 125 mm length mm diameter x 125 mm length 14

15 CEMENTED STEMS (BOWED) Ordering Information Cat. No. Description mm diameter x 150 mm length mm diameter x 150 mm length mm diameter x 150 mm length mm diameter x 150 mm length mm diameter x 150 mm length mm diameter x 150 mm length mm diameter x 150 mm length mm diameter x 200 mm length mm diameter x 200 mm length mm diameter x 200 mm length mm diameter x 200 mm length POROUS STEMS (BOWED) Ordering Information Cat. No. Description mm diameter x 150 mm length mm diameter x 150 mm length mm diameter x 150 mm length mm diameter x 150 mm length mm diameter x 150 mm length mm diameter x 150 mm length mm diameter x 150 mm length mm diameter x 200 mm length mm diameter x 200 mm length mm diameter x 200 mm length mm diameter x 200 mm length 15

16 PROXIMAL TIBIAL REPLACEMENT COMPONENT 66 mm M/L, X-small 73 mm Height 16

17 MATERIAL Cobalt Chrome alloy FEATURES 105 mm minimum resection 73 mm component + 12 mm bearing insert + 20 mm collar Female taper with anti-rotation tabs Highly polished plateau articulation surface Anterior suture holes POROCOAT Porous Coating USE Replaces missing proximal tibial bone Mates with segmental components and LPS stem extensions Accepts the LPS Universal Tibial Hinge insert bearing to connect with the S-ROM NOILES rotating hinge femoral component or the LPS distal femoral replacement component Intended for cemented use only PROXIMAL TIBIAL REPLACEMENT COMPONENT Ordering Information Cat. No. Description LPS, X-small 17

18 18 MBT REVISION TRAY

19 MATERIAL Cobalt Chrome alloy FEATURES Tibial tray baseplate 5 is mm thick Mates with metaphyseal sleeves (29, 37, 45, 53 and 61 mm options) Mates with modular step wedges (5, 10 and 15 mm thicknesses) Mates with universal press-fit stems Titanium alloy 75, 115 and 150 mm lengths in mm diameters Mates with SIGMA cemented stems Titanium alloy 30, 60, 90, 120 and 150 mm lengths in 13 mm diameter 30, 60 and 90 mm lengths in 15 mm diameter Thick tray options available in 15 and 25 mm thicknesses, sizes 2, 3 and 4 USE Resurfacing of tibia in distal femoral and total femoral replacement procedures Accepts the LPS Universal Tibial Hinge insert bearing to connect with the LPS distal femoral replacement component or the S-ROM NOILES rotating hinge femoral component Intended for cemented use only 19

20 20 MBT REVISION TRAY (CONT.)

21 MBT REVISION TRAY Ordering Information Cat. No. Cemented Size Description mm M/L x 39 mm A/P mm M/L x 41 mm A/P mm M/L x 43 mm A/P mm M/L x 44 mm A/P mm M/L x 46 mm A/P mm M/L x 49 mm A/P mm M/L x 53 mm A/P mm M/L x 57 mm A/P MBT REVISION THICK TRAY Ordering Information Cat. No. Cemented Size Description MBT Rev Thick Tray Size 2, 15 mm MBT Rev Thick Tray Size 2, 25 mm MBT Rev Thick Tray Size 3, 15 mm MBT Rev Thick Tray Size 3, 25 mm MBT Rev Thick Tray Size 4, 15 mm MBT Rev Thick Tray Size 4, 25 mm 21

22 LPS UNIVERSAL TIBIAL HINGE INSERT BEARING Cobalt Chrome Core S-ROM NOILES Articular Geometry Parallel Sides 22

23 MATERIAL Forged Cobalt Chrome pin for enhanced strength FEATURES Polyethylene bushings mate with hinge pin Flat anterior surface with hyperextension stop XX-small, X-small, small and medium sizes 12, 14, 16, 18, 21, 23, 26, 28 and 31 mm plateau bearing thickness USE Provides stability for missing ligaments Hinge provides stability in flexion and extension and acts as a pivot point for distal femoral internal and external rotation Mates with the LPS distal femoral replacement component or the S-ROM NOILES rotating hinge femoral component and the MBT Revision Tray or the LPS proximal tibial replacement component Femoral Component and tibial insert must match size for size LPS UNIVERSAL TIBIAL HINGE INSERT BEARING Ordering Information Cat. No. Description XX-small, 12 mm Small, 16 mm XX-small, 14 mm Small, 18 mm XX-small, 16 mm Small, 21 mm XX-small, 18 mm Small, 23 mm XX-small, 21 mm Small, 26 mm XX-small, 23 mm Small, 28 mm X-small, 12 mm Small, 31 mm X-small, 14 mm Medium, 12 mm X-small, 16 mm Medium, 14 mm X-small, 18 mm Medium, 16 mm X-small, 21 mm Medium, 18 mm X-small, 23 mm Medium, 21 mm X-small, 26 mm Medium, 23 mm X-small, 28 mm Medium, 26 mm X-small, 31 mm Medium, 28 mm Small, 12 mm Medium, 31 mm Small, 14 mm 23

