original m.e. müller acetabular reinforcement ring...3 | original m.e. müller® acetabular...

Original M.E. Müller® Acetabular Reinforcement Ring

Surgical Technique

Table of Contents

Preoperative Planning .............................................................................................. 2

Surgical Technique ................................................................................................... 5

Implants .................................................................................................................... 8

Instruments ............................................................................................................ 11

2 | Original M.E. Müller® Acetabular Reinforcement Ring

Figure 1 Figure 2

The acetabular roof reinforcement ring is fixed with 3 to 6 cancellous bone screws. These are positioned in the os ilium in the direction of the iliosacral joint and are inclined approximately 20° medially and posteriorly in relation to the long axis of the body. The polyethylene cup has an inclination of approximately 40° which corresponds in most cases with the position of the ring (Fig. 1, 2).

Implant ConceptThe Acetabular Roof Reinforcement Ring was designed by Prof. Maurice E. Müller. Reinforcement of the acetabulum using an acetabular roof reinforcement ring is indicated in total hip replacement in cases of osteoporosis, rheumatoid arthritis, acetabular roof cysts, simultaneous bone grafting, small dysplastic hips, after arthrodeses and in socket revision.

An acetabular roof reinforcement ring is also recom-mended in combination with polyethylene cups with low wall thickness.

After the preparation of the acetabulum, an acetabular roof reinforcement ring with a diameter of 4 mm smaller than the last reamer is normally used. The implant is wedged into the acetabulum with the metal impac-tor. The ring is positioned correctly if its lateral rim lies on the border of the acetabulum. It is imperative that the area of the screw holes and the lower border of the ring should have sufficient bone contact.


Use a Müller low-profile cup of the same size as the ring (i.e. cup size 50 mm) for a cement mantle of 1 mm thickness. For a 2 mm cement mantle use a low- profile cup of a size 2 mm smaller than the ring (i.e. cup size 48 mm).

Sizing Principle of the Acetabular Roof Reinforcement Ring (ARRR)Ream the acetabulum with the appropriate size acetabular reamer (i.e. 54 mm). Implant a ring 4 mm smaller than the last reamer used, which yields a pressfit of 2 mm (i.e. ring size 50 mm).

1 with a 2-mm cement layer, 2 with a 1-mm cement layer

Ref.

Number

Ring Outer

Diameter

(mm)

Ring Inner

Diameter

(mm)

PE Cup

Diameter

(mm)

