ANCA-FIT - MediservisANCA-FIT™ Screw Fit Cup: the prosthesis is inserted using the same technique. Special attention should be paid to selecting the holes. These should be placed

™ANCA-FITHIP SYSTEM

Surgical Technique

STEP 1 HOHMANN LEVERSThe position of the Hohmann retractors is quite important. They must be inserted until they contact the acetabular bone margin without impingement of any capsule or muscle tissue.

STEP 2REAMING THE ACETABULUMThe acetabulum is well exposed. Whatever approach is used by the surgeon, acetabulum bone margins must be completely visible so that the prosthesis can be inserted in the correct position. Once residual peri-acetabular capsule tissue has been completely removed, the acetabulum is reamed with hemispherical acetabular reamers. Initially, a smaller diameter reamer can be used although the diameter selected should not be excessively smaller than the acetabulum (except in the case of a dysplastic acetabulum for which a small diameter reamer is needed to deepen the cavity). Next a larger diameter is selected until any fibrous and associated tissue has also been removed. It is sufficient to ream until you note that the instrument is covered by the acetabular bone.

Surgical Technique for the Cup

ANCA-FIT™HIP SYSTEM

FIGURE B

ø 52ø 50ø 48

ø 48

ø 50

FIGURE A

ø 48

ø 48

ø 48

ø 50



STEP 3TRIAL CUP (PRE-OPERATIVE TRIAL)

Choosing the diameter of the prosthesis on the basis of the diameter of the last reamer used can result in the wrong size of prosthesis being selected. This is often because “basket” reamers do not give the kind of precision cuts that permit accurate prosthetic size selection. Thus it is necessary to check the acetabulum using the trial cups provided. These trials are hemispherical in form with adequate slots that permit you to check for contact between trial and bone. It is recommended to initially trial the same size as the last reamer used, and then one size larger. If the trial cup can be inserted into the acetabulum and achieves all-round contact, try the next size up. Continue this process until you have a template that will not insert completely into the cavity with its apical section shifted. The true prosthesis to be inserted will have the diameter of the last trial that fitted completely into the acetabular cavity.

STEP 4CHOOSING THE ACETABULAR PROSTHESIS The standard ANCA-FIT™ or the ANCA-FIT™ Screw prosthesis with optional screwed fixation can be used. The reasoning behind the choice of one or the other prosthesis is simple: the ANCA-FIT™ Cup with holes is used whenever press-fit alone offers insufficient stability, particularly in the case of revision (especially when bone grafts are used) or in primary prosthetic application in patients with osteoporosis, rheumatoid arthritis, prolonged cortisone therapy, etc. The ANCA-FIT™ Cup without holes can be considered in all other cases.

FIGURE C

ø 52ø 50

ø 48ø 48

ø 54ø 52ø 50

FIGURE 3

FIGURE 2

FIGURE 1

FIGURE 4



STEP 5INSERTING THE ACETABULAR PROSTHESIS Once the ANCA-FIT™ sterile pack has been opened, the prosthesis is allowed to rest on the soft mount in the pack. While firmly held, the instrument is applied (cup introducer) making sure that the printed reference mark on the instrument is lined up with the recess on the inside wall of the flattened central pole of the cup.Now, the inner shaft of the introducer may be simply screwed down until it is firmly against the prosthesis.Important! Check to ensure the cup is attached firmly and is not cross-threaded or malaligned on the introducer. Incorrect loading can cause a number of problems when the prosthesis has been inserted and the introducer must be unscrewed and separated from the cup.The two angled reference rods, 45° and 10°, may be attached to the cup holder to assist the surgeon with correct orientation. With the acetabulum fully exposed, the prosthesis is inserted into the cavity keeping the fins positioned superiorly. To be sure that the acetabulum prosthesis has the correct valgus (2) will depend on patient position:- Supine decubitus: the rod at 45° (3b) is horizontal to the operating table plane and at right angles to patient axis (corresponding to 45° cup valgus). The 10° rod (3a) must be vertical to the operating table plane and at 90° to the patient’s horizontal axis (corresponding to 10° of anti-version).- Lateral decubitus: the rod at 45° (4a) is vertical to the operating table plane and at a right angle to the patient’s axis (corresponding to 45° cup valgus). The 10° rod (4b) must be horizontal to the operating table plane and at 90° to the patient’s horizontal axis (corresponding to 10° of anti-version).These angles can be used for most patients. In the case of dysplasia, acetabular fractures, or reimplants, the surgeon will apply the prosthesis in the most suitable position but without exceeding a valgus angle of 50°.