24 24 S-ROM NOILES ROTATING HINGE FEMORAL COMPONENT

25 MATERIAL Cobalt Chrome alloy FEATURES Three sizes (X-small, small and medium) Anatomic (left and right) Six degrees of hyperextension with polyethylene bumper stop Load share design between hinge pin bushings and plateau bearing surface Posterior hinge point for maximum flexion Cobalt Chrome hinge pin Mates with universal femoral metaphyseal sleeves (20, 31, 34, 40 and 46 mm options) USE Assembles with the LPS proximal tibial replacement component or the MBT Revision Tray components using the LPS Universal Tibial Hinge insert bearing Intended for cemented use only Use with S-ROM patella S-ROM NOILES ROTATING HINGE FEMORAL COMPONENT Ordering Information Cat. No. Description L X-small, 66 mm M/L x 58 mm A/P, left R X-small, 66 mm M/L x 58 mm A/P, right L Small, 66 mm M/L x 62 mm A/P, left R Small, 66 mm M/L x 62 mm A/P, right L Medium, 71 mm M/L x 66 mm A/P, left R Medium, 71 mm M/L x 66 mm A/P, right S-ROM Patella Components mm Patellar Dome mm Patellar Dome mm Patellar Dome mm Patellar Dome 25

26 26 METAPHYSEAL SLEEVES

27 MATERIAL Titanium with clinically proven POROCOAT Porous Coating FEATURES Five tibial sleeve sizes: 29, 37, 45, 53, and 61 mm Five femoral sleeve sizes: 20 (cemented only), 31, 34, 40 and 46 mm (fully or distally porous) Femoral sleeves are compatible with SIGMA, LCS, S-ROM NOILES and LPS knee systems LPS distal femoral to sleeve adapter available in 0, 5, and 10mm lengths to increase distal offset Tibial sleeves are compatible with the MBT Revision Tray and MBT Revision Thick Trays Accepts universal press-fit and SIMGA cemented stems USE Employs Wolff s Law to progressively load the bone with its stepped design Provides rotational stability to help prevent component loosening Same straightforward surgical technique at every level of constraint METAPHYSEAL SLEEVES AND ADAPTERS Ordering Information Cat. No. Description MBT Revision Porous Tibial Sleeve, 29 mm MBT Revision Cemented Tibial Sleeve, 29 mm MBT Revision Porous Tibial Sleeve, 37 mm MBT Revision Porous Tibial Sleeve, 45 mm MBT Revision Porous Tibial Sleeve, 53 mm MBT Revision Porous Tibial Sleeve, 61 mm Universal Femoral Sleeve - Cemented, 20 mm Universal Femoral Sleeve - Distally Porous, 31 mm Universal Femoral Sleeve - Fully Porous, 31 mm Universal Femoral Sleeve - Distally Porous, 34 mm Universal Femoral Sleeve - Fully Porous, 34 mm Universal Femoral Sleeve - Distally Porous, 40 mm Universal Femoral Sleeve - Fully Porous, 40 mm Universal Femoral Sleeve - Distally Porous, 46 mm Universal Femoral Sleeve - Fully Porous, 46 mm LPS Femoral to Sleeve Adapter +0 mm LPS Femoral to Sleeve Adapter +5 mm LPS Femoral to Sleeve Adapter +10 mm 27

28 28

29 In this section, the five major lower extremity procedural uses and the instruments and implants needed to prepare for a case are reviewed. In addition, the instruments and implants that integrate with the LPS System are included for a total overview. PROCEDURAL USES Proximal Femoral Replacement Proximal Tibial Replacement Total Femoral Replacement Midshaft Replacement Distal Femoral Replacement Procedural Uses 29

30 Procedural Uses PROXIMAL FEMORAL REPLACEMENT Note: Acetabular options: Unipolar heads, bipolar cups, fixed cups, cages, etc., are options dependent on the surgeon s needs or preferences from the DePuy Synthes Joint Reconstruction* hip product portfolio. Do not use or mix other manufacturer s implants with the LPS implants. Remember to have the appropriate instrumentation to support the acetabular option chosen. These implants and instruments need to be obtained for the case. They are not sent automatically with an LPS order. 30

31 The LPS System offers flexibility to address a variety of difficult surgical situations in cases where there is the need for replacement due to the significant loss of proximal femoral bone. In a proximal femoral replacement case, a proximal femoral replacement body, segmental component(s) and a stem extension are generally used. The proximal femoral replacement body offers the option of neutral or 15 degrees of built-in anteversion depending on the need in surgery. The proximal femoral body with trochanteric build-up is an option with shortened abductors. The length of segmental component(s) used depends upon the amount of missing bone that needs to be replaced with metal. The stem size used will depend upon the remaining bone diameter and length needed to provide adequate stability and fixation in the host bone. The construct s minimum resection is 90 mm (using a +1.5 mm femoral head). PROXIMAL FEMORAL REPLACEMENT Instrument Ordering Information DePuy ExpressCare Set No. Description 791 B LPS Calcar/Bevel Reamer Set 792 B LPS Component Trial Set 793 B LPS Straight Stem Trial Set 794 B LPS Bowed Stem Trial Set 795 B LPS Instrument Set 797 B LPS Proximal Tibial and Femoral Trial Set Not Available through DePuy ExpressCare Straight Reamers (7-21 mm) Not Available through DePuy ExpressCare Flexible Reamers ( mm) PROXIMAL FEMORAL REPLACEMENT Implant Ordering Information DePuy ExpressCare Set No. Description 780 A LPS Cemented Straight Stem Set 781 A LPS Cemented Bowed Stem Set 782 A LPS POROCOAT Straight Stem Set 783 A LPS POROCOAT Bowed Stem Set 784 A LPS Proximal Femoral Body Set, Neutral/Left 785 A LPS Proximal Femoral Body Set, Neutral/Right 788 A LPS Segmental Component Set 31

