HIP Solutions by Tornier MEIJE DUO 12/14 TAPER SURGICAL TECHNIQUE. surgical technique

Transcription

1 HIP Solutions by Tornier MEIJE DUO 12/14 TAPER SURGICAL TECHNIQUE surgical technique

2 MEIJE DUO 12/14 TAPER SURGICAL TECHNIQUE Meije duotm H I P P R O S T H E S I S

3 1. Locating the pelvic horizontal line 2. Choosing the acetabular cup size 3. Selecting the femoral implant 4. Assessing the new center of rotation ContentsT M T O R N I E R M E I J E D U O 1. PREOPERATIVE PLANNING p Approach 2. Cutting the femoral neck 3. Preparing the femur 4. Choosing the neck 5. Placing the final implant 2. SURGICAL TECHNIQUE p MEIJE DUO STANDARD INSTRUMENTATION 1. Box YKAH160, common to both approaches p Box YKAH162, posterior approach 3. Box YKAH161, anterior approach 4. MEIJE DUO MODULAR INSTRUMENTATION 1. POSTERIOR APPROACH p ANTERIOR APPROACH 1. FEMORAL STEMS 5. IMPLANTS p. 18 Meije Duo TM - Surgical Technique - UHMT151 3

4 preoperative planning By evaluating the patient s current anatomy, the appropriate implants can be selected for surgery. Planning is the first stage of the operative strategy. It makes it easier to: select the implants determine implant position, and select the procedures associated with the prosthetic reconstruction. This preparation is performed using a radiological workup (AP pelvis, AP hip x-rays with the femoral neck rotated internally as far as possible), and rigid slotted templates provided by TORNIER. 1. Locating the horizontal line of the pelvis Locate the horizontal pelvic line by joining the two pelvic teardrops (1). (1) 2. Choosing the acetabular cup size Choose the acetabular cup size and its position in terms of height and depth with respect to the acetabulum s inner edge (acetabular cup shown at 45 on the templates) (2). Position the template and mark the center of the prosthetic acetabulum. (2) Meije Duo TM - Surgical Technique - UHMT151 4

5 preoperative planning 3. Choosing the femoral implant Choose the femoral implant based on 3 parameters: (3) fit and fill of the femur potential need for lengthening or shortening need for lateralization 4. Assessing the new center of rotation (3) Assess the position of the new joint center of rotation relative to the top of the greater trochanter. At this stage, the template slots allow the surgeon to record the measured value and locate the implants during surgery using the instrumentation (4). Ensure that the center of rotation of the future femoral head coincides with the center of the reconstructed acetabulum, except in cases where a correction must be made (e.g., position the head center above the cup s center if lengthening is desired; position it outside when the femur is excessively lateralized due to femoral head subluxation caused by posterior acetabular osteophytes). The templates have several landmarks that help with intraoperative verification of the correct stem positioning (subsidence consistent with planning). Relative to top of greater trochanter: the template s horizontal slots are used to identify the level of the head center relative to the greater trochanter; this manipulation can be replicated during the procedure using specialized instrumentation (see below) Relative to the lesser trochanter, by measuring its distance from the resection level By measuring the vertical distance between the upper edge of the shoulder of the prosthetic stem and the superior cortex of the femoral neck These three length checking methods help reduce the risk of error, including when using minimally invasive approaches. (4) Meije Duo TM - Surgical Technique - UHMT151 5

6 surgical technique The surgeon will use the same instrumentation and technique, whatever the implant fixation method used (cemented or cementless). With cementless stems, models with or without a collar can be selected. 1. Approach The Meije duo can be implanted using any hip approach according to the surgeon s experience and practice. Anterior and posterior rasp handles are available. 2. Cutting the femoral neck It is recommended that an oscillating saw (5) be used to cut the femoral neck based on the preoperative planning landmark. (5) Meije Duo TM - Surgical Technique - UHMT151 6

7 surgical technique 3. Preparing the femur To avoid placing the stem in varus, the upper edge of the neck can be hollowed out towards the greater trochanter using a curved chisel, bone forceps, or punch (included in the instrumentation). The metaphyseal cancellous bone can be compacted using the compactor (6). Depending on the approach (aim for solid cortical contact with the final rasp or simply compact the cancellous epiphysis), the medullary canal can be opened using the: starter rasp greater trochanter punch cancellous bone compactor. or or (6) Rasping always begins with the smallest rasp. Progressively larger rasps are then inserted. The surgeon guides the rasp into valgus based on the desired rotation (anteversion) (7). (7) Meije Duo TM - Surgical Technique - UHMT151 7

