mis hip joint replacement surgical technique - … mis hip - posterolateral... · 1 mis hip joint...

MIS Hip Joint Replacement Surgical Technique

Posterolateral MIS Approach

654_11_LSP49_Rev1_MIS_Hip_Posterolateral_SP_US_Layout 1 4/19/11 1:58 PM

It is Stryker’s mission to deliver state ofthe art MIS technologies and implantsfor hip and knee arthroplasty, whileproviding the highest standards oftraining and education for the medicalcommunity. Stryker’s ultimate goal isto promote patient lifestyle recoverysupported by responsible science.Stryker will endeavor to invent,develop and deliver proceduralsimplification through innovativetechnologies that provide greaterpatient satisfaction and potentiallylead to long-term clinical success.

MIS Hip Joint Replacement Surgical Technique

The decision to perform an MIS procedure is ultimately left up to the surgeon’s professionalmedical and clinical judgment. It is the surgeon who must carefully evaluate each patient todetermine if MIS surgery is indeed appropriate. In some cases the clinical risks that apply toMIS total joint arthroplasty may be greater than conventional total joint arthroplasty. Strykerstrongly recommends that surgeons complete a formalized training program beforeattempting these operative techniques on their own.

Posterolateral MIS Approach


Stryker MIS Technique for THA Introduction 1

Posterolateral MIS Technique 2

Incision 3 - 4

Capsulotomy 5

Femoral Neck Osteotomy 6 - 7

Acetabular Reaming 8 - 9

Acetabular Implant Placement 10

Femoral Canal Preparation 11

Implant Trial Reduction 12

Acetabular and Femoral Implant Insertion 13

Wound Closure 14

Stryker MIS Instrumentation

The Retractor Set 15 - 17

Femoral Set 18 - 19

Table of Contents


1 MIS Hip Joint Replacement Surgical Technique

Minimally Invasive Surgery (MIS) is asurgical technique, which may enablethe surgeon to potentially reduce theamount of soft tissue dissection,manipulation, and overall disruption ofthe surgical site throughout the surgery.

Minimally invasive procedures bringtechnique and implant together in asynergy that may improve patientoutcome and may reduce recovery time.MIS techniques and instrumentationmay minimize the impact of the surgicalprocedure on tissue and/or bone thatmay accelerate post-operativerehabilitation, recovery, and return topain-free function.

The MIS total hip arthroplasty (MIS-THA) procedures you are going to learnabout in this surgical protocol eachbegin with a single incision. Thepurpose of the incision is to minimizesoft tissue trauma dissection that mayreduce muscle and other tissue trauma.This may contribute to reduced patientpain and decreased recovery time.

The key to MIS is soft tissuemanagement. Although bone andimplant management are no lessimportant than in conventional hipsurgery, the incremental benefits ofpain reduction and improved strengthare closely related to soft tissuemanagement.

Stryker MIS Technique for THA


2Posterolateral Approach

Conventional total hip arthroplasty relieson maximum exposure of the joint sothe entirety can be seen at once. Suchexposure, however, requires much of thesoft tissue to be cut, inflicting damageon tissue that can increase pain andrecovery time.

MIS-THA may reduce tissue trauma,which may reduce the patient’s pain andlead to a quicker recovery. To achievethese results, the surgeon using MIS-THA must pay as much attention to theposition of the leg and to soft tissuemanagement as to the instruments thatmake the procedure possible. At thesame time, the limited field of visionoffered by MIS requires that the surgeondevelop greater confidence using thesense of touch (tactile sensation) tosupplement visualization.

As you work through a MIS-THA, ithelps to ask yourself two questions:1. What am I doing with the softtissues at this stage of theprocedure?

2. What am I doing with the bone atthe stage of the procedure?

Posterolateral MIS Technique

Preoperative planning aids in theselection of the appropriate implant styleand size for the patient’s hip pathology.Preoperative X-ray analysis can be usedto evaluate:• Optimal femoral stem fit• Prosthetic neck length• Neck offset• Acetabular component sizing

Determination of probable implant styleand size can facilitate operating roompreparation by ensuring that theappropriate size selection is available.Anatomic anomalies that could preventthe intra-operative achievement of theestablished preoperative goals may alsobe detected through such planning.

The patient position is the same for boththe Posterolateral and for theAnterolateral Approach.

The patient is placed in the lateraldecubitus position with the operativehip superior. Care should be taken toposition the pelvis so that a lineconnecting the anterior superior iliacspines (ASIS) is vertical when viewedfrom both the end and the side of theoperating table.

