exceed abt acetabular system - surgitech exceed abt...surgical technique surgical protocols by mr e...

Surgical Technique

Surgical Protocols by Mr E J Smith BSc MB BCh FRCS

Exceed ABT Acetabular System

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Table of ContentsExceed ABT Acetabular System

Preoperative Planning ............................................................................................................................................5Manual Preoperative PlanningDigital Preoperative Planning

Surgical Exposure ..................................................................................................................................................6 Preparation of the Acetabulum

Gauging the Acetabulum .......................................................................................................................................7

Preliminary Trial Reduction (without implants) .......................................................................................................7Trial Reduction with Trial BIOLOX® delta or E1 Tapered BearingTrial Reduction with Trial E1 RingLoc-X Bearing

Insertion of Acetabular Shell ................................................................................................................................10RingLoc-X Impaction PlatesRingLoc-X Ring RetainersFinal Seating of the Shell

Supplementary Screw Fixation ............................................................................................................................14Exceed ABT Multi-hole/Revision ShellScrew Hole Preparation

Secondary Trial Reduction with the Trial Liners (with implants) ..........................................................................15

Insertion of Acetabular Bearing ............................................................................................................................16Insertion of E1 RingLoc-X BearingInsertion of BIOLOX® delta or E1 Tapered Bearing

Modular Head Selection and Impaction ..............................................................................................................17

BIOLOX® delta Option Femoral Heads ................................................................................................................18Head Removal and Inspection of the Stem TaperAssembly Instructions

Removal of the Acetabular Bearing and Shell .....................................................................................................20Removal of BIOLOX® delta or E1 Tapered BearingRemoval of E1 RingLoc-X BearingRemoval of Exceed ABT Acetabular Shell

Ordering Information ............................................................................................................................................22

The Exceed ABT Acetabular System comprises fully instrumented acetabular components designed specifically for

cementless application. Each acetabular component comprises a titanium alloy shell and acetabular bearing. Bearings

for the Exceed ABT acetabular system are available in Vitamin E stabilised highly crosslinked polyethylene (E1), BIOLOX®

delta ceramic and in articulation diameters of 22.22, 28, 32, 36 and 40 mm. The initial press-fit fixation and later

secondary fixation of the Exceed ABT shell, into the prepared acetabulum, is enhanced by Biomet’s proprietary Porous

Plasma Spray (PPS) coating, a clinically proven closed pore structure. The additional nano-crystalline hydroxyapatite

coating, BoneMaster, retains the surface topography of PPS and further improves both bone/implant contact and

density.

For details of the complete product range including instrumentation, please refer to pages 22-28 of this document.


5

Figure 1

Preoperative PlanningSelection of the correct acetabular component is attained through careful preoperative planning. This can be achieved manually by means of x-ray templates, or digitally by means of a Picture Archiving and Communication System. (PACS)

Manual Preoperative PlanningThe Exceed ABT Acetabular system provides a comprehensive selection of acetabular x-ray templates in 100% and 115% magnification.

These templates are positioned over the anterior/posterior x-ray to best decide the correct implant size, centre of rotation and whether Standard, Hi-Wall, 10 degree inserts or angled shells are required to restore the patient’s natural anatomy.

Digital Preoperative PlanningThe Exceed ABT Acetabular System digital templates are available through various digital template providers. When using digital templating for a primary total hip replacement, it is necessary to use a magnification marker with a known dimension. This is required in order for the system to calculate the correct magnification.

As soon as the correct magnification has been determined, the system can be used to best decide the correct implant size, centre of rotation and whether Standard, Hi-Wall, 10 degree inserts or angled shells are required to restore the patient’s natural anatomy.

Figure 2


6

Preparation of the AcetabulumIt is important to remove all articular cartilage and any soft tissue protruding into the acetabulum. In order to seat the acetabular component, some loss of subchondral bone may be inevitable. However, it is important to note, that subchondral bone, particularly peripheral bone, should be preserved.

The acetabular preparation (Figure 4) is undertaken using the grater reamers supplied. The axis of the grater reamer should be positioned at 40 to 45 degrees from the vertical axis and in 20 to 25 degrees of anteversion (Figure 5). Begin reaming with the smallest available grater reamer, increasing the diameter of each sequential grater reamer until the required diameter is achieved. As the shell is hemispherical, it is recommended to under ream the bone by 1-2 mm depending on bone quality.

E.g. 54 mm diameter Exceed ABT acetabular shell requires ream diameter of 52/53 mm.

NOTE: If acetabular osteotomes are used, final shaping must still be achieved using the hemispherical grater reamer to ensure a congruent fit between the shell and the floor of the acetabulum.

