Exeter™ Contemporary™

Flanged Cup

Exeter™

ProvidingSolutions

Design Benefits

Even Cement Mantle

Four polymethylmethacrylate(PMMA) cement spacers areattached to the cup to maintaina minimum thickness of cementmantle 1, 2. The risk of bottomingout is reduced (Fig. 1). The cuphas a flat non-hooded face.

Clinical Experience

The external profile of theContemporary flanged cup,including its cement spacers,has been in use since 19913.

Pressurisation

The flange thickness allows for an adequate balance offlexibility versus stiffness, tocontain the cement while efficiently pressurising it 4, 5.

Some different flange shapes,because their posterior aspectis inclined in the oppositedirection, can lead to either:-

• inefficient cementpressurisation

or

• cup retroversion by trying to close the posterior gap

Trimming Reference

Four circular lines areincorporated into the implantflange to be used as trimming references.

1

O.D.: Outer diameter including cement spacer

O.D. (2 or 3 mm cement mantle according to cup size)

O.D. + 4 (5 mm cement mantle)

O.D. +14 (10 mm cement mantle)

O.D. +24 (15 mm cement mantle)

Fig. 1

2

Selection of Implant size:

The acetabular cup size refers to the outer diameter of thecement spacers and thereforeincludes a 3 mm cementmantle.

Flange Trimming

The flange of the cup hasreference lines corresponding to 2 or 3 mm, 5 mm, 10 mmand 15 mm of cement mantle.The lines are also marked toshow the diameter of the flange.They may be used to trim theflange to the acetabulum size.

Flexibility

A trimming aid is provided forthe surgeons who prefer to use a template.

Cup Introducer:

The lateral cup introducerpresents the cup at 45 degreesinclination and neutral version.

45° 90°

Acetabular reamers are thenused to remove articularcartilage and, where possible,subchondral bone. Cancelloussurface should be exposedwherever possible with theexception of the true medialwall. Reamers should be used at2mm increments ensuring thatthe anterior and posterior wallsare not over reamed.

Pre-Operative PlanningPre-operative templating willusually allow the surgeon toselect the implant sizesappropriate for the hip to bereconstructed and to plan theposition in which the cupshould be placed.

Acetabular preparation:

The true acetabulum should beidentified. In complex cases theposition of the transverseacetabular ligament is useful inestablishing the position of thetrue acetabulum.

Peripheral osteophytes shouldbe removed. The true floor ofthe socket should be identifiedby removing any curtainosteophyte using either reamersor gouges.

3

Surgical Protocol

4

Multiple fixation pits are madeusing the acetabular step drill,smaller drill holes are madearound the rim of theacetabulum using the distal endof the step drill. Care should betaken not to perforate the innertable of the acetabulum. Thewall is thinnest medially andanteriorly. If the cortex isbreached, then bone graftshould be used to fill the hole.

A cup size 2 mm smaller thanthe acetabular reamer is usuallyappropriate. A trial cup isplaced on the introducer andinserted into the preparedacetabulum in a position of 45˚abduction and approximately20-30˚ of flexion as indicated bythe acetabular introducer in thecorrect position. There shouldbe a small space around the trialsocket for the flange.

The trial flange, like the implantflange, is marked withcalibrations indicating thediameter of the flange and alsothe thickness of cement that willbe established around the cup ifthe flange is trimmed to thecalibration mark. In most casesthe flange is trimmed to thediameter of the largest reamerused. The lateral portion of theflange may be cut to a slightlylarger diameter.

The trial flange is now placedon the trial cup and bothapplied on to the introducer.The window on the trial flangeshould allow the posterior‘marking’ on the trial cup to beread. The trial flange is nowtrimmed with scissors to fit the size and shape of theacetabulum.

5

Final minor modifications maybe made at this point. It isimportant to rehearse cupinsertion so that the trimmedflange positions the socket in anappropriate location with theedges of the flange lying justwithin the mouth of theacetabulum. The inferior edgeof the socket should lie at thelevel of the transverse ligament.

Once trimming of the trialflange is complete, it is placedover the implant and theimplant flange is then trimmedto match using scissors.

Avoid contact of the spacersagainst any surface duringpreparation of the socket as it ispossible to detach them. Ifdetached, the spacers can easilybe reapplied.

6

If using Simplex® bone cementit should be mixed for 1 minute,left to stand for 2 minutes andinserted into the cavity between3-4 minutes after mixing. Abolus of cement should be leftin the acetabulum such that itssurface is fractionally below thelevel of the mouth of theacetabulum. The acetabularpressuriser may then be applied.Over-filling of the acetabulumwill result in cement beingforced into the peri-acetabularsoft tissues. The cement shouldthen be pressurised with anacetabular pressuriser using fullforce until the cement viscosityhas risen to a doughy state. Thesucker aspirator may be used toaid cleaning and drying of theacetabulum. For further detailsplease refer to retractoraspirator op-tech EXEFY04E01.

Acetabular cementing andpressurisation:

The acetabulum is thoroughlycleaned using lavage. It isirrigated with Hartmann'ssolution, and packed with swabssoaked in hydrogen peroxidewhilst the bone cement is beingmixed. These swabs are heldfirmly in place using the cuppusher until the cement is readyfor use.

