Joint Replacements ABG II Cementless Surgical Technique · ABG®II Pre-operative planning 3...

Joint Replacements

ABG®II CementlessSurgical Technique

EfficacyInnovation

Introduction

1

This surgical technique has beenproduced to help surgeons perform atotal hip replacement with an ABG®IIimplant using a standard approach.

Great progress has been made in termsof implants and materials during thelast few decades and MIS techniquesaimed at soft tissue preservation arecurrently undergoing scientific scrutiny.The aim of these techniques is toreduce post operative pain, facilitatefunctional rehabilitation and acceleratethe functional restoration of patientsundergoing this type of procedure.

It should therefore, be consideredprudent when performing MIStechniques to refer to this surgicaltechnique which describes in moredetail the characteristics of a standardapproach using ABGII implants.

ABG®IIPre-operative planning

2

The choice of implant is madeaccording to 3 reference points (Fig. 2):

1 At the diaphyseal level, the stem ofthe implant drawn on the templatemust merge with the shaft of thefemoral diaphysis, the prothesisbeing centred to avoid either varusor valgus positioning.

2 Height is determined by the digitalpoint (D) indicated on the template.The shoulder of the implant must belevel with the lower part of thedigital fossa (d).

3 The inferior-external or trochanteric-diaphyseal point (E). The lower,external part of the prosthesis mustcome to lean against the infero-external part of the greatertrochanter (e) marked on theradiograph, ensuring a minimal3mm thickness of cancellous bone.

Implant sizing is determined duringtemplating (Fig. 3). The chosenimplant should fill the metaphysiswhilst preserving the femoral calcar(Fig. 4).

Precise pre-operative planning isperformed using templates.

Fig. 1 Measuring radiographof the femur with ruler.

Fig. 2 Radiographwith markers.

d

e

t

st

d

ce

t

st

Use of templates

Pre-operative planning is essential andshould be conducted using templateswhich are placed on a frontalradiograph of the femur and thenchecked against the enlargement valuenoted on the template.

Templates are available with a magnif-ication of 10% 15% and 20%.

The enlargement of the femur dependson the focal distance, which is constantand the object-plate distance which isvariable.

To calculate the level of magnification asmall centimetre ruler is placed in theplane of the greater trochanter. Thisruler can then be used to determine theenlargement of the femur shown on theradiograph (Fig. 1).

ABG®IIPre-operative planning

3

Requirements to be checked

Several requirements must be checked:

• Filling of the metaphysis shouldbe optimised. When presentedwith the option of choosing 2implants it is suggested that thesmaller one be used since thiswill allow for greaterpreservation of cancellous bone.This is dependent on intra-operative stability (particularlyrotatory) of the broach.

• Head centre (T) shown on thetemplate should be situated on aline perpendicular to the axis ofthe femur and the tip of thegreater trochanter (plus orminus heads can then be used toachieve leg length).

• There must not be any contactat the diasphyseal level betweenthe stem and the cortex of thefemur. The template can be usedto indicate the minimumdrilling diameter to beperformed pre-operatively.

Adjustment of femoral neckosteotomy

The cervical point (C) can be found onthe template and the line of the femoralneck osteotomy (cervical osteotomy)drawn by linking the digital point (D)to the cervical point (C). This makes anangle of approximatly 60° with the axisof the diaphysis.

The vertical osteotomy line is thendrawn parallel to the axis of thefemoral diaphysis and begins at thetrochanteric fossa moving towards thetip of the greater trochanter.

The pre-operative template shouldthen be taken as an indication of theimplant to be used. However, this maychange based upon stability of thebroaches and trial heads.

In addition, certain measurementswhich can be made on the template willbe useful pre-operatively:

1. For the femur:

• The osteotomy level: Havinglocated the most prominent partof the lesser trochanter (st)using the graduation of thetemplate, the exact distancebetween the osteotomy level andthe lesser trochanter (distanceC-st) or between the tip of thefemoral head and the osteotomycan be measured.