Figure 3

Figure 4

Figure 5

Surgical ExposureThe Exceed ABT system can be implanted using any of the standard approaches for total hip replacement. The aim of the approach selected is to provide adequate visualization of both the acetabulum and proximal femur (Figure 3).

7

Gauging the AcetabulumThoroughly clean and dry the acetabulum ensuring that any overhanging soft tissue has been excised. Attach the monoblock insertion handle to the trial shell/gauge. Care must be taken to thread the handle perpendicular to the face of the gauge to avoid risks of cross-threading or tip breakage upon impaction. Insert the trial shell/gauge into the reamed acetabulum (Figure 6). The diameter should correspond to the diameter of the implant to be used*. These trial shells/gauges are used to, a) check the stability of the final implant diameter prior to insertion, and b) to ensure the acetabulum is hemispherical. Should the trial shell/gauge be unstable, or if there are gaps between the trial shell/gauge and the acetabulum, it may be necessary to increase the diameter of the final grater reamer. However, in some instances it may not be possible to increase the reamed diameter. If this is indeed the case, then supplementary screw fixation will be necessary. Please refer to page 14 for method of supplementary screw fixation.

* i.e 1-2 mm greater than the last grater reamer used

Preliminary Trial Reduction (without implants)The preliminary trial reduction of the hip joint can only be carried out once the acetabulum and femur have been fully prepared in accordance with the relevant surgical technique. With the trial shell/gauge firmly located within the acetabulum, a preliminary trial reduction can be completed in order to assess the stability of the joint and to revalidate the component type and size selected at the preoperative planning stage (Figure 7 & 8). For information on head to shell ratios please see Table 1 below.

Table 1. Exceed ABT Acetabular Shell System

Bearing Material

Shell Diameter (mm)

40 42 44 46 48 50 52 54 56 58 60 62 64 66 68 70

E1 RingLoc-X Liners

22.22

32

2836

- 40

BIOLOX® delta & E1 Tapered

Liners- 28 32

36

- 40

Figure 6 Figure 7 Figure 8


8

Trial Reduction with Trial BIOLOX® delta or E1 Tapered BearingThe Standard Exceed ABT acetabular shell should be used where adequate femoral head coverage and joint stability is achieved with the component at 40–45 degrees of inclination (Figure 9). The 15 degree Exceed ABT acetabular shell should be used to improve femoral head coverage and stability should the standard shell not suffice. Each 15 degree component is identified with the word ‘cranial’ located superiorly on the lip of the 15 degree feature and highlights the segment of the shell that should be positioned approximately 45 degrees superior/posterior within the acetabulum. It is also important to seat the inferior lip of the component within the rim of the acetabulum (Figure 10). Failure to follow these instructions may result in impingement between the neck of the femoral component and the 15 degree feature or the inferior rim of the component.

With the trial shell in place, select the correct diameter trial tapered insert (28, 32, 36 or 40 mm) to match the diameter of the shell. By selecting the appropriately sized trial tapered bearing, the head diameter is automatically selected (See Table 1 on page 7).

The trial tapered bearings without captive screw can be placed into the trial shell/gauge by hand or using screw forceps provided. The trial tapered bearings with captive screw are placed by hand into the gauge and then locked with a 3.5 mm hex-driver.

A trial reduction can then take place as long as the femur contains the relevant components and trial head.

To remove the trial without captive screw, the screw forceps are engaged into the apical holes and gripped. The trial can then be removed. To remove the trials with captive screws use the 3.5 mm hex-driver to release.

NOTE: The trial tapered liners with captive screws should only be used in conjunction with the trial shell gauges and not with the definitive Exceed ABT shell.

Figure 9 Figure 10

9

Trial Reduction with Trial E1 RingLoc-X BearingStandard E1 RingLoc-X bearings should be used where adequate femoral head coverage and joint stability is achieved. The Hi-Wall components provide additional head coverage and security against dislocation. They are positioned with the Hi-Wall segment of the liner aligned approximately 45 degrees superior/posterior within the acetabulum. The 10 degree component is used to change the inclination or anteversion of the bearing surface.

The E1 +3 mm RingLoc-X trial liner is used to lateralise the femoral head by 3 mm. It can be selected as an alternative to a modular femoral head with a longer neck.

Once the adequate trial components are selected and inserted, the trial reduction can be carried out.

Figure 11

NOTE: RingLoc-X trial reduction can only be completed with the definitive implant. Please refer to page 15.

Care must be taken to ensure that the correct joint biomechanics are restored. Soft tissue tension, risk of impingement, range of motion and leg length should be assessed. The trial reduction procedure should be repeated until satisfactory joint stability and biomechanics are achieved (Figure 11).


