Global Cup System. Surgical Technique

Transcription

1 Global Cup System Surgical Technique

2

3 Contents Introduction 2 Pre-operative Planning 3 Suggested Templating Method 3 Surgical Technique 4 Surgical Exposure 4 Acetabular Reaming 4 Acetabular Cup Trialling 5 Acetabular Cup Insertion 6 Acetabular Cup Screw Placement & Fixation 6 Acetabular Cup Trial Liner Evaluation 8 Acetabular Cup Dome Hole Cover Insertion 9 Acetabular Cup Liner Insertion 9 Poly Liner Insertion: 9 Ceramic Liner Insertion: 11 Final Assessment 12 Acetabular Cup Liner Removal 12 Ceramic Liner Removal: 12 Poly Liner Removal: 12 Implant Catalogue 13 Instrument Catalogue 15 XLPE Liner Specifications 17 A/Prof Michael J. Neil MBBS, FRCSEd(Orth), FRACS, FAOrthA Dr Craig Waller MBBS, FRACS, FRCS(Ed) Dr Simon Coffey MBBS (Hons), FRACS (Orth), FAOA A/Prof Rami Sorial MBBS (Hons), FAOrthA, FRACS Surgical Technique 1

4 Introduction The Global Cup System is a cementless, press-fit, primary acetabular cup that is to be used in conjunction with a compatible femoral head and femoral stem component. There are two primary cup options; a 3-hole and a multi-hole cup. The 3-hole acetabular cup includes threaded sector screw holes and a threaded dome hole for accurate insertion and placement of the implant into the acetabulum. The multi-hole cup has an array of 6-12 non-threaded screw holes and a threaded dome hole. The Global Cup System utilises a hemispherical outer profile to the equator and a taper profile between the equator and the top face. On the inside of the cup a female taper is designed to engage multiple liner options, while a circumferential locking groove and anti-rotation feature adds additional locking support for the polyethylene liner. The Global Cup System ranges in size from 44mm to 68mm OD increasing incrementally by 2mm, manufactured from Titanium alloy. The surface finish includes a Titanium coating and a composite coating of plasma sprayed Hydroxyapatite over the Titanium coating to increase osseointegration between the acetabulum and the implant cup. Table 1: Global Cup System Compatibility Table Group Global Cup Size XLPE Insert Neutral XLPE Insert Lipped BIOLOX delta Insert Grey Orange Blue Purple Green Global Cup 3-Hole Global Cup Multi-Hole Global Cup XLPE Neutral Global Cup XLPE Lipped 15 Global Cup BIOLOX delta Figure 1: Global Cup Primary System 2 Global Cup System

5 Pre-operative Planning Suggested Templating Method A pre-operative assessment of the acetabulum is recommended to determine the appropriate size and position of the implant. The templates are provided at 120% and 100% magnification for compatibility with standard radiographs. The Global Cup templates are positioned at 45 degrees and allow measurement for any hip that is suitable for the Global Cup System primary range from 44-68mm. The outline of the cup templates represents the porous coated diameter of the Global Cup. A peripheral dot and horizontal cut-out are located at the edges of the equator for marking, along with the head centres of the largest available head sizes. To start, position the overlay over the A/P radiograph at approximately 45 degrees of abduction against the radiographic teardrop. It is recommended to use a radiographic marker or scale. Determine the hip s centre of rotation. Size the acetabular component using the appropriate templates. If medialising the acetabular cup the native centre of rotation may be slightly different from the centre of rotation for the templated interface porous cup, place a small mark on the radiograph at the centre of rotation of the selected porous cup. The objective is to determine the template that provides the best fit and bony coverage. The largest component that appears suitable is to be chosen. Note: The final component size is to be determined intra-operatively. Templating is for planning purposes only. Figure 2: Global Cup acetabular templating System Surgical Technique 3

6 Surgical Technique Surgical Exposure The approach to the hip is the surgeon s choice; it varies and is influenced to a degree by the pathology present. The Global Cup can be inserted with equal ease using a posterior, posterolateral, anterolateral, straight lateral or transtrochanteric approach. Acetabular Reaming Figure 3: 3: Attach reamer reamer to acetabular to acetabular reamer reamer quick quick connect connect handle. handle Figure 4: 4: Acetabular reaming. Note: The acetabular reamer and Global Cup are True Sizing. For a 52mm Cup ream to 51mm for a 1mm press-fit. The acetabular reamers and definitive cup implants are marked with the true size and measure 180 degrees. For a 52mm cup ream to 51mm for a 1mm press-fit. The acetabular reamers are available from 40mm to 68mm in 1mm increments. Start with a smaller size reamer and progress to the next largest size until exposing bleeding cancellous bone, reaming a continuous surface. Take care to centre the reamer and apply a constant pressure in the recommended final implant orientation of 45 degrees of abduction and 20 degrees of anteversion. 4 Global Cup System

