adept hip resurfacing system - matortho€¦ · operative technique delivering results through....

Operative Technique

Delivering Results Through Performance

ADEPT®

Hip Resurfacing System

Con

tent

s 3

4

5

9

14

24

26

32

35

39

45

Section 1 | Preoperative Planning and Surgical Approach

Section 2 | Assessment of Head Size

Section 3 | Preparing the Acetabulum

Section 4 | Cup Implantation

Section 5 | Preparing the Femoral Head | Medial Referencing Instruments

Section 6 | Resurfacing Head Implantation

Appendix A | Medial Referencing Instrument | Alternative Top Cut Method

Appendix B | Alternative Drilling Method

Appendix C | Preparing the Femoral Head | Lateral Referencing Instruments

Appendix D | Instrument Assembly / Disassembly Instructions

Appendix E | Instrument Inventory

Appendix F | Implant Sizing Chart

Manufactured by MatOrtho Limited

19/20 Mole Business Park | Randalls Road | Leatherhead | Surrey | KT22 7BA | United

Kingdom T: +44 (0)1372 224 200 | [email protected]

For more information visit: www.MatOrtho.com

© MatOrtho Limited 2019All 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

50

ADEPT® Hip Resurfacing System | Operative Technique | 3

section 1 | Pre-Operative Planning and Surgical A

pproach

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 1.5-2.5 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.

1.5cm-2.5cm

10090

8070

6050

4030

2010

0mm

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.


sect

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2 | A

sses

smen

t of H

ead

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


section 3 | Preparing the Acetabulum

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.

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section 3 | Preparing the Acetabulum

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.

Size (-1 mm) Size


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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.


section 4 | Cup Im

plantation

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.


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ion

4 | C

up Im

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tati

on

Set required abduction angle by loosening ratchet screw, setting required angle and tightening with Knob Tightener.

Note: 35° abduction angle is recommended

Set required anteversion angle and hand tighten the thumb screw HAND TIGHT only.

Note: A 20° anteversion angle is recommended

Insert the Alignment Rod into the correct set of holes for either the left or right hip as indicated.


section 4 | Cup Im

plantation

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.


sect

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4 | C

up Im

plan

tati

on 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.

ADEPT® Hip Resurfacing System | Operative Technique| 13

section 4 | Cup Im

plantation

Step 12

Assemble Cap Remover

Screw either the Standard or Flexible Modular Cap Removal Tool onto the Straight Handle and tighten fully.

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.

3

2

1

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.


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Preparing the Femoral Head

| Medial Referencing Instruments


Section 5 | Preparing the Femoral H

ead | Medial Referencing Instrum

ents

Step 1

Assemble Medial Referencing Jig

Assemble the selected Medial Referencing Jig Ring onto the Jig as shown. When the screw thread is semi-engaged, 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.

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.

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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.


135˚

135°

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.




ents

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.


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2

1

3

Step 5

Remove Jig

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.




ents

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.

Step 8

Insert Guide Rod

Insert the Guide Rod up to the depth stop.


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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.




ents

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


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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).

Step 14

Prepare for Cement

Drill several equidistant key holes perpendicular to the chamfer using a Ø4.5 drill as detailed above.

For C

annula

For

Key

Hol

es




entsStep 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).

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.

For

Can

nula

For K

ey Holes


Sect

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6 | R

esur

faci

ng H

ead

Impl

anta

tion 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.

ADEPT® Hip Resurfacing System | Operative Technique| 25

Section 6 | Resurfacing Head Im

plantation

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.

Step 22

Close Wound

Follow the preferred procedure to reattach muscular structures and suture the fat layers and skin, inserting a drain if required.


Appe

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A |

Med

ial R

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d

Appendix AMedial

Referencing Instrument

| Alternative Top Cut Method


Appendix A | Medial Referencing Instrum

ent | Alternative Top C

ut Method

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.


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ial R

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2

1

3

Step A3

Remove Jig

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.




ut Method

Step A4

(Guide Wire Method)


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.


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Step A6

Complete Top Cut

Complete the top cut with the Guide Wire or Guide Rod removed.

Step A7

Insert Guide Rod


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.




ut Method

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.


Appe

ndix

B |

Alt

erna

tive

Dri

lling

Met

hod

Appendix B Alternative

Drilling Method


Appendix B | Alternative D

rilling Method

Step B1

Follow Steps 1-6, pages 15-17, having assembled the Medial Referencing Jig with the large bore Spiked Drill Tube (Part Number 270-732).

Using the Non Cannulated Drill to the depth indicated for the chosen head.

Step B2

Remove Jig

First remove the drill, then the spiked tube, then unlock the ring and remove the jig.


Appe

ndix

B |

Alt

erna

tive

Dri

lling

Met

hod Step B3

Insert Guide Rod


Step B4


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.



Appendix C | Preparing the Fem

oral Head | Lateral Referencing Instrum

ents

Appendix C Preparing the Femoral Head

| Lateral Referencing Instruments


Appe

ndix

C |

Pre

pari

ng th

e Fe

mor

al H

ead

| Lat

eral

Ref

eren

cing

Inst

rum

ents

°

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.


Appendix C | Preparing the Fem

oral Head | Lateral Referencing Instrum

ents

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.


Appe

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ater

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efer

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men

ts 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.



