MIS Hip Joint Replacement Surgical Technique - … MIS Hip - Anterolateral... · 3 MIS Hip Joint Replacement Surgical Technique Incision Palpate the greater trochanter on the outer

MIS Hip Joint Replacement Surgical Technique

Anterolateral MIS Approach

655_11_LSP50_Rev1_MISHip_Anterolateral_SP_US_Layout 1 5/24/11 3:50 PM Page 1

It is Stryker’s mission to deliver state ofthe art MIS technologies and implantsfor hip and knee arthroplasty, whileproviding the highest standards oftraining and education for the medicalcommunity. Stryker’s ultimate goal isto promote patient lifestyle recoverysupported by responsible science.Stryker will endeavor to invent,develop and deliver proceduralsimplification through innovativetechnologies that provide greaterpatient satisfaction and potentiallylead to long-term clinical success.

MIS Hip Joint Replacement Surgical Technique

The decision to perform an MIS procedure is ultimately left to the surgeon’s professionalmedical and clinical judgment. It is the surgeon who must carefully evaluate each patient todetermine if MIS surgery is indeed appropriate. In some cases the clinical risks that apply toMIS total joint arthroplasty may be greater than conventional total joint arthroplasty. Strykerstrongly recommends that surgeons complete a formalized training program beforeattempting these operative techniques on their own.

Anterolateral Approach


Stryker MIS Technique for THA Introduction 1

Anterolateral MIS Technique 2

Incision 3 – 5

Femoral Neck Osteotomy 6

Acetabular Preparation 7

Acetabular Reaming 8

Acetabular Trial Placement 9

Femoral Exposure/Canal Preparation 10 – 11

Implant Trial Reduction 12

Acetabular Implant Placement 13

Acetabular and Implant Insertion 14

Wound Closure 15

Stryker MIS Instrumentation

The Retractor Set 16 - 17

Femoral Set 18 - 19

Table of Contents


1 MIS Hip Joint Replacement Surgical Technique

Minimally invasive surgery (MIS) is asurgical technique, which may enablethe surgeon to potentially reduce theamount of soft tissue dissection,manipulation, and overall disruption ofthe surgical site throughout the surgery.

Minimally invasive procedures bringtechnique and implant together in asynergy that may improve patientoutcome and may reduce recovery time.MIS techniques and instrumentationmay minimize the impact of the surgicalprocedure on tissue and/or bone thatmay accelerate post-operativerehabilitation, recovery, and return topain-free function.

The MIS total hip arthroplasty (MIS-THA) procedures you are going to learnabout in this surgical protocol eachbegin with a single incision. Thepurpose of the incision is to minimizesoft tissue trauma dissection that mayreduce muscle and other tissue trauma.This may contribute to reduced patientpain and may decrease recovery time.

The key to MIS is soft tissue management.Although bone and implant managementare no less important than in conventionalhip surgery, the incremental benefits ofpain reduction and improved strengthare closely related to soft tissuemanagement.

Stryker MIS Technique for THA


Conventional total hip arthroplasty relieson maximum exposure of the joint sothe entirety can be seen at once. Suchexposure, however, requires much of thesoft tissue to be cut, inflicting damageon tissue that can increase pain andrecovery time.

The surgeon using MIS-THA must payas much attention to the position of theleg and to soft tissue management as tothe instruments that make the procedurepossible. At the same time, the limitedfield of vision offered by MIS requiresthat the surgeon develop greaterconfidence using the sense of touch(tactile sensation) to supplementvisualization.

As you work through a MIS-THA, ithelps to ask yourself two questions:1. What am I doing with the softtissues at this stage of the procedure?

2. What am I doing with the bone atthe stage of the procedure?

Preoperative planning aids in theselection of the appropriate implant styleand size for the patient’s hip pathology.

Anterolateral MIS Technique

Preoperative X-ray analysis can be usedto evaluate:

• Optimal femoral stem fit • Prosthetic neck length• Neck offset• Acetabular component sizing

Determination of probable implant styleand size can facilitate operating roompreparation by ensuring that theappropriate size selection is available.Anatomic anomalies that could preventthe intra-operative achievement of theestablished preoperative goals may alsobe detected through such planning.

The patient position is the same for boththe Posterolateral and for the AnterolateralApproach.

