surgical technique - surgitech avantage st.pdf · biomet does not practice medicine and does not...

AVANTAGE

Acetabulum System

Surgical Technique

This publication and all content, artwork, photographs, names, logos and marks contained in it are protected by copyright, trademarks and other intellectual property rights owned by Biomet or its affiliates or licensed to Biomet or its affiliates. This brochure must not be used, copied or reproduced in whole or in part for any purposes other than marketing by Biomet or its authorised representatives. Any other purposes are prohibited.

Biomet does not practice medicine and does not recommend any particular orthopaedic implant or surgical technique for use on a specific patient. The surgeon who performs any implant procedure is responsible for determining and utilising the appropriate techniques for implanting prosthesis in each individual patient.

Biomet is not responsible for selection of the appropriate orthopaedic implant or surgical technique, nor does it advocate a particular technique to be utilised on an individual patient.

© Biomet 2015

Contents

Page

Pre-operative planning 1

Surgical exposure 1

Acetabular reaming 2

Acetabular gauging 2

Acetabular implant insertion 3

Trial inserts 4

Implants reduction 5

3P cup 6

Cemented cup 8

Revision cup 9

Cemented reconstruction system 10

Removal of the insert 11

Removal of 3P pegs 11

Ordering information 12

1

Pre-operative planning can be achieved with AVANTAGE

X-ray templates or digitally by means of a PAC system.

It is necessary to use a magnification marker with a known dimension to carry out accurate templating of the anatomy.

2. Surgical Exposure

The AVANTAGE hip system can be implanted using any of the standard approaches for total hip replacement.

1. Pre-Operative Planning

STEMEXCEPTION STD

S. 5S. 28

CUPT. 58Lat. 0.00Leg lenght 0.00

FEMORAL HEAD

Lat. – . –Leg lenght – . –

MARKER BALL

S. 30

MESURE

2

Figure 1

Figure 2

3. Acetabular Reaming

It is important to start reaming with the smallest diameter grater reamer available, perpendicular to the acetabu-lum, in order to find the true acetabular floor.

Sequential reaming then follows, ensuring that the reamer handle is angled at the same orientation of the component to be implanted, 40 to 45 degrees of inclina-tion and 10 to 15 degrees of anteversion (Figure 1).

4. Acetabular Gauging

The AVANTAGE cup is implanted size to size:

Reaming diameter = Gauging diameter Reaming diameter = Gauging diameter = Definitive implant diameter= Definitive implant diameter

Assemble the appropriate trial cup onto the trial cup positioner. The gauge selected should correlate directly with the size of acetabular component.

Impact the trial cup in the reamed acetabulum. A 5mm slot on the trial cup indicates the future position of the superior rim of the definitive implant. This slot must be positioned towards the superior rim of the acetabulum (Figure 2).

Once impacted, the trial cup should remain stable in the acetabulum. Should the trial cup be unstable, it may be necessary to increase the diameter of the final grater reamer. Should the stability of the trial cup remain un-satisfying, it is recommended to use the AVANTAGE 3P.

The supplementary pegs & the 4.5mm screw of the 3P cup will enhance the acetabular primary fixation.

3

Assemble the black impactor tips, corresponding to the definitive acetabular component size, with the impaction handle using the expansion rod.

Partially engage the thread of the tip of the expansion rod into the impaction handle through the black impac-tor tip. Care must be taken not to expand the diameter of the black impactor tip.

Mount the final implant onto the impaction assembly. Align one of the black impactor tip slots with the laser mark on the superior rim of the definitive implant, and fully screw the impaction handle until the cup is secured on the expanded tip (Figure 3).Care must be taken to position the flat surface of the black impactor tip flush with the superior rim of the cup.

Cup impaction

The 45-degree angulation guide can be mounted onto the impaction handle for an accurate cup inclination (Figure 4).

Partially unscrew the impaction handle and tap it gently to release the black impaction tip from the cup.

Should the cup be inadequately oriented, the orientation nozzle can be used as shown (Figure 5).

Should there be need to carry out additional impaction of the acetabular component, the final impaction tip can be used.

5. Acetabular Implant Insertion

Figure 3

Figure 4

Figure 5

4

6. Trial Inserts

The trial inserts are available in 22mm diameter (green inserts) and 28mm (blue inserts).