Sulene® PE

22 mm

Sulene PE

28 mm

Sulene PE

32 mm

Durasul® PE

28 mm

Durasul PE

32 mm

Durasul PE

36 mm

36 97.36.49 42 38 362 63.22.36 – – – – –

38 97.38.49 44 40 361

382

63.22.3663.22.38

––

––

––

––

––

40 97.40.49 46 42 381

402

63.22.3863.22.40

––

––

––

––

––

42 97.42.49 48 44 401

422

63.22.4063.22.42

–63.28.42

––

–01.00284.042

––

––

44 97.44.49 50 46 421

442

63.22.4263.22.44

63.28.4263.28.44

–63.32.44

01.00284.04201.00284.044

–01.00324.044

––

46 97.46.49 52 48 441

462

63.22.4463.22.46

63.28.4463.28.46

63.32.4463.32.46

01.00284.04401.00284.046

01.00324.04401.00324.046

––

48 97.48.49 54 50 461

482

63.22.4663.22.48

63.28.4663.28.48

63.32.4663.32.48

01.00284.04601.00284.048

01.00324.04601.00324.048

–05.95001.050

50 97.50.49 56 52 481

502

63.22.4863.22.50

63.28.4863.28.50

63.32.4863.32.50

01.00284.04801.00284.050

01.00324.04801.00324.050

05.95001.05005.95001.051

52 97.52.49 58 54 501

522

63.22.5063.22.52

63.28.5063.28.52

63.32.5063.32.52

01.00284.05001.00284.052

01.00324.05001.00324.052

05.95001.05105.95001.052

54 97.54.49 60 56 521

542

63.22.5263.22.54

63.28.5263.28.54

63.32.5263.32.54

01.00284.05201.00284.054

01.00324.05201.00324.054

05.95001.05205.95001.053

56 97.56.49 62 58 541

562

63.22.5463.22.56

63.28.5463.28.56

63.32.5463.32.56

01.00284.05401.00284.056

01.00324.05401.00324.056

05.95001.05305.95001.054

58 97.58.49 64 60 561

582

63.22.5663.22.58

63.28.5663.28.58

63.32.5663.32.58

01.00284.05601.00284.058

01.00324.05601.00324.058

05.95001.05405.95001.055

Original M.E. Müller Low-Profile CupsOriginal M. E. Müller Ring


The size of the implant, as well as the localization of the screws in the flange, can be determined by directing the screws towards the iliosacral joint. The definitive size of the implant, the po sitioning and the number of screws re quired can only be determined intra-operatively. Finally, one must evaluate the need for bone grafting.

Preoperative PlanningPreoperative planning is done with the aid of a template that serves to determine the size and position of the ring before the operation. By using this method, potential difficulties that might occur during the operation can be foreseen and complications avoided. Adequate radiographs and, if indicated, CT or MRI imaging should allow the eva l uation of the condition of the acetabulum. The planning should aim to restore the center of rotation of the hip, which should be calculated by taking the contralateral side into account.

X-ray template REF 06.00806.000X

+H84406008060001/$130201B13O

Original M.E.Müller® Ring, Uncemented

These reference numbers must correspond to

those of the prostheses to be implanted.

© 2013. All rights reserved, Zimmer GmbH,

Sulzerallee 8, CH-8404 Winterthur, Switzerland

Lit. No. 06.00806.000 – Ed. 2013-02

20 cm

15 cm

5 cm

10 cm

5 cm 10 cm 15 cm

Magnification 1.15:1

LeftRight

Size 58 – REF 97.58.49Size 50 – REF 97.50.49Size 42 – REF 97.42.49

585042


564840


544638


524436


Insertion of the Ring

Use the metal impactor to place the acetabular roof re inforcement ring (usually 4 mm smaller than the last reamer) (Figure 5).

Implantation of the Acetabular Roof Reinforcement RingReaming of the Acetabulum

After removing all debris, use the acetabular reamers to create a even, rounded acetabular floor. The last reaming is done by hand (Figure 3).

Insertion of the Trial Ring

Use the Original M.E. Müller Trial Rings to examine correct implant sizing. In addition, check if bone quality, especially near screw holes, suffices to ensure primary stability (Figure 4).

Figure 3

Figure 5

Surgical Technique

Figure 4


Testing the Cup Size

Check the cup position with the test cup (cup and ring usually correspond in size). (Figure 10)

Anchoring

Drill of the first screw hole medially using the flexible shaft and drill guide. (Figure 6)

To utilize the full length of the drill bit, hold the bit with the drill guide. (Figure 7)

Determining the depth of the screw hole with the depth gauge. (Figure 8)

Insert and tighten the cancellous bone screw with the cardan joint screwdriver or the extra-long screwdriver. (Figure 9)

Figure 6 Figure 7 Figure 8

Figure 9 Figure 10


Alignment of the Cup

Position of the cup with an inclination of 40° and an anteversion of 12°; in most cases, identical to the position of the ring (Figure 13).

Apply pressure to the cup using the impactor without the metal top. Press the cement in with the cement pusher (Figure 14).

Cementing the Cup

Insert the cement and implant the cup. Push the cup horizontally and as far medially as possible (Figure 11).

Remove excess cement (Figure 12).

Figure 11 Figure 12

Figure 13

Figure 14


Original M.E. Müller Acetabular Roof Reinforcement Ring

Cancellous Bone Screws

Product Description Size (mm) Part Number

CP titanium (Protasul® Ti) 363840424446485052545658

97.36.4997.38.4997.40.4997.42.4997.44.4997.46.4997.48.4997.50.4997.52.4997.54.4997.56.4997.58.49