A pelvic stabilizing device must be usedto ensure that the patient’s pelvisremains stable throughout theprocedure. The dependent leg is flexedat both the knee and the hip so that thehip is flexed up to 45˚. As the imageshown here makes clear, this positionalso maintains a perpendicularorientation of the hip to the table so thatimproper implant placement can beavoided. (See illustration below)

A general guide to follow for a MIS Hipposterolateral procedure is an incisionlength of 6 to 10cm. The incision mayneed to be lengthened beyond 10 cm toaccommodate a patient’s anatomy andsize. Retractor placement is critical to thesuccess of the MIS-THA. Therefore, it isrecommended that the surgeon beginwith a standard incision. Once he isfamiliar with retractor placement, he canmake the incision progressively smaller.

It is also recommended that the surgeonselect smaller patients to begin with. Thisapproach helps ensure a safe andreproducible procedure.



Incision

Palpate in detail the posterior aspect ofthe greater trochanter on the outer aspectof the thigh. The posterior edge of thegreater trochanter is more superficialthan the anterior and lateral portions, soit is easier to palpate. (Figure 1)

Use a sterile marking pen to mark thetip of the posterior aspect of the greatertrochanter.

Figure 1

Figure 2

Figure 3

As a general guideline, the incision canrange from 6 to 10cm, extending twothirds proximally and one third distallyfrom the posterior tip of the greatertrochanter. (Figure 2)

Divide the subcutaneous tissue. Identifyand incise the gluteus fascia on theposterior aspect of the femur. Verify thatthe fascial incision is in line with theinitial skin incision and the muscle fibersof the gluteus maximus. (Figure 3)



Identify the gluteus maximus muscleand split the fibers bluntly, starting at thetip of the greater trochanter and incisingposteriorly. (Figure 4)

Retract the fibers of the split gluteusmaximus and the deep fascia of thethigh anteriorly and posteriorly to allowfor adequate exposure to the externalrotator muscle tendons. Because of theproximity of the sciatic nerve, do not useretractors with teeth, which couldaccidentally sever the nerve. (Figure 5 / 6)

Rotate the leg internally enough tostretch the short external rotator muscles.This positioning makes the muscles andthe capsule more prominent, clearlyvisible, and moves the operative fieldfurther from the sciatic nerve.

Figure 4

Figure 5

Figure 6



Capsulotomy

Incise the external rotators off theposterior femur as close to the bone aspossible.

Tag the tendons with sutures. (Figure 7)

Reflect the tendons posteriorly and laythem over the sciatic nerve to protect itduring the remainder of the procedure.

Figure 7

Figure 8

Figure 9

Incise the capsule in line with the femoralneck to the level of the acetabular rim.(Figure 8)

Excise the capsular attachment to thefemur around the base of the neck.

Tag the edges of the capsular attachmentwith sutures for reattachment at the end ofthe procedure.

Reflect the capsule edges to provideexposure of the neck. (Figure 9)



Femoral Neck Osteotomy

Dislocate the hip by flexing the knee andinternally rotating the leg slowly to avoidinjury to the knee.

Resect the remaining capsulotomy andsoft tissue around the neck withelectrocautery, exposing the neck to thelevel of the lesser trochanter. The correctneck resection level ensures proper stemfit and placement. Anatomic landmarks(identified during templating) used inconjunction with the neck resectionguide allow the correct resection level tobe determined easily. (Figure 10)

After the level of the neck cut has beendetermined, one Cobra retractor (or aNarrow Hohmann) is placed over theposterior aspect of the neck, and anotheris positioned over the greater trochanter.The femoral neck exposure is locatedbetween these two retractors (Figure 11).Through careful preoperative templating,the neck resection guide is placed on theanterior aspect of the exposed proximalfemoral neck.

Figure 10

Figure 11



While holding the Neck ResectionGuide Assembly by the handle, place theleft or right guide leg on theanterior/posterior aspect of the exposedproximal femur (Figure 12). The widthof each leg guide is 1 cm and can beused as an estimate of distance from thelesser trochanter. The Alignment Rodshould be positioned so that it is parallelwith the long axis of the femur. Electrocauterization or Methylene Blue canthen be used to indicate the neckresection level (Figure13).

With the leg rotated internally, make thefemoral neck cut with an extra smalloscillating saw blade. The axial resectionis made at the medial border of thegreater trochanter to connect it with theneck resection. (Figure 14) Use theFemoral Head Extractor with the T-Handle to elevate the head and extricateit from the wound.

