ADEPT Hip Resurfacing System. Operative Technique. Delivering Results Through Performance

Transcription

1 ADEPT Hip Resurfacing System Operative Technique Delivering Results Through Performance

2 Contents Section 1 Preoperative Planning and Surgical Approach 3 Section 2 Assessment of Head Size 4 Section 3 Preparing the Acetabulum 5 Section 4 Cup Implantation 9 Section 5 Preparing the Femoral Head Medial Referencing Instruments 14 Section 6 Resurfacing Head Implantation 24 Appendix A Medial Referencing Instrument Alternative Top Cut Method 26 Appendix B Alternative Drilling Method 32 Appendix C Preparing the Femoral Head Lateral Referencing Instruments 35 Appendix D Instrument Assembly / Disassembly Instructions 39 Appendix E Instrument Inventory 45 Appendix F Implant Sizing Chart 50 Manufactured by MatOrtho Limited 13 Mole Business Park Randalls Road Leatherhead Surrey KT22 7BA United Kingdom T: +44 (0) info@matortho.com For more information visit: UK Patent Number USA Patent Number UK Patent Number USA Patent Number MatOrtho Limited 2017 All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording or any information storage and retrieval system. 2 ADEPT Hip Resurfacing System Operative Technique

3 Step 1 X-ray Template for Component Size and Alignment. Using the templates provided, assess the X-ray to approximate the most suitable size of components to replicate the original head size and position. Position the femoral head in neutral or slight valgus alignment. As a rough guide, the centre line of the stem should emerge up to 0.5 cm above or 1 cm below the bottom of the lesser trochanter as it appears on the X-ray. As another guide, the centre line should be parallel to a cm section of the proximal medial neck as indicated. If the lateral referencing instruments are to be used, measure the distance between the highest point of the greater trochanter and the intersection of the centre line with the lateral cortex of the femur, using the rule included on each template. 0mm cm-2.5cm section 1 Pre-Operative Planning and Surgical Approach Step 2 Surgical Approach Typically a posterior approach has been used with the traditional lateral referencing instruments. However, an alternative approach which provides adequate access and visualisation may be considered. This document illustrates the patient lying on their contra-lateral side. Step 3 Remove Osteophytes To help assessment of optimum head size and position, remove osteophyte formation from around the head/ neck junction with rongeurs. ADEPT Hip Resurfacing System Operative Technique 3

4 section 2 Assessment of Head Size Step 4 Size Femoral Head: Template Place the selected Head/Neck Template around the neck at the widest ML dimension and draw upwards towards the head/neck junction. The optimum head size template will rest on the head/neck junction. The outer and inner surfaces of the Head Template represent the inner and outer surfaces of the implant. Thus the outer diameter may be compared to the original head diameter. Size Femoral Head: Medial referencing Jig Select the estimated size of Medial Referencing Jig Ring and place it over the femoral neck. The ring should close fully with some free-play on the neck and, when pulled upwards, it should rest approximately on the head/neck junction. If the ring does not close fully or reach the head/neck junction, try a larger size. If it moves past the head/neck junction and rests near the equator of the head, try a smaller size. Ensure that the ring is held fully closed at all times. The outer and inner surfaces of the ring represent the outer and inner diameter of the implant. Thus, the outer diameter maybe compared to the original head diameter. If the ring impinges upon osteophytes, remove them carefully. Please refer to Implant Sizing Chart on the back page of this document 4 ADEPT Hip Resurfacing System Operative Technique

5 section 3 Preparing the Acetabulum Preparing the Acetabulum ADEPT Hip Resurfacing System Operative Technique 5

6 section 3 Preparing the Acetabulum Step 5 Expose the Acetabulum Excise the labrum and remove osteophytes to visualise the entire acetabular rim. Clear soft tissue and cartilage to reveal the true floor of the acetabulum. A clear unrestricted view should be achieved. Step 6 Ream Acetabulum Check which cup size options are available in line with the head size assessment. Use successively sized reamers to ream to the desired acetabular size, without excessive thinning of the walls. Under normal circumstances 1mm under-reaming (e.g. 59mm for a 60mm cup) or line-to-line reaming (e.g. 60mm for a 60mm cup) is suitable. In soft bone or large acetabulae, up to 2mm under-reaming may be considered. The recommended approach is to prepare first to a 1mm under-ream and assess fit using the appropriate trial (Step 7). Ream line-to-line if thereafter deemed appropriate. Note: It is advisable to ream 1-2 mm deeper than the hemisphere, so the acetabular cup engages fully up to the rim. Insufficient depth is highlighted by a tendency for the Cup Trial to `jump out when moved and should be rectified by further reaming. 6 ADEPT Hip Resurfacing System Operative Technique