Countersunk Cancellous Bone Screw ∅ 6.5 mm Protasul 100

15 202530354045505560

42.19.1542.19.2042.19.2542.19.3042.19.3542.19.4042.19.4542.19.5042.19.5542.19.60

Cancellous Bone Screw ∅ 6.5 mm Protasul 100

20253035 4045 50 5560

02.03147.02002.03147.02502.03147.03002.03147.03502.03147.04002.03147.04502.03147.05002.03147.05502.03147.060

sterile packed

HEX

HEX

Implants


Low-Profile Cups


Original M.E.Müller Low-Profile Cup, cemented UHMW Polyethylene (Sulene PE) Radiological mark CP Titanium (Protasul Ti)

36* 38* 40* 42 44 46 48 50 52 54 56 58

63.22.3663.22.3863.22.4063.22.4263.22.4463.22.4663.22.4863.22.5063.22.5263.22.5463.22.5663.22.58


42*4446485052545658606264

63.28.4263.28.4463.28.4663.28.4863.28.5063.28.5263.28.5463.28.5663.28.5863.28.6063.28.6263.28.64


44*46*485052545658606264

63.32.4463.32.4663.32.4863.32.5063.32.5263.32.5463.32.5663.32.5863.32.6063.32.6263.32.64

22 mm

32 mm

28 mm

* Must be implanted with an acetabular roof reinforcement ring, an acetabular roof reinforcement ring with hook or a Burch-Schneider® Reinforcement Cage.

sterile packed

sterile packed

sterile packed

Implants (cont.)


Low-Profile Cups


Durasul PE Low-Profile Cup, cementedDurasul Radiological mark CP Titanium (Protasul Ti)

424446485052545658606264

01.00284.04201.00284.04401.00284.04601.00284.04801.00284.05001.00284.05201.00284.05401.00284.05601.00284.05801.00284.06001.00284.06201.00284.064


4446485052545658606264

01.00324.04401.00324.04601.00324.04801.00324.05001.00324.05201.00324.05401.00324.05601.00324.05801.00324.06001.00324.06201.00324.064


485052545658606264

05.95001.05005.95001.05105.95001.05205.95001.05305.95001.05405.95001.05505.95001.05605.95001.05705.95001.058

sterile packed

sterile packed

sterile packed

28 mm

32 mm

36 mm

Implants (cont.)


Instruments

Basic Instruments for Reinforcement Cages and Rings

Product Description Label ∅ mm L mm Part Number

Case for Acetabular Roof Reinforcement, complete, see Product Catalogue

- - - ZS99.29.30-00

Case (empty) - - - 75.80.01

Insert (empty) - - - 75.80.03

Depth Gauge A - - 75.80.15

Flexible Shaft1 for REF 75.11.00-06, 75.11.00-07, 75.11.00-08

B - - 75.11.00-05

Hexagonal Wrench for REF 75.11.00-05, 75.11.40-25

C - - 75.11.00-04

Drill Bit1, to be used only with REF 75.11.00-05

D 3.53.53.5

405065

75.11.00-0675.11.00-0775.11.00-08

Drill Guide E 5.8/3.5 - 75.85.70

T-handle for Tap for REF 75.11.40-20 F - - 75.11.40-25

Tap1 for REF 75.11.40-25 G 6.5 - 75.11.40-20

Drill Bit H 3.5 195 75.85.25

A

B

D

E

F

G

H

1 For basic equipment, order 2 pieces.


Instruments (cont.)

Basic Instruments for Reinforcement Cages and Rings

Product Description Label ∅ mm L mm Part Number

Countersink I 9.0 - 75.80.27

Case for Cancellous and Cortical Bone Screws (empty)

J - - 75.85.34

Self-Holding Screw Forceps K - - 100.90.005

Screwdriver with Cardan Joint L - 300 75.80.34

Top for Screw Extraction M - - 75.80.28

M

L

I

J

K


Instruments for Trial Shells

Instruments for Low-Profile Cups


Instrument Tray (complete) - ZS01.00239.100

Tray for Special Instruments (empty) - 74.01.82

Test Shell for Müller Ring 363840424446485052545658

01.00239.00101.00239.00201.00239.00301.00239.00401.00239.00501.00239.00601.00239.00701.00239.00801.00239.00901.00239.01001.00239.01101.00239.012

Handle for trial shell - 01.00239.000


Tray Instruments for Low-Profile Cup (complete)

- ZS01.00245.626

Tray Instruments for Low-Profile Cup (empty)

- 01.00245.627

Insert for Tray Instruments for Low-Profile Cup (empty)

- 01.00245.628

Standard Tray Cover - 01.00029.031

Cup Impactor, Curved - 75.00.39

Cup Impactor, Straight - 75.00.49

Instruments (cont.)