The patient is placed in the lateraldecubitus position with the operativehip superior. Care should be taken toposition the pelvis so that a lineconnecting the anterior superior iliacspines (ASIS) is vertical when viewedfrom both the end and the side of theoperating table.

A pelvic stabilizing device must be usedto ensure that the patient’s pelvisremains stable throughout theprocedure. The dependent leg is flexedat both the knee and the hip so that thehip is flexed up to 45˚.

As the image shown here makes clear,this position also maintains aperpendicular orientation of the hip tothe table so that improper implantplacement can be avoided. (Seeillustration below).

A general guide to follow for a MIS Hipposterolateral procedure is an incisionlength of 6 to 10cm. The incision mayneed to be lengthened beyond 10 cm toaccommodate a patient’s anatomy andsize. Retractor placement is critical to thesuccess of the MIS-THA. Therefore, it isrecommended that the surgeon beginwith a standard incision. Once he isfamiliar with retractor placement, he canmake the incision progressively smaller.

It is also recommended that the surgeonselect smaller patients to begin with.This approach helps ensure a safe andreproducible procedure.

2Anterolateral Approach



Incision

Palpate the greater trochanter on theouter aspect of the thigh. Using a sterilemarking pen, mark the outline of thegreater trochanter on the skin. Start thelocation for the initial incision on theanterior tip of the greater trochanter andextend the incision distally along theanterior aspect of the femoral shaftapproximately 6 to 8 cm. (Figure 1+2)

Using the initial incision mark as aguide, make the initial incision anddivide the subcutaneous tissue. Identifythe interval between the tensor fascialata and the gluteus maximus. This isdone by first visually identifying thedivergent fibers of the two muscles andthen palpating the soft spot where thetissue is thin. (Figure 3)

Incise along the posterior aspect of thetensor fascia lata and retract it anteriorlyto expose the gluteus medius. Ligate thesuperior gluteal artery to reducebleeding. (Figure 4)

Figure 1

Figure 3

Figure 4

Figure 2


The medius fascia creates a very tightsling effect that can reduce visibility.Perform a T release of a 1cm portion ofthe gluteus medius fascia proximally.(Figure 5)

Place a Blunt Cobra retractor or aNarrow Hohmann retractor on bothsides of the deep fascia. The greatertrochanter and the abductors shouldnow be visible. (Figure 6)

Place a Narrow Cobra retractor or aHohmann Retractor under the greatertrochanter to elevate the tendons foreasier manipulation. (Figure 7)

Use your finger to lift the gluteus mediusand the minimus slightly away from thefemur. (Figure 8)

Split the gluteus medius with a NarrowCobra retractor or a Narrow Hohmannretractor approximately 1.5 cm from itsmost posterior aspect and continuedistally for approximately 3 cm. Takecare to avoid the gluteal nerve whensplitting the gluteus medius. The glutealfibers are identified and a small nick ismade in them at the distal end of theincision. (Figure 9)

Use your finger to release the gluteusmedius by starting distally and workingproximally, leaving a cuff of tissue forrepair. Leave enough tendon(approximately 1.5cm) on both themuscle side and the bone side to facilitatelater reattachment. One of the mostimportant steps in doing a goodAnterolateral approach is leaving goodtendon and good soft tissue on the boneso these tissues can be sewn into and willhold a stitch.

Figure 5 Figure 6

Figure 7

Figure 9

Figure 8




Place a Narrow Cobra retractor or aHohmann Retractor under the inferioraspect of the resected medius to exposethe gluteus minimus for resection. Leaveenough tendon (approximately 1.5cm)on both the muscle side and the boneside to facilitate later reattachment.(Figure 10)

Reposition the Blunt Cobras to restrainand protect the resected abductors.Externally rotate the leg to make thecapsule tight and clearly visible. (Figure 11)

Place a Hohmann Retractor superiorunder the top part of the gluteus mediusand another Hohmann Retractorinferior underneath the femoral neckand elevate slightly. Make a T incision inthe center of the exposed capsule,centering the top of the T near or on thefemoral head. (Figure 12)

Remove the retractors. Palpate theremaining attached gluteus medius. Takenote of the degree of tension in thegluteus medius with the leg in theneutral position for leg length comparisonafter the implants have been place.Dislocate the hip by rotating and flexingit externally while simultaneouslydepressing the knee into adduction.