7 Step 7 Cup Trial Correct assessment of reamed size can only be made with the Cup Trials, which are 1 mm smaller than the cups on diameter. These must be a firm fit when fully seated in the acetabulum. Screw the handle fully into the selected Cup Trial, position and impact into the acetabulum. Check that full bone contact is achieved around the trial edge. Assess the fit by letting go of the Trial Handle to see if it holds in the acetabulum. Also try to move the trial (it should be firm but just possible to rotate it whilst fully seated). Remove the trial and wash the acetabulum with a pressurised saline lavage and dry thoroughly. section 3 Preparing the Acetabulum Size (-1 mm) Size ADEPT Hip Resurfacing System Operative Technique 7

8 section 3 Preparing the Acetabulum Step 8 Prepare Cup Implant To mount the Cup Implant on the Introducer, open the latch by pulling the locking arm away from the body of the Introducer. Slide the dovetail section of the cap into the recess on the Cup Introducer. Close the latch by pulling the locking arm towards the body of the Introducer. 8 ADEPT Hip Resurfacing System Operative Technique

9 section 4 Cup Implantation Step 9 Cup Alignment Aerial An optional Cup Alignment Aerial can be attached to the Cup Introducer which can help to guide the cup into position. It is recommended that the definitive acetabular implant should be guided into a defined position of 35 abduction and 20 anteversion in the acetabulum, with the Alignment Rod used as a reference for orientation. ADEPT Hip Resurfacing System Operative Technique 9

10 section 4 Cup Implantation Set required abduction angle by loosening ratchet screw, setting required angle and tightening with Knob Tightener. Note: 35 abduction angle is recommended Insert the Alignment Rod into the correct set of holes for either the left or right hip as indicated. Set required anteversion angle and hand tighten the thumb screw HAND TIGHT only. Note: A 20 anteversion angle is recommended 10 ADEPT Hip Resurfacing System Operative Technique

11 Step 10 Position and Impact Cup With the pelvis orientated in the true lateral position, the Alignment Rod should be in line with the longitudinal axis of the trunk. Impact the cup with several firm hammer blows until fully seated. A change in impact note should be heard when the cup is fully home. Confirm this by observing good peripheral cup/ bone contact. Test the firmness of the cup fit by gently trying to rock the pelvis with the Cup Introducer. Remove the Cup Introducer by pulling the knob away from the body of the introducer. A gentle twisting motion will release the Cup Introducer. section 4 Cup Implantation ADEPT Hip Resurfacing System Operative Technique 11

12 section 4 Cup Implantation Step 11 Assess Cup Orientation Do not separate the cap without first confirming satisfactory cup orientation. If necessary, re-attach the Cup Introducer to remove and reposition the cup. Attaching the Slide Hammer will aid cup removal. 12 ADEPT Hip Resurfacing System Operative Technique

13 Step 12 Assemble Cap Remover Screw either the Standard or Flexible Modular Cap Removal Tool onto the Straight Handle and tighten fully. section 4 Cup Implantation 1 Step 13 Remove the Impaction Cap Locate the socket over the hexagonal nut in the centre of the Impaction Cap. Strike the end of the handle with two firm hammer blows to cut the cables. Turn the handle clockwise one full turn to withdraw the cables and release the Impaction Cap from the cup. If the handle will not turn, strike again, to ensure that the cable is cut fully. Remove the Impaction Cap and check all cables are fully removed from the cup. 2 Alternative Cable Cutting (not additional step) Impact can be avoided altogether by cutting each of the three cable loops with Backup Cable Cutters. Use the Modular Cap Remover to withdraw the cables and release the cup. 3 ADEPT Hip Resurfacing System Operative Technique 13

14 Section 5 Preparing the Femoral Head Medial Referencing Instruments Preparing the Femoral Head Medial Referencing Instruments 14 ADEPT Hip Resurfacing System Operative Technique