7 Acetabular Cup Trialling Figure 5: Cup trialling. Trial Trial Cup Sizes Group Shell Size Grey Orange Blue Purple Green Trial cups are available to assess the bone quality of the reamed acetabulum and to Trial cups are available to assess the bone quality of the reamed acetabulum determine the appropriate implant size. Trial cups are 1mm undersized from the marked size and (e.g. to determine a 52mm trial the cup appropriate is 51mm in diameter). implant size. Trial cups are 1mm undersized from the marked size (e.g. a 52mm trial cup is 51mm in diameter). While holding the cup impactor screw the trial cup onto the impactor shaft through the threaded hole, until the impactor sleeve has bottomed out and the trial is secure. While holding the cup impactor screw the trial cup onto the impactor shaft Assemble through the alignment threaded guide hole, onto until the the cup impactor sleeve by inserting has bottomed the shaft into out the and the alignment trial is secure. tower on the impactor until you hear a click and the alignment guide does not pull out. The alignment tower can be rotated by loosening the knob and then retightened once in position. Assemble the alignment guide onto the cup impactor by inserting the shaft into the alignment tower on the impactor until you hear a click and the alignment guide does not pull out. The alignment tower can be rotated by loosening the knob and then retightened once in position. Orientate the trial cup in an anatomic position approximately 45 degrees of abduction and 20 degrees of anteversion and impact Orientate the trial cup in an anatomic position the approximately handle with a mallet. 45 degrees Verify that of abduction the trial has properly and 20 seated degrees by of sighting anteversion through and the cut-outs impact in the trial handle confirm with a fit. mallet. Verify that the trial has properly seated by sighting Note: The trial cup is not to be used with the trial liners. through the cut-outs in the trial and confirm fit. Note: The trial cup is not to be used with the trial liners. Figure Figure 6: 6: Adjusting alignment tower. Surgical Technique 5

8 Acetabular Cup Insertion Both the 3-Hole and Multi-Hole primary cups can be implanted using the same surgical technique. Figure 7: Thread cup cup onto onto impactor. impactor Figure 8: 8: Orientate the the cup cup into into the the anatomical position. Secure the cup implant onto the cup impactor by threading the shaft of the impactor into the apical hole of the cup. Ensure that the impaction sleeve is flush with the internal radius of the cup. Take care when threading the cup onto the impactor as excessive force may cause damage to the thread. Orientate the cup in the acetabulum using the alignment guide and bony landmarks. Confirm the placement of the cup and impact the implant into position. Additional impaction may be required, confirm proper seating by sighting through the apical hole. The required impaction force is dictated by the quality of the bone. Take care when repositioning the cup, do not lever on the impactor or cup as this may cause damage to the internal diameter of the cup and threads. Figure 9: Cup insertion Acetabular Cup Screw Placement & Fixation The Global Cup 3-Hole is packaged with pre-installed screw-hole covers which can be removed when additional screw fixation is required. The Global Cup Multi-Hole does not utilize screw-hole covers. Figure 10: Removal of screw-hole covers from the Global Cup. Figure 10: Removal of screw-hole covers from the Global Cup To remove the screw-hole covers from the acetabular cup, attach the 3.5mm hex screwdriver shaft to the ratchet handle. Unscrew the appropriate screw-hole cover as needed. 6 Global Cup System

9 Safe Quadrant Figure 11: Recommended placement of the bone screw Figure 12: Acetabular screw-hole preparation To prepare the bone screw for insertion, drill a pilot hole using the drill guide, 3.2mm drill and flexible drill shaft. The 3.2mm diameter drill is available in a length of 50mm and 70mm. Ensure that the drill guide is fully inserted into the screw-hole. Approximately 15 degrees of range of motion is available with the drill guide and bone screws (Figure 14). Ensure that the screw lies within the safe quadrant, refer to Figure 11 (Wasielewski et al., 1990). Figure 13: Verify screw-hole depth Figure 14: Global Cup 6.5mm cancellous bone screw Verify the depth of the screw-hole using the depth gauge. Select the appropriate length Global Cup 6.5mm cancellous bone screw and while holding the bone screw with the screw forceps use the 3.5mm hex universal joint screwdriver shaft with ratchet handle to insert the bone screw into the acetabulum. Surgical Technique 7