Figure 10

Figure 12

Figure 11


Using the Neck ResectionGuide

While holding the Neck Resection GuideAssembly by the handle, place the left orright guide leg on the anterior/posterioraspect of the exposed proximal femur.The width of each leg guide is 1 cm andcan be used as an estimate of distancefrom the lesser trochanter. TheAlignment Rod should be positioned sothat it is parallel with the long axis of thefemur. Electro cauterization orMethylene Blue can then be used toindicate the neck resection level. Markthe planned femoral neck cut with anelectrocautery device. Care should betaken to align the body of the guide withthe axis of the femoral canal. Once theneck cut has been marked, remove theneck resection guide. With the legrotated externally, make the femoralneck cut with an extra small oscillatingsaw blade. The axial resection is made atthe medial border of the greatertrochanter to connect it with the neckresection. Use the Femoral HeadExtractor with the T-Handle to elevatethe head and extricate it from thewound.

Femoral Neck Osteotomy

A proper neck resection level directlyaffects stem fit and placement. Thecorrect resection level can be easilydetermined by using the anatomiclandmarks identified during templatingin conjunction with a Neck ResectionGuide.

To obtain appropriate exposure of thefemoral neck, place a HohmannRetractor under the Anterior/Inferioraspect of the femoral neck and anotherHohmann Retractor at thesuperior/posterior position and elevatethe femur. (Figure 13)

Note: Poor exposure can often result inan anteverted neck resection. Carefulorientation of the flexed kneeperpendicular to the floor helpsprevent this error. If necessary, a re-cutcan be made to correct the initial neckresection.

Use electrocautery to indicate the neckresection level. Use an oscillating orreciprocating saw to resect the femoralneck along the scribed line. Be carefulnot to extend the cut laterally into thegreater trochanter. If necessary, this issuecan be avoided by making an axialresection at the medial border of thegreater trochanter to connect it with theneck resection cut.

Puncture the surface of the femoral headby applying axial force onto the FemoralHead Extractor Assembly. Continueapplying axial force to the assembly andbegin to rotate the T-Handle clockwise.When approximately 50% of theFemoral Head Extractor’s threads havebeen engaged, the femoral head can bepulled or levered out of the incision. Useyour preferred method for removing thefemoral head.

Figure 13

Figure 14


Using the Femoral HeadExtractor (Figure 14)



For the Anterolateral approach, theacetabulum is put in the neutralposition.

Position three retractors (NarrowHohmann or Narrow Cobra, WideHohmann and Left/Right AcetabularRetractors) over the edges of theacetabulum to gain adequate exposure foracetabular preparation.

Acetabular Preparation

Place the Narrow Cobra retractor or theHohmann retractor in theposterior/inferior position over theischial column to retract the femurposteriorly. The sciatic nerve is nearby, socare should be taken when placing thisretractor. Place a Left/Right AcetabularRetractor over the anterior columnalong the bony margin. Place a secondNarrow or Wide Hohmann over the topof the superior rim of the acetabulum.Take care to prevent soft tissueimpingement between the retractors andthe acetabulum. The Narrow and WideHohmann Retractors have sharp tipsthat can fix to bone. If necessary,additional fixation can be achievedthrough the use of the Retractor Impactor.Insert the Retractor Impactor into theimpaction window of the Hohmann andimpact with the Slotted Mallet. Cautionmust be taken not to break through thesuperior wall of the acetabulum.

To improve visibility, the Light Pipe canbe attached to the Narrow Hohmann,Wide Hohmann, and Left/RightAcetabular retractors. To assemble theLight Pipe onto the retractor, insert thetwo distal tabs into the retractor slots.Slide the device upward until the tabs hitthe top edge of the slots. Snap the twoproximal tabs into the slot on the topsurface of the retractor. To disassemble,reverse the preceding steps (Figure 15).The device can be pre-assembled to thefiber optic cable when you begin thesesteps. Excise the labrum and osteophytesfor proper visualization of the bonyanatomy and to improve ease ofreaming.

Figure 15


Begin reaming with a Spherical Reamerthat is 4 mm smaller than the templatedor gauged size of the implant. IncreaseReamer size in 1mm increments untilfinal sizing is achieved.

