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H I P S Y S T E M

CORAILFracture Management

Product Rationale and Surgical Technique

Madame Veyrat. The first fractured neck of femur patient to be treated with a Corail® stem.

DePuy believes in an approach to hip replacement that places equal importance on recovery, function and survivorship.

R E C O V E R Y F U N C T I O N S U R V I V O R S H I P

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Garden Classification type 3

The treatment options for intracapsular fractured neck of femur Garden type 3 and Garden type 4 are somewhat controversial.1,2,3,4,5,6,7 Traditionally monoblockhemiarthroplasty has been the treatment of choice for many patients, however, if we consider those patients suffering from Garden Type 3 and 4 who are younger,healthy, independent and lucid there is increasing evidence that we should consider more stable, long lasting, proven solutions.1,3,4,5,6

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Garden Classification 4

Garden Classification type 4

Effective, Reliable and Reproducible

Corail® was developed by the ARTRO group in 1986. Corail® is a well established and highly successful option for hip replacement, with published long term clinicalresults.11,12,13 The reported survivorship in the Norwegian Hip register notes 95% survivorship at 15 years in over 5000 THR Cases.8

Proven Survivorship8,9,10

Improves, sustains health for an active life after surgery1,3,5,11

Maintains function reducing the risk of re-operation2,3,4,6

“Corail is an implant that performs predictably and fixes to the bone in all cases, regardless of the age of the patient”Dr Dominique C.R. Hardy, University Hospital Saint-Pierre, Brussels, Belgium

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Madame Veyrat was the very first Corail® stem patient and the first fractured neck of femur patient treated with Corail®. Although suffering from severe osteoporosis,Madame Veyrat was then a very active 56 year old woman, she was a keen alpine skier and mountaineer. In August 1986, she suffered from a fractured neck of femur aftera mountain accident. Madame Veyrat was operated on at the Clinique d’Argonnay, Annecy, by Dr Machenaud of the ARTRO Group, who implanted the first Corail® Stem.In December 2007 Madame Veyrat is still doing very well and participates in winter sports with family and friends. Madame Veyrat is just of one of the many fractured neckof femur patients who have benefited from the Corail® stem reliability.

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Implanting a positive future

Corail® has established a unique survivorship record for long-term hip arthoplasty,as a primary implant in elective surgery and for fracture treatment.

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1986Immediate post-operative

199913 year follow-up

200721 year follow-up

Dr Dominique C.R Hardy, University Hospital Saint-Pierre, Brussels, Belgium. Results from 293 intracapsular hip fracture patients10

Within the first post-operative year:• 219 uneventful implantations

• 6 recurrent dislocations • 67 deaths (22.8 %) • 1 femoral fracture

Within the 5 years post-operatively: • 141 Uneventful implantations

• 148 deaths (50.5 %) • 4 ectopic ossifications type III (Brooker)

• no loosening • no macroscopic subsidence

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Different needs, different solutions

The Cathcart Modular Endo Head and CathcartSelf-Centering Bipolar Head offer initial qualityand stability, but also the option to revise to aTotal Hip Replacement if needed at a later stage,without having to remove the femoral component.

The Cathcart head may be suitable for the elderlypatient who has little need for improved level ofactivity, but simply demands a lower level of pain.The Cathcart Modular Endo Head and CathcartSelf-Centering Bipolar head also enable thesurgeon to perform a hip replacement withoutremoving unaffected acetabular bone.

The Gyros® cup system offers a double mobilityTotal Hip Replacement, which meets the needs of fractured neck of femur patients, who stilldemand the ability to carry our their dailyactivities. The double mobility concept of Gyrosallows for increased range of motion whichreduces the risk of dislocation.

The Gyros® cup is fully HA coated and is alsoavailable with legs to provide additional support.

The Pinnacle™ Acetabular Cup System is DePuy’spremium product for acetabular indications andcan address all existing pathologies.

For the first time surgeons have the choice betweenhigh performance bearings which all work withinthe Pinnacle™ Acetabular Cup System.