a a

b b

FIGURE 6

FIGURE 5

FIGURE 7 FIGURE 8



Once the correct prosthesis position has been checked, it is inpacted into the acetabulum until it is covered by the bone margins. The cup introducer is then removed and correct seating of the prosthesis is checked through the central hole (use a forceps to see if the acetabular bone is in immediate contact with the outside surface of the prosthesis). If there is a small gap, the prosthesis will be inpacted in with the requisite mallet (5) until it touches the base of the acetabulum.ANCA-FIT™ Screw Fit Cup: the prosthesis is inserted using the same technique. Special attention should be paid to selecting the holes. These should be placed where the acetabular wall is thickest, but always in the two top quadrants of the acetabulum (6). Once the cup has been inserted, the drill guide and flexible drill (7a) (always starting with the shortest of the two) is used to control the direction so that the screw is always applied to one of the iliac bone cortices. The depth gauge (7b) is used to determine the correct length of screw required. The screw is then applied using the joint headed screwdriver and initially held by the screw holders (7c).Important! If the screw does not grip sufficiently, remove it and try one of the other five holes of the prosthesis. Two screws are normally sufficient for good prosthetic stabilisation.

STEP 6THE ACETABULAR INSERTCeramic: once the truncated cone section of the prosthesis has been carefully washed, the ceramic insert (8a) is placed in it by hand and without forcing it. Make sure it is coplanar to the prosthesis (8c). There is a special plastic tipped probe (8b) that can be used to prevent the insert from going in at an angle to the implant. Only when the insert is practically all the way down, the special impactor can be used to drive it down definitively (8d). Polyethylene: the polyethylene insert has a border to prevent luxation. Select the position for this border based on prosthetic stability requirements. Then line up the 4 anti-rotation fins with their seatings and drive the insert all the way down (8e).

a

a

b

e

c

d

b

c

FIGURE 1 FIGURE 2 FIGURE 3 FIGURE 4

STEP 1PRE-OPERATIVE PLANNING AND FEMORAL NECK OSTEOTOMYYou will have to identify the axis of the diaphyseal canal. During pre-op planning, overlay the outline of the shaft on the femur at the position you feel is the most correct.Next use the graduated scale on the films (this will contribute for the 15% enlarge-ment of the X-ray) to measure the distance (1b) between the top of the femoral epi-physis and the femoral neck osteotomy plane plus the distance between the internal surface of the spur (formed during the osteotomy) and the seat where the rasp must arrive laterally to ensure correct insertion of the shaft. These measurements will have to be repeated during the actual operation (2a and 3b) to make sure that the shaft is positioned as determined during the pre-op planning. Here it is good standard operating practice to use a Luer forceps to lower the lateral edge of the neck (2c). The rasps can then be used on the spongy bone exposed to remove a part of the metaphyseal cancellous bone as measured during the pre-op planning to create the necessary lateralisation (3c).

STEP 2APPLYING THE RASPSAfter this preliminary stage, the 9,5 mm rasp is inserted (4). As it moves down, the rasp must be held parallel to the femur to prevent varus deviation. On the basis of the pre-op plan and depending on the diameter of the diaphyseal canal made during the previous operative stage, the size of the final rasp is more or less defined. The definitive selection will be based on the sequential use of the rasps during the opera-tion. The basis for defining the optimum rasp to be used for each patient is the fol-lowing: if the rasp sinks below the osteotomic plane, the next larger rasp is used until you have one whose transition edge between the cutting surface and the oblique edge (5b) does not sink beyond the osteotomic plane.Important: if the rasp was inserted in varus, further sinkage can not occur despite the use of rasps with a diameter less than the diaphyseal measurement (3a). In order to prevent selection of a shaft that is too small compared with the femur, it is recom-mended to check to make sure that the rasp (3b) is not less than the diaphyseal diameter peviously measured (1b). In this case, the rasp will have to be removed, rasp again more laterally towards the Greater Trochanter and repeat rasp insertion. If it sinks below the osteotomic plane of the neck, a larger size rasp can be used (5).

