HIP EXTRACTION INSTRUMENTATIONHIP EXTRACTION INSTRUMENTATION

This publication is not intended for distribution in the USA.

PRODUCT OVERVIEW

DePuy Synthes Revision Solutions offers a comprehensive portfolio of implants and instruments to address almost any unpredictable obstacles encountered during revision THA.

DePuy Synthes is working with Symmetry Medical® to distribute advanced hip extraction instrumentation. These instruments provide for confident component removal through solid construction, soft-touch silicone handles, and a variety of optimised cutting tips.

DePuy Synthes Hip Extraction Instrumentation Product Overview

ADVANCED PERFORMANCE

Soft-touch silicone handles facilitate ergonomic use.

Locking pliers with slap hammer attachment provide extra leverage for difficult implant extraction.

Instrument tip geometry etched on handle base for ease of identification.

Cutting tip orientation groove on strike plates.

Large strike plate for easy impaction.

Modern instrument layout with O.R. efficiencies in mind.

1Hip Extraction Instrumentation Product Overview DePuy Synthes

“V” Splitter

8 mm Chisel

Straight Gouge

Angled Gouge

Flag Splitter

Reverse Curette

“V” Splitter 8 mm Chisel Straight Gouge Angled Gouge Flag Splitter Reverse Curette

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CEMENTED REVISION INSTRUMENTATION

“V” Splitter The “V” Splitter (Cat. No. 2709-01-003) may be used to fragment and remove cement from the proximal lateral cement mantle. It is important to remove cement laterally so that the component may move in a proximal direction without fracturing the metaphyseal bone. This instrument may also be used to fragment cement from the femoral canal after the component has been removed.

8 mm Chisel The 8 mm Chisel (Cat. No. 2709-01-008) may also be used to remove cement in the proximal femur. The tip is intended to debond cement from the proximal implant or to separate cement from the cortices. Removal of the cement in the proximal femur will provide better access to the cement metaphyseal / diaphyseal junction.

Flag Splitter Once the femoral component has been removed, the Flag Splitter (Cat. No. 2709-01-002) may be used to fragment any remaining cement. The blunt, non-cutting, edge guides the tip along the cortices to prevent perforating the femur as the sharp edge splits the cement.

Straight and Angled GougesAfter the proximal region of the femur has been cleared of cement, the Straight (Cat. No. 2709-01-004) and / or Angled (Cat. No. 2709-01-005) Gouges may be used to simultaneously split and separate the cement for quick and efficient removal from the femur.

Reverse CuretteThe 6, 7, 9, and 11 mm Reverse Curettes remove cement along the femoral wall. The tip is scraped in an upward motion along the cortices. The curette may also be used to remove the cement restrictor if sufficient room exists to bypass the restrictor along the femoral wall. Once the curette tip is past the restrictor it is used to hook and lift the restrictor from the distal end.

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7 mm "X" Osteotome

Conical Taps

Crochet Hook

Self-Locking Long Rongeur

DePuy Synthes Hip Extraction Instrumentation Product Overview4

CEMENTED REVISION INSTRUMENTATION

7 mm “X” OsteotomeThe “X” Osteotome (Cat. No. 2709-01-010) is an efficient tool for fragmenting the hard distal cement mantle. Impacting and rotating this osteotome will fragment the cement so that it may be removed via suction or rongeur. This instrument can also be used to break up the cement mantle for a cemented acetabular component.

Conical TapsIn the event the cement mantle has debonded from the bone it may be easier to remove the mantle in one-piece instead of breaking it into sections. Threaded Conical Taps are offered in 9 mm (Cat. No. 2709-01-012) and 11 mm (Cat. No. 2709-01-013) options and may be used to tap into the one-piece cement mantle. Once the tap is firmly seated, use mild force to extract the cement mantle from the femur.

Self-Locking Long Rongeur The 300 mm Self-Locking Long Rongeur (Cat. No. 2709-01-016) helps facilitate removal of cement fragments from the canal. Upon grasping cement fragments or fibrous membrane with the jaws, the handle clamp may be engaged to lock the jaws in place to ease cement extraction from the canal.