10

Insertion of Acetabular ShellUpon correct sizing, attach the appropriate Exceed ABT shell directly to the inserter handle. Check that the strike plate is connected to the spring loaded inner shaft by attempting to pull it free. If the strike plate is not connected, firmly push and twist it downwards. When fully seated (Figure 12), the threaded tip of the inner shaft will protrude from the outer shaft of the handle. Turn the strike plate clockwise to firmly tighten the spring loaded threaded tip in the shell apical hole. Hold the shell with the other hand whilst engaging the thread to prevent the shell from rotating. Once assembled to the shell attach the alignment guide to the handle to aid accurate placement (Figure 13, 14 & 15).

IMPORTANT: It is advised to check that the threaded tip is always fully engaged in the cup apical hole when impacting. This helps minimise any risks of threaded tip damage.

For correct placement and orientation of the shell, the dome hole cluster should be positioned in the superior/posterior quadrant. The shell should be impacted at 40 to 45 degrees of inclination from the horizontal axis of the pelvis (Figure 14) and with 20-25 degree anteversion (Figure 15).

When implanting the RingLoc-X shell, it is recommended to use the Exceed ABT impaction plates or ring retainers.

Figure 12 Figure 13 Figure 14 Figure 15

45°

45°

11

RingLoc-X Impaction PlatesThe impaction plates help prevent potential risks of locking ring disengagement from the shell upon impaction.

Select the correct sized impaction plate and position it onto the face of the definitive implant. The plates cut-outs are positioned on the lugs of the cup (Figure 16).

Check that the compression sleeve on the impaction handle is in its upper position. Place the handle through the impaction plates and attach the handle securely to the implant. Turn the compression sleeve clockwise until it tightly clamps the impaction plate against the rim of the shell. Turn the handle strike plate to securely tighten the assembly (Figure 17).

IMPORTANT: Ensure impaction plate is fully seated on shell face to avoid damage to locking ring/locking ring groove (Figure 18).

Figure 16

Impaction plate is seated firmly against rim of cup

Space between impaction plate and rim of cup should not be present

Handle strike plate

Impaction Plate

Compression Sleeve

Figure 17 Figure 18

Incorrect seating of impaction plates.Correct seating of impaction plates.


12

RingLoc-X Ring RetainersThe ring retainers provide an alternative solution to prevent potential risks of locking ring disengagement from the shell upon impaction.

Select the correct sized ring retainer and position it into the shell (Figure 19).

Place the handle through the ring retainer and attach the handle securely to the implant (Figure 20).

Following impaction, removal of the ring retainer is possible using the removal forceps provided (Figure 21).


IMPORTANT: When implanting the RingLoc-X shell, it is important to check that the locking ring is fully engaged with the locking groove before impaction begins. If the impaction plates or ring retainers are not used for shell impaction and should the locking ring dissociate from the cup during impaction (but remain in the sterile field), fully seat the cup into the acetabulum. The locking ring can then be repositioned by hand into the cup locking groove. In case the locking ring has fallen outside the sterile field, or is deemed to be damaged by its disengagement from the locking groove, it must be replaced with a new spare locking ring.

13

Final Seating of the ShellIMPORTANT: The position of the shell is crucial in the use of hard on hard bearings (BIOLOX® delta liners) to reduce the risk of impingement.

Check via the apical hole to determine whether the shell is in full contact with the floor of the acetabulum. If not, the impactor handle must be re-attached to the shell and further impaction is required until the shell is fully seated. Failure to fully seat the shell into the acetabulum

may compromise the quality of fixation.

When utilising the curved shell impaction handle, to facilitate tightening or loosening of the thumb wheel, it may be necessary to utilise the 3.5 mm hex-driver contained within the Exceed ABT general instrument tray.

Once the Exceed ABT shell is fully seated, the apical hole is closed using the apical screw provided. The apical screw is secured into position by means of the 3.5 mm hex-driver (Figure 22).

The Exceed ABT acetabular shell is supplied as a solid shell with the option of removing titanium-blanking plugs intra-operatively, should supplementary screw fixation be necessary.*

*All Exceed ABT standard and 15 degree 3 hole shells are provided with titanium blanking plugs inserted in the Exceed ABT shell.