The Corail® stem combined with a high performancebearing provides low wear and high stability for theyoung, independent and active patient. 14, 15

The Cathcart Head Gyros® Acetabular Cups Pinnacle™ High Performance Bearings

The Corail® stem can be paired with a number of DePuy bearings depending on the patient’s needs and cost implications.

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Recent results of fractured neck of femur show that primary arthroplasty provides a better solution than hemi-arthroplasty or internal fixation. In randomised clinical trialsTotal Hip Replacement (THR) has been found to provide improved clinical results in relation to hip function, level of pain and health-related quality of life than either internalfixation or hemiarthroplasty, in previously mobile, otherwise healthy lucid fractured neck of femur patients.3,4,5 In those patients, randomised clinical trials have also reportedlower revision rates for THR than either hemi-arthroplasty or internal fixation.5

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Life after surgery

THR is associated with improved health and overall quality of life

relative to other treatment options

THR following femoral neck fracture consistently leads to reduced post-operative pain.

The Corail® stem extramedullarygeometry is designed for extended

range of motion to provide increasedstability reducing the risk of

dislocation and revision surgery.

Percentage of Revisions in 290 Hip Fracture Patients Over the Age of 651

35%

30%

25%

20%

15%

10%

5%

0%Internal Fixation Hemiarthroplasty

Treatments

% o

f Rev

isio

ns

THR

Percentage of Patients with Pain Grades 3 and 44

70

60

50

40

30

20

10

0Internal Fixation

1 Year

13 Years

Hemiarthroplasty

Procedure

Per

cent

age

(%)

THA

Health Outcomes Following Hip Fracture1, 3

0.75

0.7

0.65

0.6

0.55

0.54

THA

HA

Internal Fixation

12

Months

EQ

-5D

24

6

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The use of the Corail® stem in the treatment of intracapsular fractured neck of femurs uses the same surgical technique and instrumentation as the primary Corail®

system, with the addition of these three simple recommendations. The Corail® stem provides one simple, reproducible, proven system for multiple indications, whichprovides a better outcome for both primary arthritis and fractured neck of femur patients.

When broaching the femur, compactcancellous bone to create a solid bony

bed, never remove any bone.

Always test rotational stability with thefinal broach.

Ensure all hydroxyapatite is covered with bone, it may be necessary to add

bone graft.

To achieve optimum stability a collaredstem is recommended for the treatment

of fractured neck of femurs.

Surgical Technique

CORAIL®

STEM SPECIFICATIONS / ORDERING INFORMATION

Corail® Standard Stem (Collarless)

3L92507 Corail® K8S 125 mm











Corail® Standard Stem (Collared)

3L92498 Corail® K8A 125 mm











Corail® Coxa Vara Lateralised Stem (Collared)

3L93709 Corail® KLA9 130 mm










Corail® High Offset Lateralised Stem (Collarless)

L20309 Corail® KHO9 130 mm










Bearing options

9066-300-01 Cathcart Reference Guide

9066-300-02 Gyros Reference Guide

9080-10-000 Pinnacle reference Guide

The length of the stems mentioned below refers to the distance between the tip of the lateral shoulder and the distal tip.Collared stems are the recommended solution for femoral neck fracture.

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00

Corail® is a registered trademark of DePuy (Ireland) Ltd.

Pinnacle™ is a trademark of DePuy Orthopaedics, Inc.

Gyros® is a registered trademark of DePuy France S.A.S.

© 2008 DePuy International Limited. All rights reserved.

Cat No: 9066-35-020 version 1

Issued: 02/08

This publication is not intended for distribution in the USA

DePuy International LtdSt Anthony’s RoadLeeds LS11 8DTEnglandTel: +44 (0)113 387 7800Fax: +44 (0)113 387 7890

0459

References:

1. Keating JF, Grant A, Masson M, Scott NW, Forbes JF. Randomised Comparison of Reduction and Fixation, BipolarHemiarthroplasty, and Total Hip Arthroplasty in the Treatment of Displaced Intracapsular Hip Fractures in HealthyOlder People. Journal of Bone and Joint Surgery, American Edition, 2006; 88- A (2): 249-60.