Acetabular Reaming

The Reamer Handle Assembly, consistingof a Reamer Handle and SphericalReamers, is used to prepare the acetabulum.(Figure 16 and 17)

To obtain congruity in the reamingprocess, an optional 45˚ Abduction 20˚Anteversion Alignment Guide can beattached to the Reamer Handle. Whenthe Alignment Guide is perpendicular tothe axis of the patient, it will orient theReamer Handle Assembly at 45˚ ofabduction, placing the axis of theSpherical Reamer at the appropriate 45˚of inclination. The Reamer HandleAssembly may then be positioned at 20˚of anteversion by aligning the left/rightanteversion rod on the Alignment Guideso that it is parallel to the long axis ofthe patient.

Although the alignment guide offerssome assistance, it is important tocritically evaluate anatomic landmarksbefore placement of the metal shell.These anatomic landmarks include• Anterior and posterior walls of theacetabulum

• Sciatic notch (if visible)• Acetabular fossa

Drive the reamer head to the pointwhere the crossbars contact theacetabular wall at the peripheral lunateregion. Take care to avoid enlarging ordistorting the acetabulum by eccentricreaming. Final acetabular reamingideally shows the hemisphericalacetabulum denuded of cartilage, withthe subchondral plate intact and theanterior acetabular wall preserved.

Figure 16 Figure 17




While performing the trial reduction,moving soft tissue out of the way solvesthe difficulty of getting the head intoplace. With the hand introducedmedially and the smaller two fingerssupporting the bone, use the longerfingers under the head to skid themuscles out of the way. This creates asoft tissue envelope in which to dropthe head.

Acetabular Trial Placement

Thread a Window Trial, of the samediameter as the last Spherical Reamer,onto the Shell Positioner/Impactor andplace it in the acetabulum to evaluate thesize and congruity of the preparation.

If desired, the Abduction/AnteversionAlignment Guide can be attached to theShell Positioner/Impactor to helpestablish the recommended 45˚ ofabduction inclination and 20˚ ofanteversion. When the AlignmentGuide is perpendicular to the long axisof the patient, it will orient the ShellPositioner/Impactor at 45˚ of abduction,placing the axis of the Window Trial atthe appropriate 45˚ of inclination. TheShell Positioner/Impactor may then bepositioned at 20˚ of anteversion byaligning the left/right anteversion rod onthe Alignment Guide so that it is parallelto the long axis of the patient.


Use the femoral rasp to contour theMedial Lateral and Anterior Posterioraspects of the femur. The raspgeometry is relative to the surfaceenhanced proximal geometry in theM/L plane and offers a press-fit in theA/P plane, approximating the finalstem seating level.

Graduate the Axial Starter Reamercircumferentially along the flutesindicating both the depth (length) andthe width of the implant body. TheReamer can be used with powerequipment or with a T-handle. The AxialStarter Reamer is used to enter thefemoral canal. The Axial Starter Reamerhas a sharpened point to facilitate entryand should be inserted to the depth ofthe final rasp. The proper depth of theAxial Starter Reamer can be determinedby aligning the designated engravedgrooves on the reamer shaft with themedial calcar. Lateral pressure on theAxial Starter Reamer will help provide aneutral orientation of the implant.(Figure 20)

Femoral Exposure / Canal Preparation

With the leg externally rotated, retractorscan be placed to achieve the exposurenecessary to prepare the femur. The tibiashould be perpendicular to the floor tomaximize exposure and facilitateimplant alignment.

Place the Femoral Elevator under themedial aspect of the femur and elevatethe femur out of the incision to provideaccess to the femoral canal. If additionalretraction of soft tissue is required, aHohmann retractor or a Narrow Cobraretractor can be placed under theFemoral Elevator.

Figure 20




Lock the Rasp Handle onto the Rasp byinserting the post of the Rasp into thecorresponding hole on the Rasp Handleand pressing the two together. Align theversion post on the Rasp Handle with thepositioning slot on the Rasp. (Figure 21)

Begin rasping with the smallest rasp.Increase rasp size upward until the sizeof the rasp matches that of the plannedstem size and application. The final raspshould seat firmly against medial andlateral cortical bone. To preventmisalignment, it is imperative that axialalignment of the rasp in the canal bemaintained at all times.

