Cormet Precision™

Advanced Hip Resurfacing System Surgical technique

Cormet Precision™

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Contents

Operative summary 4

Pre-operative planning 6

Femoral neck sizing 6

Assembling the head centring jig 7

Alternative head centring 7

Initial head cut 9

Femoral head resection 9

Chamfer cut 10

Checking the femoral cuts 10

Reaming the acetabulum 10

Trialling the acetabular cup 11

Assembling the vacuum cup introducer 11

Alignment of the cup 12

Introducing the cup 13

Removing the vacuum cup introducer 13

Preparing the stem opening 14

Impacting the femoral component 15

Reduction and final checks 15

Compatibility chart 16

Ordering information 17

Instrumentation 18

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Cormet™

Activity | History | Technology

The original modern metal-on-metal hip resurfacing

Cormet Precision™

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a. Femoral neck sizing b. Locking ring c. Drilling the guide wire

h. Top head milling

Operative summary

d. Guide wire position

e. Cannulated drill f. Initial head cut g. Femoral head resection

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m. Introducing the cup n. Final cup impaction o. Preparing the stem opening p. Impacting the femoral component

i. Chamfer cut j. Checking the femoral cuts k. Reaming the acetabulum l. Trialling the acetabular cup

Cormet Precision™

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Pre-operative planning

The X-ray is assessed for acetabular cup and femoral head size based on the size of the neck using the Cormet templates provided. The femoral component should be positioned in neutral or slight valgus alignment; varus positioning should be avoided.1 Access to the acetabulum is generally made easier by preparing the femur first, as this will debulk the femoral head.

In order to ensure that there is sufficient clearance around the neck for the definitive implant initial preparation of the femur may be carried out to one size larger than that templated. Further preparation (to the templated size) may then be carried out if it is evident

MAGNIFICATION:

120%(1.2:1)hip resurfacing

system Catalog No. LTEM95

100

90

80

70

60

50

40

30

20

10

0

TEMPLATE No: LTEM95-1REV: 01 ECR: 7510 DATE: 18/JUNE/07

FRM388 Rev: Original DATE: 09/JUN/07ECR: 7434

52mm

50mm

56mm

54mm

62mm

60mm

58mm

44mm

48mm

56mm

52mm

4

610

8

Example template

superior-inferior

1. Beaule P, Lee J, Le Duff M, Amstutz H, Ebramzadeh E. Orientation of the femoral component in surface arthroplasty of the hip. J Bone Joint Surg 2004 Sept;86-A (9):2015-21.

that there is sufficient clearance around the neck and that the integrity of the neck will not be compromised.

Sufficient clearance may occasionally still remain to allow a smaller size to be used than was suggested by templating. In this case, further preparation to the smaller size may be carried out therefore ensuring the use of the most appropriate size of femoral component and minimising the amount of bone removed from the acetabulum.

1. Femoral neck sizing

The femoral neck is sized using the head template. It is important to remove large osteophytes and soft tissue in order to gain an accurate measurement. The femoral neck is usually oval in shape and should be sized in its largest dimension, typically superior-inferior as shown.

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2. Positioning the locking ring

The appropriate sized locking ring is positioned around the femoral neck. It is essential that the ring closes fully using the handles since the internal diameter of the ring matches the internal diameter of the barrel cutter.

Note: The ring thus used represents the smallest head size that may be used without notching the neck.

3a. Assembling the head centring jig and positioning the orientation guide wiresThe head centring jig is assembled onto the locking ring and held in place with the captive screw. The drill guide is centred over the centre of the locking ring, providing accurate placement of the fluted guide wire. There are two holes for a guide wire in the side of the head centring jig. The short arm can be used to position a second guide wire at 90° (either side of the head). These guide wires are intended to show the varus/valgus and anteversion/retroversion of the head centring jig and hence the position of the definitive fluted guide wire.

Note: The guide wire should be placed in a neutral or slightly valgus position. A varus position should not be chosen as this may lead to a fractured neck of femur.

3b. Alternative head centring using head templates

It is also possible to assemble the drill guide and guide wires onto the head templates. This may be helpful in cases where the femoral head is very distorted and the locking ring cannot be used.