• Positioning of the implant: Inorder to avoid varus or valguspositioning it is often useful tomeasure the exact distancebetween the internal edge of theimplant and the internal edge ofthe calcar on the template. Thiscan then be transferred pre-operatively with the enlargedruler of the template.

2. For the acetabulum:

• Templates are available todetermine the correct size andpositioning of the acetabularcup as well as the centre ofrotation of the hip.

• As there is no spatial referencefor a patient in the lateraldecubitus position it isnecessary to mark correctly thedistance and position of theupper edge of the cup on thetemplate and the upper edge ofthe acetabular roof to ensurecorrect orientation of the cup.

Templating is also useful to determineboth offset and anticipated leg length.

Fig. 3 Cementless ABGIIStem template.

Fig. 4 ABGII Templatesuperimposed on the radiograph.

D

E

T

C

D d

E

e

Tt

C

c

st

ABG®IIApproaches

44

All approaches may be used for theimplantation of the ABG® prosthesis.

Patient positioning

The patient is positioned in the lateraldecubitus position and the pelvis isthen fixed in strict profile using a pubicand buttock support. It is important toensure that the hip being operatedupon is free to move in flexion,adduction and rotation whilst alsoensuring the brachial plexus isprotected.

Postero-lateralapproach

Skin incision

The incision is centred on the tip of thegreater trochanter, longitudinal for6cm (at the level of the femoraldiaphysis) and slightly oblique aboveand behind in the direction of theposterosuperior iliac spine, also for6cm.

Approach to the joint

After incision of the fascia lata, dissectthe gluteus maximus muscle in the axisof its fibres before placing anorthostatic retractor.

The pelvi-trochanteric muscles aresevered level with the posterior face ofthe neck of the femur as is theaponeurotic expansion of the gluteusmaximus. Conversely it is extremelyimportant to keep the posterior fasciaof the gluteus medius which is retainedby a retractor. The articular capsule isthen incised.

Dislocation of the hip

By using flexion, adduction andinternal rotation, the head and neck ofthe femur are then exposed and alipped retractor is placed under theneck of the femur.

Antero-lateralapproach

Skin incision

The incision is made vertically, about15cm long and centred on the tip of thetrochanter.

Approach to the joint

The gluteus medius and the gluteusminimus are severed 1cm from theirdistal insertion point on the greatertrochanter. The gluteus medius is thenseparated at the top by 2 to 3cm and thearticular capsule incised.

Dislocation of the hip

The hip is dislocated forwards byflexion, external rotation andadduction to expose the femoral headand neck.

ABG®IIFemoral neck osteotomy

5

Postero-lateralapproachThe trochanteric fossa is identified andan oblique line of 60° in relation to theaxis of the femoral diaphysis can thenbe traced on the neck (Figs. 5 & 6).

The osteotomy can then be performedin two cutting planes using a Strykeroscillating saw:

• The first plane corresponds to theoblique line from the posteriorface of the neck without it beingnecessary to provide anyanteversion to the cut.

• The second plane is then madevertically and parallel to theinternal face of the greatertrochanter, running from thetrochanteric fossa upwards.

Removal of the femoral head

The femoral head is grasped with claw forceps (and the use of a gouge chisel) at thelevel of the trochanteric fossa to complete the osteotomy.

The femoral head and neck can then be removed by freeing the capsule below andin front of the neck. It can be kept in a dish of normal saline solution in the eventthat any bone grafting be required during the procedure.

Antero-laternalapproachAs the trochanteric fossa is not visible,the only reliable marker is the lessertrochanter. Transfer the “C-st’’ distance(between the middle of the lessertrochanter and the level of the neckosteotomy) from the pre-operativeoverlay onto the femur.

The neck osteotomy is then performedwith a Stryker oscillating saw followingan angle of 60° in relation to the axis ofthe femoral diaphysis. It is extendedoutwards to the cervico-trochantericjunction, taking care that the saw doesnot penetrate the greater trochanter.The vertical osteotomy can now beperformed.