7

Acetabular implantation:

The right angle introducer willposition the cup face at 45˚ ofabduction and the amount offlexion will be indicated by theangle between the long axis ofthe patient and the horizontalhandle of the introducer whenviewed from above.

Typically using surgical Simplexat a theatre temperature of 21 ,̊6-7 minutes should have elapsedafter the commencement ofmixing before the socket ispushed into place. A quantity ofcement held in the surgeon’shand will help indicate whenthe cup should be inserted. Theviscosity should be chosen suchthat significant force is requiredto introduce the cup into thecorrect position in theacetabulum.

8

9

Final implantation

After the cup has beenintroduced to the pre-rehearsedposition, it should be held inplace under pressure with thepusher until the cement hasfully polymerised. Firm pressureshould be maintained on theflanged cup throughout thiswhole procedure until thecement has fully polymerised.

I.D. 22.2 mm IMPLANTS TRIALS

O.D. 44 mm 6309-4-244* 6304-7-244

O.D. 46 mm 6309-4-246 6304-7-246

O.D. 48 mm 6309-4-248 6304-7-248

O.D. 50 mm 6309-4-250 6304-7-250

O.D. 52 mm 6309-4-252 6304-7-252

O.D. 54 mm 6309-4-254 6304-7-254

O.D. 56 mm 6309-4-256 6304-7-256

O.D. 58 mm 6309-4-258 6304-7-258

I.D. 32 mm IMPLANTS TRIALS

O.D. 50 mm 6309-4-350* 6304-7-350

O.D. 52 mm 6309-4-352 6304-7-352

O.D. 54 mm 6309-4-354 6304-7-354

O.D. 56 mm 6309-4-356 6304-7-356

O.D. 58 mm 6309-4-358 6304-7-358

O.D. 60 mm 6309-4-360 6304-7-360

I.D. 26 mm IMPLANTS TRIALS

O.D. 44 mm 6309-4-644* 6304-7-644

O.D. 46 mm 6309-4-646 6304-7-646

O.D. 48 mm 6309-4-648 6304-7-648

O.D. 50 mm 6309-4-650 6304-7-650

O.D. 52 mm 6309-4-652 6304-7-652

O.D. 54 mm 6309-4-654 6304-7-654

O.D. 56 mm 6309-4-656 6304-7-656

O.D. 58 mm 6309-4-658 6304-7-658

I.D. 28 mm IMPLANTS TRIALS

O.D. 46 mm 6309-4-846* 6304-7-846

O.D. 48 mm 6309-4-848 6304-7-848

O.D. 50 mm 6309-4-850 6304-7-850

O.D. 52 mm 6309-4-852 6304-7-852

O.D. 54 mm 6309-4-854 6304-7-854

O.D. 56 mm 6309-4-856 6304-7-856

O.D. 58 mm 6309-4-858 6304-7-858

O.D. 60 mm 6309-4-860 6304-7-860

Acetabular step drill

6781-8-750

Cup introducer - lateral

6304-4-060

Trimming scissors

6304-4-140

Cup pusher - straight

6304-4-110

Cup pusher - curved6304-4-120

Pusher head 6304-4-122 • 22.2 mm diameter

6304-4-126 • 26 mm diameter

6304-4-128 • 28 mm diameter

6304-4-132 • 32 mm diameter

Instruments tray6304-4-080 - One level

6304-4-090 - Two level

Incl. acetabular pressurisation handles

0935-0-001 • straight

0935-0-002 • curved

10

Implants

Instruments

* These cups have 2 mm high cement spacers. All the other sizes have 3 mm high cement spacers.

Surgical template. 5 pack - Scale 1

6309-4-000

Surgical template. 5 pack - Scale 1.20

6309-4-020

Surgical templates for the whole cup range

(I.D. 22.2 / 26 / 28 / 32)

Stryker SACité-CentreGrand-Rue 901820 MontreuxSwitzerland

t : +41 21 966 12 01

f : +41 21 966 12 00

www.europe.stryker.com

1) Oh I, Sander TW, Treharne RW: Total hip acetabular cup design and its effect on cement fixation. Clinical Orthopaedicsand Related Research (1985) 195.

2) Joshi RP, Eftekhar NS, McMahon DJ, Nercessian OA: Osteolysis after Charnley primary low friction arthroplasty, acomparison of two matched paired groups. Journal of Bone and Joint Surgery (1998) 80-B, N°4: 585-590.

3) Waddell JP, Morton J: Generic total hip arthroplasty. Clinical Orthopaedics and Related Research (1995) 311.

4) Charnley J: Low friction arthroplasty of the hip, theory and practice. Springer Verlag Berlin Heidelberg (1979).

5) Kobayashi S, Terayama K: Factors influencing survival of the socket after primary low friction arthroplasty of the hip.Archives of Orthopaedic and Trauma Surgery (1993) 112:56-60.

This document is intended solely for the use of healthcare professionals.

The information presented in this brochure is intended to demonstrate the breadth of Stryker product offerings.Always refer to the package insert, product label and/or user instructions before using any Stryker product. Productsmay not be available in all markets. Product availability is subject to the regulatory or medical practices that governindividual markets. Please contact your Stryker representative if you have questions about the availability of Strykerproducts in your area.

Products referenced with ™ designation are trademarks of Stryker.Products referenced with ® designation are registered trademarks of Stryker.

Literature Number: MTXCNFBRO2E01MTX/GS 02/07

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