ExcEption® Femoral StemPrimary Cementless

Operative Technique

Preoperative planning can be easily performed with EXCEPTION® templates for femoral sizing. Our software B-fits can also be used.

It is recommended to use a radiographic marker to assess x-ray magnification on an individual basis so that the proper templates can be selected.Determine the center of rotation of the hip, and choose the EXCEPTION® femoral stem which is the most suitable on the frontal and the sagittal plane.

The recommended surgical approach is a posterolateral approach as it allows excellent exposure of the femoral shaft for canal preparation.

Generally, any commonly employed surgical approach can be used with the EXCEPTION® stem.

Preoperative Planning

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Femoral Neck Resection Femoral Canal Preparation

Once the femoral head is dislocated, the femoral neck can be cut using classic marks between the greater and the lesser trochanter (Figure 1).

The box punch allows preparation of the femoral canal avoiding rasps’ undersizing or bad positioning (Figure 2).

It is sometimes necessary to remove a small part of the greater trochanter medial cortex to allow correct align-ment of the broaches.

Figure 1

Figure 2

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The smallest broach is attached to the broach handle and the femur is prepared increasing broach sizes progressively (Figure 3).

If necessary, the broach can be removed using the sliding hammer used for revision implants.In this case, use the adaptor to connect it to the broach thread. (Figure 4).

Femoral Broaching

Figure 3

Figure 4

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Figure 6

Figure 5

Length Trial

The final broach stays in the femur (Figure 5).

The multicenter neck allows us to control the neck length of the femoral head and to confirm the choice of the implant (EXCEPTION® or EXCEPTION® Varised).

Snap the multicenter neck corresponding to the size of the broach and with the mark tip determine the proper neck length aligned to the greater trochanter (Figure 6).

The multicenter necks are defined by groups of 3 sizes (1.2.3 / 4.5.6 / 7.8.9) in both version EXCEPTION® and EXCEPTION® Varised (therefore 3 multicenter necks).

The multicenter neck colors correspond to the colors of the final implants’ neck colors by groups of 3 sizes (1.2.3: yellow, 4.5.6: green and 7.8.9: blue).

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Figure 7

Figure 8

Trial Reduction

The final broach stays in the femur.

With the final broach in place, trials can be done snap-ping the trial neck (EXCEPTION® or EXCEPTION® Varised) directly onto the broach and choosing the appropriate pinned trial head, to restore the proper length and offset (Figure 7).

Once the trials have been done, remove the trials and the broach using the broach handle (Figure 8).

The trial necks are defined by groups of 3 sizes (1.2.3 / 4.5.6 / 7.8.9 in version EXCEPTION® and EXCEPTION®

Varised).

The trial necks colors correspond to the colors of the de-finitive implants’ neck colors by groups of 3 sizes (1.2.3: yellow, 4.5.6: green and 7.8.9: blue).

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Figure 9

Figure 10

Femoral Component Insertion

The femoral component, corresponding to the trial stem, is inserted into the femoral canal, using the stem impactor (Figure 9).

A trial head is placed on the neck of the stem and the hip is reduced again to assess joint stability and range of motion (Figure 10).

The trial heads used on the final implant are the grey ones.

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Figure 11

Figure 12

Femoral Head Component Insertion and Reduction

Once the trial head is removed, carefully clean the joint before placing the final femoral head on the cleaned and dried taper of the stem (Figure 11).

Impact using the femoral head impactor (Figure 12).

The joint is then reduced.