60°

30°

Fig. 5 Femoral Neck Osteotomy. Fig. 6 Orientation of theosteotomy lines.

ABG®IIInsertion of the ABGII trial cup

6

Exposure of the acetabulum

Insertion of the cup requires excellentexposure of the bony acetabulum. Afterpracticing an "economic" capsulotomy,the anterior and posterior horns areablated (Figs. 7 & 8).

The labrum is excised as well as thetransverse ligament of the acetabulum.

Any possible osteophytes of the rearfundus are removed. Preliminaryhollowing with a gouge chisel makes itpossible to find the rear fundus and theupper edge of the obturator foramen inorder to open up the areas of bonesclerosis.

The smallest reamer is used vertically toperfect this first hollowing (Fig. 9).

Fig. 7

Fig. 8 Fig. 9 Fig. 10 Fig. 11

45°

Preparation of the acetabulum and hemispherical reaming until the exact size of the final implant is reached.

ABG®IIInsertion of the trial cup

7

Insertion of the ABG®II trial cup

The trial cup with a diameter identicalto that of the last reamer (line to line) isintroduced into the acetabulum byimpaction following the sameanteversion and inclination as that ofthe reamer (Fig. 12).

This trial cup should be stable withinthe acetabulum and the holes make itpossible to check if good contact withthe bone has been obtained. If both ofthese points are satisfactory anacetabular shell of corresponding sizeshould be chosen.

If the trial cup is unstable it is necessaryto ensure that no soft or capsular tissueis overlapping the edge of theacetabulum making impaction of thetrial cup difficult.

Instability may sometimes be due toinsufficient reaming. To address thisissue use a reamer 2 to 4mm smallerthan the size of the trial cup andrecheck stability.

Once stability has been achieved thetrial cup can then be removed.

If required, any subchondral lesionscan be opened, curetted and filled withcancellous bone taken from theremains of the femoral head.

Fig. 12 Insertion of the trial cup in order to check stability, anddetermine correct sizing of the acetabular component.

Reaming

Reaming of the acetabulum isperformed seeking a subchondralimplantation of the cup which is by farthe most preferable for good biologicalfixation.

The bony acetabulum is prepared usingreamers the sizing of which increases in2mm increments. It is suggested that aninclination of between 40-45 degreesand an anteversion of 15 degreesapproximately should be achieved.Reaming should continue until goodbleeding subchondral bone has beenobtained and the trial cup is stable andsufficiently covered by acetabular bone.During the use of the last reamer it isrecommended that excessive rotationalmovements are not made, so as not toproduce an oversized or oval shapedcavity (Figs. 10 & 11).

ABG®IIInsertion of the ABGII no-hole cup

8

The ABG®II cup is available in 2options: holed and no-holed.

The ABGII ceramic-ceramic (alumina)cup comes in 3 versions. These are: No-hole / solid back cup, 3 hole cup – for46mm, 48mm and 50mm cups and5 hole cup – for 52mm and above.

The ABG®II no-hole / Solid backcup

For primary surgery.

Fixing the spikes

After opening the internal packaging,the cup is fixed to the cup-holderscrewdriver.

Using a "spikedriver", screw 2 x 8mmspikes into holes adjacent to the row ofholes closest to the pole. It is importantthat the spikes be screwed in as firmlyas possible (Fig. 13).

It is possible to use only one spike if thebone quality allows.

Insertion of the cup

The cup is then fixed on the acetabularimpactor and the cup-holderscrewdriver removed.

The cup is impacted into theacetabulum following an inclination of45° and an anteversion of approximatly15°. This is obtained by introducing thecup in such a way that the spikespenetrate the upper part of theacetabulum at 11 and 1 o’clock(Fig. 14).

The cup is then impacted until itpenetrates the bony acetabulumcorrectly (the lower edge of the shellshould be flush with the upper edge ofthe obturator foramen). The stability ofthe cup is then checked.