15 Step 1 Assemble Medial Referencing Jig Assemble the selected Medial Referencing Jig Ring onto the Jig as shown. When the screw thread is semiengaged, the ring will open and close against a spring bias. When fully tight, the ring will be locked. Also ensure that the Spiked Guide Wire Tube is assembled and held by the other knob. The unlocked position is achieved when the small indicating dots are fully visible and locked when the dots are fully obscured. Section 5 Preparing the Femoral Head Medial Referencing Instruments ADEPT Hip Resurfacing System Operative Technique 15

16 Section 5 Preparing the Femoral Head Medial Referencing Instruments Step 2 Varus/Valgus Alignment With the Medial Referencing Jig Ring unlocked, bias the ring open and place it over the femoral neck. Close the ring and lock it by tightening the knob fully. Loosen the screw holding the Spiked Guide Wire Tube and with a `syringe grip pull the ring upwards onto the head/neck junction. Place the flag adjacent to the medial calcar. Viewed from posterior or anterior direction the flag should be approximately parallel to the medial calcar for correct varus/valgus alignment of the head. Secure the Medial Referencing Jig by hand tightening the No.2 Screw. 135 Optionally attach the External Alignment Guide and pass the selected Goniometer through to further indicate varus/ valgus alignment. The short leg of the Goniometer should point towards the traditional position of a lateral referencing pin. This can also be checked with a guide wire if desired ADEPT Hip Resurfacing System Operative Technique

17 Step 3 Anteversion Alignment Assess the anteversion angle of the flag by viewing it from a mediolateral direction. The flag should be adjusted to point straight down the neck, following the natural anteversion angle. Press the spiked tube firmly against the femoral head and re-tighten the screw. Re-check the varus/valgus angle in case it has changed. Step 4 Drill Guide Wire Drill the Guide Wire through the centre of the spiked tube, to a depth of at least 6 cm. Note: To follow the alternative drilling method (which does not use the guide wire), now go to Appendix B / page 32. To follow the alternative top cut method, go to Appendix A / page 26. Section 5 Preparing the Femoral Head Medial Referencing Instruments ADEPT Hip Resurfacing System Operative Technique 17

18 Section 5 Preparing the Femoral Head Medial Referencing Instruments 3 2 Step 5 Remove Jig 1 With the Guide Wire in position, first remove the spiked tube, then unlock the ring and carefully remove the jig without bending the Guide Wire. 18 ADEPT Hip Resurfacing System Operative Technique

19 Step 6 Check Guide Wire Position Attach Guide Wire Adapter to the stylus. Rotate the stylus through a complete revolution at the head/neck junction to check the position of the Guide Wire. Position and rotate the stylus on top side of the head to ensure that enough superior bone is present to support the resurfacing head. Step 7 Over-drill Guide Wire Using the Cannulated Stem Drill, over-drill the Guide Wire to the depth indicated for the chosen head. Section 5 Preparing the Femoral Head Medial Referencing Instruments Step 8 Insert Guide Rod Insert the Guide Rod up to the depth stop. ADEPT Hip Resurfacing System Operative Technique 19

20 Section 5 Preparing the Femoral Head Medial Referencing Instruments Step 9 Cylinder Cut Select the correct sized Cylinder Cutter determined by the Jig. Slowly advance the Cylinder Cutter over the Guide Rod as far as the head/neck junction, taking great care to avoid notching the femoral neck. The Head Templates may be used to protect the neck from the advancing cutter. Use swabs to prevent debris from entering the soft tissue. Trim any remaining peripheral bone and osteophytes and remove the Guide Rod. 20 ADEPT Hip Resurfacing System Operative Technique

21 Step 10 Position Top Cutting Guide Slide the correct sized Top Cutting Guide over the cylindrical head, with the lower rim positioned on the medial head/neck junction. Tighten the knob to fix its position. Step 11 Complete Top Cut Make the top cut with a saw, using the flat rim as a guide for the saw blade Section 5 Preparing the Femoral Head Medial Referencing Instruments ADEPT Hip Resurfacing System Operative Technique 21

22 For Key Holes Section 5 Preparing the Femoral Head Medial Referencing Instruments Step 12 Chamfer Cut Reinsert the Guide Rod. Slowly advance the Chamfer Cutter until the depth stop is reached. Use swabs to prevent debris from entering the soft tissue. Step 13 Assemble Ø4.5 Drill Assemble Ø4.5 drill as illustrated. (For assembly details see Appendix D, page 39). For Cannula Step 14 Prepare for Cement Drill several equidistant key holes perpendicular to the chamfer using a Ø4.5 drill as detailed above. 22 ADEPT Hip Resurfacing System Operative Technique