Select the appropriate trial head and seat it inside the trial insert corresponding to the implanted cup size.

Sit the trial assembly onto the trial stem or definitive femoral implant (Figure 6).

Use the head pusher to reduce the trial into the AVANTAGE cup. The usual assessment of joint stability, range of motion and leg length should be carried out (Figure 7).

Figure 7

Figure 6

5

Assemble the appropriate femoral head and polyethy-lene insert using the press.

Open the press completely.

Slide the press base plate over the fork of the press to assemble a modular femoral head and insert. Tighten the base plate with the adjusting knob. Should a mono-bloc femoral implant be implanted, the fork of the press must be positioned under the femoral head (Figure 8).

Place the press assembly on the instrumentation table and position the femoral head on the black lug of the base plate.Position and hold the insert above the femoral head.Rotate the press handle clockwise until the head is forced into the insert (Figure 9). A distinctive “pop” sound should be heard.

Open the press by rotating the press handle anticlock-wise and check that the femoral head rotates freely in the insert (Figure 10).Use the press again should the femoral head be inappropriately assembled into the polyethylene insert.

Impact the assembled femoral head and insert on the neck of the final femoral implant and gently impact them using the head reducer (Figure 11).

Finally, reduce the final implants into the Avantage cup (Figure 12).

7. Definitive Implants Reduction

Figure 8

Figure 10

Figure 12

Figure 11

Figure 9

6

Figure 9

3P Cup

Figure 15

Preparation / Impaction

The assembly of the Avantage 3P on the impaction de-vice is similar to that of the AVANTAGE RELOAD (See page 5).

When using the 3P cup, the superior rim laser mark is replaced by the superior plate.

Prior to impaction, it is necessary to bend the superior plate so that it fits the anatomy of the acetabulum contour. Use the bending iron whilst securely holding the cup (Figure 13).

The cup is positioned, oriented and impacted in the same fashion as the AVANTAGE RELOAD implant (See page 5) (Figure 14).

Pegs positioning

The 2 pegs should be implanted prior to the 4.5mm screw insertion.

Using the flexible drill shaft, the short drill and the drill guide, drill through the cup holes. Finalise the peg preparation with the peg shaper (Figure 15).

Figure 13

Figure 14

7

Figure 17Figure 16

Figure 20Figure 19

Figure 18

Introduce the peg with the peg clamp. Gently impact the peg into its final position with the straight or curved peg impactor (Figure 16).

Ensure that the pegs are sufficiently inserted and do not protrude nor disturb the insert mobility (Figure 17).

Screw position and reduction

Cortical screw positioning (4.5mm diameter).

Drill the superior rim of the acetabulum with the long 3.2mm diameter drill through the drill guide (Figure 18).

Measure the screw length with the depth gauge.

Insert the 4.5mm screw and tighten it firmly with the screwdriver (Figure 19).

Assemble the definitive femoral head and poly insert and reduce the joint as shown page 7 (Figure 20).

8

Cemented Cup

When using the cemented cup, it is important to note the operative technique differs to the cementless ver-sion.

To select the final implant size, it is recommended to choose a cup smaller than the trial cup in order to allow a minimal cement mantle around the implant.

The final implant and impaction device assembly remains unchanged. However, the impaction tip should be one size smaller than that of the final cup.

ExampleExample

Reamer = 54mm Trial cup = 54mm Definitive implant = 52mm Impaction tip = 50mm

After cementing of the reamed acetabulum, the cemented AVANTAGE cup is positioned and inserted as shown page 5 (Figure 21).

Release and remove the impaction tip without waiting for the cement to become hard (Figure 22).

Pressurise the implant until the cement hardens using the final impactor (Figure 23).

During cement pressurisation, remove the surplus of cement from around the implant (Figure 24).

Carry out the trial reduction to assess leg length and joint stability.

Assemble and insert the definitive femoral head, then reduce the joint as shown page 7 (Figure 25).

Figure 21

Figure 22

Figure 23Figure 24

Figure 25

9

Revision CupImpaction

Impaction of the AVANTAGE Revision cup assembly

Figure 27

Figure 28 Figure 29

Figure 30

Figure 26

is achieved in a similar fashion to the AVANTAGE RELOAD cup.

When using a Revision cup, the superior rim laser mark is replaced with the superior plate.