STEP 3CHOOSING THE STEMThe stem must correspond to the last size of rasp used, where the edge has not sunk beyond the resection edge at the top of the cutting surface.

Surgical Technique for the Stem


a

aab

bb c c

STEP 4INSERTING THE STEMThe stem is connected firmly to its handle (6). It is initially inserted by hand pressure and completed by mallet impaction (7). The principle to apply for its insertion is based on the progress: to the demarcation line on the proximal medial collar high- lighted by the glossy finish. Afterwards, complete the positioning using the final impactor (8). Excessive force applied may cause the femur to fracture.

STEP 5CHOOSING THE INTERCHANGEABLE NECKOnce the stem has been inserted in its definitive position, the handle is removed and the trial interchangeable neck can be inserted. Choice of the modular neck to be used is based on conclusions drawn during the pre-op planning stages, by assessing the length of the limb, offset geometry and the stability of the reduction. The indications for the different shapes and sizes of the available interchangeable necks are clear.

STEP 6 INSERTING THE INTERCHANGEABLE NECKThe interchangeable neck is inserted in the stem after it has been thoroughly washed. Use three (medium to hard) hammer blows. Neck/stem stability is in proportion to the insertion force. However, excessive force can be transmitted through the stem to the bone interface.

STEP 7SELECTING THE HEADThe press fitting of the modular neck can potentially cause further stem insertion. It is advisable to recheck the selection of head (and leg length) by means of a further trial reduction.

STEP 8 APPLYING THE CERAMIC HEADOnce the surface of the truncated cone surface of the modular neck has been thoroughly washed, the head is inserted onto it by hand giving it a half turn (180°).Do not inpact the head onto its seating.

STEP 9 REDUCTIONReduction must be done without the help of the reduction spoon. This instrument can cause excessive tensioning in the ceramic head.

Surgical Technique for the Stem


FIGURE 8

FIGURE 7

FIGURE 6

FIGURE 5

a b c

AR 8 AR 15 STRAIGHT VV 8 AR / VV 1 AR / VV 2VV 15

CUP W/HOLESHA COATED

PPR67242PPR67244PPR67246PPR67248PPR67250PPR67252PPR67254PPR67256PPR67258PPR67260PPR67262PPR67264PPR67266

Ø 42 mmØ 44 mmØ 46 mmØ 48 mmØ 50 mmØ 52 mmØ 54 mmØ 56 mmØ 58 mmØ 60 mmØ 62 mmØ 64 mmØ 66 mm

CUP W/OUT HOLESHA COATED



CUP W/HOLESNO FINSHA COATED



PE LINER STANDARD PPR67742PPR67744PPR67746PPR67748PPR67750PPR67752PPR67754PPR67756PPR67758PPR67760PPR67762PPR67764PPR67766

Ø 42x22 mmØ 44x22 mmØ 46x28 mmØ 48x28 mmØ 50x28 mmØ 52x28 mmØ 54x28 mmØ 56x28 mmØ 58x28 mmØ 60x28 mmØ 62x28 mmØ 64x28 mmØ 66x28 mm

DESCRIPTION CODE SIZE

Cup Implant


IMPLANT

PE LINER 10° PPR67543PPR67544PPR67946PPR67948PPR67950PPR67952PPR67954PPR67956PPR67958PPR67960PPR67962PPR67964PPR67966PPR67546PPR67548PPR67550PPR67552PPR67554PPR67556PPR67558PPR67560PPR67562PPR67564PPR67566PPR68150PPR68152PPR68154PPR68156PPR68158PPR68160PPR68162PPR68164PPR68166v