Using the head templates for the alignment involves a greater amount of estimation by eye to find the centre of the femoral neck. Care should be taken not to position the guide wire too posteriorly due to the oval nature of the femoral neck. The anteversion/retroversion guide wire may be helpful in judging the correct position of the guide wire.

Cormet Precision™

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4. Checking the position of the guide wire

The stylus can be used to check the position of the guide wire if required, by placing it over the guide wire and running the stylus around the neck at a pre-set size. The diagram shows the stylus set to size 6 (for a 48mm head). The inner most line represents the size 2 and the outer most size 10.

A separate stylus is available for sizes 3, 5, 7 and 9.

Note: To avoid notching the neck the stylus should run freely around the neck without catching.

5. Cannulated drill

The cannulated drill is advanced over the guide wire as far as the corresponding line for the head size as shown. Both the drill and the pin are removed and the guide rod is inserted.

3c. Drilling the guide wire

With the jig orientated correctly the definitive fluted guide wire can now be drilled into the femoral head. Do not apply power until the tip of the guide wire touches the apex of the femoral head.

Note: Care should be taken not to bend the wire during introduction.

Removing the centring jig

Disassemble the head centring jig by removing the orientation wires and loosening the captive screw.

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6. Making the initial head cut

The appropriate size of barrel cutter is advanced over the guide rod as far as the head-neck junction thus ensuring the neck is not notched. A head template can be placed over the greater trochanter and neck to protect them. Swabs can be used to prevent bone debris entering the soft tissue.

Note: A barrel cutter of one size larger than templated can be used for the initial preparation. This will debulk the head before preparation of the final size. At this point the acetabulum can be prepared before final preparation of the head giving the choice of four sizes of acetabular cup.

7. Femoral head resection

The guide rod is removed. The top head guide should be positioned so that the inferior edge is in line with the head-neck junction. The head is then resected with an oscillating or reciprocating saw.

8. Milling the top head cut

Following the removal of the top head guide the guide rod is re-inserted and the top head cutter is advanced to create a surface perpendicular to the neck axis.

Note: Care must be taken as this instrument should only remove a small amount of bone which will not change the depth of the definitive implant.

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10. Checking the femoral cuts

The corresponding size of head template or trial head can be used to check the prepared shape. The head template or the trial head can be used to make a mark on the head-neck junction to indicate how far the femoral component should be advanced when fully seated.

Cement keyholes can be drilled into the femoral head at this stage if required.

9. Making the chamfer cut

The appropriate head chamfer cutter is then used to create the chamfer.

Note: Care should be taken with this instrument; the cutter should be advanced slowly to avoid snatching, ‘high speed’ rather than ‘ream’ should be used on the power tool.

11. Reaming the acetabulum

The acetabulum is exposed such that the entire acetabular margin may be seen. The acetabulum is then reamed sequentially until the true floor is exposed and the required size is reached.

Note: Since the Cormet cup is equatorially expanded, the acetabulum is reamed to the nominal cup size i.e, the cup size stated. For example, for a 54mm cup, the acetabulum is reamed to 54mm.

To allow unhindered cup insertion all osteophytes should be removed and soft tissue cleared from the acetabular margin.

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12. Trialling the acetabular cup

The appropriate acetabular trial is assembled onto the trial handle and placed at 45º to the horizontal, with 10-15º of anteversion. It should fit snugly into the reamed acetabulum.

Note: The trial is NOT equatorially expanded and does not require impacting into the acetabulum.

13. Vacuum cup introducer

The Cormet vacuum cup introducer is part of the Cormet Precision instrumentation. It allows in-theatre suction to be used to introduce the Cormet cup.

The following table gives guidelines for the vacuum pressures and absolute pressures required from the in-theatre suction equipment when using the vacuum cup introducer.

Guidelines for vacuum pressure

Unit Vacuum pressure Absolute pressure

mmHg 550 210

cmHg 55 21

atm 0.72 0.28

KPa 73.3 28

14. Assembling the vacuum cup introducer

The introducer is assembled as shown ensuring that the baseplate and plastic insert are paired correctly according to size. The hole in the baseplate must be lined up with the alignment peg on the base of the handle, as shown, prior to the locking nut being fully tightened.

Note: It is recommended that the minimum vacuum level attainable by the in-theatre suction equipment should be 550mmHg BELOW atmospheric pressure, or 55cmHg BELOW atmospheric pressure, 0.3 atm, or 28kPa for the vacuum introducer to work correctly.