10 During insertion evaluate the quality of the bone when tightening. After tightening verify that the screw head is below the inner diameter of the cup, incorrect placement can prevent the liner from seating properly in the acetabular cup. Figure 15: Bone screw insertion (left), verify proper seating after insertion (right) Acetabular Cup Trial Liner Evaluation Provisional acetabular liners are available to trial in the definitive cup implant. The trial liners are not to be used in conjunction with the trial cups as final seating of the cup implant may vary. The trial liners are available in neutral and lipped in the sizes listed in Table 2. Table 2: Trial Liner Size Availability Global Cup Trial Liner Neutral Global Cup Trial Liner Lipped Group Head Size Group Head Size Grey 28mm Grey 28mm Orange 28mm 32mm 32mm Orange 32mm Blue 32mm 36mm Blue 36mm Purple 36mm 40mm Purple 36mm Green 36mm 40mm Green 36mm Remove any debris from inside of the cup before inserting the trial liner. Insert the trial into the cup implant by hand. Thread the trial liner into the dome hole of the cup implant using a 3.5mm hex driver shaft and ratchet handle until the trial liner bottoms out on the internal cup radius. The liner should be flush with the top surface of the cup implant. Assess the cup implant stability, position and range of motion with the femoral components. Once the appropriate liner selection has been made, remove the trial liner. Note: Do not impact the trial liner as damage may occur. Figure Figure 16: 16: Trial Trial Liner liner insertion. 8 Global Cup System

11 Acetabular Cup Dome Hole Cover Insertion Figure 17: Dome-hole cover insertion. Upon completion of of the the trial trial evaluation, evaluation, insert the insert dome-hole the dome-hole cover into the cover into threaded the threaded dome hole dome of the hole cup implant of the using cup implant the 3.5mm using hex screwdriver the 3.5mm shaft hex and ratchet handle. Use care to ensure that the dome-hole cover is not over screwdriver shaft and ratchet handle. Use care to ensure that the tightened and that the dome hole is below the internal radius of the cup. dome-hole cover is not over tightened and that the dome hole is below the internal radius of the cup. Acetabular Cup Liner Insertion Acetabular Cup Liner Insertion Prior to inserting the acetabular liner into the cup implant, ensure that the internal surfaces of the cup implant are free from any debris and are cleaned Prior to inserting the acetabular liner into the cup implant, ensure that and dried. Inspect the internal taper of the cup implant and check that all the screw-hole internal covers, surfaces dome-hole of the cover cup implant and screw are heads free are from not protruding any debris into and are the cleaned internal radius. and dried. It is important Inspect to the ensure internal that the taper locking of groove the cup and implant the entire internal surface of the cup implant is free from debris. and check that all screw-hole covers, dome-hole cover and screw heads are not protruding into the internal radius. It is important to ensure that the locking groove and the entire internal surface of the cup implant is free from debris. Poly Liner Insertion: Figure Figure 18: Depress 18: Depress the the suction cup into the poly liner liner. Note: Do not impact the liner inserter instrument. Figure 20: 20: Poly liner insertion. Figure 19: Place poly liner into the acetabulum. Figure 19: Place poly liner into the acetabulum Place the polyethylene liner into the acetabular cup either by hand or with the liner inserter instrument. If using the liner inserter, engage the liner by depressing the suction cup into the liner. Water or saline may be used to lubricate the suction cup for assistance with assembly and dis-assembly. Remove the liner inserter suction cup by placing one hand on the liner rim and cup face and pulling up on the suction cup. Select the appropriate liner impactor adapter that corresponds with the implant liner head size. There are four available liner impactor adapters: 28mm, 32mm, 36mm and 40mm. Surgical Technique 9