Appendix D | Instrum

ent Assem

bly / Disassem

bly Instructions

Appendix D Instrument Assembly /

Disassembly Instructions


Appe

ndix

D |

Inst

rum

ent A

ssem

bly

/ Dis

asse

mbl

y In

stru

ctio

ns

Cup Introducer271014

Cup Latch - UNLOCKED

UNLOCKED

Cup Latch - LOCKED

LOCKED



ent Assem

bly / Disassem

bly Instructions

FIXED GONIOMETERS

271770

271772

271771

130

135

140

Lateral Referencing Jig271764

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.

Inside Tray Lid


Appe

ndix

D |

Inst

rum

ent A

ssem

bly

/ Dis

asse

mbl

y In

stru

ctio

ns

Medial Referencing Jig271774

Lateral Referencing Jig

Stylus Assembly271765



ent Assem

bly / Disassem

bly Instructions

Slotted Top Cutting Guide270209

4.5Ø mm Drill Exploded View271216


Appe

ndix

D |

Inst

rum

ent A

ssem

bly

/ Dis

asse

mbl

y In

stru

ctio

ns

Cup Alignment Aerial Exploded View



Appendix EInstrument

Inventory


Appe

ndix

E |

Inst

rum

ent

Inve

ntor

y Part No. Qty Description

271965 Acetabular Cup Core Instrument Set

231133 1 Slide Hammer

268001 1 Impaction Cap Punch

270006 1 Modular Cap Remover

270019 1 Knob Tightener

270468 1 Guide Rod Extractor

271014 1 Cup Introducer (curved)

271115 1 Hip Slider

271117 1 Alignment Aerial Location Clamp

271118 1 Alignment Aerial Adjustable Arm

271119 1 Aerial Alignment Rod

271420 1 Head Impactor Handle

271421 1 Impaction Head

271866 1 Tray for Acetabular Cup Instruments

299033 2 No. 8 Screw

299034 1 Ratchet Locking Screw

Part No. Qty Description

271966 Acetabular Cup Trials

270253 1 Cup Trial 54mm









271112 1 Acetabular Trial Handle (curved)

271114 1 Acetabular Trial Handle (straight)

271200 1 Scissors

271201 2 Retractor Nail

1 900g Hammer

271867 1 Tray for Acetabular Cup Trials


271967 Universal Acetabular Reamer Set

1 Acetabular Reamer MPRO 38mm





























2 EZ Clean Reamer Handle Zimmer-Hall Fitting

271868 1 Tray for Universal Reamers




271968 Resurfacing Head Core Instrument Set

270410 1 Head Cutter Drive

270460 5 Guide Wire

270466 1 Guide Post

270704 1 Femoral Head Slot Cutting Guide

271204 1 Drainage Cannula

271216 2 4.5Ø Drill

271218 2 Safety Sleeve for 4.5Ø Drill

271462 1 Cannulated Stem Drill

271466 1 Short Guide Post

271562 1 Short Cannulated Stem Drill

271765 1 Head/Neck Stylus

271766 1 Head/Neck Template 48 - 58mm

271776 1 Stylus Guide Wire Adapter

271869 1 Tray for Resurfacing Head Core Instruments


271969 Resurfacing Head Reamers

270248 1 Top Cutting Guide 48mm






270448 1 Cylinder Cutter 48mm






270548 1 Chamfer Cutter 48mm






271863 1 Tray for Resurfacing Head Reamers

299008 2 No. 3 Screw


Appe

ndix

E |

Inst

rum

ent I

nven

tory


270980 ADEPT® Resurfacing Head Trials

270305 1 ADEPT® Resurfacing Head Trial 48mm






270865 1 Tray for Resurfacing Head Trials


271983 Medial Referencing Jig Instrument Set

270209 1 Slotted Top Cutting Guide

270210 1 Closed Top Cutting Guide

270731 1 Spiked Guide Wire Tube

270732 1 Spiked Drill Tube

270763 1 Spacer

270879 1 Medial Referencing Jig Ring 48mm






271463 1 Non Cannulated Stem Drill

271770 1 130° Fixed Goniometer



271774 1 Medial Referencing Jig

271775 1 External Alignment Guide

271857 1 Tray for Medial Referencing Jig

299005 2 No. 1 Screw

299026 1 No. 2 Screw


270949 ADEPT® Resurfacing X-ray Template

299300 Cup Positioning X-ray Template


271963 Lateral Referencing Jig Instrument Set

271858 1 Tray for Lateral Referencing Jig

270203 3 Lateral Pin

271764 1 Lateral Referencing Jig

271773 1 Spiked Tube

299005 1 No. 1 Screw



Part No. Description

172545 ADEPT® Metal On Metal Cup 54mm with 48mm bore












Part No. Description

181148 ADEPT® Metal on Metal Resurfacing Head 48mm






Appe

ndix

F |

Impl

ant S

izin

g C

hart


48 54 56

ADEPT ®Resurfacing Head

ADEPT ® Metal-on-Metal Cup

ADEPT ®Extra Fixation Cup

ADEPT ®Extra Fixation Screw

(length, mm)

50 5856 58

52 58 60

54 6260 62

56 62 64

58 6664 66

16202428323640444852566064687276808488


Notes

adept hip resurfacing system - matortho€¦ · operative technique delivering results through....

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