Cormet Precision™

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16. Alignment of the cup

The handle and alignment guide can be used to align the cup at 45º to the horizontal and with 10-15º of anteversion as shown.

15. Mounting the cup onto the vacuum introducer

The cup is now mounted as shown onto the introducer and then the suction tubing applied.

The cup can be mounted in three different positions but the ideal position would allow the splines to be in line with the markings on the introducer and base plate. Thus the splines will be implanted at 5 and 7 o’clock (if the introducer handle is at 12 o’clock when the cup is viewed face on) in the ischium and pubis.

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19. Repositioning the cup

If the position of the cup is not satisfactory the rim impactor can be placed on one segment of the rim of the acetabular component and gently impacted to reposition the cup.

18. Removing the vacuum cup introducer

Once the cup is firmly impacted the suction can be released and the introducer removed.

17. Introducing the cup

The cup is introduced into the acetabulum such that the two sets of anti-rotation fins engage with the ischium and pubis.

Note: The vacuum seal will be broken if the introducer is levered on or rotated during introduction.

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21. Preparing the stem opening

The head finishing reamer can be used to prepare the stem opening prior to impacting the cemented or cementless head to aid head seating.

20. Final cup impaction

If the rim impactor is used or the cup is not fully seated then the cup impactor should be used for final impaction.

22. Preparing a cemented femoral component

If a cemented head is used low viscosity cement is poured into the femoral component up to the line shown.

Cementless heads are simply impacted into position with the head impactor.

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23. Impacting the femoral component

The definitive component is placed onto the femoral head and impacted into position with the head impactor. Excess bone cement is removed.

24. Reduction and final checks

The hip is then reduced, avoiding scratching of the femoral component against the cup.

A full check is then made to ensure there is no impingement and that the range of motion and stability are satisfactory.

Cormet Precision™

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Resurfacing heads

Cups

Modular heads

Dysplasia cups

Available with short, standard or long neck

42mm

42mm

48mm

50mm

46mm

46mm

52mm

54mm

50mm

50mm

56mm

58mm

40mm

40mm

46mm

48mm

48mm

44mm

44mm

50mm

52mm

52mm

48mm

54mm

56mm

56mm

48mm

52mm

52mm

58mm

60mm

60mm

36mm

42mm

44mm

44mm

54mm

54mm

60mm

62mm

56mm

56mm

64mm

64mm

62mm

Compatibility chartSize 0 Size 2 Size 3 Size 4 Size 5 Size 6 Size 7 Size 8 Size 9 Size 10

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Ordering information

Cormet resurfacing heads179.040 40mm size 2 cemented479.042 42mm size 3 cemented179.044 44mm size 4 cemented479.046 46mm size 5 cemented179.048 48mm size 6 cemented479.050 50mm size 7 cemented179.052 52mm size 8 cemented479.054 54mm size 9 cemented179.056 56mm size 10 cemented

179.040B 40mm size 2 Bi-coated479.042B 42mm size 3 Bi-coated179.044B 44mm size 4 Bi-coated479.046B 46mm size 5 Bi-coated179.048B 48mm size 6 Bi-coated479.050B 50mm size 7 Bi-coated179.052B 52mm size 8 Bi-coated479.054B 54mm size 9 Bi-coated179.056B 56mm size 10 Bi-coated

Cormet acetabular cups179.242B 42mm size 0 Bi-coated179.244B 44mm size 0 Bi-coated179.246B 46mm size 2 Bi-coated179.248B 48mm size 2 Bi-coated479.248B 48mm size 3 Bi-coated479.250B 50mm size 3 Bi-coated179.250B 50mm size 4 Bi-coated179.252B 52mm size 4 Bi-coated479.252B 52mm size 5 Bi-coated479.254B 54mm size 5 Bi-coated179.254B 54mm size 6 Bi-coated179.256B 56mm size 6 Bi-coated479.256B 56mm size 7 Bi-coated479.258B 58mm size 7 Bi-coated179.258B 58mm size 8 Bi-coated179.260B 60mm size 8 Bi-coated479.260B 60mm size 9 Bi-coated479.262B 62mm size 9 Bi-coated179.262B 62mm size 10 Bi-coated179.264B 64mm size 10 Bi-coated