32 32 PROXIMAL TIBIAL REPLACEMENT

33 The LPS System provides the surgical latitude needed to address the replacement of significant proximal tibial bone loss. Proximal tibial replacement generally uses a proximal tibial replacement component, possibly a segmental component and an LPS stem extension. The S-ROM NOILES rotating hinge femoral component articulates with the LPS proximal tibial replacement component that uses the LPS Universal Tibial Hinge insert bearing. The need for LPS segmental component(s) depends upon the amount of missing bone that needs to be replaced with metal. The stem size used will depend upon the remaining bone diameter and length needed to provide adequate stability and fixation in the host bone. The S-ROM NOILES rotating hinge femoral component requires the use of a sleeve and stem. The construct s minimal tibial resection is 105 mm (when using a 12 mm bearing insert). PROXIMAL TIBIAL REPLACEMENT Instrument Ordering Information DePuy ExpressCare Set No. Description 791 B LPS Calcar/Bevel Reamer Set 792 B LPS Component Trial Set 793 B LPS Straight Stem Trial Set 795 B LPS Instrument Set 796 B LPS Tibial Trial Set 797 B LPS Proximal Tibial and Femoral Trial Set Not Available through DePuy ExpressCare Straight Reamers (7-21 mm) KN 981 B S-ROM Hinge Femoral Instrument Set* KN 982 B S-ROM Hinge Common Instrument Set* *If using S-ROM hinge femoral implants PROXIMAL TIBIAL REPLACEMENT Implant Ordering Information DePuy ExpressCare Set No. Description KN 489 A Universal Fluted Stems KN 490 A Universal Femoral Sleeves - Distally Porous KN 491 A Universal Femoral Sleeves - Fully Porous KN 974 A S-ROM Hinge Femoral Components 780 A LPS Cemented Straight Stem Set 782 A LPS Porous Straight Stem Set 786 A LPS Distal Femoral Set, Left 787 A LPS Distal Femoral Set, Right 788 A LPS Segmental Component Set 789 A LPS Proximal Tibial Replacement 799 A LPS Univesal Hinged Insert Set 33

34 TOTAL FEMORAL REPLACEMENT Note: Acetabular options: Unipolar heads, bipolar cups, fixed cups, cages, etc., are options dependent on the surgeon s needs orpreferences from the DePuy Synthes Joint Reconstruction hip product portfolio. Do not use or mix other manufacturer s implants with the LPS implants. Remember to have the appropriate instrumentation to support the acetabular option chosen. These implants and instruments need to be obtained for the case. They are not sent automatically with an LPS order. 34

35 With a total femoral replacement, the entire femur is replaced by the prosthetic construct. This femoral construct articulates with a tibial component through a hinged insert connection. A total femoral replacement utilizes the proximal femoral replacement body, a total femoral segmental component, the segmental component(s) and the distal femoral replacement component. The MBT Revision Tray is recommended on the tibial side with the option to use sleeves and stems. TOTAL FEMORAL REPLACEMENT Instrument Ordering Information DePuy ExpressCare Set No. Description 792 B LPS Component Trial Set 795 B LPS Instrument Set 796 B LPS Tibial Trial Set 797 B LPS Proximal Tibial and Femoral Trial Set Not Available through DePuy ExpressCare MBT Revision Prep Not Available through DePuy ExpressCare MBT Revision Stem Trials Not Available through DePuy ExpressCare MBT Revision Reamers Not Available through DePuy ExpressCare MBT Revision Tray Trials/Wedge Instruments TOTAL FEMORAL REPLACEMENT Implant Ordering Information DePuy ExpressCare Set No. Description 784 A LPS Proximal Femoral Body Set, Neutral Left 785 A LPS Proximal Femoral Body Set, Neutral Right 786 A LPS Distal Femoral Replacement Set, Left 787 A LPS Distal Femoral Replacement Set, Right 788 A LPS Segmental Component Set 799 A LPS Universal Hinged Insert Set 382 A MBT Revision Trays/Step Wedges, Size A MBT Revision Thick Trays, Sizes A MBT Revision Trays, Sizes A MBT Revision Sleeves 387 A MBT Revision Step Wedges, Sizes A MBT Revision Trays/Step Wedges, Sizes KN 489 A Universal Fluted Stems 35

36 36 MIDSHAFT REPLACEMENT

37 The LPS System addresses the replacement of significant midshaft femoral bone loss. With midshaft bone loss, use the 55 mm intercalary segmental component with two stem extensions to bridge the gap of missing bone. If additional length is needed in the midshaft area, a segmental component can be used to make up for the missing bone. The diameter, type and length of the LPS stem extension used depends upon the remaining bone diameter, quality and stability needed with appropriate length. The construct s minimum resection length is 95 mm. MIDSHAFT REPLACEMENT Instrument Ordering Information DePuy ExpressCare Set No. Description 791 B LPS Calcar/Bevel Reamer Set 792 B LPS Component Trial Set 793 B(2) LPS Straight Stem Trial Set* 795 B LPS Instrument Set Not Available through DePuy ExpressCare Straight Reamers (7-21 mm) MIDSHAFT REPLACEMENT Implant Ordering Information DePuy ExpressCare Set No. Description 780 A(2) LPS Cemented Straight Stem Set** 782 A(2) LPS Porous Straight Stem Set** 788 A LPS Segmental Component Set *Note: Need to order two sets of straight stem trials. **Note: Need to order two sets of straight stem implants. 37

