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Versys® Advocate® V-Lign® and Non V-Lign Cemented Hip Prosthesis Surgical Technique

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Versys® Advocate® V-Lign® and Non V-Lign Cemented Hip Prosthesis Surgical Technique Versys® Advocate® V-Lign® and Non V-Lign Cemented Hip Prosthesis Surgical Technique Versys® Advocate® V-Lign® and Non V-Lign Cemented Hip Prosthesis 1 Versys Advocate V-Lign Table of Contents and Non V-Lign Cemented Hip Prosthesis Design Philosophy 2 Surgical Technique Preoperative Planning 2 Surgical Technique 3 Incision and Exposure of the Hip Joint 3 Determination of Leg Length 3 Osteotomy of the Femoral Neck 3 Preparation of the Femur 4 Calcar Planing 5 Trial Reduction 5 Preparation for the Metal V-Lign Proximal Centralizer 6 Assembly of Femoral Head and Stem 8 Preparation for the Proximal Centralization Sleeve (optional) 8 Sizing and Preparation of the Canal 8 Cement Introduction and Stem Insertion 10 VerSys Advocate Hip Prosthesis Sizing 12 Product Scope 13 2 Versys® Advocate® V-Lign® and Non V-Lign Cemented Hip Prosthesis Design Philosophy The overall objective or preoperative The neck osteotomy level can be marked The Advocate Cemented Hip Stems planning is to enable the surgeon to on the x-ray once the template has been enable optimal placement and fixation of gather anatomic parameters which allow properly superimposed. Head centers for the femoral stem. The aggressive taper accurate intraoperative placement of the each head-neck combination are shown of the distal tip helps reduce the strains femoral implant. in 3.5mm increments from -3.5mm to +10.5mm (depending on head in the cement mantle around the distal In femoral templating, it is important diameter). By using the “STANDARD” tip.1 The addition of an external distal to appreciate that magnification of the (+0) level to determine the level of the centralizer helps centralize the implant size of the femur will vary depending on osteotomy cut, the surgeon has the distally. The metal ¬V-Lign¬ Proximal the distance from the x-ray source to the option of using either a standard (+0) Centralizer and optional Proximal PMMA film and the distance from the patient head or one that is -3.5mm shorter, Sleeve Centralizer are innovations that to the film. The Advocate Hip System +3.5mm longer, or +7.0mm longer than aid in proximal centralization of the templates use standard 20 percent the standard (+0) without having to use stem. The stem geometry enhances magnification, which is close to the a femoral head with a metal skirt. If more stability in both frontal and sagittal average magnification on most clinical length is needed at the time or surgery, planes. The stem is prepared with a satin x-rays. Larger patients or obese patients one additional femoral head is available finish designed to accommodate a stable may have magnification greater than 20 with a neck length of +10.5mm longer and enduring cement/stem interface. percent because their osseous structures than the standard (+0) neck length. This The option of standard and extended are farther away from the surface of the head (with the longest neck length) has a offset implants allows for soft tissue film. To determine the magnification of metal skirt. stability without increasing leg length. any x-ray film, use a standardized marker at the level of the femur when exposing Caution: The skirted heads allow less the x-ray film. range of motion than the skirtless Preoperative Planning heads, which may increase chance of The key to successful implantation is Mark the center of rotation of the femoral dislocation. accurate preoperative planning. Effective head on the preoperative x-ray. Overlay preoperative planning allows the the template onto the A/P x-ray so the For a complete listing of compatible surgeon to predict the impact of different midline of the implant is aligned over femoral head options, refer to interventions in order to perform the the anatomical axis of the femoral www.productcompatibility.zimmer. joint restoration in the most accurate and medullary canal. The template is then com or consult with your Zimmer safe manner. moved superior or inferior so the head representative. level marked +0mm is superimposed on The objective of preoperative planning the center of rotation of the femoral head include: (Fig. 1). Choose the appropriate size 1. Determination of leg length of the stem so that the rasp envelope fills the femur to the endosteal cortices. 