Figure 12 Figure 13

Figure 14

Figure 15

Puncture the surface of the femoral headby applying axial force onto the FemoralHead Extractor Assembly. Continueapplying axial force to the assembly andbegin to rotate the T-Handle clockwise.When approximately 50% of theFemoral Head Extractor’s threads havebeen engaged, the femoral head can bepulled or levered out of the incision.

Using the Neck Resection Guide(Figure 12 and 13)

Using the Femoral HeadExtractor (Figure 15)



Acetabular Reaming

The acetabulum is prepared with the legin the neutral position. Retract theproximal femur anteriorly. Place a CobraRetractor or a Narrow HohmannRetractor over the anterior acetabularcolumn along the bony margin. Take carenot to pinch any soft tissue between theretractor and the acetabulum. To protectthe sciatic nerve, use Narrow HohmannRetractors or Cobra Retractors to reflectthe soft tissues posteriorly and superiorly.Position the retractors over the capsuleedges to facilitate the release and removalof the labrum and to gain adequateexposure for reaming.

The Narrow and Wide HohmannRetractors have sharp tips that can fix tobone. If necessary, additional fixationcan be achieved through the use of theRetractor Impactor. Once the Hohmannis placed within the incision, insert theRetractor Impactor into the impactionwindow of the Hohmann and impactwith the Slotted Mallet. Caution must betaken not to break through the superiorwall of the acetabulum. Excise thelabrum and osteophytes to allow propervisualization of the bony anatomy and toimprove ease of reaming.

To improve visibility, the Light Pipe canbe attached to the Narrow Hohmann,Wide Hohmann, or Left/Right AcetabularRetractors. To assemble the Light Pipeonto the Retractor, insert the two distaltabs into the Retractor slots. Slide thedevice upward until the tabs hit the topedge of the slots. Snap the two proximaltabs into the slot on the top surface ofthe Retractor. To disassemble, reversethe preceding steps. The device can bepre-assembled to the fiber optic cablewhen you begin these steps. (Figure 16)

Assemble the reamer. To obtain congruityduring reaming, an optional 45˚abduction/20˚ anteversion alignmentguide can be attached to the reamerhandle. When the alignment guide isperpendicular to the long axis of thepatient, it will orient the reamer handleat 45˚ of abduction, placing the axis ofthe spherical reamer at the appropriate45˚ of inclination. The reamer handlecan then be positioned at 20˚ ofanteversion by aligning the left/rightanteversion rod, thus paralleling the longaxis of the patient. (Figure 17)

Figure 16

Figure 17



Although the Alignment Guide offerssome assistance, it is important toevaluate anatomic landmarks criticallybefore placement of the metal shell.These anatomic landmarks include:• Anterior and posterior walls of theacetabulum

• Sciatic notch (if visible)• Acetabular fossa

It is recommended that reaming beginwith an acetabular reamer that is 4 mmsmaller than the templated or gaugedsize. (Figure 18)

Figure 18

Increase reamer size in 1mm incrementsuntil the final sizing is achieved. Thereamer head should be driven to thepoint where the crossbars contact theacetabular wall at the peripheral lunateregion. Take special care to avoidenlarging or distorting the acetabulumby eccentric reaming.

Use a finger to feel how much reaminghas been done. Palpation is key duringthe reaming process to augmentvisualization. Final acetabular reamingshould show the hemisphericalacetabulum denuded of cartilage, withthe subchondral plate preferably intactand the anterior acetabular wall preserved.



To evaluate the size and congruity ofthe prepared acetabulum, withdraw thereamer shell. Thread the appropriatewindow trial of the reamer shell ontothe acetabular shell’s PositionerImpactor. Place the window trial in theacetabulum.

Note: It is important to engage thethreads fully and to seat thePositioner Impactor against the trialbecause the threads on the windowtrial could become damaged whenimpacted into the acetabulum.

Acetabular Implant Placement

The trial is “windowed” for visualizationand assessment of fit, contact, andcongruency of the trial within theacetabulum.

Select the appropriately sized acetabularcup implant. If desired, theabduction/anteversion alignment guidecan be attached to the shell PositionerImpactor to help establish therecommended 45˚ of abductioninclination and 20˚ of anteversion.Thread the metal shell onto the Impactorusing the threaded hole in the dome ofthe metal shell.