If there is not sufficent stability, the cupis removed to ensure that there is noimpingement of the capsule or the softtissue. In some cases stability can beimproved by the addition of a third8mm spike inplaced in a triangularformation and screwed into the mostequatorial line. The shell can then bereimplanted and its stability checked.

The acetabular impactor is removedand a trial insert is put in place.

Fig. 14 Insertion of theno-hole cup.

Fig. 13 Fixing the spikes.No-hole cup.

9

ABG®IIInsertion of the ABGII holed cup

Fig. 17 Fixing the cup onthe impactor.

Fig. 15 The 5-hole cup fixed withthe cup-holder screwdriver.

The ABG®II holed cup

This cup is rarely used in primarysurgery and is used mainly in revisionsurgery.

Fixing the spikes

After opening the internal packaging,the cup is fixed to the cup-holderscrewdriver (Fig. 15). Use of two spikes(7mm or 9mm) is recommended.Using a hexagonal screwdriver, thespikes should be screwed to the interiorof the cup, in 2 holes adjacent to therow of holes closest to the pole. It isimportant that the spikes be screwed inas firmly as possible.

Threaded obturators

One or several obturators may bescrewed into the unused holes. Theyhave been designed to reduce the risk ofparticle migration into surroundingbone.

The obturators must be introducedusing the hexagonal socket screwdriverand screwed down fully.

The cup is then fixed on the acetabularimpactor and the cup-holderscrewdriver withdrawn (Fig. 17).

Insertion of the cup

The cup is impacted into theacetabulum following an inclination of45° and an anteversion of approximatly15°. This is obtained by introducing thecup in such a way that the spikespenetrate the upper part of theacetabulum at 11 and 1 o’clock(Fig. 14).

The cup is then impacted until itpenetrates the bony acetabulumcorrectly (the lower edge of the shellshould be flush with the upper edge ofthe obturator foramen). The stability ofthe cup is then checked, the acetabularimpactor removed and a trial linerintroduced.

If there is not sufficent stability, the cupis removed to ensure that there is noimpingement of the capsule or the softtissue.

Insertion of the cancellous bonescrews

In some cases of instability, or duringrevision surgery, the spikes may bereplaced by 6mm cancellous bonescrews. The drill guide and its end willbe screwed into the implantation holeusing a socket screwdriver. A mesh ofthe required length is put in the drillguide in order to drill the cancellousbone. The drill guide is then removed.The gauge makes it possible to measurethe length of the screw, which will beinserted with the socket screwdriver. Itis important to makes sure that thescrew, interlocked with the prostheticacetabulum by means of its doublescrew thread, is driven in sufficientlyand that it does not overlap its housingin order to avoid a conflict with thepermanent insert. One or severalscrews may be used.

The permanent insert is then put inplace.

Fig. 16 Fixing the spikes.

10

ABG®IIInsertion of the ABGII ceramic-ceramic cup

Key points of the surgicaltechnique

✔ Do not combine components from

different manufacturers.

• Do not use ceramic femoralheads from other manufacturerswith Stryker ceramic inserts.

• Do not use metallic femoralheads with Stryker ceramicinserts.

• Do not use zirconia femoralheads with Stryker ceramicinserts.

• Make sure that the Strykerceramic femoral heads are usedwith approved femoral stems.The instructions contained inthe implant packaging must bereferred to for informationabout the approval of theproduct.

✔ Particular points about the use of

ceramics

• The implants are sterile whendelivered and must never beresterilised.

• All precautions must be taken toavoid any damage includingcontact with metal or any otherabrasive material.

• Never use equipment whichshows signs of damage.

• Never reuse a ceramic insert.

✔ Main points of the actual surgical

technique

• Pre-operative planning isnecessary to determine the rightsize of implant and correctpositioning of the acetabularcup and the centre of rotationof the hip.

• Correct assembly of the insertand the ceramic head regardingtheir respective spigots isfundamental in preserving theintegrity of the prosthetic joint.

• Incorrect positioning of theinsert or the head may cause adifference in the length of theneck, separation of theimplants, or even a fracture ofthe head.