Cormet dysplasia cups179.544B 44mm size 0 Bi-coated179.548B 48mm size 2 Bi-coated179.552B 52mm size 4 Bi-coated179.556B 56mm size 6 Bi-coated179.560B 60mm size 8 Bi-coated179.564B 64mm size 10 Bi-coated

Cormet dysplasia cup screws079.025 25mm079.030 30mm079.035 35mm079.040 40mm079.045 45mm079.050 50mm079.055 55mm079.060 60mm079.065 65mm079.070 70mm

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Instrumentation

A/Z/H 379.705 Cormet Precision standard instrument system Sizes 2, 4, 6, 8 and 10

279.022 Sterile fluted guide wire. Single use379.701 Head alignment instrument set Sizes 2, 4, 6, 8 and 10 379.702 Femoral preparation instrument set Sizes 2, 4, 6, 8 and 10 A/Z/H379.703 Head trial and acetabular sizer instrument set Sizes 2, 4, 6, 8 and 10379.704 Cup introducer and impactor instrument set Sizes 2, 4, 6, 8 and 10

A/Z/H379.711 Cormet Precision advanced instrument system Sizes 2, 3, 4, 5, 6, 7, 8, 9 and 10

279.022 Sterile fluted guide wire. Single use 379.707 Head alignment instrument set Sizes 2, 3, 4, 5, 6, 7, 8, 9 and 10379.708 Femoral preparation instrument set Sizes 2, 3, 4, 5, 6, 7, 8, 9 and 10A/Z/H379.709 Head trial and acetabular sizer instrument set Sizes 2, 3, 4, 5, 6, 7, 8, 9 and 10 379.710 Cup introducer and impactor instrument set Sizes 2, 3, 4, 5, 6, 7, 8, 9 and 10

379.702 Femoral preparation instrument tray

379.032 Modular barrel cutter. Size 2/40mm379.034 Modular barrel cutter. Size 4/44mm379.036 Modular barrel cutter. Size 6/48mm379.038 Modular barrel cutter. Size 8/52mm379.040 Modular barrel cutter. Size 10/56mm379.042 Top head guide. Size 2/40mm379.044 Top head guide. Size 4/44mm379.046 Top head guide. Size 6/48mm379.048 Top head guide. Size 8/52mm379.050 Top head guide. Size 10/56mm379.052 Modular chamfer cutter. Size 2/40mm379.054 Modular chamfer cutter. Size 4/44mm379.056 Modular chamfer cutter. Size 6/48mm379.058 Modular chamfer cutter. Size 8/52mm379.060 Modular chamfer cutter. Size 10/56mm379.061 Top head cutterA379.030 Head finishing reamer379.793T Femoral preparation instrument set tray

STANDARD CORMET PRECISION

279.022 Sterile fluted guide wire. Single use Individually packed

379.701 Head alignment instrument tray

379.262 S.I. Head alignment template. Size 2/40mm 379.264 S.I. Head alignment template. Size 4/44mm 379.266 S.I. Head alignment template. Size 6/48mm 379.268 S.I. Head alignment template. Size 8/52mm 379.270 S.I. Head alignment template. Size 10/56mm379.252 S.I. Head alignment ring. Size 2/40mm 379.254 S.I. Head alignment ring. Size 4/44mm379.256 S.I. Head alignment ring. Size 6/48mm 379.258 S.I. Head alignment ring. Size 8/52mm379.260 S.I. Head alignment ring. Size 10/56mm379.271 S.I. Head alignment jig379.172 S.I. Head alignment stylus. Sizes 2, 4, 6, 8 and 10 379.173 S.I. Head alignment guide rod379.791T S.I. Head alignment instrument set tray

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379.703B Acetabular sizer tray

379.083 Acetabular sizer. Size 46mm379.084 Acetabular sizer. Size 48mm379.085 Acetabular sizer. Size 50mm379.086 Acetabular sizer. Size 52mm379.087 Acetabular sizer. Size 54mm379.088 Acetabular sizer. Size 56mm 379.089 Acetabular sizer. Size 58mm 379.090 Acetabular sizer. Size 60mm 379.091 Acetabular sizer. Size 62mm 379.092 Acetabular sizer. Size 64mm379.093 Acetabular sizer handle379.094 Hammer379.796T Acetabular sizer instrument set tray

