Featuring Technology Product Rationale
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Optimum implant geometry Extending proven TRI-LOCK heritage The original TRI-LOCK Stem was introduced in 1981. This implant was the first proximally coated tapered-wedge hip stem available to orthopaedic surgeons and their patients. Since its introduction, the original TRI-LOCK Stem has demonstrated 95% survivorship at 10 years. 1-4 Preserving the natural anatomy The reduced lateral shoulder, thin geometry and optimised length of the TRI-LOCK Bone Preservation Stem minimise the amount of bone removed from the patient. These same features, along with approach enabling instrumentation, allow the surgeon to perform minimally invasive techniques. Delivering stable, predictable performance The TRI-LOCK Bone Preservation Stem incorporates GRIPTION fixation technology. GRIPTION is designed to help provide consistent implant seating height and additional initial stability that helps maximise the potential for long-term bony ingrowth. Restoring high level function The TRI-LOCK Bone Preservation Stem neck geometry has been optimised to improve range-of-motion. Progressive dual offsets with direct lateralisation provide the ability to optimise soft tissue tension. An extensive size range and consistent intervals between sizes help achieve proper fit and aid in recreating leg length. Providing High Performance Bearing options The TRI-LOCK Bone Preservation Stem s 12/14 ARTICUL/EZE taper enables the use of all DePuy s high performance bearing options. The PINNACLE Acetabular Cup System gives the surgeon a choice of bearing materials, and the option for screw fixation. Enabling a simple, reproducible technique Today s total hip surgeon demands proven performance, OR efficiency, and surgical approach flexibility. The new TRI-LOCK Bone Preservation Stem has a sound clinical heritage. The broach-only technique and wide range of instrumentation enable both traditional and less-invasive surgical approaches. 3
Extending proven TRI-LOCK heritage 95% Survivorship at 10 years. 1 0% Revisions for aseptic loosening of stem at 15 years. 2 The original TRI-LOCK was introduced in 1981. This implant was the first proximally coated tapered wedge hip stem available to orthopaedic surgeons and their patients. Since its introduction, the success of TRI-LOCK has been well documented in published studies 1-4. Using component revision for aseptic loosening as the end point, the numbers are convincing. 4
Axial Stability The TRI-LOCK Bone Preservation Stem achieves axial stability within the femur by making intimate cortical contact at the medial and lateral endosteal cortices. The natural taper of the femoral canal is reflected in TRI-LOCK s proximal-to-distal taper, as viewed in an A/P radiograph. This taper prohibits distal migration when cortical contact is achieved. Rotational Stability The inherent rotational stability of the TRI-LOCK Bone Preservation Stem is a result of the narrow anterior-to-posterior width of the stem. This narrow geometry allows the stem to be sized to fill the largest dimension of the femoral canal (the medial-to-lateral width). Since the M/L width of the implant is larger than the A/P width of the femoral canal, the TRI-LOCK Bone Preservation Stem maintains excellent rotational stability. Long-Term Osteointegration The initial axial and rotational stability of the TRI-LOCK Bone Preservation Stem provide the opportunity for long-term osteointegration. Initial stability limits micromotion at the implant to cortical bone interface, resulting in a higher probability for bony ingrowth. 5
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Preserving the natural anatomy Soft Tissue Preservation Optimised length, contoured distal tip and reduced lateral shoulder enhance stem insertion through the anterior and anterolateral approaches Broach only technique enables minimally invasive surgical approaches where access with straight reamers is limited Instrumentation designed to enable the surgeon s preferred approach Bone Preservation Reduced lateral shoulder enables the preservation of the greater trochanter Thin anterior-to-posterior width requires minimal cancellous bone removal Optimised length to preserve distal canal Reduced distal medial-to-lateral width to provide proper proximal fit and preserve distal cortical bone in Dorr Type A femora High 50-degree neck cut preserves calcar bone and increases proximal support 7
Delivering stable, predictable performance GRIPTION s predicted 1.2 coefficient of friction exceeds that of plasma spray and porous tantalum material. 5,6 The volume porosity of GRIPTION reaches 63% at the surface. This increased porosity allows for higher oxygenation and revascularisation of bony tissue. 7,8 GRIPTION provides a clinically advantageous 300-micron average pore size. This pore size has been proven optimal for osteointegration. 7,9 GRIPTION is highly microtextured. This microtexture provides an increased surface area for osteoblast cells to adhere and proliferate. 8 GRIPTION is made of commercially pure titanium but not the TRI-LOCK BPS stem which made from Ti6Al4V titanium alloy, a material with proven biocompatibility and a low modulus of elasticity. 10 The TRI-LOCK Bone Preservation Stem incorporates GRIPTION fixation technology. GRIPTION is an evolutionary advancement in implant coating technology. This advanced coating technology builds upon DePuy s 30-year tradition of cementless implant excellence. The critical coating properties that POROCOAT has proven effective for long-term survivorship have been replicated in GRIPTION. 11,12 Advanced technology has allowed DePuy to optimise GRIPTION s properties, to provide consistent implant seating height, exceptional initial stability and a maximised potential for long-term osteointegration. 8