The rasp has been inserted to the properdepth when it seats tightly within thecanal as determined by visual andauditory clues. The surgeon’s clues thatthe implant has been firmly fixatedinclude increased sound pitch of blowson rasp handle, increased resistance toforward advancement, and a decrease inmotion. Reliance only on neck cut maylead to improper sizing and inadequatecomponent fixation. (Figure 22)

Note: Generally, if a rasp sinks belowthe level of the neck cut, advance to thenext larger rasp. On the other hand, ifthe surgeon feels that the neck cut mayhave been slightly high, remove the raspand re-cut the neck at a slightly lowerlevel. Once the rasp sinks below thelevel of the neck cut, the surgeontypically loses the visual and auditoryclues that indicate the rasp is properlyseated.

Upon reaching the proper size and depthof rasp, leave the final rasp fully seated inthe canal. Disengage the rasp handle bycompressing the trigger located on therasp handle body.

Figure 21

Figure 22


Trial reductions are necessary forconfirming proper placement of thefemoral and acetabular componentsbefore final selection and implantation.Intraoperative radiographs can also beused for this purpose. It is recommendedthat both of these techniques be used,especially during early experience withminimally invasive techniques.

Implant Trial Reduction

Use the Trial Assembly (consisting of theRasp, Trial Neck, Trial Head, WindowTrial, and Insert Trial) to carry out athorough evaluation of hip mechanicsduring trial reduction. This evaluationallows for preoperative modification ofneck length, head diameter, head offset,cup orientation, and insert selection.(Figure 23)

Select a Trial Neck that has the samebase neck length as the inserted FemoralRasp by matching the color indicator ontop of the Trial Neck to the colorindicator on top of the Rasp.

Select a plastic tapered Trial Head andplace it onto the Trial Neck. The taperedTrial Heads are available in a variety ofoffset lengths to create the desired necklength of the prosthesis.

Place the Trial Head/Neck Assemblyover the post of the rasp by positioningthe assembly onto the slot located atthe proximal tip of the rasp andpressing firmly.

Perform a trial reduction of the hip andadjust neck length until leg lengths areequal. Stability can also be checked bytelescoping the leg and performing a fullrange of motion. The face orientation ofthe trial insert to the acetabular cupaffects optimal joint stability. If it isdetermined that the leg is unstable,reposition the trial insert within themetal shell in 30˚ increments to createoptional positions in which the cupinsert may be oriented.

Upon confirmation of the selectedcomponents, remove the TrialHead/Neck Assembly.

Reassemble the Rasp Handle to theRasp. Remove the rasp with the slottedmallet to preserve the integrity of thehandle and locking mechanism.

Figure 23




Use the Narrow Hohmann or Cobra andLeft/Right Acetabular retractors to exposethe acetabulum. (Figure 24)

Select the appropriately sized acetabular

Acetabular Implant Placement

cup implant. Thread the metal shellonto the Shell Positioner/Impactorusing the threaded hole in the dome ofthe metal shell.

Note: It is important to engage thethreads fully and seat the Impactoragainst the shell. Otherwise, thethreads on the metal shell couldbecome damaged, resulting indifficulty with the removal of theImpactor from the shell.

Confirm the removal of the labrum andany osteophytes from the acetabulum.Confirm that soft tissue has beenretracted to avoid impingement betweenthe metal shell and the acetabulumduring cup implantation.

Evaluate anatomic landmarks beforeplacement of the metal shell. Theseanatomic landmarks include:• The anterior and posterior walls ofthe acetabulum

• The sciatic notch (if visible)• The acetabular fossa

When inserting the acetabular componentinto the wound, retrovert it to getaround the femoral neck, then antevertit to the desired position. The placementof the cup can be checked with anarthroscope. Impact the metal shell intothe acetabulum to achieve a tight, stablepress-fit. Unthread the ShellImpactor/Positioner carefully from theshell.

Determine the depth of the shell seatingby viewing through the threaded hole inthe dome.

Figure 24


Based on the desired acetabular insertsize, load the appropriate size SiliconeInsert Positioner Tip into the InsertPositioner/Impactor Handle. Attach theinsert onto the Insert Positioner Tip bypressing the two firmly together. Gentlyintroduce the insert into the shell andalign the barbs and grooves. Remove theSilicone Insert Positioner Tip from theInsert Positioner/Impactor Handle. Loadthe appropriate size Plastic InsertImpactor Tip into the InsertPositioner/Impactor Handle.