Note: It is important to engage thethreads fully and to seat the Impactoragainst the shell. Otherwise, the threadson the metal shell could becomedamaged, resulting in difficulty of theremoval of the Impactor from theshell.

Remove the labrum and any osteophytesfrom the acetabulum. Retract soft tissueduring cup implantation to avoidimpingement between the cup implantand the acetabulum.

The recommended metal shell abductionangle of 45˚ is determined bypositioning the alignment guideperpendicular to the long axis of thepatient. Anteversion is set by movingthe cup Impactor so that the left/rightanteversion rod is parallel to the longaxis of the patient. Evaluate anatomiclandmarks before placement of themetal shell.

Impact the metal shell into theacetabulum to achieve a tight, stablepress fit. Loosen the thumbscrew on thealignment guide. Remove the alignmentguide. Unthread the Impactor handlefrom the shell. Determine the depth ofshell seating by viewing through thethreaded hole in the dome. Use thecup’s trial insert to reevaluate the cupface position and to provide a finalcheck of hip mechanics.



Prepare the femoral canal by placing theFemoral Elevator deep into the neck andplacing Narrow Cobra retractors orNarrow Hohmann retractors around theneck and greater trochanter for access tothe canal meatus.

Note: To achieve the proper trajectoryduring femoral broaching, ensure thatall remnants of the external rotatortendons have been excised from thefemoral neck.

Assemble the axial starter reamer. Theaxial starter reamer is circumferentiallygraduated along the flutes, indicatingboth the depth and width of the implantbody. The fitting on the proximal end ofthe axial starter reamer allows it to beused manually with T-handle or powerequipment. (Figure 19)

Insert the axial starter reamer into thefemoral canal. This reamer has asharpened point to facilitate entry andshould be inserted to the depth of thefinal rasp. Its proper depth can bedetermined by aligning the designatedengraved grooves on the reamer shaft,for the size templated, with the medialcalcar. Lateral pressure on the reamer willhelp provide for a neutral orientation ofthe implant.

Femoral Canal Preparation

Use the femoral rasp to contour themediolateral and anterioposterior aspectsof the femur. The rasp geometry isrelative to the surface enhanced proximalgeometry in the mediolateral plane andoffers a press-fit in the anterioposteriorplane, thus approximating the final stemseating level.

Lock the rasp handle firmly onto therasp by inserting the post into thecorresponding hole on the handle andpressing the two together. Make sure theversion post is aligned with thepositioning slot on the face of the rasp.(Figure 20)

Figure 19

Figure 20 Figure 21

Begin rasping with the smallest rasp.Rasp size can be increased sequentiallyuntil the rasp matches the planned stemsize and application. The final raspshould seat firmly against medial andlateral cortical bone.

The rasp has been inserted to the properdepth when the rasp seats tightly withinthe femoral canal based on visual andauditory clues, such as an increased pitchof sound with blows on rasp handle andan increased resistance to forwardadvancement.

Leave the final rasp in the canal andremove its handle. (Figure 21)



Adjust neck length until the leg lengthsare equal. Stability can also be checkedby telescoping the leg and performing afull range of motion. If the leg is unstable,re-evaluate the acetabular cup and theface orientation of the trial liner byrepositioning the cup trial insert withinthe metal shell in 30˚ increments. Thisprocedure creates optional positions inwhich the cup insert may be oriented.

Remove the trial head and trial neck.Reattach the rasp handle to the rasp. Topreserve the integrity of the handle andlocking mechanism, use the slottedmallet to remove the rasp.

Implant Trial Reduction

To confirm the proper placement of thefemoral and acetabular componentsbefore final selection and implantationof the components, it is important toattempt trial reductions and obtainroutine intraoperative radiographs,especially during early experience withthe mini-incision technique.

The trial assembly consists of• rasp• trial neck• trial head• trial cup liner

The assembly is used to provide athorough evaluation of the hipmechanics during trial reduction.Modifications to the preoperative plan interms of neck length and/or headdiameter can be made.

Figure 22

Select a trial neck that has the samebasic neck length as the planned implantsize.

Place the trial neck over the post of therasp by positioning it onto the slotlocated on the proximal tip of the raspand pressing firmly.

Select a plastic tapered trial head andplace it onto the trial neck. The taperedtrial heads are available in a variety ofoffset lengths to create the desired necklength of the prosthesis.

Perform a trial reduction of the hip.(Figure 22)



Strike the Positioner Impactor handlewith four firm mallet blows to seat thecup in sert fully. Verify that the insert isfully seated and properly aligned intothe acetabular shell. Insert the femoralstem Impactor into the recess on theproximal end of the femoral stem.