8 surgical technique The last teeth of the rasp correspond to where the hydroxyapatite meets the polished neck of the final implant. The last teeth of the rasp must be even with the cut. This allows the surgeon to check the implant s depth relative to various bone landmarks (calcar, lesser trochanter, upper edge of neck) (8 et 9). Preoperative planning provides an indication of the size of the rasp to be used, within the margin of error of the x-ray magnification. Good vertical and rotational stability of the rasp is achieved by tapping it lightly with a hammer. A gap of more than two sizes between the planned size and rasp is suspect. For example, the metaphyseal portion may get hung-up prematurely if the greater trochanter was not sufficiently hollowed out. This results in undersizing of the stem and risk of secondary subsidence. Conversely, if a solid fit can only be achieved with a stem two sizes larger, the femur is likely fractured. (8) (9) Remove the rasp holder. If the femur was prepared first, the final rasp stays in the femur. The surgeon can perform the acetabular preparation without being hampered by the rasp (10). If a collared stem will be used, the calcar reamer should be used on the embedded rasp to mark and optimize the collar s stability. The next steps depend on the calcar reamer model being used: 11a Screw the guide to the rasp. Mount the reamer on the surgical handpiece and lower it onto the guide until even with the neck cut. 11b Attach the calcar reamer to the motorized handpiece. Insert the tip of the calcar rasp guide on the rasp. Make sure the guide rests on rasp collar. Push the calcar reamer down until it stops. (10) (11a) (11b) Meije Duo TM - Surgical Technique - UHMT151 8

9 surgical technique The height of the center of the head relative to the top of the greater trochanter can be measured and compared to the measurement taken during preoperative planning: Position the height gauge in the hole designed for this purpose located on the adaptor (12); the height can also be measured using a multineck measuring device (13) (optional, but particularly well-suited to the anterior approach). The hole in the adaptor corresponds to the height of a medium neck. (12) (13) 4. Choosing the neck A neck adaptor is mounted on the rasp for length testing. The adaptors are different colors depending on the rasp size (3 colors for 3 neck lengths) (14). At this stage, the surgeon confirms the choice of the standard or lateralized version by testing with one of the adaptors. Reduction tests can be carried out using the trial implants. After these tests and measurements, the rasp is extracted using the rasp holder. (14) Meije Duo TM - Surgical Technique - UHMT151 9

10 surgical technique 5. Placing the final implant The size of the final implant will be the same as the size of the last rasp. The stem must be slowly and gently inserted into the intramedullary canal, guiding it so that it follows the rasp s path (particularly with respect to rotation). The implant is placed manually for the first few centimeters. After that, one of the two available impactors is used. The tip of the impactor is placed in the hole on the top of the stem (15 or 16). The stem is impacted with light hammer taps and is firmly lodged at the same level as the trial rasp. This level corresponds to the boundary between the HAP coating and the mirror-polished neck. If the difference in depth is more than 3 mm, the reason should be determined (excessive varus, curved femur, champagnefluted femur, etc.). With cemented prostheses, a cement restrictor is inserted in the intramedullary canal which is then carefully cleaned by pulsed lavage and then dried. Cementing is done by retrograde filling to ensure homogeneous distribution. The same precautions should be taken when placing the implant. The surgeon should watch for varus during the cementing phase. The implant size corresponds to the last rasp size. (15) (16) After the stem s taper is carefully cleaned and dried, the final head is placed on it using the clamp provided for this purpose and then impacted (17). The metal head is impacted using the head impactor. The ceramic head is set in place using a twisting motion, and then impacted along the neck axis using the head impactor (18). This technique reduces the risk of breakage. The joint can now be reduced. (17) (18) Meije Duo TM - Surgical Technique - UHMT151 10

11 standard instrumentation Box YKAH160, instruments common to both approaches Stem impactor MLP300 Stem holder impactor MLP301 Head impactor MLP302 Calcar reamer MLP303A Calcar reamer guide MLP304 Balhead holder MLP305 Trial heads Metal Ceramic Ø 22,2-2 MLP MLP MLP544 Ø 28-5 MLP561 +3,5 MLP MLP MLP562-3,5 MLP MLP MZC286 Ø 32-4 MLP MLP MLP578 Ø 36-4 MLP MLP MLP582 Trochanter cutter Cancellous bone compaction item MLP313 MLP314 Allen Key, 3.5 mm MLP311 First thin rasp file MLP312 Stem height gage MLP332 Meije Duo TM - Surgical Technique - UHMT151 11