Position the Insert Positioner/ImpactorHandle into the inner diameter of theinsert. Take care to ensure the soft tissuearound the shell has been retracted andthat the handle is aligned with the axisof the shell. (Figure 25 and 26)

Acetabular and Implant Insertion

Strike the handle approximately fourtimes with a mallet to seat the insertfully. Verify that the insert is fullyseated and properly aligned into theacetabular shell. Thread the FemoralStem Impactor/Extractor into therecess on the proximal face of the stem.

Note: To help prevent damaging thefemoral stem or the femoral stemImpactor, be certain that the femoralstem Impactor is fully seated againstthe proximal face of the femoral stem.

Do NOT continue impacting thefemoral component if visual andauditory clues indicate that the restingposition of the femoral component hasbeen reached, even if the femoralcomponent is not yet down to the levelof the rasp trials. If the femoralcomponent comes to a rest at a levelbelow that of the rasp trial, it is verylikely that a femoral split has beencreated. It is imperative that thesurgeon investigates this possibility.

Note: Before implanting the headassembly, the neck length selectionmay be re-evaluated using the trialhead by placing the trial head onto thestem’s neck and reducing the hip toverify that the mechanics have notbeen altered because of implantseating.

Place the corresponding tapered headimplant onto the dry trunnion of thefemoral stem with a slight twist. Impactthe tapered head onto the stem with twomoderate blows using the Head Impactor.Reduce the femoral head into theacetabular cup/insert assembly and re-check for stability and range of motion.

Figure 25 Figure 26




Reapproximate the tagged inferior andanterior capsule leaves, completelyencasing the femoral head of theprosthesis within the acetabulum.Tendons have some elasticity and arestronger than osteoporotic or osteopenicbone. Therefore, reattach the shortexternal rotators to the gluteus mediustendon that is still attached to thegreater trochanter. This reattachmentplaces the rotators in a physiologicposition that increases their potential toremain attached.

Complete fascia and skin closures.(Figure 27)

Wound Closure

Figure 27


Retractor Impactor(1440-1020)

Additional retractor fixation can be achievedthrough the use of the Retractor Impactor.Once the retractor is placed within theincision, insert the Retractor Impactor intothe impaction window of the appropriateretractor with the Slotted Mallet. Cautionmust be taken not to break through thesuperior wall of the acetabulum.

Stryker MIS Instrumentation

Stryker’s streamlined instruments allow a minimally invasive approach for both Posterolateral and Anterolateral surgery.

The Retractor SetThe Retractor Set available for use in minimally invasive hip procedures includes:

• 2 Blunt Narrow Cobra Retractors• 2 Narrow Hohmann Retractors• 1 Wide Hohmann Retractor


Blunt Narrow Cobra Retractors(1440-1140)

The Blunt Narrow Cobra Retractor has anincreased bend to maximize visualizationand a blunt tip design to protect soft tissue.

Narrow Hohmann Retractors(1440-1130S)

The Narrow Hohmann Retractor has asharp tip that allows for bone fixation. Theretractor also has an impaction window forthe Retractor Impactor and slots to installthe Light Pipe.

Wide Hohmann Retractors(1440-1135S)

The Wide Hohmann Retractor has an extrawide body to move soft tissue out of theincision area. The sharp tip allows for bonefixation. The retractor has an impactionwindow for the Retractor Impactor andslots to install the Light Pipe.

• 1 Retractor Impactor• 1 Left and 1 Right Acetabular Retractor• 1 Femoral Elevator



Acetabular Retractors(1440-1105S/1110S)

An Acetabular Retractor is provided forboth the left and right hip. Sharp tipsallow for bone fixation. The Retractorincludes an impaction window for theRetractor Impactor and slots to installthe Light Pipe.

Light Pipe(1440-1080)

The Stryker Light Pipe provides a lowprofile, efficient light source allowingexcellent visibility of the acetabulum. Asterile, single-use, disposable device, theLight Pipe is composed of a polymerinner core and a metallic outer shield. Itis intended for use with the followingMinimally Invasive Hip InstrumentRetractors with mating slots:• Narrow Hohmann Retractors• Wide Hohmann Retractors • Left/Right Acetabular Retractors

The Surgeon’s preference will dictatewhich Retractor will be used as the lightsource.

Before clinical use, attach the Light Pipeto the fiber optic cable of the StrykerX6000 Light Source.

To attach the Light Pipe to a retractor:

Insert the two distal tabs into theretractor slots. Slide the device upwardsuntil the tabs hit the top edge of the slots.Snap the two proximal tabs into the sloton the top surface of the retractor.