23 For Key Holes Step 15 Femoral head trial Assemble the appropriate sized femoral head trial to check the head preparation and optionally reduce the joint. Step 16 Assemble Ø4.5 Drill Assemble Ø4.5 drill as illustrated. (For assembly details see Appendix D, page 43). For Cannula Section 5 Preparing the Femoral Head Medial Referencing Instruments Step 17 Insert Drainage Cannula Drill a hole in the lesser trochanter for the Drainage Cannula using the Ø4.5 drill, assembled as illustrated above. Insert the Drainage Cannula, ensuring that it does not extend into the stem hole. Connect to a suction pump and apply suction. Wash the prepared bone surfaces with saline lavage and dry thoroughly. ADEPT Hip Resurfacing System Operative Technique 23

24 Section 6 Resurfacing Head Implantation Step 18 Prepare cement Fill the femoral head 1/3 to 1/2 full with low viscosity antibiotic cement. Low viscosity cement should always be used with this implant, since high viscosity cement may prevent full seating of the component. Step 19 Assemble Head Impactor Assemble the Head Impactor handle and Impaction Head. Step 20 Impact Femoral Head Maintain suction throughout head impaction to reduce pressure build up as the head is impacted. Place the implant onto the femur very quickly and advance into position with the Resurfacing Head Impactor. Do not allow the cement to thicken before impaction as this will also prevent full seating of the component. Remove excess bone cement taking particular care not to damage the polished surface of the Resurfacing Head. Wash the polished head with pressurised saline lavage. Avoid wiping the superfinished bearing surface which can result in minor scratches. 24 ADEPT Hip Resurfacing System Operative Technique

25 Step 21 Reduction Flush the entire joint with saline, and wash and inspect the polished surfaces. Reduce the hip, taking great care to reduce the components cleanly without scraping the head on the cup rim. A retractor can be used to hold the hip capsule away from the acetabulum. Perform a full check to ensure that there is no entrapment of soft tissues and that the range of movement and stability is satisfactory. Section 6 Resurfacing Head Implantation Step 22 Close Wound Follow the preferred procedure to reattach muscular structures and suture the fat layers and skin, inserting a drain if required. ADEPT Hip Resurfacing System Operative Technique 25

26 Appendix A Medial Referencing Instrument Alternative Top Cut Method Appendix A Medial Referencing Instrument Alternative Top Cut Method 26 ADEPT Hip Resurfacing System Operative Technique

27 Step A1 Assemble Cutting Guide With the Guide Wire in position (if used) and before releasing the jig, attach the Top Cutting Guide. The guide can be attached either way up, without influencing the cut position. The top saw cut position will be correct relative to the ring size used. The ring resting position on the head/neck junction corresponds to the final position of the head implant skirt edge. Check to ensure that the ring position approximately corresponds with the traditional position of the Top Cutting Guide on the head/neck junction. Step A2 Start Top Cut Tighten all knobs with the Knob Tightener in preparation for the top saw cut using a 1mm saw blade. Option A If Guide Wire is used, cut to establish the plane avoiding the Guide Wire. Option B If Non Cannulated Stem Drill had been used, cut to establish the plane avoiding breaking through into the drilled hole. Appendix A Medial Referencing Instrument Alternative Top Cut Method ADEPT Hip Resurfacing System Operative Technique 27

28 Appendix A Medial Referencing Instrument Alternative Top Cut Method 3 2 Step A3 Remove Jig 1 With the Guide Wire (if used) in position, first remove the spiked tube, then unlock the ring and carefully remove the jig without bending the Guide Wire. 28 ADEPT Hip Resurfacing System Operative Technique

29 Step A4 (Guide Wire Method) Check Guide Wire Position Rotate the stylus through a complete revolution at the head/neck junction to check the position of the Guide Wire. Position and rotate the stylus on top side of the head to ensure that enough superior bone is present to support the resurfacing head. Step A5 (Guide Wire Method) Over-drill Guide Wire Using the Cannulated Drill, over-drill the Guide Wire to the depth indicated for the chosen head. Remove Guide Wire and Drill. Appendix A Medial Referencing Instrument Alternative Top Cut Method ADEPT Hip Resurfacing System Operative Technique 29