Prior to impaction, it is necessary to bend the superior and the posterior plates so that they fit the anatomy of the acetabulum.Use the bending iron whilst securely holding the cup (Figure 26).

Position the inferior obturator hook, then orient and impact the implant in the same fashion as described page 5 (Figure 27).

Screw positioning and reduction

4.5mm cortical screw positioning.Drill using the long 3.2mm diameter drill and the drill guide; you can insert 5 screws through the superior plate and one through the posterior plate (Figure 28).

Measure the screw length with the depth gauge. Thread the screws and firmly tighten them with the screw driver (Figure 29).

Assemble the definitive femoral head & insert, then reduce the joint as shown page 7 (Figure 30).

10

Reconstruction System

Positioning and reduction

The cemented cup combined with the reinforcement plate enables the reconstruction of the acetabulum.

Position the obturator hook of the reinforcement plate and impact the plate (Figure 31).

4.5mm cortical screw positioning.Drill using the long 3.2mm diameter drill and the drill guide; 4 screws can be implanted through the superior part of the reinforcement plate (Figure 32).

Cement and pressurise the Avantage cemented cup using the same operative technique described page 10 (Figure 33).

Carry out the trial reduction to assess leg length and joint stability.

Assemble the definitive femoral head and insert, then reduce the joint as shown page 7 (Figure 34).

Figure 31

Figure 33

Figure 32

Figure 34

11

In revision cases, the polyethylene insert can be disas-sembled from the femoral head.

ATTENTION!

The removed insert must not be re-implanted.

Adjust the jaws of the insert extractor around the insert. Close the jaws tightly onto the insert, making sure the sharp pin penetrates the insert and that the femo-ral head is securely attached to the femoral stem (Figure 35).

Lever the handle of the insert extractor to disassemble the insert from the femoral head (Figure 36).

Removal of 3P Pegs

In revision cases, the pegs can be removed by threading the tip of the peg extractor inside the pegs (Figure 37).

Removal of the Insert

Figure 37

Figure 35

Figure 36

12

ProductProduct ReferenceReference DescriptionDescription SizeSize

P0460P44P0460P44

AVANTAGEAVANTAGE RELOAD Acetabular Cup CementlessRELOAD Acetabular Cup Cementless

4444P0460P46P0460P46 4646P0460P48P0460P48 4848P0460P50P0460P50 5050P0460P52P0460P52 5252P0460P54P0460P54 5454P0460P56P0460P56 5656P0460P58P0460P58 5858P0460P60P0460P60 6060P0460P62P0460P62 6262P0460P64P0460P64 6464P0461044P0461044

AVANTAGEAVANTAGE 3P Acetabular Cup Cementless3P Acetabular Cup Cementless

4444P0461046P0461046 4646P0461048P0461048 4848P0461050P0461050 5050P0461052P0461052 5252P0461054P0461054 5454P0461056P0461056 5656P0461058P0461058 5858P0461060P0461060 6060P0461062P0461062 6262P0461064P0461064 6464

P0461070P0461070 AVANTAGEAVANTAGE PegPeg

P0463044P0463044

AVANTAGEAVANTAGE Cemented Acetabular CupCemented Acetabular Cup

4444P0463046P0463046 4646P0463048P0463048 4848P0463050P0463050 5050P0463052P0463052 5252P0463054P0463054 5454P0463056P0463056 5656P0463058P0463058 5858P0463060P0463060 6060P0464454P0464454