To disassemble:

Reverse the steps above: unsnap theproximal tabs, slide the device downwards,and disengage the two distal tabs.

The device can be pre-assembled to thefiber optic cable when you begin thesesteps. Please note that when the device isfully threaded onto the cable, one threadwill be exposed.

Femoral Elevator Retractor(1440-1120)

The Femoral Elevator is designed toelevate the femur out of the incision. Itis placed superiorly under the medialaspect of the femur.


Femoral Set

The Femoral Set available for use in minimally invasive hip procedures includes:

• Neck Resection Guide• Alignment Rod• T-Handle• Femoral Head Extractor• Straight Accolade Rasp Handle• Quick Connect Handle• Femoral Head Impactor• Offset Neck Trial Forceps


The straight design of the StraightAccolade Rasp Handle limits soft tissueimpingement. It is designed for theAccolade TMZF Implant Stem system.

The Straight Accolade Rasp Handlelocks firmly onto the Accolade Rasps byinserting the post of the Rasp into thecorresponding hole on the Rasp Handleand pressing the two together. Careshould be taken to align the version poston the Rasp Handle with the positioningslot on the Rasp.

Accolade Neck Resection Guide & Alignment RodAccolade Neck Resection Guide (1440-1000) / Alignment Rod (1440-1050)

The Accolade Neck Resection GuideAssembly consists of the Neck ResectionGuide and the Alignment Rod. It isdesigned to work with the AccoladeTMZF implant system.

To correctly assemble the instrument,place the Alignment Rod through thecorresponding left or right hole in theNeck Resection Guide. While holdingthe Neck Resection Guide Assembly bythe handle, place the left or right guideleg on the anterior/posterior aspect ofthe exposed proximal femur.

The width of each guide leg is 1 cm andcan be used as an estimate of distancefrom the lesser trochanter. TheAlignment Rod should be positioned sothat it is parallel with the long axis of thefemur. Electrocauterization orMethylene Blue can then be used toindicate the neck resection level.

Straight Accolade Rasp Handle Straight Accolade Rasp Handle (1440-1400)



Offset Neck Trial Forceps(1440-1700)

The Offset Neck Trial Forceps can beused to facilitate placement of theTrial Head/Neck Assembly in a MISincision.

Clasp the Trial Head/Neck Assemblybetween the forceps tips and applypressure until the lock is engaged.The bent end tip of the forceps ispointed up towards the user.

Femoral Head Impactor(1440-1070)

The Femoral Head Impactor has aslim profile to allow better entry intoa reduced MIS incision.

Femoral Head Extractor(1440-1010) and T-Handle (5900-0050)

The femoral head can be deliveredfrom the incision with the use of theFemoral Head Extractor Assemblythat consists of the Femoral HeadExtractor and the T-Handle.

Puncture the surface of the femoralhead by applying axial force onto theFemoral Head Extractor Assembly.Continue applying axial force to theassembly and begin to rotate the T-Handle in a clock-wise direction.Once approximately 50% of theFemoral Head Extractor’s threads areengaged, the femoral head can bepulled or levered out of the incision.



MIS Hip Joint

325 Corporate DriveMahwah, NJ 07430t: 201 381 5000

www.stryker.com

A surgeon must always rely on his or her own professional clinical judgment when deciding whether to use a particularproduct when treating a particular patient. Stryker does not dispense medical advice and recommends that surgeons betrained in the use of any particular product before using it in surgery.

The information presented is intended to demonstrate the breadth of Stryker product offerings. A surgeon must alwaysrefer to the package insert, product label and/or instructions for use before using any Stryker product. Products may notbe available in all markets because product availability is subject to the regulatory and/or medical practices in individualmarkets. Please contact your Stryker representative if you have questions about the availability of Stryker products inyour area.

Stryker Corporation or its divisions or other corporate affiliated entities own, use or have applied for the followingtrademarks or service marks: Accolade, Stryker, Stryker Orthopaedics, TMZF, Trident. All other trademarks aretrademarks of their respective owners or holders.

Literature Number: LSP50 Rev. 1MS/GS 05/11

Copyright © 2011 StrykerPrinted in USA


Documents

MIS Hip Joint Replacement Surgical Technique - … MIS Hip - Anterolateral... · 3 MIS Hip Joint Replacement Surgical Technique Incision Palpate the greater trochanter on the outer