Note: To help prevent damaging thefemoral stem or the femoral stemImpactor, be certain that the femoralstem Impactor is fully seated againstthe proximal face of the femoral stem.

Do NOT continue impacting thefemoral component if visual andauditory clues indicate that the restingposition of the femoral component hasbeen reached, even if the femoralcomponent is not yet down to the levelof the rasp trials. If the femoralcomponent comes to a rest at a levelbelow that of the rasp trial, it is verylikely that a femoral split has beencreated. It is imperative that thesurgeon investigates this possibility.

Insert the appropriately sized cup andgently introduce it into the shell.

Align the barbs and grooves so that the cupinsert seats flush into the acetabular cup.

Make sure that all soft tissue has beenretracted. For proper seating, positionthe Positioner Impactor handle into theinner diameter of the cup insert. (Figure23 and 24)

Acetabular and Femoral Implant Insertion

Figure 23 Figure 24

Use a mallet to seat the stem into thecanal. If visual and auditory cluesindicate that the resting position of thefemoral component has been reached,special care should be taken to avoidcontinued impaction of the femoralcomponent, even if the femoralcomponent is not yet down to the levelof the rasp trials.

Note: Before implanting the headassembly, the neck length selectionmay be re-evaluated using the trialhead by placing the trial head onto thestem’s neck and reducing the hip toverify that the mechanics have notbeen altered because of implantseating.

Select the appropriate implant head andplace it onto the dry trunnion of thefemoral stem.

Align the implant’s head Impactor overthe implant head and strike the Impactoronce with a mallet. Reduce the femoralhead into the acetabular cup and checkfor stability and range of motion.



Wound Closure

Figure 25

Completely encase the femoral head ofthe prosthesis within the acetabulum byre-approximating the tagged inferior andanterior capsule.

Tendons have some elasticity and arestronger than osteoporotic or osteoponicbone, so the short external rotatorsshould be re-attached to the gluteusmaximus tendon that is still attached tothe greater trochanter. Attaching thetendons in this way places them in aphysiologic position to increase theirpotential to remain attached. Completethe fascia and skin closures according toestablished procedures. (Figure 25)



Stryker MIS Instrumentation

Stryker’s streamlined instruments allow a minimally invasive approach for bothPosterolateral and Anterolateral surgery that may reduce the amount of soft tissuedisruption.

The Retractor SetThe Retractor Set available for use in minimally invasive hip procedures includes:

• 2 Blunt Narrow Cobra Retractors• 2 Narrow Hohmann Retractors• 1 Wide Hohmann Retractor• 1 Retractor Impactor• 1 Left and 1 Right Acetabular Retractor• 1 Femoral Elevator

Blunt Narrow Cobra Retractors(1440-1140)

The Blunt Narrow Cobra Retractor hasan increased bend to maximizevisualization and a blunt tip design toprotect soft tissue.

Narrow Hohmann Retractors(1440-1130S)

The Narrow Hohmann Retractor has asharp tip that allows for bone fixation.The retractor also has an impactionwindow for the Retractor Impactor andslots to install the Light Pipe.



Wide Hohmann Retractors(1440-1135S)

The Wide Hohmann Retractor has anextra wide body to move soft tissue outof the incision area. The sharp tipallows for bone fixation. The retractorhas an impaction window for theRetractor Impactor and slots to installthe Light Pipe.

Retractor Impactor(1440-1020)

Additional retractor fixation can beachieved through the use of theRetractor Impactor. Once the retractoris placed within the incision, insert theRetractor Impactor into the impactionwindow of the appropriate retractor withthe Slotted Mallet. Caution must betaken not to break through the superiorwall of the acetabulum.

Acetabular Retractors(1440-1105S/1110S)

An Acetabular Retractor is provided forboth the left and right hip. Sharp tipsallow for bone fixation. The Retractorincludes an impaction window for theRetractor Impactor and slots to installthe Light Pipe.



Femoral Elevator Retractor(1440-1120)

The Femoral Elevator is designed toelevate the femur out of the incision. It is placed superiorly under the medialaspect of the femur.

Light Pipe(1440-1080)

The Stryker Light Pipe provides a lowprofile, efficient light source allowingexcellent visibility of the acetabulum. Asterile, single-use, disposable device, theLight Pipe is composed of a polymerinner core and a metallic outer shield. Itis intended for use with the followingMinimally Invasive Hip InstrumentRetractors with mating slots:

• Narrow Hohmann Retractors• Wide Hohmann Retractors • Left/Right Acetabular Retractors

The Surgeon’s preference will dictatewhich Retractor will be used as the lightsource.