38 38 DISTAL FEMORAL REPLACEMENT

39 The LPS System provides the options to address replacement of significant distal femoral bone loss. A distal femoral replacement uses the distal femoral replacement component, the segmental component(s) and an LPS stem extension. Surgeons also have the option to use universal femoral metaphyseal sleeves for additional fixation. The MBT Revision Tray provides multiple options for use on the tibial side. Use the LPS Universal Tibial Hinge insert bearing with the MBT Revision Tray. The length of segmental component(s) used depends upon the amount of missing bone that needs to be replaced with metal. The stem size used will depend upon the remaining bone diameter and length needed to provide adequate stability. The distal femoral minimum resection is 70 mm when using LPS stems and 50 mm when using universal femoral metaphyseal sleeves. DISTAL FEMORAL REPLACEMENT Instrument Ordering Information DePuy ExpressCare Set No. Description 791 B LPS Calcar/Bevel Reamer Set 792 B LPS Component Trial Set 793 B LPS Straight Stem Trial Set 794 B LPS Bowed Stem Trial Set 795 B LPS Instrument Set 796 B LPS Proximal Tibial Trial Set 797 B LPS Proximal Tibial and Femoral Trial Set 798 B LPS Metaphyseal Instrument Set Not Available through DePuy ExpressCare Straight Reamers (7-21 mm) Not Available through DePuy ExpressCare Flexible Reamers ( mm) Not Available through DePuy ExpressCare MBT Revision Tray Prep Not Available through DePuy ExpressCare MBT Revision Stem Trials Not Available through DePuy ExpressCare MBT Revision Reamers Not Available through DePuy ExpressCare MBT Revision Tray Trials/Wedge Instruments Not Available through DePuy ExpressCare Femoral Adapter Instrument Set 39

40 DISTAL FEMORAL REPLACEMENT Implant Ordering Information DePuy ExpressCare Set No. Description 780 A LPS Cemented Straight Stem Set 781 A LPS Cemented Bowed Stem Set 782 A LPS POROCOAT Straight Stem Set 783 A LPS POROCOAT Bowed Stem Set 786 A LPS Distal Femoral Replacement Set, Left 787 A LPS Distal Femoral Replacement Set, Right 788 A LPS Segmental Component Set 799 A LPS Universal Hinged Insert Set 382 A MBT Revision Trays/Step Wedges, Size A MBT Revision Thick Trays, Sizes A MBT Revision Trays, Sizes A MBT Revision Sleeves 387 A MBT Revision Step Wedges, Sizes A MBT Revision Trays/Step Wedges, Sizes KN 463 A SIGMA Cemented Stems KN 489 A Universal Stems 798 A LPS Metaphyseal Sleeve Set 40

41 The LPS System instrumentation provides the ability to prepare the remaining host bone, perform trial assessment and reduction, and assemble and insert the modular construct. This section reviews the sterilization case layout of the instruments and provides an overview of the individual instruments. INSTRUMENTS/TRIALS LPS Calcar Planer and Bevel Reamer Set Bevel Reamer Calcar Planer Assembled Reamer LPS Component Trial Set LPS Component Trial Set Instruments Proximal Femoral Body Replacement Trial Segmental Component Trial Distal Femoral Replacement Trial Total Femoral Segmental Component Trial Intercalary Segmental Component Trial Segmental Stack Chart LPS Straight Stem and Bowed Stem Trial Sets Cemented Stem (Trial Use) Porous Stem (Trial Use) LPS Ream and Trial Chart LPS Instrument Set Universal Handle with Quick Release and Femoral Driver Impaction Cap Disassembly Tool Assembly Stand Inserter/Extractor (Version Guide and Slap Handle) Ruler LPS Tibial Trial Set Tibial Hinge Insert Trial and Tibial Post Trial LPS Metaphyseal Sleeve Set Instruments/ Trials 41

42 LPS CALCAR PLANER AND BEVEL REAMER SET The calcar planer and bevel reamer case contains instruments designed to prepare the resected bone for acceptance of the stem extension. LPS CALCAR/BEVEL REAMER SET Ordering Information Express Care No. Description Quantity 791 B LPS Calcar/Bevel Reamer Sterilization 1 Case Complete Instruments/ Trials Top Tray Cat. No. Description Quantity LPS Calcar Planer, Small LPS Calcar Planer, Large LPS Bevel Reamer Insert, 9 mm LPS Bevel Reamer Insert, 9.5 mm LPS Bevel Reamer Insert, 10 mm LPS Bevel Reamer Insert, 10.5 mm LPS Bevel Reamer Insert, 11 mm LPS Bevel Reamer Insert, 11.5 mm LPS Bevel Reamer Insert, 12 mm LPS Bevel Reamer Insert, 12.5 mm LPS Bevel Reamer Insert, 13 mm LPS Bevel Reamer Insert, 13.5 mm LPS Bevel Reamer Insert, 14 mm LPS Bevel Reamer Insert, 14.5 mm LPS Bevel Reamer Insert, 15 mm 1 42

43 LPS CALCAR/BEVEL REAMER SET (CONT.) Top Tray (cont.) Cat. No. Description Quantity LPS Bevel Reamer Insert, 15.5 mm LPS Bevel Reamer Insert, 16 mm LPS Bevel Reamer Insert, 16.5 mm LPS Bevel Reamer Insert, 17 mm LPS Bevel Reamer Insert, 17.5 mm LPS Bevel Reamer Insert, 18 mm LPS Bevel Reamer Insert, 18.5 mm LPS Bevel Reamer Insert, 19 mm LPS Bevel Reamer Insert, 19.5 mm LPS Bevel Reamer Insert, 20 mm LPS Bevel Reamer Insert, 20.5 mm LPS Bevel Reamer Insert, 21 mm LPS Bevel Reamer Insert, 21.5 mm 1 CALCAR PLANER AND BEVEL REAMER Bevel reamers have pilots in.5 mm increments to assist in centering the bevel reamer in the canal. 43