Figure 22


14

Supplementary Screw FixationFor primary cases where good bone stock is present and the shell is firmly seated within the acetabulum, the use of fixation screws is generally unnecessary. However, in cases where motion can be detected between the shell and the acetabulum, or where the bone quality is not optimal, supplementary screw fixation is advised. When dome screws are utilized they should be placed posterosuperiorly into the thick part of the ilium (Figure 23). Screw placement must be chosen carefully to avoid injury to neurovascular structures. Care should also be exercised when supplementary screw fixation is required, to avoid damaging or scratching the internal surfaces of the Exceed ABT acetabular components. Should screw fixation be necessary, the blanking screws are removed by means of a 3.5 mm hex-driver (Figure 24).

NOTE: Screws should never be placed in the anteromedial area of the acetabulum.

Exceed ABT Multi-hole/Revision ShellIn cases where extreme motion can be detected between the shell and the acetabulum, where the bone quality is not optimal or a revision shell is required, multi-screw fixation is advised. Screw placement must be chosen carefully to avoid injury to neurovascular structures. Care should also be exercised when supplementary screw fixation is required, to avoid damaging or scratching the internal surfaces of the Exceed ABT acetabular components.

NOTE: Titanium blanking plug screws are not provided as standard in the Exceed ABT multi-hole shell but all holes should be filled before inserting the bearing liner.

Additional titanium blanking plugs are available to fill spare screw holes.

Figure 23 Figure 24

15

Screw Hole PreparationPrepare the screw holes utilizing the quick connect drill bits, the drill guide and the flexible drill bit shaft (Figure 25). When drilling into the posterior/superior quadrant, place a finger posteriorly into the sciatic notch to ensure the screw cannot penetrate too deeply. Measure the length of the drill holes with the flexible depth gauge (Figure 26). Insert the low profile dome screws using the forceps and universal joint screwdriver (Figure 27).

NOTE: To avoid impingement of the acetabular insert, check that all screw heads are seated below the inner surface of the shell. Only use Biomet 6.5 mm low profile dome screws.

Secondary Trial Reduction with the Trial LinersFollowing the insertion and fixation of the acetabular shell, select the correct diameter trial acetabular bearing (22.22, 28, 32, 36 or 40 mm) that matches the diameter of the shell. By selecting the appropriately sized trial bearing, the head diameter is automatically selected (See Table 1 on page 7). This trial insert is then placed into the acetabular component by hand. A trial reduction can then take place. The trial reduction procedure should be repeated until satisfactory joint stability and biomechanics are achieved (Figure 28).

The removal forceps can be utilised with the trial tapered liners (without captive screws) to take them out more easily. Care must be taken not to scratch the shell taper when doing so.

NOTE: The trial tapered liners with captive screws should not be used in conjunction with the definitive Exceed ABT acetabular implant.

Figure 25

Figure 28

Figure 27

Figure 26


16

Insertion of Acetabular BearingThe definitive acetabular bearing should only be inserted into the acetabular shell once the shell is deemed to be stable and placed in the correct inclination and orientation. Failure to follow this instruction may cause premature implant failure.

Insertion of E1 RingLoc-X BearingThe definitive E1 RingLoc-X bearing may now be introduced. The bearing should be positioned initially by hand into the shell ensuring that it is correctly aligned both radially and longitudinally. The bearing is then finally impacted in position using the appropriately sized ball impactor and impactor handle (Figure 29). A visual indicator window is located within the shell to highlight whether or not the bearing is successfully restrained within the shell.

Insertion of BIOLOX® delta or E1 Tapered BearingThe definitive BIOLOX® delta or E1 Tapered bearing may now be positioned with the aid of the insertion device and handle, being careful not to misalign the insert (Figure 30). The surgeon should place their fingers around the face of the shell to ensure that the bearing is properly aligned. The edge of the bearing must be flush with the edge of the acetabular shell prior to applying any impaction force to the bearing (Figure 31).


17

Several moderate impactions of the bearing are necessary, utilising the appropriately sized ball impactor to ensure stable seating of the bearing (Figure 32). This is especially important when inserting ceramic bearings. Failure to follow these instructions may result in damaged ceramic bearings.

IMPORTANT: When inserting the trial or definitive bearing, the interior of the acetabular shell should be carefully cleaned and dried. The taper region of the acetabular insert should also be dry before insertion into the acetabular shell. Care should be taken not to scratch the taper surface of the BIOLOX® delta or E1 tapered bearing or the inner taper.

NOTE: The below table (Table 2) shows the different articulations available within the Exceed ABT system. BIOLOX® delta liners can only be used in conjunction with the Exceed ABT TaperFit shell. E1 can be used with the Exceed ABT TaperFit and RingLoc-X shell.

Modular Head Selection & ImpactionWith the definitive acetabular bearing in place and upon completion of femoral reconstruction and trial reduction, the corresponding modular head can now be selected (see Table 1, page 7). Position the modular head onto a dry and clean surface of the trunnion. Fully seat the modular head by means of firm axial impaction utilizing the femoral head pusher and mallet (Figure 33).