Before clinical use, attach the Light Pipeto the fiber optic cable of the StrykerX6000 Light Source.

To attach the Light Pipe to a retractor:

Insert the two distal tabs into theretractor slots. Slide the device upwardsuntil the tabs hit the top edge of the slots.Snap the two proximal tabs into the sloton the top surface of the retractor.

To disassemble:

Reverse the steps above: unsnap theproximal tabs, slide the device downwards,and disengage the two distal tabs.

The device can be pre-assembled to thefiber optic cable when you begin thesesteps. Please note that when the device isfully threaded onto the cable, one threadwill be exposed.



The straight design of the StraightAccolade Rasp Handle limits soft tissueimpingement. It is designed for theAccolade TMZF Implant Stem system.

The Straight Accolade Rasp Handlelocks firmly onto the Accolade Rasps byinserting the post of the Rasp into thecorresponding hole on the Rasp Handleand pressing the two together. Careshould be taken to align the version poston the Rasp Handle with the positioningslot on the Rasp.

Femoral Set

The Femoral Set available for use in minimally invasive hip procedures includes:

• Neck Resection Guide• Alignment Rod• T-Handle• Femoral Head Extractor• Straight Accolade Rasp Handle• Quick Connect Handle• Femoral Head Impactor• Offset Neck Trial Forceps

The Accolade Neck Resection GuideAssembly consists of the Neck ResectionGuide and the Alignment Rod. It isdesigned to work with the AccoladeTMZF implant system.

To correctly assemble the instrument,place the Alignment Rod through thecorresponding left or right hole in theNeck Resection Guide. While holdingthe Neck Resection Guide Assembly bythe handle, place the left or right guideleg on the anterior/posterior aspect ofthe exposed proximal femur.

The width of each guide leg is 1 cm andcan be used as an estimate of distancefrom the lesser trochanter. TheAlignment Rod should be positioned sothat it is parallel with the long axis of thefemur. Electrocauterization orMethylene Blue can then be used toindicate the neck resection level.

Accolade Neck Resection Guide & Alignment RodAccolade Neck Resection Guide (1440-1000) / Alignment Rod (1440-1050)

Straight Accolade Rasp Handle Straight Accolade Rasp Handle (1440-1400)



Offset Neck Trial Forceps(1440-1700)

The Offset Neck Trial Forceps can beused to facilitate placement of the TrialHead/Neck Assembly in a MIS incision.

Clasp the Trial Head/Neck Assemblybetween the forceps tips and applypressure until the lock is engaged. Thebent end tip of the forceps is pointed uptowards the user.

Femoral Head Impactor(1440-1070)

The Femoral Head Impactor has a slimprofile to allow better entry into areduced MIS incision.

Femoral Head Extractor(1440-1010) and T-Handle(5900-0050)

The femoral head can be delivered fromthe incision with the use of the FemoralHead Extractor Assembly that consistsof the Femoral Head Extractor and theT-Handle.

Puncture the surface of the femoral headby applying axial force onto the FemoralHead Extractor Assembly. Continueapplying axial force to the assembly andbegin to rotate the T-Handle in a clock-wise direction. Once approximately 50%of the Femoral Head Extractor’s threadsare engaged, the femoral head can bepulled or levered out of the incision.


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A surgeon must always rely on his or her own professional clinical judgment when deciding whether to use aparticular product when treating a particular patient. Stryker does not dispense medical advice and recommendsthat surgeons be trained in the use of any particular product before using it in surgery.

The information presented is intended to demonstrate the breadth of Stryker product offerings. A surgeon mustalways refer to the package insert, product label and/or instructions for use before using any Stryker product.Products may not be available in all markets because product availability is subject to the regulatory and/ormedical practices in individual markets. Please contact your Stryker representative if you have questions aboutthe availability of Stryker products in your area.

Stryker Corporation or its divisions or other corporate affiliated entities own, use or have applied for thefollowing trademarks or service marks: Accolade, Stryker, Stryker Orthopaedics, TMZF, Trident. All othertrademarks are trademarks of their respective owners or holders.

Literature Number: LSP49 Rev. 1MS/GS 04/11

Copyright © 2011 StrykerPrinted in USA


mis hip joint replacement surgical technique - … mis hip - posterolateral... · 1 mis hip joint...

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