44 ASSEMBLED REAMER The calcar planer and bevel reamer are assembled together to prepare for a flat cut and a bevel angle of the medullary canal of the resected bone. For a porous stem extension, begin reaming with the calcar/bevel reamer two to three sizes below the chosen implant size. The final bevel reamer must match the final stem extension. For example, if using a 15.5 mm stem extension the final bevel reamer with pilot should be 15.5 mm. This allows for a slight press-fit of the stem extension bevel. For a cemented stem extension, begin the calcar/ bevel reaming two to three sizes below the final intermedullary (I.M.) ream size. For example, if an 11 mm stem is chosen with a 2 mm cement mantle, the final I.M. reamer will be 15 mm. The final calcar/bevel reamer will be 15 mm. This allows for a cement mantle around the stem extension bevel. 44

45 LPS COMPONENT TRIAL SET The component trial case contains some of the trials needed to prepare a trial construct for assessment prior to the final implant assembly. This instrument case contains all the segmental, proximal femoral body, distal femoral replacement and femoral head trials. LPS COMPONENT TRIAL SET Ordering Information Express Care No. Description Quantity 792 B LPS Component Trial 1 Sterilization Case Complete 45

46 Top Tray Cat. No. Description Quantity LPS Segmental Component Trial 25 mm LPS Segmental Component Trial 30 mm LPS Segmental Component Trial 35 mm LPS Segmental Component Trial 40 mm LPS Segmental Component Trial 45 mm LPS Segmental Component Trial 65 mm LPS Segmental Component Trial 85 mm LPS Segmental Component Trial 105 mm LPS Segmental Component Trial 125 mm LPS Total Femoral Segmental Trail, 55 mm LPS Intercalary Component Trial, 55 mm Distal Femoral Component, 1 Left, X-small Trial Distal Femoral Component, 1 Left, XX-small Trial Distal Femoral Component, 1 Right, X-small Trial Distal Femoral Component, 1 Right, XX-small Trial 46

47 Bottom Tray Cat. No. Description Quantity LPS Proximal Femoral Body 1 Neutral Standard Trial LPS Proximal Femoral Body 1 Neutral Trochanter Trial LPS Proximal Femoral Body Left, 1 15 mm diameter, Standard Trial LPS Proximal Femoral Body Left, 1 15 mm diameter, Trochanter Trial LPS Proximal Femoral Body Right, 1 15 mm diameter, Standard Trial LPS Proximal Femoral Body Left, 1 15 mm diameter, Trochanter Trial ARTICUL/EZE Femoral Head Trial mm ARTICUL/EZE Femoral Head Trial mm ARTICUL/EZE Femoral Head Trial mm ARTICUL/EZE Femoral Head Trial mm ARTICUL/EZE Femoral Head Trial mm ARTICUL/EZE Femoral Head Trial mm ARTICUL/EZE Femoral Head Trial mm ARTICUL/EZE Femoral Head Trial mm ARTICUL/EZE Femoral Head Trial mm ARTICUL/EZE Femoral Head Trial mm ARTICUL/EZE Femoral Head Trial mm ARTICUL/EZE Femoral Head Trial mm 1 47

48 LPS COMPONENT TRIAL SET PROXIMAL FEMORAL BODY REPLACEMENT TRIAL Proximal femoral body trials replicate the implant and are used in trial reduction to assess leg length, offset and joint stability. The six femoral body trials mirror the system implants. The trials accept ARTICUL/EZE femoral trial heads and segmental and stem trials as needed. 48

49 LPS COMPONENT TRIAL SET SEGMENTAL COMPONENT TRIALS Segmental component trials help plan the amount of missing bone that needs to be replaced by the prosthesis or adjustment of leg length. The nine segmental component trial sizes match the nine implant sizes (25, 30, 35, 40, 45, 65, 85, 105 and 125 mm lengths). The segmental trials offer the ability to provide 5 mm increments of adjustment with single components or through a stacking combination. 49

50 LPS COMPONENT TRIAL SET DISTAL FEMORAL REPLACEMENT TRIAL These trial components match the distal femoral replacement implant, allowing for trial reduction. The left and right components accept the LPS Universal Tibial Hinge insert bearing trials, segmental, total, femoral to sleeve adapter trials, or LPS stem trials as needed. 50

51 LPS COMPONENT TRIAL SET TOTAL FEMORAL SEGMENTAL COMPONENT TRIAL This trial matches the 55 mm total femoral segmental component. It is used when performing a total femoral replacement trial reduction. 51

52 LPS COMPONENT TRIAL SET INTERCALARY SEGMENTAL COMPONENT TRIAL The 55 mm intercalary segmental trial is used to assess replacement bone in a midshaft tumor replacement. It is used with two LPS stem extension trials to assess leg length. Segmental trials are used to assess more extensive midshaft bone loss if needed. 52