IMPORTANT: Ensure all taper surfaces are clean and dry before seating the modular head on the stem taper. It is important that the stem and cup tapers are new, as a used taper can reduce the fatigue strength of ceramic components.

Once the correct modular femoral head has been attached to the femoral component, the hip joint can be reduced (Figure 34).

Table 2: Liners

BIOLOX® delta E1

HeadsBIOLOX® delta Yes Yes

CoCrMo No Yes



18

BIOLOX® delta Option Femoral HeadsThe BIOLOX® delta Option modular femoral head system is available for use within the Exceed ABT acetabular system. The BIOLOX® delta Option heads can be used in conjunction with the BIOLOX® delta liners and E1 bearings. Please see Table 2, page 17.

The BIOLOX® delta Option heads can be used as a primary implant or as a revision option where a ceramic head is required to replace a ceramic head on a slightly damaged stem taper.

Definition regarding stem taper’s condition: Intact stem taper: condition of the stem taper after removal of the intact head.

Slightly damaged taper: condition of the stem taper after revision of the femoral head.

Head Removal and Inspection of the Stem TaperIn case of revision surgery, extract the remaining femoral head (and adapter, if applicable) with a suitable extraction instrument to avoid unnecessary damage to the stem taper.

Inspection of the stem taper and decision:

Pristine taper (see Figure 35A).

Tolerable condition with scratches of less than 0.25 mm (see Figure 35B).

Intolerable condition (see Figure 35C through to 35E).

Do not use the BIOLOX® delta Option modular femoral head system with tapers where damage is the same or exceeds that illustrated in Figure 35C to 35E.

Figure 35A

Pristine Taper

Figure 35B

Scratches less

than 0.25 mm

Figure 35C

Intolerable

Figure 35D

Intolerable

Figure 35E

Intolerable

19


Assembly InstructionsThe modular head components must be assembled together before positioning them onto the stem. Verify that the appropriate head size and matching tapers are being utilized before assembly.

The modular head components are assembled by placing the head onto the sleeve as shown in Figures 36 and 37. Ensure the tapers are clean and dry and they are aligned axially before applying pressure. The tapers are engaged once resistance is felt.

Place the BIOLOX® delta Option head assembly on the stem taper with a twisting motion, while applying manual pressure until it locks. Impact the modular head components onto the stem with several brisk mallet strikes using a plastic head impactor only (Figure 38). Metal impactors or any other metallic objects may scratch or crack the modular head bearing surface and, therefore, should not be used.

If the modular ceramic head becomes scratched or cracked, the head and sleeve must be replaced.

NOTE: In cases in which the BIOLOX® delta Option system cannot be put on the stem taper using more pressure, due to scratches or warping of more than 0.25 mm, the BIOLOX® delta Option system should not be used.

NOTE: In vitro testing has shown that the burst strength of BIOLOX® delta Option heads meet current standards when used on defects up to 0.25 mm. In vitro testing on trunnions with greater defects demonstrated a reduced burst strength for the ceramic head which would indicate an increased risk of failure. If the femoral stem is well fixed but the trunnion is damaged and the defects may be greater than 0.25 mm then the surgeon should consider the risks associated with use of the BIOLOX® delta Option heads against the risks associated with removal of the femoral component.


20

Removal of Acetabular Bearing & ShellShould it be necessary to remove a bearing from an Exceed ABT shell, you must first endeavour to identify the type of acetabular component inserted as the two shells have differing methods of bearing extraction.

Removal of BIOLOX® delta or E1 Tapered BearingShould it be necessary to remove a BIOLOX® delta or E1 tapered bearing, the insert remover can be used in conjunction with the insertion device. First attach the insertion device to the articulation surface of the bearing and impact the rim of the shell with the insert remover, being careful not to impact the bearing itself. The vibration created from the impact will loosen the bearing from the shell and allow it to be removed (Figure 39).

Removal of E1 RingLoc-X Bearing Should it be necessary to remove an E1 RingLoc-X bearing from an Exceed ABT shell, it will be necessary to locate the open end of the locking ring located within the shell. This open end of the locking ring is located inside the window situated on the mouth of the acetabular shell. To open the ring, utilize the circlip pliers to widen the opening and with the liner extraction tool, remove the liner from the shell (Figure 40).

Figure 39Figure 40

21

Removal of Exceed ABT Acetabular ShellOnce the bearing has been removed as described on page 20, unscrew the apical hole blanking screw with a 3.5 mm hex-driver. Remove any supplementary screw fixation to ensure any bone/implant fixation has been severed (Figure 41). Low profile screws are removed with a 3.5 mm hex-driver, whilst the bone/implant interface is severed with curved osteotomes.