AVANTAGEAVANTAGE Reinforcement Plate Reinforcement Plate

44-5444-54

P0464858P0464858 48-5848-58

P0465262P0465262 52-6252-62

P0465666P0465666 56-6656-66P0464H48P0464H48

AVANTAGEAVANTAGE Revision CupRevision Cup

4848P0464H52P0464H52 5252P0464H54P0464H54 54 54P0464H56P0464H56 5656P0464H58P0464H58 5858P0464H62P0464H62 6262

P0464H66P0464H66 6666

AVANTAGE Acetabulum System

Implants References

13


P0560044P0560044

AVANTAGEAVANTAGE Insert Ø 22.2mmInsert Ø 22.2mm

4444

P0560046P0560046 4646

P0560048P0560048 4848

P0560050P0560050 5050

P0560052P0560052 5252

P0560054P0560054 5454

P0560056P0560056 5656

P0560058P0560058 5858

P0560060P0560060 6060

P0560062P0560062 6262

P0560064P0560064 6464

P0560066P0560066 6666

P0561050P0561050

AVANTAGE Insert Ø 28mmAVANTAGE Insert Ø 28mm

5050

P0561052P0561052 5252

P0561054P0561054 5454

P0561056P0561056 5656

P0561058P0561058 5858

P0561060P0561060 6060

P0561062P0561062 6262

P0561064P0561064 6464

P0561066P0561066 6666

P0560E44P0560E44

AVANTAGEAVANTAGE Insert E1™ Ø 22.2mmInsert E1™ Ø 22.2mm

4444

P0560E46P0560E46 4646

P0560E48P0560E48 4848

P0560E50P0560E50 5050

P0560E52P0560E52 5252

P0560E54P0560E54 5454

P0560E56P0560E56 5656

P0560E58P0560E58 5858

P0560E60P0560E60 6060

P0560E62P0560E62 6262

P0560E64P0560E64 6464

P0560E66P0560E66 6666

P0561E50P0561E50

AVANTAGEAVANTAGE Insert E1™ Ø 28mmInsert E1™ Ø 28mm

5050

P0561E52P0561E52 5252

P0561E54P0561E54 5454

P0561E56P0561E56 5656

P0561E58P0561E58 5858

P0561E60P0561E60 6060

P0561E62P0561E62 6262

P0561E64P0561E64 6464

P0561E66P0561E66 6666


Implants References

14


P0606020P0606020

AVANTAGEAVANTAGE Ø 4.5mm ScrewØ 4.5mm Screw

2020P0606022P0606022 2222P0606024P0606024 2424P0606026P0606026 2626P0606028P0606028 2828P0606030P0606030 3030P0606032P0606032 3232P0606034P0606034 3434P0606036P0606036 3636P0606038P0606038 3838P0606040P0606040 4040P0606042P0606042 4242P0606044P0606044 4444P0606046P0606046 4646P0606048P0606048 4848P0606050P0606050 5050P0606052P0606052 5252P0606054P0606054 5454P0606056P0606056 5656P0606058P0606058 5858P0606060P0606060 6060P0606062P0606062 6262P0606064P0606064 6464


Implants References

15

Instrumentation References


A4610044A4610044

AVANTAGEAVANTAGE Trial CupTrial Cup

4444A4610046A4610046 4646A4610048A4610048 4848A4610050A4610050 5050A4610052A4610052 5252A4610054A4610054 5454A4610056A4610056 5656A4610058A4610058 5858A4610060A4610060 6060A4610062A4610062 6262A4610064A4610064 6464A4620044A4620044

AVANTAGEAVANTAGE Trial Insert Ø 22mmTrial Insert Ø 22mm

4444A4620046A4620046 4646A4620048A4620048 4848A4620050A4620050 5050A4620052A4620052 5252A4620054A4620054 5454A4620056A4620056 5656A4620058A4620058 5858A4620060A4620060 6060A4620062A4620062 6262A4620064A4620064 6464A4630050A4630050

AVANTAGEAVANTAGE Trial Insert Ø 28mmTrial Insert Ø 28mm

5050A4630052A4630052 5252A4630054A4630054 5454A4630056A4630056 5656A4630058A4630058 5858A4630060A4630060 6060A4630062A4630062 6262A4630064A4630064 6464A4640044A4640044

AVANTAGEAVANTAGE Impactor TipImpactor Tip

4444A4640046A4640046 4646A4640048A4640048 4848A4640050A4640050 5050A4640052A4640052 5252A4640054A4640054 5454A4640056A4640056 5656A4640058A4640058 5858A4640060A4640060 6060A4640062A4640062 6262A4640064A4640064 6464A4650001A4650001 AVANTAGEAVANTAGE Cup Impaction HandleCup Impaction Handle

A4650002A4650002 AVANTAGEAVANTAGE Expanding RodExpanding Rod

A4650004A4650004 AVANTAGEAVANTAGE Peg ShaperPeg Shaper

A4650019A4650019 AVANTAGEAVANTAGE Drill GuideDrill Guide

A0208002A0208002 Twist Drill Ø 3.5mm LongTwist Drill Ø 3.5mm Long 70 70 A4650020A4650020 Small Drill Ø 3.5mmSmall Drill Ø 3.5mm 35 35