30 Appendix A Medial Referencing Instrument Alternative Top Cut Method Step A6 Complete Top Cut Complete the top cut with the Guide Wire or Guide Rod removed. Step A7 Insert Guide Rod Insert the Guide Rod up to the depth stop. Step A8 Add Blue Spacer Before making the cylindrical cut, slide the Blue Spacer onto the Guide Rod. This will ensure that the Cylindrical Cutter stops at the correct depth. 30 ADEPT Hip Resurfacing System Operative Technique

31 Step A9 Complete Cylindrical Cut Advance the Cylindrical Cutter slowly until the depth stop is reached. This position should be safe but take care to avoid notching the femoral neck. Step A10 Remove Blue Spacer Remove the blue spacer before progressing to the chamfer cut. Return to Step 15, page 22 to complete the femoral head preparation. Appendix A Medial Referencing Instrument Alternative Top Cut Method ADEPT Hip Resurfacing System Operative Technique 31

32 Appendix B Alternative Drilling Method Appendix B Alternative Drilling Method 32 ADEPT Hip Resurfacing System Operative Technique

33 Step B1 Follow Steps 1-6, pages 15-17, having assembled the Medial Referencing Jig with the large bore Spiked Drill Tube (Part Number ). Using the Non Cannulated Drill to the depth indicated for the chosen head. Appendix B Alternative Drilling Method Step B2 Remove Jig First remove the drill, then the spiked tube, then unlock the ring and remove the jig. ADEPT Hip Resurfacing System Operative Technique 33

34 Appendix B Alternative Drilling Method Step B3 Insert Guide Rod Insert the Guide Rod up to the depth stop. Step B4 Check Guide Wire Position Rotate the stylus through a complete revolution at the head/neck junction to check the position of the Guide Rod. Position and rotate the stylus on the top side of the head to ensure that enough superior bone is present to support the resurfacing head. Return to Step 11, page 19 to complete the femoral head preparation. 34 ADEPT Hip Resurfacing System Operative Technique

35 Appendix C Preparing the Femoral Head Lateral Referencing Instruments Appendix C Preparing the Femoral Head Lateral Referencing Instruments ADEPT Hip Resurfacing System Operative Technique 35

36 Appendix C Preparing the Femoral Head Lateral Referencing Instruments 48 Step C1 Insert Lateral Pin Measure down from the greater trochanter to locate the lateral pin in the position predetermined from the X-ray. Drill the pin directly into the mid lateral cortex and then angle towards the femoral head, leaving at least 5 mm of pin protruding from the soft tissue. Step C2 Set Head Size Assemble the stylus into the Stylus Holder and set to the selected head size. Close Stylus assembly as illustrated. Fit the Stylus onto the Lateral Referencing Jig. Set the Lateral Referencing Jig to the zero position as indicated. Step C3 Adjust to Correct Anteversion Hook the long arm of the jig over the lateral pin and reposition the leg to elevate the femoral head out of the exposure. Locate the spiked tube approximately on the head, position the stylus uppermost and the pin arm perpendicular to it (posterior or anterior). Adjust the hinge until the stylus and guide tube follows the anteversion angle of the neck. A Guide Wire may be used to extend the stylus axis. If required the Jig can be reset to its neutral ZERO position without removing it. 36 ADEPT Hip Resurfacing System Operative Technique

37 Step C4 Centralise the Jig Rotate the stylus around the head/neck junction to centralise the jig. Once a central position is gauged, tap the spiked rod into the femoral head to fix. Rotate the stylus again through a complete revolution to check position. The stylus position on the head/neck junction will represent the exit point of the Cylinder Cutter. Step C5 Drill Guide Wire Drill the Guide Wire into the head to a depth of at least 6 cm. To remove the jig, first withdraw the Spiked Rod and remove the stylus. Unhook the jig from the lateral pin leaving the Guide Wire in position. Appendix C Preparing the Femoral Head Lateral Referencing Instruments ADEPT Hip Resurfacing System Operative Technique 37

38 Appendix C Preparing the Femoral Head Lateral Referencing Instruments Step C6 Check Guide Wire position Remove Lateral Referencing Jig body and, with the stylus fitted onto the Spiked Tube as illustrated rotate the stylus through a complete revolution at the head/ neck junction to check the position of the Guide Wire. Position and rotate the stylus on top side of the head to ensure that enough superior bone is present to support the resurfacing head. Step C7 Over-Drill Guide Wire Using the Cannulated Drill, over-drill the Guide Wire to the depth indicated for the chosen head. Return to Step 8, page 19 to complete the femoral head preparation. 38 ADEPT Hip Resurfacing System Operative Technique