53 The chart below provides a quick reference to choose the segmental component(s) needed to replace the missing bone gap. SEGMENTAL STACK CHART Remaining LPS Segmental Gap Components or or or or Remaining LPS Segmental Gap Components or PROCEDURE Proximal Femoral Replacement Distal Femoral Replacement with LPS Stems Distal Femoral Replacement with Metaphyseal Sleeves Minimum resection length 90 mm (70 mm femoral body with 1.5 mm head center + 20 mm stem collar) 70 mm (50 mm distal femoral component + 20 mm stem collar) 50 mm (using XX-Small femur) 60 mm (using X-Small femur) Proximal Tibial Replacement 105 mm (73 mm tibial component + 12 mm insert bearing +20 mm stem collar) Midshaft Tumor Replacement 95 mm (55 mm intercalary segment length + two 20 mm stem collars) 53

54 LPS STRAIGHT STEM AND BOWED STEM TRIAL SETS The straight stem trial components are available in 1 mm increments from 9 to 19 mm in diameter and 100 and 125 mm lengths that correspond to the implants. The bowed stem trials are available in 1 mm increments from mm in diameter and 150 and 200 mm in lengths that correspond to the implants. The trial s purpose is to assess fit and provide for the ability to perform a construct trial reduction. Choose trials based on the implant options selected and the last reamed size. 54

55 LPS STRAIGHT STEM TRIAL SET Ordering Information Express Care No. Description Quantity 793 B LPS Straight Stem Trial 1 Sterilization Case Complete Top Tray Cat. No. Description Quantity x 100 mm Stem Extension Trial, Straight x 100 mm Stem Extension Trial, Straight x 100 mm Stem Extension Trial, Straight x 100 mm Stem Extension Trial, Straight x 100 mm Stem Extension Trial, Straight x 100 mm Stem Extension Trial, Straight 1 Bottom Tray Cat. No. Description Quantity x 125 mm Stem Extension Trial, Straight x 125 mm Stem Extension Trial, Straight x 125 mm Stem Extension Trial, Straight x 125 mm Stem Extension Trial, Straight x 125 mm Stem Extension Trial, Straight x 125 mm Stem Extension Trial, Straight x 125 mm Stem Extension Trial, Straight x 125 mm Stem Extension Trial, Straight 1 55

56 LPS BOWED STEM TRIAL SET Ordering Information Express Care No. Description Quantity 794 B LPS Bowed Stem Trial 1 Sterilization Case Complete Top Tray Cat. No. Description Quantity x 150 mm Stem Extension Trial Bowed x 150 mm Stem Extension Trial Bowed x 150 mm Stem Extension Trial Bowed x 150 mm Stem Extension Trial Bowed x 150 mm Stem Extension Trial Bowed x 150 mm Stem Extension Trial Bowed x 150 mm Stem Extension Trial Bowed x 150 mm Stem Extension Trial Bowed x 150 mm Stem Extension Trial Bowed 1 Bottom Tray Cat. No. Description Quantity x 200 mm Stem Extension Trial Bowed x 200 mm Stem Extension Trial Bowed x 200 mm Stem Extension Trial Bowed x 200 mm Stem Extension Trial Bowed x 200 mm Stem Extension Trial Bowed x 200 mm Stem Extension Trial Bowed x 200 mm Stem Extension Trial Bowed x 200 mm Stem Extension Trial Bowed x 200 mm Stem Extension Trial Bowed 1 56

57 LPS STRAIGHT STEM AND BOWED STEM TRIAL SETS CEMENTED STEM (TRIAL USE) If using a cemented stem, the appropriate trial can be used to assess the cement mantle. For example, if the last reamed size is 15 mm, use a 13 mm trial if a 1 mm circumferential mantle is being evaluated or use an 11 mm trial if a 2 mm circumferential mantle is being evaluated. For trial reduction purposes, if a 15 mm reamer was last used, use a 15 mm trial for the trial reduction to prevent spinning of the stem extension in the canal. POROUS STEM (TRIAL USE) If using a porous stem, the reaming technique determines the appropriate trial. All porous stems are in 1 mm increments. Since the typical protocol is to underream by.5 mm, the trial used would correspond to the last reamer used. For example, if using a 13.5 mm porous stem and 13 mm was the last reamer used, select a 13 mm trial for the trial reduction. This allows for trial stability without compromising the prepared bone. 57

58 The following chart shows reamer-to-trial implant suggestions. LPS REAM AND TRIAL CHART Implant Ream Diameter (mm) Trial* Diameter (mm) Cemented Stem with 1 mm mantle/side Cemented Stem with 2 mm mantle/side Porous Stem with.5 mm underream 9 9 N/A N/A N/A N/A N/A 10.5 mm mm N/A 11.5 mm mm N/A 12.5 mm mm 9 mm 13.5 mm mm 10 mm 14.5 mm mm 11 mm 15.5 mm mm 12 mm 16.5 mm mm 13 mm 17.5 mm mm 14 mm 18.5 mm mm 15 mm N/A * Trial diameters are 0.25 to 0.50 mm less than stated to allow for clearance in the intermedullary canal. 58

59 LPS INSTRUMENT SET This instrument case contains the LPS inserter/ extractor (including the version guide and slap handle) the assembly stand and related items; and ruler and femoral impactor with driver. LPS INSTRUMENT SET Ordering Information ExpressCare Description Quantity 795 B LPS Instrument Sterilization 1 Case Complete Tray Contents Cat. No. Description Quantity LPS Disassembly Tool LPS Distal Femoral Assembly Stand LPS Proximal Femoral Assembly Stand LPS Assembly Base LPS Inserter/Extractor LPS Version Guide LPS Slap Handle LPS Extractor Moreland Adapter LPS Ruler S-ROM Tibial Driver S-ROM Femoral Driver A S-ROM Impaction Cap A S-ROM Universal Handle Quick Release 1 59