• All surfaces must be clean, dryand free from debris beforeassembly.

• Any ceramic implant can onlybe assembled with its surfacematted once. The matting mustbe light. The stability of theimplant is controlled with thefinger. The inclination andanteversion of the cup must bechosen to avoid any conflict.

• Some publications indicate thatpositioning the cup close to 45°would make it possible to obtainoptimal results.1,2

• A special instrument has beencreated to extract the insert ifnecessary.

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ABG®IIPreparation of the femur

Metaphyseal housing

The leg is dislocated again.

Using a gouge chisel, all the residue ofthe femoral neck is resected and themetaphyseal housing of the implant isprepared.

Fig. 18 Opening of the canal with the hollow chisel.

Fig. 19 A broach (size 1 or 2) is inserted to locate the medullary canal.

CorrespondenceBy using the hollow chisel adapted tothe size of the implant and fixed to thebroach handle, a cylinder of cancellousbone is removed from the metaphysistaking care to preserve the calcarfemorale to the maximum (Fig. 18).

Depending on the side being operated,the smallest broach, left or right, is thenintroduced to find the medullary canal(Fig. 19).

If the pre-operative planninganticipates a possible conflict betweenthe prosthetic stem and the diaphysealcortex, it is advisable to ream furtherwith a diameter corresponding to thechosen implant and shown on thetemplate.

The drilling guide and then the flexiblereamers are introduced starting withthe size corresponding to the diameterof the femoral medullary canalmeasured during the pre-operativeplanning.

Use of broaches/trial prostheses

Broaching

After checking that they correspond tothe side being operated, the broachesare fixed to the broach handle. They areintroduced beginning with the smallestsize up to the size chosen during pre-opplanning and favouring externalpenetration in order to avoid a varusposition.

The broach/trial prosthesis willdetermine the size of the permanentimplant if two conditions are fulfilled:

• The broach must be pusheddown to the correct level: theshoulder of the broach must beat the level of the trochantericfossa.

• The broach must be perfectlystable in the transverse direction(varus-valgus) and particularlyin rotation.

• It is often useful to check thecorrect positioning of thebroach by measuring thedistance between the internaledge of the broach and theexternal cortex of the calcarfemorale.

Chisels 8 mm 12 mm 16 mm

Stems 1, 2, 3 4, 5, 6 7, 8

12

If, despite correct reaming, abroach/trial prosthesis smaller than thesize anticipated in planning is perfectlystable in rotation (perhaps due to ananteroposterior narrowing of theneck), the use of a larger size must notbe attempted because of the risk of ametaphyseal fissure or fracture.

Conversely, if the broach/trialprosthesis is unstable, the followingsolutions may be considered:

• Use of a larger broach oncondition that the reamer is putin previously following the datagiven on the template.

• Stabilise the planned implantwith a cortico-cancellous bonegraft taken from the remains ofthe resected part (Please notehowever that stability of theimplant should rarely beentrusted to bone graft).

• Seal an ABG®II femoral stem inVitallium® (not compatible withalumina heads) with cement. (Ifavailable in your area).

Reduction trial

With the broach left in place, a trialhead of a length corresponding to theplanned length is placed onto thespigot (Fig. 20).

The hip is reduced and the followingcan be checked (Fig. 21):

• Leg length – this can be adjustedusing plus or minus trial headsand of the diametercorresponding to that of theinsert.

• Stability of the hip.

• Absence of impingement.

ABG®IIUse of broaches/ trial prostheses

Fig. 20 Fig. 21

13

ABG®IIPlacement of the insert

Placement of the permanentpolyethylene insert

The hip is again dislocated and the trialhead and then the broach/trialprosthesis are removed along with thetrial insert.

The interior of the cup is cleaned and itshould be made sure that there are nooverlapping posterior and antero-superior osteophytes present. Thepermanent insert, standard or hooded,is placed into position and impactedusing the insert impactor.