Crochet Hook The Crochet Hook (Cat. No. 2709-01-001) may be used to remove the cement restrictor from the femur. Care should be taken when using the hook due to its sharp geometry. The tip may be passed through the restrictor or along the femoral wall to engage the remaining distal construct. Ensure that the flat side of the instrument is facing the femoral wall if it is near the cortex. Once the crochet hook has been engaged it may be used to lift the distal construct from the canal.

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Quick Coupling Handle

Slap Hammer Shaft

Trephines

Osteotomes

DePuy Synthes Hip Extraction Instrumentation Product Overview6

CEMENTLESS REVISION INSTRUMENTATION

Flexible OsteotomesThe Flexible Osteotomes provide thin, sharp instruments that may be used to disrupt biological fixation. Shorter osteotomes may be used to separate an implant-to-bone interface in the anterior, posterior and lateral regions of the proximal femur. The curved thin osteotomes may then be used to clear bone medially. If you are revising a collared prosthesis, it may be necessary to transect the collar with a metal cutting burr to obtain better access to the medial curve.

Radial OsteotomesIn-growth on the lateral aspect of a femoral stem with a rounded profile can create a challenge during revision surgery. The Radial Osteotomes address this challenge by providing a radial curve designed to follow the lateral contour of the stem / bone interface. These instruments are available in multiple sizes to accommodate various stem geometries.

If either a flexible or radial osteotome becomes jammed, a small slap hammer may be attached to dislodge it. The small Slap Hammer (Cat. No. 2709-04-002) attaches to the Quick-Coupling Handle (Cat. No. 2709-04-001) to provide additional extraction force for dislodging the blade.

TrephinesTrephines are used to remove a fully in-grown cylindrical distal stem segment. An extended trochanteric osteotomy (ETO) or femoral window may be needed to obtain access to the stem. Prior to using the trephines, the proximal third of the stem must be transected (for example, using a high-speed metal cutting burr), at the transition point where the medial curve transitions to the cylindrical distal stem segment.

Upon removal of the proximal stem, the trephines may be used to “core out” the distal stem segment. The Hip Extraction Instrumentation offers trephines in 0.5 mm increments in order to preserve bone stock. Once the correct size is chosen and attached to the Slap Hammer (Cat. No. 2709-05-001), reaming can proceed either on power or manually using a T-Handle. Be sure to use irrigation during trephine reaming to minimise heat build-up which could harm remaining bone stock.

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The femoral stem extraction instruments are offered in multiple variations to aid in removal of prostheses with varying neck geometries. The extraction instrument case includes a slap hammer with multiple adapter attachments and locking pliers to facilitate component removal.

One-Piece Stem Adapter

Universal Femoral Stem Extractor

Closed Loop Extractor

Hook Stem Extractor

Slap Hammer

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FEMORAL EXTRACTION INSTRUMENTATION

Universal Femoral Stem ExtractorThe Universal Femoral Stem Extractor (Cat. No. 2709-03-002) is designed to remove femoral stems with modular heads. Once the head has been removed the femoral stem extractor attaches to the tapered trunion of the stem via the serrated jaws. The T-Handle on the instrument is used to clamp the instrument to the stem. The instrument geometry is designed to stay in-line with the long axis of the implant in order to provide the optimal force available for component extraction.

Now that the femoral stem extractor is firmly fixed to the implant trunion, attach the Slap Hammer (Cat. No. 2709-03-001) by retracting the spring-loaded sleeve and attaching it to the connection feature on the extractor. The sliding weight on the slap hammer will provide extra force to extract the stem. Care should be taken to stay in-line with the femur.

One-Piece Stem Adapter Should a monoblock stem with a fixed head be encountered, a One-Piece Stem Adapter (Cat. No. 2709-03-003) may be used in combination with the slap hammer to facilitate stem extraction. Upon ensuring that the stem is adequately loose, position the adapter around the stem distally and lateral to the head.

Hook Stem ExtractorThe Hook Stem Extractor (Cat. No. 2709-03-005) is intended to extract implants that feature a transverse extraction hole. Insert the hook into the stem hole prior to connecting the slap hammer.

Closed Loop Extractor An alternative option for removing a one-piece stem is the Closed Loop Extractor (Cat. No. 2709-03-004). The instrument works by sliding the head of the prosthesis through the loop and positioning the narrow portion of the loop around the stem neck. The slap hammer may then be attached to provide an extraction force to the loosened stem.