60 UNIVERSAL HANDLE WITH QUICK RELEASE AND TIBIAL/FEMORAL DRIVER The universal handle is connected to the tibial femoral driver and used when impacting the tibial femoral replacement construct into the remaining host bone. IMPACTION CAP Use the impaction cap to cover the end of the stem extension when impacting the component into a construct. Be sure to remove the impaction cap before implantation. 60

61 DISASSEMBLY TOOL Use this instrument to separate the morse taper connection of the components. The disassembly tool fits into the anti-rotation slot areas of the assemblies. The tool has a flat and a half-moon shape that keys into the anti-rotation slot geometry of the implants. Once secure in the slots, squeeze the handle and push the handle down to loosen the taper junction. Do not reuse implants once they are disassembled due to possible damage or scratches on the tapers. ASSEMBLY STAND The assembly stand is made up of the assembly base, distal femoral assembly stand and proximal femoral assembly stand. The assembly stand provides a method of holding a proximal femoral or distal femoral replacement construct when impacting the tapers. 61

62 INSERTER/EXTRACTER (VERSION GUIDE AND SLAP HANDLE) This instrument is used to insert a proximal femoral construct. Thread the inserter into the proximal body shoulder and use the version guide to assist in the construct orientation. This instrument also acts as an extractor by threading into a stem extension. The slap handle is used to provide extraction force. RULER The stainless steel ruler is 500 mm (19.5 in.) in length and assists in planning the resection level. It is used to approximate the gap of missing bone following resection. 62

63 LPS TIBIAL TRIAL SET This instrument case contains the proximal tibial replacement and insert trial components for trial reduction. 63

64 LPS TIBIAL TRIAL SET Ordering Information ExpressCare Description Quantity 796 B LPS Tibial Trial 1 Sterilization Case Complete Top Tray Cat. No. Description Quantity MBT Revision Trial Post LPS Tibial Hinge Trial Post Adapter LPS Tibial Insert Trial, XX-Small, 12 mm LPS Tibial Insert Trial, XX-Small, 14 mm LPS Tibial Insert Trial, XX-Small, 16 mm LPS Tibial Insert Trial, XX-Small, 18 mm LPS Tibial Insert Trial, XX-Small, 21 mm LPS Tibial Insert Trial, XX-Small, 23 mm LPS Tibial Insert Trial, X-Small, 31 mm LPS Tibial Insert Trial, Small, 31 mm LPS Tibial Insert Trial, Medium, 31 mm 1 Bottom Tray Cat. No. Description Quantity LPS Tibial Insert Trial, X-Small, 12 mm LPS Tibial Insert Trial, X-Small, 14 mm LPS Tibial Insert Trial, X-Small, 16 mm LPS Tibial Insert Trial, X-Small, 18 mm LPS Tibial Insert Trial, X-Small, 21 mm LPS Tibial Insert Trial, X-Small, 23 mm LPS Tibial Insert Trial, X-Small, 26 mm LPS Tibial Insert Trial, X-Small, 28 mm LPS Tibial Insert Trial, Small, 12 mm LPS Tibial Insert Trial, Small, 14 mm LPS Tibial Insert Trial, Small, 16 mm LPS Tibial Insert Trial, Small, 18 mm LPS Tibial Insert Trial, Small, 21 mm LPS Tibial Insert Trial, Small, 23 mm LPS Tibial Insert Trial, Small, 26 mm LPS Tibial Insert Trial, Small, 28 mm LPS Tibial Insert Trial, Medium, 12 mm LPS Tibial Insert Trial, Medium, 14 mm LPS Tibial Insert Trial, Medium, 16 mm LPS Tibial Insert Trial, Medium, 18 mm LPS Tibial Insert Trial, Medium, 21 mm LPS Tibial Insert Trial, Medium, 23 mm LPS Tibial Insert Trial, Medium, 26 mm LPS Tibial Insert Trial, Medium, 28 mm 1 64

65 LPS TIBIAL TRIAL SET Hinge hinge Pin pin Trial trial tibial Tibial hinge Hinge insert Insert trial Trial Tibial tibial Post post Trialtrial TIBIAL HINGE INSERT TRIAL, TIBIAL POST TRIAL AND HINGE PIN TRIAL The tibial hinge insert trial is available in four sizes and nine thicknesses. Trials include a tibial hinge insert, tibial post and trial hinge pin used with the proximal tibial replacement component trial or MBT Revision Tray trial depending on the need. This trial also mates with the LPS distal femoral replacement component trial or the S-ROM NOILES rotating hinge femoral component trial based on the surgical situation. The tibial hinge insert trials allow for assessment of the joint line, leg length and joint stability when performing a trial range of motion. The hinge pin trial secures the tibial hinge insert trial to the chosen distal femoral trial. 65

66 The LPS metaphyseal sleeve instrument case contains the trial instruments necessary for using a metaphyseal sleeve for a distal femoral replacement case. Instruments include sleeve adapters. LPS METAPHYSEAL SLEEVE SET Ordering Information ExpressCare Description Quantity 798 B LPS Metaphyseal Sleeve Case 1 Tray Contents Cat. No. Description Quantity Metaphyseal Sleeve Removal Tool LPS Femoral to Sleeve Adapter Trial, +0 mm LPS Femoral to Sleeve Adapter Trial, +5 mm LPS Femoral to Sleeve Adapter Trial, +10 mm Revision Femoral Stem/Adapter Clamp 1 66