A/Z/H379.703A Head trial tray

379.063 Head guide rodA/Z/H379.068 Modular drive shaftA/Z/H379.069 Cannulated drill 379.096 Cement keyhole reamer379.072 Head trial. Size 2/40mm379.074 Head trial. Size 4/44mm379.076 Head trial. Size 6/48mm379.078 Head trial. Size 8/52mm379.080 Head trial. Size 10/56mm379.065 Head impactor 379.095 Capsulotomy scissors379.795T Head trial instrument set tray

379.704A Cup introducer tray

379.214 Cup introducer baseplate. Size 2/46-48mm 379.215 Cup introducer baseplate. Size 4/50-52mm 379.216 Cup introducer baseplate. Size 6/54-56mm379.217 Cup introducer baseplate. Size 8/58-60mm379.218 Cup introducer baseplate. Size 10/62-64mm379.114 Cup introducer insert. Size 2/46-48mm 379.115 Cup introducer insert. Size 4/50-52mm 379.116 Cup introducer insert. Size 6/54-56mm379.117 Cup introducer insert. Size 8/58-60mm379.118 Cup introducer insert. Size 10/62-64mm 379.124 Cup introducer locking screw 379.126 Locking screw wrench379.127 Cup introducer alignment guide rod379.027 Cup introducer handle379.797T Cup introducer instrument set tray

Cormet Precision™

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379.704B Cup impactor tray

379.132 Cup impactor. Size 2/46-48mm 379.134 Cup impactor. Size 4/50-52mm 379.136 Cup impactor. Size 6/54-56mm 379.138 Cup impactor. Size 8/58-60mm379.140 Cup impactor. Size 10/62-64mm379.141 Cup impactor handle 379.142 1/4 Rim impactor379.798T Cup impactor instrument set tray

ADVANCED CORMET PRECISION

379.707 Head alignment instrument set379.701A Standard sizes tray

379.262 S.I. Head alignment template. Size 2/40mm 379.264 S.I. Head alignment template. Size 4/44mm 379.266 S.I. Head alignment template. Size 6/48mm 379.268 S.I. Head alignment template. Size 8/52mm 379.270 S.I. Head alignment template. Size 10/56mm 379.252 S.I. Head alignment ring. Size 2/40mm379.254 S.I. Head alignment ring. Size 4/44mm379.256 S.I. Head alignment ring. Size 6/48mm379.258 S.I. Head alignment ring. Size 8/52mm 379.260 S.I. Head alignment ring. Size 10/56mm 379.271 S.I. Head alignment jig379.172 S.I. Head alignment stylus. Sizes 2, 4, 6, 8 and 10379.173 S.I. Head alignment guide rod379.791t S.I. Head alignment instrument set tray

379.707B Intermediate sizes tray

379.263 S.I. Head alignment template. Size 3/42mm 379.265 S.I. Head alignment template. Size 5/46mm 379.267 S.I. Head alignment template. Size 7/50mm 379.269 S.I. Head alignment template. Size 9/54mm 379.253 S.I. Head alignment ring. Size 3/42mm379.255 S.I. Head alignment ring. Size 5/46mm379.257 S.I. Head alignment ring. Size 7/50mm379.259 S.I. Head alignment ring. Size 9/54mm379.175 S.I. Head alignment stylus. Sizes 3, 5, 7, and 9379.792T S.I. Head alignment instrument set tray

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379.708 Femoral preparation instrument set379.708A Standard sizes tray

379.032 Modular barrel cutter. Size 2/40mm379.034 Modular barrel cutter. Size 4/44mm379.036 Modular barrel cutter. Size 6/48mm379.038 Modular barrel cutter. Size 8/52mm379.040 Modular barrel cutter. Size 10/56mm379.042 Top head guide. Size 2/40mm 379.044 Top head guide. Size 4/44mm 379.046 Top head guide. Size 6/48mm379.048 Top head guide. Size 8/52mm 379.050 Top head guide. Size 10/56mm 379.052 Modular chamfer cutter. Size 2/40mm379.054 Modular chamfer cutter. Size 4/44mm 379.056 Modular chamfer cutter. Size 6/48mm379.058 Modular chamfer cutter. Size 8/52mm379.060 Modular chamfer cutter. Size 10/56mm379.061 Top head cutterA379.030 Head finishing reamer379.793T Femoral preparation instrument set tray