2. Establishment of appropriate abductor On the lateral view, the rasp envelope muscle tension and femoral offset should fill the canal to the endosteal 3. Determination of anticipate cortex. component sizing The Advocate Cemented stems are 4. Determination of the level of the available in both standard and extended osteotomy above the superior border offset options. This enables proper of the lesser trochanter restoration of joint kinematics in the hips that have a more varus configuration 5. Determination of lateralization into proximally, without increasing the leg the trochanteric bed to achieve neutral Fig. 1 length. alignment of the implant Versys® Advocate® V-Lign® and Non V-Lign Cemented Hip Prosthesis 3 Osteotomy of the Femoral Head After exposing the proximal femur, Surgical superimpose the Osteotomy Guide Technique (00-7890-XXX-XX) on the proximal femur 1 (Fig. 2). The longitudinal axis of the guide should be parallel to the longitudinal Incision and Exposure of the Hip axis of the femur. The hole labeled “STD” Joint refers to the standard offset implants. In total hip arthroplasty, exposure can be The hole labeled “EXT” refers to the achieved through a variety of methods. extended offset implants. All holes on The Advocate Cemented implant can the osteotomy guide refer to the +0 be inserted using a variety of standard head center. surgical approaches. On the preoperative x-ray, record the distance from the lesser trochanter to the Determination of Leg Length center of rotation of the head bilaterally Establish landmarks and obtain by using the magnified ruler provided on measurements before dislocation of the side of each template. This is a useful the hip so that a comparison of leg guide to reestablish the correct leg length and femoral shaft offset can be length. At surgery, a ruler can be used obtained after reconstruction. From this to measure the distance from the lesser comparison, adjustments can be made trochanter to the center of rotation of to achieve the goals established during the natural femoral head. The tip of preoperative planning. There are the greater trochanter should coincide several methods to measure leg length. with the mark designated as “S” (for One method is to attach the leg length standard) on the lateral edge of the caliper to the wing of the ilium, just Fig. 2 Osteotomy Guide. below the anterior-superior iliac spine. Then place a reference point on the Mark the level of the neck osteotomy. greater trochanter. Make the initial Note that the angle of the osteotomy measurement in an immobilized cut is 60 degrees to the long axis of Long Axis of Femur reproducible position and mark the the femur (Fig. 3). The neck osteotomy position of the lower limb on the table. should be made with a reciprocating saw and cut in the neutral plane. Do not attempt to build anteversion into the cut as the Calcar Planer will later assure a proper final surface, both anteriorly and posteriorly, on which the collar will rest. o 60 Fig. 3 4 Versys® Advocate® V-Lign® and Non V-Lign Cemented Hip Prosthesis Preparation of 2the Femur After removing osteophytes, particularly anterior osteophytes, use the Box Osteotome (00-6601-056-00) (Fig. 4) or the Trochanteric Reamer (00-7896-010- 00) (Fig. 5) to remove the medial portion of the greater trochanter and lateral femoral neck. After removing this cortical bone, insert the Tapered Awl to open the medullary canal (00-7896-010-00) (Fig. 6). The center of the femoral canal can be found by reaming just anterior to the trochanteric fossa. A powered Trochanteric Reamer can be used to ream sufficient lateral greater trochanteric bone so that the rasp can be placed in a neutral varus-valgus alignment. 00-6601-056-00 T-Handle (00-6551-060-00) 00-7896-010-00 Fig. 4 Fig. 5 Fig. 6 Versys® Advocate® V-Lign® and Non V-Lign Cemented Hip Prosthesis 5 LM Rasps (00-7892-XX-80) Std Rasps (00-7892-XX-70) Lg (00-9801-033-00) Small (00-9801-032-00) Rasp Handle Fig. 7 (00-9029-001-01) Fig. 9 Use the VerSys System Rasps (identifiable by the “ ” symbol near the trunnion) when preparing the canal for an Advocate Cemented implant. Do not Trial Reduction use the VerSys Large Metaphyseal or 4 Enhanced Taper Rasps when performing Modular Cone Collar Provisionals affix a cemented procedure. These rasps are Fig. 8 to the Rasp Trunnion and allow for engraved with a “LM” or “ET” near the determination of joint stability, leg length, trunnion for easy identification. Also, and range of motion (Fig. 10). Please refer do not use the Rasp Alignment Tip in the to VerSys Trial Head Surgical Technique cemented technique. The threads on the (97-8018-001-00) for addition details. tip of the standard system rasp must be Calcar visible before rasping the canal (Fig. 7). The Cone Collar Provisionals replicate Planing the collar/neck geometry of the femoral It is important to antevert the femoral 3 Once the final rasp is securely seated, component for exact trial reductions. The rasp by approximately 10 to 20 degrees remove the Rasp Handle and leave system utilizes one Cone Collar Provisional when driving it into the medullary canal. the rasp in the medullary canal. (It is for two Rasp sizes (e.g. 12/13 is marked The amount of femoral rasp anteversion necessary to countersink the rasp into the on the Cone Collar Provisional and is related to the natural anteversion of bone by 2 - 4mm to adequately prepare the indicates usage with only the size 12 and the patient‘s femoral neck.
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