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Innovative designs, such as the “V” tip acetabular gouges with soft-touch silicone handles, provide confidence in form and function of the instrumentation.

“V” Tip Acetabular Gouges

Curved Acetabular Chisel

Acetabular Component Forceps

Acetabular Component Gripper

Rounded Acetabular Cement Splitter

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ACETABULAR REVISION INSTRUMENTATION

“V” Tip Acetabular Gouges“V” Tip Acetabular Gouges of various sizes may be used to loosen a well-fixed acetabular component. The gouges are intended to slide behind and / or lever out a cup to debond it from the bone. The “V” shaped cutting tip is designed to secure the tip in place while loosening the fixed component.

Curved Acetabular ChiselSimilar to the gouge, the Curved Acetabular Chisel (Cat. No. 2709-02-004) may be used to loosen a fixed acetabular component. The curved tip should be used when it is desirable to secure the tip in a single location and slide the chisel along the shell wall.

Acetabular Component Gripper The Acetabular Component Gripper (Cat. No. 2709-02-007) is used in conjunction with the slap hammer to remove a cup with an intact polyethylene liner. Teeth on the gripper dig into and hold a polyethylene liner with an articulating surface up to 32 mm in diameter. Upon expanding the gripper teeth into the liner, apply force to extract the cup from the acetabulum.

Rounded Acetabular Cement Splitter The Rounded Acetabular Cement Splitter (Cat. No. 2709-02-005) may be used to extract the cement mantle after a cemented acetabular component is removed. The rounded tip is designed to match the curve of the extracted acetabular component and the sharp edges allow for easy cement fragmentation and removal.

Acetabular Component ForcepsThe Acetabular Component Forceps (Cat. No. 2709-02-008) may be used to extract a polyethylene liner during a liner exchange. A liner may be separated from the shell by placing the “V” notched jaw in the articulating surface of the liner and placing the wedge jaw at the liner to shell interface (this will vary based on manufacturer design of the components being extracted). Upon positioning the “V” notch and wedge shaped jaws, apply pressure to displace the liner from the shell.

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Femoral Revision KitCat No. Description 2709-01-001 1 Crochet Hook2709-01-002 2 Flag Splitter2709-01-003 3 V Splitter2709-01-004 4 Straight Gouge2709-01-005 5 Modified Angled Gouge2709-01-006 6 Reverse Curette 6 mm x 432 mm2709-01-007 Reverse Curette 7 mm x 432 mm2709-01-008 7 Chisel 8 mm x 432 mm2709-01-010 8 7 mm "X" Osteotome2709-01-011 6 Reverse Curette 11 mm x 432 mm2709-01-012 9 Conical Tap 9 mm2709-01-013 Conical Tap 11 mm2709-01-014 Twist Drill 6.4 mm2709-01-015 Twist Drill 8 mm2709-01-016 10 Rongeur with Serrated Teeth 300 mm2709-01-100 Femoral Delivery System

Acetabular Revision KitCat No. Description2709-02-001 11 Acetabular Gouge 48 mm x 13 mm2709-02-002 Acetabular Gouge 52 mm x 13 mm2709-02-003 Acetabular Gouge 56 mm x 13 mm2709-02-004 12 Curved Acetabular Chisel2709-02-005 13 Round Acetabular Cement Splitter2709-02-006 14 Slotted Mallet with Delrin Cap2709-02-007 15 Acetabular Component Gripper2709-02-008 16 Acetabular Component Forceps2709-02-100 Acetabular Delivery SystemHip Revision Extractor KitCat No. Description 2709-03-001 17 Femoral Extractor Slap Hammer2709-03-002 18 Universal Mod Stem Extractor2709-03-003 19 One-Piece Stem Adapter2709-03-004 20 Closed Looped Extractor2709-03-005 21 Hook Stem Extractor2709-03-006 22 Locking Pliers2709-03-007 Locking Pliers Slap Hammer Adapter

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DePuy Synthes Hip Extraction Instrumentation Product Overview12