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Horizontal offset

Vertical offset

A

B

c°

ExcEpTiOn®

ExcEpTiOn® ExcEpTiOn® Varised

1 pS125Y01 pS126Y01 125.5 32.6 137.5 39.2 29

2 pS125Y02 pS126Y02 128.5 33.6 137.5 40 29.7

3 pS125Y03 pS126Y03 131.5 34.6 137.5 40.5 30.7

4 pS125Y04 pS126Y04 136.5 35.5 137.5 41.9 31.4

5 pS125Y05 pS126Y05 141.5 36.5 137.5 43.4 32

6 pS125Y06 pS126Y06 146.5 37.5 137.5 44.9 32.8

7 pS125Y07 pS126Y07 152 38.5 137.5 46.4 33.5

8 pS125Y08 pS126Y08 156.5 39.5 137.5 47.9 34.2

9 pS125Y09 pS126Y09 161.5 40.5 137.5 50.2 34.9

ExcEpTiOn® Varised

1 pV125Y01 pV126Y01 125.5 32.1 125.4 44.4 22.6

2 pV125Y02 pV126Y02 128.5 33.3 126 45.3 23.6

3 pV125Y03 pV126Y03 131.5 34.4 126.6 45.9 24.9

4 pV125Y04 pV126Y04 136.5 35.6 127.3 47.2 26

5 pV125Y05 pV126Y05 141.5 36.8 127.9 48.7 27

6 pV125Y06 pV126Y06 146.5 37.9 128.6 50 28.1

7 pV125Y07 pV126Y07 152 39.1 129.2 51.5 29.2

8 pV125Y08 pV126Y08 156.5 40.2 129.9 52.8 30.4

9 pV125Y09 pV126Y09 161.5 41.4 130.5 55 31.5

product Size Left Right A B c° Horizontal Vertical

product Size Left Right A B c° Horizontal Vertical

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ExcEption® Femoral Stem

Implants References

Instruments References

ExcEpTiOn® Varised

A35M00L2 A35M00R2 EXCEPTION® Instrumentation

product Left Right Description Size

87-130-00000 87-130-00000 Box punch

A465M012 A465M012 Rasp extraction adaptator

A3500001 A3500001 Slide hammer

A35M0G01 A35M0D01 1 A35M0G02 A35M0D02 2 A35M0G03 A35M0D03 3 A35M0G04 A35M0D04 Rasp 4 A35M0G05 A35M0D05 5 A35M0G06 A35M0D06 6 A35M0G07 A35M0D07 7 A35M0G08 A35M0D08 8 A35M0G09 A35M0D09 9

31-555500 31-555500 Straight exact broach handle

A120M123 A120M123 1-2-3 A120M456 A120M456 EXCEPTION® multicenter trial neck 4-5-6 A120M789 A120M789 7-8-9

A120M000 A120M000 EXCEPTION® mark tip for multicenter trial neck

A01G6c22 A01G6c22 D 22 S A01G6M22 A01G6M22 D 22 M A01G6L22 A01G6L22 D 22 L A01G6028 A01G6028 D 28 XS A01G6c28 A01G6c28 D 28 S A01G6M28 A01G6M28 D 28 M A01G6L28 A01G6L28 EXCEPTION® pinned trial head D 28 L A01G6032 A01G6 032 D 32 XS A01G6c32 A01G6c32 D 32 S A01G6M32 A01G6M32 D 32 M A01G6L32 A01G6L32 D 32 L A01G6c36 A01G6c36 D 36 S A01G6M36 A01G6M36 D 36 M A01G6L36 A01G6L36 D 36 L

Left Right Description

9

product Left Right Description Size

ExcEption® Femoral Stem

Instruments References

A120S123 A120S123 1-2-3

A120S456 A120S456 EXCEPTION® trial neck 4-5-6

A120S789 A120S789 7-8-9

A120V123 A120V123 1-2-3

A120V456 A120V456 EXCEPTION® varised trial neck 4-5-6

A120V789 A120V789 7-8-9

A0104001 A0104001 Stem inserter

A0107001 A0107001 Head inserter

A0107c22 A0107c22 D 22 S

A0107M22 A0107M22 Trial head D 22 M

A0107L22 A0107L22 D 22 L

A01R7028 A01R7028 D 28 XS

A01R7c28 A01R7c28 D 28 S

A01R7M28 A01R7M28 D 28 M

A01R7L28 A01R7L28 Retentive trial head D 28 L

A01R7032 A01R7032 D 32 XS

A01R7c32 A01R7c32 D 32 S

A01R7M32 A01R7M32 D 32 M

A01R7L32 A01R7L32 D 32 L

A35M0203 A35M0201 EXCEPTION® Base

A35M0204 A35M0204 EXCEPTION® Bottom tray

A35M0202 A35M0202 EXCEPTION® Top tray

A35M0200 A35M0200 EXCEPTION® Lid

cA125-01 cA125-01 EXCEPTION® Standard template

cA126-01 cA126-01 EXCEPTION® Varised template

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Cases References

11

Left side case A35M00L2

Right side case A35M00R2

ExcEption® Femoral Stem

Trays References

Top tray A35M0202

Base A35M0201

Bottom tray A35M0204

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