39 Appendix D Instrument Assembly / Disassembly Instructions Appendix D Instrument Assembly / Disassembly Instructions ADEPT Hip Resurfacing System Operative Technique 39

40 Appendix D Instrument Assembly / Disassembly Instructions UNLOCKED Cup Introducer LOCKED Cup Latch - LOCKED Cup Latch - UNLOCKED 40 ADEPT Hip Resurfacing System Operative Technique

41 Lateral Referencing Jig Appendix D Instrument Assembly / Disassembly Instructions Inside Tray Lid FIXED GONIOMETERS The Goniometers should be checked against the outline profile on the inside of the lid before each use to ensure they indicate the correct angle. ADEPT Hip Resurfacing System Operative Technique 41

42 Appendix D Instrument Assembly / Disassembly Instructions Lateral Referencing Jig Stylus Assembly Medial Referencing Jig ADEPT Hip Resurfacing System Operative Technique

43 Slotted Top Cutting Guide Appendix D Instrument Assembly / Disassembly Instructions 4.5Ø mm Drill Exploded View ADEPT Hip Resurfacing System Operative Technique 43

44 Appendix D Instrument Assembly / Disassembly Instructions Cup Alignment Aerial Exploded View 44 ADEPT Hip Resurfacing System Operative Technique

45 Appendix E Instrument Inventory Appendix E Instrument Inventory ADEPT Hip Resurfacing System Operative Technique 45

46 Appendix E Instrument Inventory Part No. Qty Description Acetabular Cup Core Instrument Set Slide Hammer Impaction Cap Punch Modular Cap Remover Knob Tightener Guide Rod Extractor Cup Introducer (curved) Hip Slider Alignment Aerial Location Clamp Alignment Aerial Adjustable Arm Aerial Alignment Rod Head Impactor Handle Impaction Head Tray for Acetabular Cup Instruments No. 8 Screw Ratchet Locking Screw Part No. Qty Description Acetabular Cup Trials Cup Trial 54mm Cup Trial 56mm Cup Trial 58mm Cup Trial 60mm Cup Trial 62mm Cup Trial 64mm Cup Trial 66mm Cup Trial 68mm Cup Trial 70mm Acetabular Trial Handle (curved) Acetabular Trial Handle (straight) Scissors Retractor Nail 1 900g Hammer Tray for Acetabular Cup Trials Part No. Qty Description Universal Acetabular Reamer Set 1 Acetabular Reamer MPRO 38mm 1 Acetabular Reamer MPRO 39mm 1 Acetabular Reamer MPRO 40mm 1 Acetabular Reamer MPRO 41mm 1 Acetabular Reamer MPRO 42mm 1 Acetabular Reamer MPRO 43mm 1 Acetabular Reamer MPRO 44mm 1 Acetabular Reamer MPRO 45mm 1 Acetabular Reamer MPRO 46mm 1 Acetabular Reamer MPRO 47mm 1 Acetabular Reamer MPRO 48mm 1 Acetabular Reamer MPRO 49mm 1 Acetabular Reamer MPRO 50mm 1 Acetabular Reamer MPRO 51mm 1 Acetabular Reamer MPRO 52mm 1 Acetabular Reamer MPRO 53mm 1 Acetabular Reamer MPRO 54mm 1 Acetabular Reamer MPRO 55mm 1 Acetabular Reamer MPRO 56mm 1 Acetabular Reamer MPRO 57mm 1 Acetabular Reamer MPRO 58mm 1 Acetabular Reamer MPRO 59mm 1 Acetabular Reamer MPRO 60mm 1 Acetabular Reamer MPRO 61mm 1 Acetabular Reamer MPRO 62mm 1 Acetabular Reamer MPRO 63mm 1 Acetabular Reamer MPRO 64mm 1 Acetabular Reamer MPRO 65mm 1 Acetabular Reamer MPRO 66mm 1 Acetabular Reamer MPRO 67mm 1 Acetabular Reamer MPRO 68mm 1 Acetabular Reamer MPRO 69mm 1 Acetabular Reamer MPRO 70mm 2 EZ Clean Reamer Handle Zimmer-Hall Fitting Tray for Universal Reamers 46 ADEPT Hip Resurfacing System Operative Technique