ORDERING INFORMATION

Trephine setCat No. Description2709-05-001 27 Slap Hammer Shaft2709-05-002 28 Quick Connect T-Handle2709-05-003 T-Bar Stem Extractor2709-05-004 29 Wrench2709-05-100 Trephine Delivery System2709-05-110 30 Trephine 11 mm ID x 203 mm2709-05-115 Trephine 11.5 mm ID x 203 mm2709-05-120 Trephine 12 mm ID x 203 mm2709-05-125 Trephine 12.5 mm ID x 203 mm2709-05-130 Trephine 13 mm ID x 203 mm2709-05-135 Trephine 13.5 mm ID x 203 mm2709-05-140 Trephine 14 mm ID x 203 mm2709-05-145 Trephine 14.5 mm ID x 203 mm2709-05-150 Trephine 15 mm ID x 203 mm2709-05-155 Trephine 15.5 mm ID x 203 mm2709-05-160 Trephine 16 mm ID x 203 mm2709-05-165 Trephine 16.5 mm ID x 203 mm2709-05-170 Trephine 17 mm ID x 203 mm2709-05-175 Trephine 17.5 mm ID x 203 mm2709-05-180 Trephine 18 mm ID x 203 mm2709-05-185 Trephine 18.5 mm ID x 203 mm2709-05-190 Trephine 19 mm ID x 203 mm2709-05-195 Trephine 19.5 mm ID x 203 mm2709-05-200 Trephine 20 mm ID x 203 mm2709-05-205 Trephine 20.5 mm ID x 203 mm2709-05-210 Trephine 21 mm ID x 203 mm2709-05-215 Trephine 21.5 mm ID x 203 mm2709-05-220 Trephine 22 mm ID x 203 mm2709-05-225 Trephine 22.5 mm ID x 203 mm2709-05-230 Trephine 23 mm ID x 203 mm2709-05-235 Trephine 23.5 mm ID x 203 mm2709-05-240 Trephine 24 mm ID x 203 mm

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Flexible Osteotome KitCat No. Description2709-04-001 23 Handle with Quick-Couple End2709-04-002 Small Slap Hammer2709-04-004 24 Thin Osteotome 8 mm x 76 mm2709-04-005 Thin Osteotome 10 mm x 76 mm2709-04-006 Thin Osteotome 12 mm x 76 mm2709-04-007 Thin Osteotome 20 mm x 76 mm2709-04-008 25 Thin Osteotome Curved 12 mm2709-04-009 Thin Osteotome Curved 20 mm2709-04-010 Thin Osteotome 8 mm x 127 mm2709-04-011 Thin Osteotome 10 mm x 127 mm2709-04-012 Radial Osteotome 10 mm x 127 mm2709-04-013 Radial Osteotome 12 mm x 127 mm2709-04-014 Radial Osteotome 14 mm x 127 mm2709-04-015 Radial Osteotome 16 mm x 127 mm2709-04-016 Radial Osteotome 20 mm x 127 mm2709-04-017 Extra Long Osteotome 8 mm x 229 mm2709-04-018 26 Flex Chisel Blade 8 mm x 64 mm2709-04-019 Flex Chisel Blade 10 mm x 64 mm2709-04-020 Flex Chisel Blade 12 mm x 64 mm2709-04-021 Flex Chisel Blade 20 mm x 64 mm2709-04-022 Flex Chisel Blade 8 mm x 127 mm2709-04-023 Flex Chisel Blade 10 mm x 127 mm2709-04-024 Flex Chisel Blade 12 mm x 127 mm2709-04-025 Flex Chisel Blade 20 mm x 127 mm2709-04-100 Flex Osteotome Delivery System

Hip Extraction Instrumentation Product Overview DePuy Synthes 13

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Authorised European Representative: Symmetry MedicalBeulah RoadSheffield S6 2ANEngland

Manufactured by:Symmetry Medical3274 North SR15Warsaw. IN 46582USATel: +574 268 2252Fax: +574 267 4551

Distributed by:

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DePuy International LtdSt Anthony’s RoadLeeds LS11 8DTEnglandTel: +44 (0)113 387 7800Fax: +44 (0)113 387 7890

DePuy Orthopaedics, Inc. 700 Orthopaedic DriveWarsaw, IN 46581-0988USATel: +1 (800) 366 8143Fax: +1 (574) 267 7196

DePuy Orthopaedics EMEA is a trading division of DePuy International Limited.Registered Office: St. Anthony’s Road, Leeds LS11 8DT, EnglandRegistered in England No. 3319712

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CA#DPEM/ORT/1212/0410(1) 9099-00-100 Issued: 01/14