Ø 42x22 mmØ 44x22 mmØ 46x22 mmØ 48x22 mmØ 50x22 mmØ 52x22 mmØ 54x22 mmØ 56x22 mmØ 58x22 mmØ 60x22 mmØ 62x22 mmØ 64x22 mmØ 66x22 mmØ 46x28 mmØ 48x28 mmØ 50x28 mmØ 52x28 mmØ 54x28 mmØ 56x28 mmØ 58x28 mmØ 60x28 mmØ 62x28 mmØ 64x28 mmØ 66x28 mmØ 50x32 mmØ 52x32 mmØ 54x32 mmØ 56x32 mmØ 58x32 mmØ 60x32 mmØ 62x32 mmØ 64x32 mmØ 66x32 mm

CERAMIC LINER PPR67508PPR67510PPR67512PPR67514

28x46/48 mm28x50/52/54 mm28x56/58 mm28x60/62/64/66 mm

Cup Implant


SCREWS PPV20010PPV20001PPV20002PPV20003PPV20004PPV20005PPV20006PPV20007PPV20008

Ø 5,5 mmØ 5,5 mmØ 5,5 mmØ 5,5 mmØ 5,5 mmØ 5,5 mmØ 5,5 mmØ 5,5 mmØ 5,5 mm

12 mm15 mm20 mm25 mm30 mm35 mm40 mm45 mm50 mm

DESCRIPTION CODE SIZE LENGTH

DESCRIPTION CODE SIZEIMPLANT

IMPLANT

CUP IMPACTOR PPR68009

DRILL GUIDE PPR68012

SCREW DEPTH GAUGE PPR68020

LINER IMPACTOR PPR68036PPR68038APA04565

Ø 22 mmØ 28 mmØ 32 mm

ANCA-FIT™ CUPFINAL IMPACTOR

PPR68070

UNIVERSAL HANDLE FOR:

TRIAL CUPP/E POSITIONERLINER IMPACTORFINAL IMPACTOR

PPR68030

PPR68042-66PPR68032-34PPR68036-38PPR68070

DESCRIPTION CODE SIZEINSTRUMENT

Cup Instrumentation


PPR68000 ANCA-FIT™ CUP INSTRUMENTATION SET

FLEXIBILE DRILL PPR68014 Ø 3,2 mmL 35 mm

FLEXIBILE DRILL PPR68016 Ø 3,2 mmL 55 mm

HEXAGONALSCREWDRIVER

PP275400

TOMMY BAR PPb31902

CERAMIC LINER GUIDE PPR68072

SCREW HOLDER PPR68018

SCREW DRIVER PPF58890

P/E LINER POSITIONER PPR68032PPR68034

Ø 22 mmØ 28 mm

ANCA-FIT™TRAIL CUP



TRIAL INSERTS PPR69000PPR69002PPR69004PPR69006

46/48/*2850/52/54*2856/58*2860/62/64/66*28

Cup Instrumentation



PPR68000 ANCA-FIT™ CUP INSTRUMENTATION SET

PROXIMALLY HAPCOATED STEM

PPR67600PPR67602PPR67604PPR67606PPR67608PPR67610PPR67612PPR67614PPR67616PPR67618PPR67620PPR67622PPR67624PPR67626PPR67628PPR67630

9,5 R9,5 L11 R11 L12 R12 L13 R13 L14 R14 L15 R15 L16 R16 L17,5 R17,5 L

FULLY HAP COATED STEM

PPR69120PPR69100PPR69122PPR69102PPR69124PPR69104PPR69126PPR69106PPR69128PPR69108PPR69130PPR69110PPR69132PPR69112PPR69134PPR69114


CEMENTED STEM PPR7000PPR7002PPR7004PPR7006PPR7008PPR7010PPR7012PPR7014PPR7016PPR7018PPR7020PPR7022PPR7024PPR7026PPR7028PPR7030