Thread the tip of the monoblock cup insertion handle into the cup apical hole. Remove the cup from the acetabulum. Take extreme care when extracting the cup as too much force may damage the acetabular floor, peripheral rim and anterior and posterior columns of the acetabulum.

NOTE: The spring loaded impaction handle cannot be used for implant removal as the strike plate will detach.

Figure 41

22


ImplantsExceed ABT TaperFit Acetabular Components

Exceed ABT TaperFit Acetabular Liners

Size (mm)

15 Degree TaperFit Shells

PC HA/PC BM/PC

Ø46 233746 233746HA 233746BM

Ø48 233748 233748HA 233748BM

Ø50 233950 233950HA 233950BM

Ø52 233952 233952HA 233952BM

Ø54 234454 234454HA 234454BM

Ø56 234456 234456HA 234456BM

Ø58 234858 234858HA 234858BM

Ø60 234860 234860HA 234860BM

Ø62 235262 235262HA 235262BM

Ø64 235264 235264HA 235264BM

Ø66 235266 235266HA 235266BM

Ø68 235268 235268HA 235268BM

Ø70 235270 235270HA 235270BM

Size (mm)

BIOLOX® delta Liners

Ø28 Ø32 Ø36 Ø40

Ø46650-0790

Ø48

Ø50650-0791

Ø52

Ø54650-0795

Ø56

Ø58650-0796 650-0798

Ø60

Ø62

650-0797 650-0799

Ø64

Ø66

Ø68

Ø70

The colours correspond to those on the shell, liner labels and related trial liners.

Size (mm)

E1 Tapered Liners

Ø28 Ø32 Ø36

Std Std Std

Ø46E1-002837

Ø48

Ø50E1-003239

Ø52

Ø54E1-003644

Ø56

Ø58E1-003648

Ø60

Ø62

E1-003652

Ø64

Ø66

Ø68

Ø70

Size (mm)

Standard TaperFit Shells

PC HA/PC BM/PC

Ø46 123746 123746HA 123746BM

Ø48 123748 123748HA 123748BM

Ø50 123950 123950HA 123950BM

Ø52 123952 123952HA 123952BM

Ø54 124454 124454HA 124454BM

Ø56 124456 124456HA 124456BM

Ø58 124858 124858HA 124858BM

Ø60 124860 124860HA 124860BM

Ø62 125262 125262HA 125262BM

Ø64 125264 125264HA 125264BM

Ø66 125266 125266HA 125266BM

Ø68 125268 125268HA 125268BM

Ø70 125270 125270HA 125270BM

23

Implants

Exceed ABT E1 RingLoc-X Acetabular Liners and E1+3mm RingLoc-X Liners

Exceed ABT RingLoc-X Acetabular Shells

Size (mm)

3- Hole Shells Multi-Hole Shells

PC HA/PC BM/PC PC HA/PC

Ø40 131340 131340HA 131340BM - -

Ø42 131342 131342HA 131342BM - -

Ø44 131344 131344HA 131344BM - -

Ø46 131346 131346HA 131346BM - -

Ø48 131348 131348HA 131348BM - -

Ø50 131350 131350HA 131350BM 130450 130450HA

Ø52 131352 131352HA 131352BM 130452 130452HA

Ø54 131354 131354HA 131354BM 130454 130454HA

Ø56 131356 131356HA 131356BM 130456 130456HA

Ø58 131358 131358HA 131358BM 130458 130458HA

Ø60 131360 131360HA 131360BM 130460 130460HA

Ø62 131362 131362HA 131362BM 130462 130462HA

Ø64 131364 131364HA 131364BM 130464 130464HA

Ø66 131366 131366HA 131366BM 130466 130466HA

Ø68 131368 131368HA 131368BM 130468 130468HA

Ø70 131370 131370HA 131370BM 130470 130470HA

Size(mm)

Ø22.22 mm bearing Ø28 mm bearing

Std Hi-Wall 10o Std Hi-Wall 10o

Ø40 EP-042240 EP-052240 EP-062240

Ø42 EP-042242 EP-052242 EP-062242

Ø44 EP-042244 EP-052244 EP-062244

Ø46 EP-042846 EP-052846 EP-062846

Ø48 EP-042848 EP-052848 EP-062484

The colours correspond to those of the trial liners. The items boxed in pink are the E1 + 3mm RingLoc-X liners