Placement of a ceramic insert

The hip is dislocated again, the broachremoved, the trial insert is taken out ofthe cup and the ceramic insert put inplace. It is essential that the internalsurface of the ABG®II cup is clean, dryand free from any debris as this mayimpede the correct locking of the insertin the cup.

The insert-holder vacuum extractor ismounted on the ABGII impactor/orientator (Fig. 24).

Fig. 23 Placement of theceramic insert.

Fig. 24 Use of the insert-holder vacuum extractor.

Fig. 22 Placement of thepolyethylene insert.

14

ABG®IICeramic-Ceramic

The ceramic insert is taken out of itspackaging using the impactor/insert-holder vacuum extractor unit (Fig. 25).It is then placed correctly in thepreviously cleaned ABG®II cup(Fig. 26).

Check that the insert is correctlypositioned and is perfectly symmetricalwith the interior of the cup.

Fig. 25

Fig. 27

If the insert is correctly positioned, itshould only require one finger to fix itin place (Fig. 27). However, if the insertis slightly inclined in the cup it must betaken out to check for a possibleinterposition of tissues causing thisdeviation. Perfect congruence betweenthe insert and the implant must beobtained.

Fig. 26

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ABG®IICeramic-Ceramic

Impaction of the ceramic insert

The impaction flange is mounted onthe ABG®II impactor/orientator, andthe insert is impacted into the ABGIIcup by applying a light tap with themallet in the axis of the cup (Fig. 28).

Amplitude of movement andconflict with the prosthetic neck

At the time of the femoral implantreduction trial, it is essential to test themobility of the hip throughout theamplitude of movement, to ensure thatthe prosthetic neck does not come intocontact with the edge of the cup. Ifthere is contact, a "click" can be clearlyheard and felt.

Fig. 28 Impaction of the insert.

Fig. 29 Extraction of the insert.

Extraction of the ceramic insert

In certain cases of revision, or if there is conflict with the stem, it may be necessaryto remove the ceramic insert from the ABGII cup. The extraction flange(4930-9-12X) is screwed onto the ABGII impactor/orientator and placed againstthe titanium edge of the ABGII cup. A tap of the mallet applied to the metallic cup,well into the axis, will make it possible to free the ceramic insert, which can then begrasped with the insert-holder vacuum extractor (Fig. 29). Under the pressure ofthe insert-holder vacuum extractor, the insert may get stuck in the cup again; agentle rotation of the impactor/orientator will then make it possible to release theinsert.

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ABG®IIImplantation of the femoral unit

Fig. 30 Insertion of the permanent implant.

Implantation of the femoral unit

Insertion of the Cementless ABG®IIstem must be performed whilst takingcare to avoid touching thehydroyxyapatite with gloves. The distalpart of the stem is introduced manuallyuntil the stem starts to become wedged(generally at the last centimetre). Thenit is necessary to hammer gently andrepeatedly until the stem stops. Beforeimpaction it is often useful to place partof the cylinder of cancellous boneremoved with the hollow chiselbetween the calcar femorale andinternal edge of the prosthesis in orderto avoid a varus position.

Using the femoral impactor, theprosthesis is introduced into the femur,tapping it carefully until the shoulderof the prosthesis is flush with thetrochanteric fossa (Fig. 30).

Using the trial heads and following trialreduction, leg length can again bechecked (Figs. 31 & 32).

Insertion of the permanent head

It is essential to wash and then dry theMorse taper before the insertion of thepermanent head.

Whether it is in cobalt chrome or inalumina, the head should never bestruck but rather pushed onto thetapered cone.

V40™ Heads

The ABGII HA implant (withhydroxyapatite coating) is onlycompatible with the range of Stryker®V40™ femoral heads. These heads havea taper of 5°40’ with an entry diameterof 11.3mm and are available inVitallium® (alloy of cobalt-chrome)and in alumina.

The +8mm heads must only be usedwith stems sizes 2 to 8. They are notsuitable with size 1 stems.