47 Part No. Qty Description Resurfacing Head Core Instrument Set Head Cutter Drive Guide Wire Guide Post Femoral Head Slot Cutting Guide Drainage Cannula Ø Drill Safety Sleeve for 4.5Ø Drill Cannulated Stem Drill Short Guide Post Short Cannulated Stem Drill Head/Neck Stylus Head/Neck Template 48-58mm Stylus Guide Wire Adapter Tray for Resurfacing Head Core Instruments Part No. Qty Description Resurfacing Head Reamers Top Cutting Guide 48mm Top Cutting Guide 50mm Top Cutting Guide 52mm Top Cutting Guide 54mm Top Cutting Guide 56mm Top Cutting Guide 58mm Cylinder Cutter 48mm Cylinder Cutter 50mm Cylinder Cutter 52mm Cylinder Cutter 54mm Cylinder Cutter 56mm Cylinder Cutter 58mm Chamfer Cutter 48mm Chamfer Cutter 50mm Chamfer Cutter 52mm Chamfer Cutter 54mm Chamfer Cutter 56mm Chamfer Cutter 58mm Tray for Resurfacing Head Reamers No. 3 Screw Appendix E Instrument Inventory ADEPT Hip Resurfacing System Operative Technique 47

48 Appendix E Instrument Inventory Part No. Qty Description Medial Referencing Jig Instrument Set Slotted Top Cutting Guide Closed Top Cutting Guide Spiked Guide Wire Tube Spiked Drill Tube Spacer Medial Referencing Jig Ring 48mm Medial Referencing Jig Ring 50mm Medial Referencing Jig Ring 52mm Medial Referencing Jig Ring 54mm Medial Referencing Jig Ring 56mm Medial Referencing Jig Ring 58mm Non Cannulated Stem Drill Fixed Goniometer Fixed Goniometer Fixed Goniometer Medial Referencing Jig External Alignment Guide Tray for Medial Referencing Jig No. 1 Screw No. 2 Screw Part No. Qty Description Lateral Referencing Jig Instrument Set Tray for Lateral Referencing Jig Lateral Pin Lateral Referencing Jig Spiked Tube No. 1 Screw Part No. Qty Description ADEPT Resurfacing X-ray Template Cup Positioning X-ray Template Part No. Qty Description ADEPT Resurfacing Head Trials ADEPT Resurfacing Head Trial 48mm ADEPT Resurfacing Head Trial 50mm ADEPT Resurfacing Head Trial 52mm ADEPT Resurfacing Head Trial 54mm ADEPT Resurfacing Head Trial 56mm ADEPT Resurfacing Head Trial 58mm Tray for Resurfacing Head Trials 48 ADEPT Hip Resurfacing System Operative Technique

49 Part No. Description ADEPT Metal On Metal Cup 54mm with 48mm bore ADEPT Metal On Metal Cup 56mm with 48mm bore ADEPT Metal On Metal Cup 56mm with 50mm bore ADEPT Metal On Metal Cup 58mm with 50mm bore ADEPT Metal On Metal Cup 58mm with 52mm bore ADEPT Metal On Metal Cup 60mm with 52mm bore ADEPT Metal On Metal Cup 60mm with 54mm bore ADEPT Metal On Metal Cup 62mm with 54mm bore ADEPT Metal On Metal Cup 62mm with 56mm bore ADEPT Metal On Metal Cup 64mm with 56mm bore ADEPT Metal On Metal Cup 64mm with 58mm bore ADEPT Metal On Metal Cup 66mm with 58mm bore Part No. Description ADEPT Metal on Metal Resurfacing Head 48mm ADEPT Metal on Metal Resurfacing Head 50mm ADEPT Metal on Metal Resurfacing Head 52mm ADEPT Metal on Metal Resurfacing Head 54mm ADEPT Metal on Metal Resurfacing Head 56mm ADEPT Metal on Metal Resurfacing Head 58mm Appendix E Instrument Inventory ADEPT Hip Resurfacing System Operative Technique 49

50 Appendix F Implant Sizing Chart ADEPT Resurfacing Head ADEPT Metal-on-Metal Cup ADEPT Extra Fixation Cup ADEPT Extra Fixation Screw (length, mm) ADEPT Hip Resurfacing System Operative Technique

51 ADEPT Hip Resurfacing System Operative Technique 51 Notes

52 ARTG ARTG ARTG ARTG MatOrtho Limited 13 Mole Business Park Randalls Road Leatherhead Surrey KT22 7BA United Kingdom. T: +44 (0) For more information visit: Part No. ML L Issue 7