Size (mm)Ø32 mm bearing Ø36 mm bearing Ø40 mm bearing

Std Hi-Wall 10o Std Hi-Wall 10o Std Hi-Wall 10o

Ø46 EP-073246 EP-083246

Ø48 EP-073248 EP-083248

Ø50 EP-043250 EP-053250 EP-063250 EP-073650 EP-083650

Ø52 EP-043252 EP-053252 EP-063252 EP-073652 EP-083652

Ø54 EP-043254 EP-053254 EP-063254 EP-043654 EP-053654 EP-063654 EP-074054 EP-084054

Ø56 EP-043256 EP-053256 EP-063256 EP-043656 EP-053656 EP-063656 EP-074056 EP-084056

Ø58 EP-043258 EP-053258 EP-063258 EP-043658 EP-053658 EP-063658 EP-044058 EP-054058 EP-064058





Ø68EP-043268 EP-053268 EP-063268 EP-043668 EP-053668 EP-063668 EP-044068 EP-054068 EP-064068

Ø70

24


Modular Heads - Biomet 12/14 Taper

Modular CoCr Heads - Biomet Type 1 Taper

Head Offset

CoCrMo Modular Heads

22.22 mm

28 mm 32 mm 36 mm 40 mm

-6mm - 650-0863 650-0870 650-0839 650-1030

-5mm 164441 - - - -

-3mm 163653 650-0864 650-0871 650-0840 650-1031

0mm 164440 650-0865 650-0872 650-0841 650-1032

+3mm - 650-0866 650-0873 650-0842 650-1033

+6mm - 650-0867 650-0874 650-0843 650-1034

+9mm - - - - 650-1035

+12mm - - - - 650-1036

HeadOffset

CoCrMo Modular HeadsBIOLOX® delta Ceramic

Modular Heads

BIOLOX® delta Option Ceramic Heads

28 mm 32 mm 36 mm 40 mm

650-1055 650-1056 650-1057 650-1058

22.22 mm 28 mm 32 mm 36 mm 40 mm 28 mm 32 mm 36 mm BIOLOX® delta Option Taper Sleeves (12/14)

-4 mm - - 650-0882 650-0887 650-1020 - 650-0833 650-0836 -

-3.5 mm - 650-0877 - - - 650-0830 - - -

-3 mm - - - - - - - - 650-1060

-2 mm 164133 - - - - - - - -

0 mm 164132 650-0878 650-0883 650-0888 650-1021 650-0831 650-0834 650-0837 650-1061

+2 mm 164131 - - - - - - - -

+3.5 mm - 650-0879 - - - 650-0832 - - -

+4 mm - - 650-0884 650-0889 650-1022 - 650-0835 650-0838 650-1062

+7 mm - - - - - - - - 650-1063

+8 mm - - - 650-0890 650-1023 - - 650-0667 -

+12 mm - - - - 650-1024 - - - -

Head Offset

BIOLOX® delta Ceramic Modular Heads

BIOLOX® delta Option Ceramic Heads

28 mm 32 mm 36 mm 40 mm

650-1055 650-1056 650-1057 650-1058

28 mm 32 mm 36 mm BIOLOX® delta Option Taper Sleeves (Type 1)

-6mm - - - 650-1064

-3mm 650-1159 650-1163 650-0660 650-1065

0mm 650-1158 650-1162 650-0661 650-1066

+3mm 650-1157 650-1161 650-0662 650-1067

+5mm - - - -

+6mm - 650-1160* 650-0663 650-1068

Modular BIOLOX® delta Ceramic Heads - Biomet Type 1 Taper

*The 32+6mm modular head is used ONLY with Biomet’s Ti6Al4V Type 1 taper stems

Implants

25

Implants

Product Part Number Size Description

650-1000650-1001650-1002650-1003650-1004650-1005650-1006650-1007650-1008650-1009650-1010650-1011650-1012650-1013650-1014650-1015

Ø40 mmØ42 mmØ44 mmØ46 mmØ48 mmØ50 mmØ52 mmØ54 mmØ56 mmØ58 mmØ60 mmØ62 mmØ64 mmØ66 mmØ68 mmØ70 mm

Exceed ABT Spare Locking Ring

103530103531103532103533103534103535103536103537103538103539

Ø6.5 mm x 15 mmØ6.5 mm x 20 mmØ6.5 mm x 25 mmØ6.5 mm x 30 mmØ6.5 mm x 35 mmØ6.5 mm x 40 mmØ6.5 mm x 45 mmØ6.5 mm x 50 mmØ6.5 mm x 60 mmØ6.5 mm x 70 mm