12 standard instrumentation 2. Box YKAH162, posterior approach Grooved trial rasp n 1 MLP321 n 2 MLP322 n 3 MLP323 n 4 MLP324 n 5 MLP325 n 6 MLP326 n 7 MLP327 n 8 MLP328 n 9 MLP329 n 10* MLP330 Rasp impactor MLP308 (x 2) * Option must be specified. Available on demand and delivered separately Adaptor STD 12/14 For rasps For rasps For rasps MLP700 MLP702 MLP704 Adaptor LAT 12/14 For rasps MLP701 For rasps MLP703 For rasps MLP705 Meije Duo TM - Surgical Technique - UHMT151 12

13 standard instrumentation 3. Box YKAH161, anterior approach Grooved trial rasp n 1 MLP321 n 2 MLP322 Rasp-holder impactor MLP309 (x 2) n 3 MLP323 n 4 MLP324 n 5 MLP325 n 6 MLP326 n 7 MLP327 n 8 MLP328 n 9 MLP329 n 10* MLP330 * Option must be specified. Available on demand and delivered separately Adaptor STD 12/14 For rasps For rasps For rasps MLP700 MLP702 MLP704 Adaptor LAT 12/14 For rasps MLP701 For rasps MLP703 For rasps MLP705 Meije Duo TM - Surgical Technique - UHMT151 13

14 modular instrumentation 1. POSTERIOR APPROACH Lower tray YKAH190 Lower common tray MLP300 Stem Impactor MLP301 Stem Holder Impactor MLP332 Stem height gauge MLP321 Trial rasp no. 1 MLP322 Trial rasp no. 2 MLP323 Trial rasp no. 3 MLP324 Trial rasp no. 4 MLP325 Trial rasp no. 5 MLP326 Trial rasp no. 6 MLP327 Trial rasp no. 7 MLP328 Trial rasp no. 8 MLP329 Trial rasp no. 9 MLP330* Trial rasp no. 10 MLP700 12/14 Std tip for rasp no MLP702 12/14 Std tip for rasp no MLP704 12/14 Std tip for rasp no * In option, must be specified - available upon request and delivered separately NBR005 YRAH190 Container (height 140 mm) Tray YKAH200 MLP701 12/14 Lat tip for rasp Nr MLP703 12/14 Lat tip for rasp Nr MLP705 12/14 Lat tip for rasp Nr YRAH200 Tray YKAH201 Trochanter cutter module MLP313 Trochanter cutter YRAH201 Tray YKAH199 Calcar reamer MLP303A Calcar reamer MLP304A Calcar reamer guide YRAH199 Tray Meije Duo TM - Surgical Technique - UHMT151 14

15 modular instrumentation Upper tray YKAH193 Starter rasp module MLP312 Posterior approach first thin rasp YRAH193 Tray YKAH191 Posterior approach rasp impactors module MLP308 Posterior approach rasp impactor YRAH291 Tray YKAH195 Trial heads module MLP541 12/14 trial head Ø22,2-2 MLP542 12/14 trial head Ø22,2 +0 MLP544 12/14 trial head Ø22,2 +3 MLP561 12/14 trial ballhead Ø28-5 MLP566 12/14 ceramic head trial Ø28-3,5 MLP562 12/14 trial head Ø28 +0 MLP567 12/14 ceramic head trial Ø28 +3,5 MLP563 12/14 trial head Ø28 +5 MZC286 12/14 trial head Ø28 +8* MLP576 12/14 ceramic head trial Ø32-4 MLP572 12/14 ceramic head trial Ø32 +0 MLP578 12/14 ceramic head trial Ø32 +4 MLP580 12/14 ceramic head trial Ø36-4 MLP581 12/14 ceramic head trial Ø36 +0 MLP582 12/14 ceramic head trial Ø36 +4 MLP600 Ø22.2 and 28 head impactor tip MLP605 Ø32 and 36 head impactor tip *optional upon request Meije Duo TM - Surgical Technique - UHMT151 15

16 modular instrumentation 2. ANTERIOR APPROACH Lower tray YKAH190 Lower common tray MLP300 Stem Impactor MLP301 Stem Holder Impactor MLP332 Stem height gauge MLP321 Trial rasp Nr 1 MLP322 Trial rasp Nr 2 MLP323 Trial rasp Nr 3 MLP324 Trial rasp Nr 4 MLP325 Trial rasp Nr 5 MLP326 Trial rasp Nr 6 MLP327 Trial rasp Nr 7 MLP328 Trial rasp Nr 8 MLP329 Trial rasp Nr 9 MLP330* Trial rasp Nr 10 * In option, must be specified - available upon request and delivered separately YKAH200 MLP701 12/14 Lat tip for rasp Nr MLP703 12/14 Lat tip for rasp Nr MLP705 12/14 Lat tip for rasp Nr YRAH200 Tray YKAH201 Trochanter cutter module MLP313 Trochanter cutter YRAH201 Tray MLP700 12/14 Std tip for rasp Nr MLP702 12/14 Std tip for rasp Nr MLP704 12/14 Std tip for rasp Nr NBR005 Container (height 140 mm) YRAH190 Tray YKAH199 Calcar reamer MLP303A Calcar reamer MLP304A Calcar rasp guide YRAH199 Tray Meije Duo TM - Surgical Technique - UHMT151 16