379.708B Intermediate sizes tray

379.033 Modular barrel cutter. Size 3/42mm379.035 Modular barrel cutter. Size 5/46mm379.037 Modular barrel cutter. Size 7/50mm379.039 Modular barrel cutter. Size 9/54mm379.043 Top head guide. Size 3/42mm 379.045 Top head guide. Size 5/46mm 379.047 Top head guide. Size 7/50mm 379.049 Top head guide. Size 9/54mm 379.053 Modular chamfer cutter. Size 3/42mm379.055 Modular chamfer cutter. Size 5/46mm379.057 Modular chamfer cutter. Size 7/50mm379.059 Modular chamfer cutter. Size 9/54mm379.794T Femoral preparation instrument set tray

A/Z/H379.709 Head trial and acetabular sizer instrument set379.709A Standard and intermediate sizes tray

379.063 Head guide rod A/Z/H379.068 Modular drive shaft. Stryker driveA/Z/H379.069 Cannulated drill. Stryker drive379.096 Cement keyhole reamer379.072 Head trial. Size 2/40mm379.073 Head trial. Size 3/42mm379.074 Head trial. Size 4/44mm379.075 Head trial. Size 5/46mm379.076 Head trial. Size 6/48mm379.077 Head trial. Size 7/50mm379.078 Head trial. Size 8/52mm379.079 Head trial. Size 9/54mm379.080 Head trial. Size 10/56mm379.065 Head impactor 379.095 Capsulotomy scissors379.795T Head trial instrument set tray379.795Ti Head trial instrument set tray

Cormet Precision™

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379.703B Acetabular sizer tray 378.083 Acetabular sizer. Size 46mm379.084 Acetabular sizer. Size 48mm379.085 Acetabular sizer. Size 50mm379.086 Acetabular sizer. Size 52mm379.087 Acetabular sizer. Size 54mm379.088 Acetabular sizer. Size 56mm379.089 Acetabular sizer. Size 58mm379.090 Acetabular sizer. Size 60mm379.091 Acetabular sizer. Size 62mm379.092 Acetabular sizer. Size 64mm379.093 Acetabular sizer handle379.094 Hammer379.796T Acetabular sizer instrument set tray

379.710 Cup introducer and impactor instrument set379.710A Cup introducer standard and intermediate sizes tray 379.214 Cup introducer baseplate. Size 2/46-48mm379.303 Cup introducer baseplate. Size 3/48-50mm379.215 Cup introducer baseplate. Size 4/50-52mm379.305 Cup introducer baseplate. Size 5/52-54mm379.216 Cup introducer baseplate. Size 6/54-56mm379.307 Cup introducer baseplate. Size 7/56-58mm379.217 Cup introducer baseplate. Size 8/58-60mm379.309 Cup introducer baseplate. Size 9/60-62mm 379.218 Cup introducer baseplate. Size 10/62-64mm379.114 Cup introducer insert. Size 2/46-48mm379.403 Cup introducer insert. Size 3/48-50mm379.115 Cup introducer insert. Size 4/50-52mm379.405 Cup introducer insert. Size 5/52-54mm379.116 Cup introducer insert. Size 6/54-56mm379.407 Cup introducer insert. Size 7/56-58mm379.117 Cup introducer insert. Size 8/58-60mm379.409 Cup introducer insert. Size 9/60-62mm379.118 Cup introducer insert. Size 10/62-64mm379.124 Cup introducer locking screw379.126 Locking screw wrench379.127 Introducer alignment guide rod379.027 Cup introducer handle379.797T Cup introducer instrument set tray

379.710B Cup impactor standard and intermediate sizes tray 379.132 Cup impactor. Size 2/46-48mm379.133 Cup impactor. Size 3/48-50mm379.134 Cup impactor. Size 4/50-52mm379.135 Cup impactor. Size 5/52-54mm379.136 Cup impactor. Size 6/54-56mm379.137 Cup impactor. Size 7/56-58mm379.138 Cup impactor. Size 8/58-60mm379.139 Cup impactor. Size 9/60-62mm379.140 Cup impactor. Size 10/62-64mm379.141 Cup impactor handle 379.142 1/4 Rim impactor 379.798T Cup impactor instrument set tray

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