Stem Implant


Stem Implant


INTERCHANGEABLE NECKS 12/14

PHA01202PHA01204PHA01206

PHA01252PHA01254PHA01256

PHA01262PHA01264

PHA01232PHA01234PHA01236

PHA01242PHA01244

PHA01222PHA01224

PHA01212PHA01214

S. ShortS. LongS. X-Long

VV. ShortVV. LongVV. X-Long

VV15o. ShortVV15o. Long

AR8o. ShortAR8o. LongAR8o. X-Long

AR15o. ShortAR15o. Long

AR/VV1 ShortAR/VV1 Long


HEADS ALUMINA 12/14

PPT10250PPT10252PPT10254PPT10240PPT10242PPT10244

Ø 28 mm SØ 28 mm MØ 28 mm LØ 32 mm SØ 32 mm MØ 32 mm L

HEADS COBALT CHROME 12/14

26010001 26010002 26010003 26012801 26012802 26012803 26012804 26012805 26010007 26010008 26010009 26010010

Ø 22mm XL Ø 22mm M Ø 22mm LØ 28mm SØ 28mm MØ 28mm LØ 28mm XLØ 28mm XXLØ 32mm SØ 32mm MØ 32mm LØ 32mm XL



Stem instrumentation


ANCA FITSTEM IMPACTOR

PPR67700

INITIAL CHISEL PPR67704

ANCA FITSTEM IMPACTOR

PPR67686

EXTRACTOR FOR INTERCHANGEABLENECKS

PPG30144

CARDAN SPANNER 191431

APH00100 ANCA-FIT™ CUP INSTRUMENTATION SET

TRIAL NECK APA08102APA08104APA08106

APA08112APA08114

APA08122APA08124

APA08132APA08134APA08136

APA08142 APA08144

APA08152APA08154APA08156

APA08162APA08164

S. ShortS. LongS. X-Long



ANT.-RET. 8o ShortANT.-RET. 8o LongANT.-RET. 8o X-Long

ANT.-RET. 15o ShortANT.-RET. 15o Long

VAR.-VAL. 8o ShortVAR.-VAL. 8o LongVAR.-VAL. 8o X-Long

VAR.-VAL. 15o ShortVAR.-VAL. 15o Long


Stem instrumentation


N.D.

TRIAL HEAD12/14

APA02112APA02113APA02121APA02122APA02123APA02131APA02132APA02133

22 mm M22 mm L28 mm S28 mm M28 mm L32 mm S32 mm M32 mm L

RASP HANDLERIGHT

PPR67680

HEXAGONAL SCREWDRIVER

PP275400

ANCA-FIT™ STEM EXTRACTOR

PPR67688(on request)

RASP HANDLELEFT

PPR67682

EXTRACTION RING PPG30170

FEMORAL HEADIMPACTOR

PPR67702

STEM RASP PPR67840PPR67842PPR67844PPR67846PPR67848PPR67850PPR67852PPR67854PPR67856PPR67858PPR67860PPR67862PPR67864PPR67866PPR67868PPR67870


APH00100 ANCA-FIT™ CUP INSTRUMENTATION SET

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EH010-907EREVISION 01

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DisclaimerProper surgical procedures and techniques are the responsibility of the medical professional. These guidelines are furnished for information purposes only. Each surgeon must evaluate the appropriateness of the procedures based on his or her personal medical training and experience. Prior to use of the system, the surgeon should refer to the product package insert for complete warnings, precautions, indications, contra-indications and adverse effects. Packaging inserts are also available by contacting Wright Medical Technology Inc.

www.wmt.com

Wright Medical Technology, Inc.5677 Airline RoadArlington, TN 38002, USATel: + 1 901 867 9971Tel: 800 238 7188 (toll-free)

™ Trademarks and ®Registered marks of Wright Medical Technology, Inc.

© 2007 Wright Medical Technology, Inc. All Rights Reserved. Rev.1007

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Documents

ANCA-FIT - MediservisANCA-FIT™ Screw Fit Cup: the prosthesis is inserted using the same technique. Special attention should be paid to selecting the holes. These should be placed