12 Figure 21: Assembly of of the the polyethylene liner liner and and cup implants. cup implants Before liner impaction, the polyethylene liner will extend above the top face of the cup implant. Thread the selected liner impactor adapter onto the liner impactor instrument. Place the impactor adapter into the liner and impact until the liner is fully seated. Take care to align the impacter and impact the liner directly into the cup. Before liner impaction, the polyethylene liner will extend above the top face of the cup implant. Thread the selected liner impactor adapter onto the liner impactor instrument. Place the impactor adapter into the liner and impact until the liner is fully seated. Take care to align the impacter and impact the liner directly into the cup. Figure 22: Poly liner impaction. Figure 22: Poly liner impaction Verify that the liner is fully seated and that the rim is flush with the top face of the cup by running a finger around the top surface. Additional impactions may be required if the liner has not fully seated. Verify that the liner is fully seated and that the rim is flush with the top face of the cup by running a finger around the top surface. Additional impactions may be required if the liner has not fully seated. 10 Global Cup System

13 Ceramic Liner Insertion: Place the ceramic liner into the acetabular cup either by hand or with the liner inserter instrument. If using the liner inserter, engage the liner by depressing the suction cup into the liner. Water or saline may be used to lubricate the suction cup for assistance with assembly and dis-assembly. Remove the liner inserter suction cup by placing one hand on the liner rim and cup face and pulling up on the suction cup. Place the ceramic liner into the acetabular cup either by hand or with the liner inserter instrument. If using the liner inserter, engage the liner by depressing the suction cup into the liner. Water or saline may be used to lubricate the suction cup for assistance with assembly and dis-assembly. Remove the liner inserter suction cup by placing one hand on the liner rim and cup face and pulling up on the suction cup. Note: Do not impact the liner inserter instrument. Figure 23: Ceramic liner insertion. Select the the appropriate liner impactor liner impactor adapter that adapter corresponds that corresponds with the implant with liner the head implant size. There liner are head four available size. There liner are four impactor available adapters: liner impactor 28mm, 32mm, adapters: 36mm 28mm, and 40mm. 32mm, Before 36mm liner impaction, and 40mm. verify Before that the liner ceramic impaction, liner is uniformily verify that seated the relative ceramic to the top face of the cup implant. Eccentric placement may cause improper seating and subsequent ceramic fracture. liner is uniformily seated relative to the top face of the cup implant. Eccentric placement may cause improper seating and subsequent ceramic fracture. Figure 24: Ceramic liner impaction. Thread the selected liner impactor adapter onto the liner impactor instrument. Place the impactor adapter into the liner and firmly Thread the selected liner impactor adapter onto the liner impactor instrument. Place the impactor adapter into the strike with a mallet once to fully seat the liner. Verify that the liner is properly seated and flush with the top face of the cup. liner and firmly strike with a mallet once to fully seat the liner. Verify that the liner is properly seated and flush with the top face of the cup. Surgical Technique 11

14 Final Assessment A final assessment should be completed to verify correct placement of the implant components. Assess range of A final assessment should be completed to verify correct placement of the implant components. Assess range of motion, hip motion, hip stability and leg length. stability and leg length. Acetabular Cup Cup Liner Liner Removal Removal Should it become necessary to remove a liner from the acetabular cup, care should be taken not to damage the Should it become necessary to remove a liner from the acetabular cup, care should be taken not to damage the cup. cup. Ceramic Liner Liner Removal: Removal To remove the ceramic liner from the cup implant, To remove the ceramic liner from the cup implant, position position the tip of the the tip liner of remover the liner a remover dimple located in a dimple on the top located face of on the the cup. top Apply face a few of the short cup. mallet Apply blows, a few until short the liner is loosened from the taper. mallet blows, until the liner is loosened from the taper. Note: Once a hard bearing insert has been used with the cup implant, the cup should not be used with another hard Note: bearing Once insert. a hard bearing insert has been used with the cup implant, the cup should not be used with another hard bearing insert. Figure Figure 25: Position 25: 25: Ceramic the liner tip liner of removal. the removal. liner remover in a dimple located on the top face of the cup Poly Liner Removal: To remove the polyethylene liner from the cup implant, drill a hole slightly off centre from the liner apex using the To remove the polyethylene liner from the cup implant, drill a hole slightly off centre from the liner apex using the drill guide and drill guide and 3.2mm drill. Using the screw forceps and a 3.5mm hex screwdriver shaft with ratchet handle, insert a hole cancellous and advance screw the into screw the until pilot the hole liner disengages and advance from the the screw cup. until the liner disengages from the cup. 3.2mm drill. Using the screw forceps and a 3.5mm hex screwdriver shaft with ratchet handle, insert a cancellous screw into the pilot Figure 26: Figure Drill 26: a hole Drill a off hole centre off centre from from the liner the liner apex apex (left) (left) and and advance bone screw into into poly poly liner liner insert insert (right). (right) 12 Global Cup System