17 modular instrumentation Upper tray YKAH192 Anterior approach rasp impactors module MLP309 Anterior approach rasp impactor YRAH292 Tray YKAH195 Trial heads module MLP541 12/14 trial head Ø22,2-2 MLP542 12/14 trial head Ø22,2 +0 MLP544 12/14 trial head Ø22,2 +3 MLP561 12/14 trial ballhead Ø28-5 MLP566 12/14 ceramic head trial Ø28-3,5 MLP562 12/14 trial head Ø28 +0 MLP567 12/14 ceramic head trial Ø28 +3,5 MLP563 12/14 trial head Ø28 +5 MLP564 12/14 trial head dia * MLP576 12/14 ceramic head trial Ø32-4 MLP572 12/14 ceramic head trial Ø32 +0 MLP578 12/14 ceramic head trial Ø32 +4 MLP580 12/14 ceramic head trial Ø36-4 MLP581 12/14 ceramic head trial Ø36 +0 MLP582 12/14 ceramic head trial Ø36 +4 MLP600 Ø22.2 and 28 head impactor tip MLP605 Ø32 and 36 head impactor tip *optional upon request Meije Duo TM - Surgical Technique - UHMT151 17

18 implants Standard cementless stems, Titanium + HA (130 neck shaft angle) Without collar With collar Reference Size Reference Size HLP411 N 1 HLP421 N 1 HLP412 N 2 HLP422 N 2 HLP413 N 3 HLP423 N 3 HLP414 N 4 HLP424 N 4 HLP415 N 5 HLP425 N 5 HLP416 N 6 HLP426 N 6 HLP417 N 7 HLP427 N 7 HLP418 N 8 HLP428 N 8 HLP419 N 9 HLP429 N 9 HLP430 N 10* Lateralized cementless stems, Titanium + HA (123 neck shaft angle) Without collar With collar Reference Size Reference Size HLP441 N 1 HLP401 N 1 HLP442 N 2 HLP402 N 2 HLP443 N 3 HLP403 N 3 HLP444 N 4 HLP404 N 4 HLP445 N 5 HLP405 N 5 HLP446 N 6 HLP406 N 6 HLP447 N 7 HLP407 N 7 HLP448 N 8 HLP408 N 8 HLP449 N 9 HLP409 N 9 HLP410 N 10* * Option must be specified. Available on demand and delivered separately Standard cemented stems Without collar Reference Size HLP431 N 1 HLP432 N 2 HLP433 N 3 HLP434 N 4 HLP435 N 5 HLP436 N 6 HLP437 N 7 HLP438 N 8 HLP439 N 9 Lateralized cemented stems Without collar Reference Size HLP451 N 1 HLP452 N 2 HLP453 N 3 HLP454 N 4 HLP455 N 5 HLP456 N 6 HLP457 N 7 HLP458 N 8 HLP459 N 9 Femoral Heads Ø Short Medium Long Extra-long Metal CoCr * Option Biolox delta Ceramic 22,2-2 HZC231 0 HZC HZC HZC281 0 HZC HZC283 +8* HZC HZC321 0 HZC HZC323 +8* HZC HZC341 0 HZC HZC343 +8* HZC ,5 HZL020 0 HZL021 +3,5 HZL HZL023 0 HZL HZL HZL026 0 HZL HZL Meije Duo TM - Surgical Technique - UHMT151 18

19 Meije Duo TM - Surgical Technique - UHMT notes

20 US HEADQUARTERS Tornier, Inc Nesbitt Avenue South Bloomington, MN USA INTERNATIONAL HEADQUARTERS MANUFACTURER Tornier SAS 161 rue Lavoisier Montbonnot Saint Martin FRANCE +33 (0) Prior to using any Tornier device, please review the instructions for use and surgical technique for a complete listing of indications, contraindications, warnings, precautions, potential adverse events, and directions for use Tornier. All rights reserved. Meije Duo, Tornier and are trademarks or registered trademarks of Tornier in the U.S. and other countries CE marking is only valid if it is also mentioned on the external package labeling Meije duo TM - Surgical Technique - UHMT151