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159 Optimised Neck Geometry The TRI-LOCK Bone Preservation Stem neck geometry is optimised to improve range of motion and maximise hip stability. 159 range of motion can be achieved when coupled with the PINNACLE Acetabular Cup System. 13 10
Restoring high level function Progressive Dual Offset Stem offset is proportional to stem size. Each stem size offers a standard and high offset option. The high offset option lateralises the stem 6 to 8 mm depending on size. By maintaining a constant 130 neck angle, tissue tension can be increased without affecting leg length. Extensive Size Range The TRI-LOCK Bone Preservation Stem system features 13 stem sizes, allowing the surgeon to address the larger patient population. Consistent intervals between each stem size help achieve proper fit within the femur. Component sizing can also be used to fine tune seating height and adjust leg length. 11
Providing advanced bearing options Combines the hard wearing properties of a BIOLOX delta ceramic on ceramic bearing couple with a head-to-shell ratio that allows the use of the popular 36 mm head in a shell as small as 46 mm for extra joint stability. The design allows a range of comparatively large / stable head sizes (32 to 48 mm) to be used with a range of comparatively small cup sizes (42 to 66 mm). Maximising fracture toughness reduces the opportunity for scratches and microcracks to propagate. The addition of zirconia particles and strontium oxide to the alumina matrix provides this increase in fracture toughness to the BIOLOX delta material. 14 12
MARATHON polyethylene combines mechanical integrity with wear resistance. The established manufacturing process of MARATHON is replicated in ALTRX. After moderate cross-linking, a remelting process eliminates all free radicals and oxidative potential and provides excellent mechanical integrity. ALTRX optimises the balance between wear resistance and mechanical integrity allowing for better head-to-shell ratios. The TRI-LOCK Bone Preservation Stem 12/14 ARTICUL/EZE taper enables the use of all DePuy s high performance bearing options. The PINNACLE Acetabular Cup System gives the surgeon choice in bearing materials. 13
Straight Straight-long Curved Dual-offset Approach enabling broach handle options Threaded Straight Modular Curved Modular Offset Modular Bullet-tip Modular Approach enabling stem inserter options 14
Enabling a simple, reproducible technique Step 1: Neck osteotomy Step 2: Femoral canal preparation Step 3: Femoral component insertion 15
References 1. Burt CF et al. A Femoral Component Inserted without Cement in Total Hip Arthroplasty. A Study of the TRI-LOCK Component with an Average Ten Year Duration of Followup. J. Bone Joint Surg. 1998;80-A:952-60. 2. Purtill JJ et al. Total Hip Arthroplasty Using Two Different Cementless Tapered Stems. Clinical Orthopaedics and Related Research. 2001;393:121-127. 3. Teloken MA et al. Ten to Fifteen Year Follow-up After Total Hip Arthroplasty with a Tapered Cobalt-Chromium Femoral Component (TRI-LOCK) Inserted without Cement. J. Bone Joint Surg. 2002;84-A:2140-2144. 4. Sakalkale DP et al. Minimum 10 Year Results of a Tapered Cementless Hip Replacement. Clinical Orthopaedics and Related Research. 1999;362:138-144. 5. Data on file at Depuy. Depuy Research Lab Report WR 070146 6. Published literature: No.97-7864-001-00 7.5ML, Zimmer Inc, 2005 and Zimmer Holdings, Inc. Trabecular Metal Technology. Website accessed February 7, 2013 at URL http:// www.zimmer.com/z/ctl/op/global/action/1/id/33/template/mp/navid/312.tantalum Co of E 7. Data on file at DePuy. DePuy Research Lab Report WR070125 8. Karageorgiou et al. Porosity of 3D biomaterial scaffolds and osteogenesis, Biomaterials. 2005; 26:5474. 9. Bobyn JD et al. The Optimum Pore Size for the Fixation of Porous Surfaced Metal Implants by the Ingrowth of Bone. Clinical Orthopaedics and Related Research.1980;150:263-270. 10. Matsuno H, et al. Biocompatibility and osteogenesis of refractory metal implants, titanium, hafnium, niobium, tantalum and rhenium. Biomaterials. 2001;22(11):1253-62. 11. Grobler GP et al. Ten-year results of a press-fit, porous-coated acetabular component. J Bone Joint Surg Br 2005;87:786-9. 12. DePuy Orthopaedics, Inc. Internal Study Update. PINNACLE Multi-Liner Acetabular Cup in a Prospective Multi-Center Study. May 2011. 13. Depuy Design Verification Testing Report SCP-415 Rev R, Attachment A DVA-106976-DVER Rev A 14. Rack R et al. A new material concept for bioceramics in Orthopaedics Proceedings of the 5th International CeramTec Symposium. G. Thieme Verlag, Stuttgart, 2000:136140. The third party trademarks used herein are the trademarks of their respective owners. This publication is not intended for distribution in the USA. 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. 3319712 DePuy Orthopaedics, Inc. 700 Orthopaedic Drive Warsaw, IN 46581-0988 USA Tel: +1 (800) 366 8143 Fax: +1 (574) 267 7196 depuysynthes.com DePuy International Ltd St Anthony s Road Leeds LS11 8DT England Tel: +44 (0)113 387 7800 Fax: +44 (0)113 387 7890 0086 DePuy International Ltd. and DePuy Orthopaedics, Inc. 2012. All rights reserved. 0612-88-506 version 2 Issued: 06/13 CA#DPEM/ORT/1112/0328b