A0900046A0900046 AVANTAGEAVANTAGE InstrumentationInstrumentation


16


Instrumentation References


A0208004A0208004 Drill Flexible ShaftDrill Flexible Shaft

A4650008A4650008 Straight Peg InserterStraight Peg Inserter

A4650009A4650009 Curved Peg InserterCurved Peg Inserter

A4650010A4650010 Peg ClampPeg Clamp

A4650012A4650012 Insert ExtractorInsert Extractor

A4650014A4650014 Peg ExtractorPeg Extractor

A0310074A0310074 Plate BenderPlate Bender

A4650013A4650013 AVANTAGEAVANTAGE Trial Cup PositionerTrial Cup Positioner

A4650011A4650011 AVANTAGEAVANTAGE Insert PressInsert Press

A4650015A4650015 AVANTAGEAVANTAGE Final Orientation/Impaction TipFinal Orientation/Impaction Tip

A4650016A4650016 AVANTAGEAVANTAGE Head/Liner Pusher TipHead/Liner Pusher Tip

A4650024A4650024 AVANTAGEAVANTAGE Cup Positioner V3Cup Positioner V3

A4650017A4650017 AVANTAGEAVANTAGE Impaction HandleImpaction Handle L. 250L. 250

A0207007A0207007 ALIZEALIZE®® 45° Angulation Guide Rod 45° Angulation Guide Rod

A0305003A0305003 DrillDrill Ø 3.2Ø 3.2

A4650071A4650071 Long ScrewdriverLong Screwdriver H. 3.5H. 3.5

MJP310010MJP310010 Depth Gauge for Acetabular ScrewsDepth Gauge for Acetabular Screws31-10064431-100644

Concept Grater ReamerConcept Grater Reamer

444431-10064631-100646 464631-10064831-100648 484831-10065031-100650 505031-10065231-100652 525231-10065431-100654 545431-10065631-100656 565631-10065831-100658 585831-10066031-100660 606031-10066231-100662 626231-10066431-100664 6464

31-100637-331-100637-3 Modified AO Reamer Handle 9’’ V.3Modified AO Reamer Handle 9’’ V.3

17


A4654454A4654454

AVANTAGEAVANTAGE Trial Revision CageTrial Revision Cage

44/5444/54A4654858A4654858 48/5848/58A4655262A4655262 52/6252/62A4655666A4655666 56/6656/66

A4610066A4610066 AVANTAGEAVANTAGE Trial CupTrial Cup 6666

A4620066A4620066 AVANTAGEAVANTAGE Trial Insert Trial Insert Ø 22Ø 22mmmm 6666

A4630066A4630066 AVANTAGEAVANTAGE Trial InsertTrial Insert Ø 28 Ø 28mmmm 6666

A4640066A4640066 AVANTAGEAVANTAGE Impactor TipImpactor Tip 6666

3542.3003542.300 CMK3CMK3 Trial Cup Pusher Trial Cup Pusher

31-100637-331-100637-3 Modified AO Reamer Handle 9’’ V.3Modified AO Reamer Handle 9’’ V.3

31-10066631-100666 Concept Grater ReamerConcept Grater Reamer 6666


Revision Complement Instrumentation References

A0900067A0900067 AVANTAGEAVANTAGE Revision Complement InstrumentationRevision Complement Instrumentation

A4650101 AVANTAGE Revision Tray Only

ReferenceReference DescriptionDescription

A4650102A4650102 AVANTAGEAVANTAGE Revision Tray LidRevision Tray Lid

E01C0013E01C0013 Cont 600 x 300 x 110 Alu 1F Ref B037Cont 600 x 300 x 110 Alu 1F Ref B037

18


Tray References

A4650090 AVANTAGE Primary Instr Tray 1 Only



19


A4650098 Acetabular Reamers Case

ReferenceReference DescriptionDescription

A4650091A4650091 AVANTAGEAVANTAGE Primary Instr Tray 1 LidPrimary Instr Tray 1 Lid




A4650099A4650099 Acetabular Reamers Case CoverAcetabular Reamers Case Cover




Tray References

©2015 Biomet Orthopedics • Form No. BMET1307.0-ENG • REV0315

Legal ManufacturerBiomet FrancePlateau de Lautagne26000 ValenceFrance

www.biomet.com

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