LP Cancellous Bone Screw

123741 Exceed ABT Apical Plug - Spare

123743 Exceed ABT Threaded Plug - Spare

26


Instrumentation

ProductPart

NumberSize Description

31-601120 —Exceed ABT General Instrument Tray

Assembly

31-601122 —Exceed ABT Supplementary

Screw Fixation Tray Assembly

31-601124 —Exceed ABT Trial

Standard Shell and Liner Tray Assembly

31-601126 —Exceed ABT Trial

15° Shell and Liner Tray Assembly

31-60150131-60150231-601503

—

Exceed ABT RingLoc-X Standard Trial Instr Tray & Instr

Exceed ABT RingLoc-X Hi-Wall Trial Instr Tray & Instr

Exceed ABT RingLoc-X 10° Trial Instr Tray & Instr

31-601518 —Exceed ABT RingLoc-X

+3 mm Liners Instr Tray Complete

E1-100000 —Exceed ABT E1 Tapered Trial Liners

Complete Set

Exceed ABT Acetabular System Instrumentation

27

Instrumentation

ProductPart

NumberSize Description

31-600055 —Grater Reamer Tray Assembly

(1 mm Increments)

31-60111231-10059231-60111431-100593

Ø3.2 mm x 40 mmØ3.2 mm x 50 mmØ3.2 mm x 60 mmØ3.2 mm x 70 mm

Stainless Steel Twist Drill

31-601128 22-36 mmExceed ABT Trial Modular

Head Tray Assembly Type 1

31-601130 22-36 mmExceed ABT Trial Modular

Head Tray Assembly (12/14 Taper)

31-601374 40/44 mmExceed ABT Trial Modular

Head Type 1 Tray Complete

31-601376 40/44 mmExceed ABT Trial modular

Head (12/14) Tray Complete

28


Instrumentation

Product Part Number Size Description

31-601621 31-60162231-60162331-60162431-60162531-60162631-60162731-60162831-60162931-60163031-60163131-60163231-60163331-60163431-601635

Ø40 mmØ42 mmØ44 mmØ46 mmØ48 mmØ50 mmØ52 mmØ54 mmØ56 mmØ58 mmØ60 mmØ62 mmØ64 mmØ66 mm

Ø68/70 mm

RingLoc-X/MH Impaction Plate

Exceed ABT RingLoc-X Impaction Plate

Exceed ABT RingLoc-X Ring Retainers

Product Part NumberSize

RingLoc-X/RingLocDescription

110007401

110007412

110007415

110007406

110007408

110007409

110007402

110007403

110007404

110007411

110007405

110007407

110007413

110007414

110007410

Ø40 mm/20

Ø42 mm

Ø44 mm/21

Ø46 mm/22

Ø48 mm

Ø50 mm/23

Ø52 mm

Ø54 mm/24

Ø56 mm

Ø58 mm/25

Ø60 mm/26

Ø62 mm

Ø64 mm/27

Ø66 mm

Ø68/70 mm/28

RingLoc-X Ring Retainer

29

The Complete Exceed ABT Family

BIOLOX® delta Ceramic Liner E1 STD Liner E1 HW Liner E1 10˚ Liner

CoCr Modular HeadBIOLOX® delta Ceramic Head

E1 Flanged Cemented Cup E1 Non Flanged Cemented Cup E1 Muller Cemented Cup

Exceed ABT Standard TaperFit Shell

Exceed ABT 15° TaperFit Shell

Exceed ABT RingLoc-X Shell

Exceed ABT RingLoc-X Multi-Hole Shell

E1 Tapered STD Liner

BIOLOX® delta Option

30

Notes

Legal ManufacturerBiomet UK, Ltd.Waterton Industrial EstateBridgend, South WalesCF31 3XA UK

www.biometeurope.com

0086

©2014 Biomet Orthopedics • Form No. BMET0326.3-ENG • REV1214

All content herein is protected by copyright, trademarks and other intellectual property rights owned by or licensed to Biomet Inc. or its affiliates unless otherwise indicated, and must not be redistributed, duplicated or disclosed, in whole or in part, without the express written consent of Biomet.

This material is intended for health care professionals and the Biomet sales force. Distribution to any other recipient is prohibited.

For complete product information, including indications, contraindications, warnings, precautions, and potential adverse effects, see the package insert and www.Biomet.com” where appropriate.

BIOLOX® delta and BIOLOX® delta Option are trademarks of CeramTec AG

For product information see package insert and Biomet’s website. Check for local product clearances and reference product specific instructions for use.

Note: Biomet UK may not be the legal manufacturer of all instruments listed in this surgical technique. Refer to the instrument labeling for Legal Manufacturers name and address.

exceed abt acetabular system - surgitech exceed abt...surgical technique surgical protocols by mr e...

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