2. Parker MJ, Gurusamy K. Internal fixation versus arthroplasty for intracapsular proximal femoral fractures in adults.Cochrane Database of Systematic Reviews, 2006, Issue 4. Art. No.: CD001708. DOI:.1002/14651858.CD001708.pub2.

3. Blomfeldt R, Tornkvist H, Eriksson K, Soderqvist A, Ponzer S, Tidermark J. A Randomised Controlled Trial ComparingBipolar Hemiarthroplasty with Total Hip Replacement for Displaced Intracapsular Fractures of the Femoral Neck inElderly Patients Journal of Bone and Joint Surgery, 2007; 89-B: 160-5.

4. Ravikumar KJ, Marsh G. Internal Fixation Versus Hemiarthroplasty Versus Total Hip Arthroplasty for DisplacedSubcapital Fractures of the Femur - 13 Year Results of a Prospective Randomised Study. Injury. 2000; 31(10): 793-7.

5. Baker RP, Squires B, Gargan MF, Bannister GC. Total Hip Arthroplasty and Hemiarthroplasty in Mobile, IndependentPatients with a Displaced Intracapsular Fracture of the Femoral Neck. A Randomized, Controlled Trial Journal of Boneand Joint Surgery, 2006; 88- A: 2583-2589.

6. Rogmark C, Carlsson A, Johnell O, Sernbo I. Costs of internal fixation and arthroplasty for displaced femoral neckfractures: A randomized study of 68 patients. Acta Orthopaedica Scandinavica 2003; 74(3): 293-8.

7. Bhandari,M.; Devereaux,P.J.; Swiontkowski,M.F.; Tornetta,P.,III; Obremskey,W.; Koval,K.J.; Nork,S.; Sprague,S.;Schemitsch,E.H.; Guyatt,G.H. Internal fixation compared with arthroplasty for displaced fractures of the femoral neck.A meta-analysis Journal of Bone and Joint Surgery, 2003; 85 -A:1673-1681.

8. The Norwegian Arthroplasty Register 1987-2004, Prospective Studies of Hip and Knee Prostheses. AAOS, 2005.Avalible from: http://www.haukeland.no/nrl/

9. Vidalain JP. Corail® Stem Long-Term Results Based upon the 15-Years ARTRO Group Experience. Fifteen Years ofClinical Experience with Hydroxyapatite Coatings in Joint Arthroplasty, Ed. Springer, 217-224, 2004.

10. Hardy D, Frayssinet P. Hydroxyapatite-Coated Femoral Arthroplasties : Long Term Study Through 29 Corail®Prostheses Explanted During Ten Year Survey, Surgical Technology International. 2003 X, 237-245.

11. Røkkum M, Reigstad A. Total Hip Replacement With an Entirely Hydroxyapatite-Coated Prosthesis, 5 Years Follow-Up of 94 Consecutive Hips. Journal of Arthroplasty, 1999, 14(6), 698-700.

12. Vidalain JP. Reliability of Cemented Titanium Femoral Implant: A Retrospective Study of a Personal Series of 120Prostheses With More Than 10 Years of Follow-Up. Journal of Bone and Joint Surgery. 79-B: SUPP I, 1997.

13. Evaluation of the Corail® Hip by the Orthopeadic Data Evaluation Panel (ODEP) in Respect of the National Institutefor Clinical Excellence (NICE) Ten Year Benchmark for Primary Hip Replacement, 2004.

14. Berry D, Von Koch M, Schleck, C, Harmsen W. Effect of Femoral Head Diameter and Operative Approach on Riskof Dislocation After Primary Total Hip Arthtoplasty. Journal of Bone and Joint Surgery, 2005; 87-A: 2456-63.

15. Bystrom S, Espehaug B, Furnes O, Havelin LI. Femoral Head Size is a Risk Factor for Total Hip Luxation. A Study of42,897 Primary Hip Arthroplasties from the Norwegian Arthroplasty Register. Acta Orthopaedics Scandinavia. 2003;74(5): 514-524.

DePuy France S.A.S.7 Allée Irène Joliot Curie69800 Saint PriestFranceTél : +33 (0) 472 79 27 27Fax : +33 (0) 472 79 28 28

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