15 Implant Catalogue Images included in the catalogue below are representative only, please contact your representative for the most current information Global Cup 3-Hole Porous Coated + HA Catalogue Number Size (mm) GM GM GM GM GM GM GM GM GM GM GM GM GM Global Cup Multi-Hole Porous Coated + HA Catalogue Number Size (mm) GM GM GM GM GM GM GM GM GM GM GM GM GM Global Cup XLPE Liner Neutral Catalogue Number Head Size Shell Size (mm) (mm) GM GM GM GM GM GM GM GM GM GM Surgical Technique 13

16 Global Cup XLPE Liner Lipped Global Cup Ceramic Liner Catalogue Number Head Size (mm) Shell Size (mm) GM GM GM GM GM GM GM GM Catalogue Number Head Size (mm) Shell Size (mm) GM GM GM GM GM GM GM Global Cup Bone Screw Catalogue Number Size (mm) GM GM GM GM GM GM GM GM Global Cup Dome Hole Cover Catalogue Number Size (mm) GM Global Cup Screw Hole Cover Catalogue Number Size (mm) GM Global Cup System

17 Instrument Catalogue Images included in the catalogue below are representative only, please contact your representative for the most current information Global Cup Instrument Box 1 Catalogue Number Size (mm) GM Global Cup Trial Cup Catalogue Number Size (mm) GM GM GM GM GM GM GM GM GM GM GM GM GM Global Cup Straight Acetabular Cup Impactor Catalogue Number Size (mm) SGM Global Cup Cup Curved Alignment Cup Impactor Guide Catalogue Number Size (mm) GM GM Global Cup Alignment Guide Catalogue Number Size (mm) Global Cup Liner Impactor Catalogue Number Size (mm) GM GM Global Cup Liner Impactor Adapter Catalogue Number Size (mm) Global Cup Liner Impactor Catalogue GM Number Size 28 (mm) GM GM GM Global Cup Liner Impactor Adapter Catalogue GM Number Size 40 (mm) GM GM GM GM Surgical Technique 15

18 Global Cup Liner Inserter Catalogue Number Size (mm) GM Global Cup Instrument Box 2 Catalogue Number Size (mm) GM GM Global Cup Liner Remover Catalogue Number Size (mm) GM Head Size Shell Size Global Cup Trial Liner Neutral Catalogue Number (mm) (mm) GM GM GM GM GM GM GM GM GM GM GM GM GM GM GM GM Head Size Shell Size Global Cup Trial Liner Lipped Catalogue Number (mm) (mm) GM GM GM GM GM GM GM GM GM GM GM GM GM GM GM Global Cup Ratchet Handle Catalogue Number Size (mm) GM Global Cup 3.5mm Hex UJ Driver Shaft Catalogue Number Size (mm) GM Global Cup System

19 Global Cup 3.5mm Hex Driver Shaft Catalogue Number Size (mm) GM Global Cup Flexible Drill Shaft Catalogue Number Size (mm) GM GM or SGM Global Cup Screw Forceps Catalogue Number Size (mm) GM Global Cup Bayonet Drill 3.2mm Catalogue Number Size (mm) GM GM Global Cup Drill Guide 3.2mm Catalogue Number Size (mm) GM Global Cup Depth Gauge Catalogue Number Size (mm) GM XLPE Liner Specifications XLPE Liner Head Size Global Cup Size XLPE Liner thickness (DIM A) XLPE Liner thickness (DIM B) 28mm mm mm mm mm Head Size: 28mm- 40mm 32mm mm mm mm mm mm mm Head Size: 28mm- 36mm 40mm mm References: 1. Wasielewski R, Cooperstein L, Rubash H. Acetabular anatomy and the transacetabular fixation of screws in total hip arthroplasty. J Bone Joint Surg Am. 1990; 72: Surgical Technique 17

20 Global Orthopaedic Technology Unit 10, 7 Meridian Place Norwest Business Park Baulkham Hills NSW 2153 Australia PO Box 7745 Baulkham Hills BC NSW 2153 Australia Toll Free: Phone: Fax: info@globalortho.com.au globalortho.com.au Manufactured by Global Manufacturing Technology Unit 10, 7 Meridian Place Norwest Business Park Baulkham Hills NSW 2153 Australia GM Global Cup Surgical Technique REV 8