67 LPS PROXIMAL TIBIAL AND FEMORAL TRIAL SET This instrument case contains the proximal tibial and proximal femoral trial components. 67

68 LPS PROXIMAL TIBIAL AND FEMORAL TRIAL SET Ordering Information ExpressCare Description Quantity 797 B LPS Proximal Tibial and Femoral Case 1 Tray Contents Cat. No. Description Quantity LPS Proximal Femoral Body, Neutral Standard Trial LPS Proximal Femoral Body, Neutral Trochanter Trial LPS Proximal Femoral Body, Left Standard Trial, 15 degree anteversion LPS Proximal Femoral Body, Left Trochanter Trial, 15 degree anteversion LPS Proximal Femoral Body, Right Standard Trial, 15 degree anteversion LPS Proximal Femoral Body, Left Trochanter Trial, 15 degree anteversion LPS Proximal Tibial Replacement Trial, X-Small Implant to Trial Adapter, 25 mm Implant to Trial Adapter, 30 mm Implant to Trial Adapter, 35 mm Implant to Trial Adapter, 40 mm Implant to Trial Adapter, 45 mm ARTICUL/EZE Grooved Ball Trial, 28 mm, +1.5 degree ARTICUL/EZE Grooved Ball Trial, 28 mm, +5 degree ARTICUL/EZE Grooved Ball Trial, 28 mm, +8.5 degree ARTICUL/EZE Grooved Ball Trial, 28 mm, +12 degree ARTICUL/EZE Grooved Ball Trial, 28 mm, degree ARTICUL/EZE Grooved Ball Trial, 32 mm, +1 degre ARTICUL/EZE Grooved Ball Trial, 32 mm, +5 degree ARTICUL/EZE Grooved Ball Trial, 32 mm, +9 degree ARTICUL/EZE Grooved Ball Trial, 32 mm, +13 degree ARTICUL/EZE Grooved Ball Trial, 32 mm, +17 degree ARTICUL/EZE Grooved Ball Trial, 36 mm, -2 degree ARTICUL/EZE Grooved Ball Trial, 36 mm, +1.5 degree ARTICUL/EZE Grooved Ball Trial, 36 mm, +5 degree ARTICUL/EZE Grooved Ball Trial, 36 mm, +8.5 degree ARTICUL/EZE Grooved Ball Trial, 36 mm, +12 degree ARTICUL/EZE Grooved Ball Trial, 36 mm, degree 68

69 LPS TIBIAL TRIAL SET PROXIMAL TIBIAL REPLACEMENT TRIAL The proximal tibial replacement trial replicates the proximal tibial replacement component and is used to assess fit and for trial reduction utilizing the trial construct. It is used with the stem extension trials and segmental components if needed due to extensive bone loss. 69

70 LPS METAPHYSEAL SLEEVE INSTRUMENTATION SET LPS METAPHYSEAL SLEEVE INSTRUMENTATION SET Ordering Information Express Care No. Description Quantity 798B LPS Metaphyseal Sleeve Instrumentation Case 1 Top Tray Cat. No. Description Quantity LPS Femoral to Sleeve Adapter Trial, +0 mm LPS Femoral to Sleeve Adapter Trial, +5 mm LPS Femoral to Sleeve Adapter Trial, +10 mm Revision Femoral Stem/Adapter Clamp Metaphyseal Sleeve Removal Tool 1 70

71 Below is a complete listing of DePuy ExpressCare set numbers for The LPS System. Please refer to the guide for special set numbers needed for the various procedural uses. LPS TOTAL DEPUY EXPRESSCARE SET NUMBER LISTING Instrument Ordering Information Set No. Description 791 B LPS Calcar/Bevel Reamer Set 792 B LPS Component Trial Set 793 B LPS Straight Stem Trial Set 794 B LPS Bowed Stem Trial Set 795 B LPS Instrument Set 796 B LPS Tibial Trial Set 797 B LPS Proximal Tibial and Femoral Trial Set 798 B LPS Metaphyseal Sleeve Instruments KN 463 B SIGMA Cemented Stem Instruments KN 981 B S-ROM Hinge Femoral Instrument Set KN 982 B S-ROM Hinge Common Instrument Set Implant Ordering Information Set No. Description 780 A LPS Cemented Straight Stem Set 781 A LPS Cemented Bowed Stem Set 782 A LPS Porous Straight Stem Set 783 A LPS Porous Bowed Stem Set 784 A LPS Proximal Femoral Body Set, Neutral Left 785 A LPS Proximal Femoral Body Set, Neutral Right 786 A LPS Distal Femoral Replacement Set, Left 787 A LPS Distal Femoral Replacement Set, Right 788 A LPS Segmental Component Set 789 A LPS Proximal Replacement 798 A LPS Metaphyseal Sleeve Set 799 A LPS Universal Hinged Insert trials Set 382 A MBT Revision Trays/Step Wedges, Size A MBT Revision Thick Trays, Sizes A MBT Revision Trays, Sizes A MBT Revision Sleeves 387 A MBT Revision Step Wedges, Sizes A MBT Revision Trays/Step Wedges, Sizes KN 463 A SIGMA Cemented Stems KN 489 A Universal Fluted Stems KN 490 A Universal Femoral Sleeves - Distally Porous KN 491 A Universal Femoral Sleeves - Fully Porous KN 974 A S-ROM Hinge Femoral Components 71

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