Instruments for Trial Shells (cont.)


Positioning Guide 40°Positioning Bar

--

75.85.1975.85.00

Cup-inserting Device for Cemented Cups with inner ∅ 22mm

- 75.00.33

Top for Impactor (black)Top for Impactor (blue)Top for Impactor (green)Top for Impactor (green)

22283236

78.22.51*78.28.5178.32.5105.95001.060*

Positioning Top for Low-Profile Cups (Blue)Positioning Top for Low-Profile Cups (Green)Positioning Top for Low-Profile Cups (Black)

283236

75.28.9475.32.94* 05.95001.059*

Positioning top for Low-Profile Cups, Black 22 75.22.94

Test Cup, Low Profile 36 38 40 42 44 46 48 50 52 54 56 58 60 62 64

54.36.0854.38.0854.40.0854.42.0854.44.0854.46.0854.48.0854.50.0854.52.0854.54.0854.56.0854.58.0854.60.0854.62.0854.64.08

Instruments (cont.)

* On special request


X-Ray Templates


Original M.E. Müller Ring, Uncemented 115%

- 06.00806.000X

Instruments (cont.)

Cement Pushers


Cement pusher, small - 75.00.50

Cement pusher - 75.00.41


Instruments (cont.)

Acetabular Reamers

Product Description Label Size (mm) Part Number

Acetabular Reamers Instrument Tray (empty)

- - 01.00209.400

Standard Tray Cover, Grey - - 01.00029.031

EZ Clean Straight Reamer Handle (AO Connection)

A 312 T2227

4-Strut Spherical Reamer B 404244464850525456586062646668

00-1206-090-4000-1206-090-4200-1206-090-4400-1206-090-4600-1206-090-4800-1206-090-5000-1206-090-5200-1206-090-5400-1206-090-5600-1206-090-5800-1206-090-6000-1206-090-6200-1206-090-6400-1206-090-6600-1206-090-68

4-Strut Spherical Reamer(extra small / extra large)

C 3638707274

00-1206-090-3600-1206-090-3800-1206-090-7000-1206-090-7200-1206-090-74

Adapter AO-3 jaw Chuck D - 5637

B

C

D A

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This material is intended for health care professionals. Distribution to any other recipient is prohibited.

For indications, contraindications, warnings, precautions, potential adverse effects and patient counselling information, see the package insert or contact your local representative; visit www.zimmerbiomet.com for additional product information.

Not for distribution in France. Check for country product clearances and reference product specific instructions for use.

Zimmer Biomet does not practice medicine. This technique was developed in conjunction with health care professionals. This document is intended for surgeons and is not intended for laypersons. Animations and virtual reality are provided as a visual guide based on surgical techniques; a written copy of the surgical technique is available at www.zimmerbiomet.com or from your local representative. Each surgeon should exercise his or her own independent judgment in the diagnosis and treatment of an individual patient, and this information does not purport to replace the comprehensive training surgeons have received. As with all surgical procedures, the technique used in each case will depend on the surgeon’s medical judgment as the best treatment for each patient. Results will vary based on health, weight, activity and other variables. Not all patients are candidates for this product and/or procedure.

Caution: Federal (USA) law restricts this device to sale by or on the order of a surgeon. Rx only.

©2019 Zimmer Biomet.

2756.1-GLBL-en-REV1019

Legal ManufacturerZimmer GmbHSulzerallee 88404 Winterthur, SwitzerlandTelephone +41/ (0)52 262 60 70Fax +41/ (0)52 262 01 39

www.zimmerbiomet.com

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CE mark on a surgical technique is not valid unless there is a CE mark on the product label.

original m.e. müller acetabular reinforcement ring...3 | original m.e. müller® acetabular...

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