Table of heads

Heads in Vitallium® (CoCr) V40™Diameter 22.2mm 28mm 32mmShort necks - -4 -4Standard necks 0 0 0Long necks +3 +4 +6 +8 +4 +8

Heads in Ceramic (Alumina) V40™Diameter 28mm 32mm 36mm*Short necks -2.7 -4 -5Standard necks 0 0 0Long necks +4 +4 +5(*For Trident acetabulum)

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ABG®IIReduction & post-operative period

Reduction

After copious washing of the jointcavity with normal saline solution(avoiding solutions with acid pH), thehip is reduced.

The capsulo-ligamentary plane isclosed carefully in order to reduce therisk of post-operative dislocation. Careshould be taken to avoid shortening ofposterior capsular plane, which couldcreate a risk of anterior stability.

Post-operative period

24 to 48 hours after the operation, thepatient can begin walking withcomplete support on elbow crutchesfor the first month post-operatively.

Fig. 33 Radiograph of an ABGII HA stem with ABGII cup(3 months post-operatively).

Fig. 31

Fig. 32

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Pre-operative templatesABGTP04E01ABGII Ceramic Cup100% Magnification

ABGTP08E02ABGII Ceramic Cup110% Magnification



Acetabular instrumentation for ABG®II cup

ABG®II Ceramic-Ceramicinstrumentation

4930-9-100*28mm Alumina insert-holder vacuum extractor

4930-9-110*Impaction flanges for 28mmalumina inserts

EXTRACTION FLANGES FOR ALUMINAINSERT*

ITEM SIZE (MM)4930-9-121 FOR ED 46, 48, 504930-9-122 FOR ED 52, 544930-9-123 FOR ED 56, 584930-9-124 FOR ED 60, 624930-9-125 FOR ED 64, 66

* The insert-holder vacuum extractor, theimpaction flange and the extractionflange are provided for use with theABGII impactor/orientator

4930-9-200Box for ABGII ceramic-ceramicinstrumentation

The instruments in the box highlighted inorange are specific to ceramic implants.

ABGTP02E02ABGII Standard PE Cup100% Magnification




ABGTP03E02ABGII Hooded PE Cup100% Magnification




To be used with ABG®II cups

OUTER OUTERITEM DIA ITEM DIA

48390038 38mm 48390058 58mm48390040 40mm 48390060 60mm48390042 42mm 48390062 62mm48390044 44mm 48390064 64mm48390046 46mm 48390066 66mm48390048 48mm 48390068 68mm48390050 50mm 48390070 70mm48390052 52mm 48390072 72mm48390054 54mm 48390074 74mm48390056 56mm 48390076 76mm

ABG Acetabular reamers

Pre-operative templates

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Acetabular Instrumentation for ABG®II Cup

79121520253035404550

50 40 30 20 10

VIS

Ø 6

PO

INT

ES

48498353ABGII Hexagonal Socket Screwdriver

1826350Standard Hexagonal Screwdriver

48496010"Spikedriver" for 8mm Spikes

48492013Standard Screw-holding Forceps

48492014Curved Screw-holding Forceps

48493000Double Drill Guide

48493015Flexible Drill Diameter 3.2mm,Active Length 15mm

48493030Flexible Drill Diameter 3.2mm,Active Length 30mm

48492012Screw Depth Gauge

48496050 ABGII Spike, Screw and ObturatorSterilisation Case

ABG®II Acetabular instruments storage

48496200ABGII Acetabular InstrumentationBox (empty)

48496100Tray for Reamers, Trial Cups, Spikes(empty)Tray for Reamer Handles/Cup-holder Screwdriver/CupImpactor/Screwdriver (empty)

To be used with ABG®II inserts

ABGII Impactor Flanges

48494222

For Standard Inserts ID 22.2mm

48494228

For Standard Inserts ID 28mm

48494232

For Standard Inserts ID 32mm

48494322

For Hooded Inserts ID 22.2mm

48494328

For Hooded Inserts ID 28mm

48494332

For Hooded Inserts ID 32mm

48390100NBG Reamer Handle with HudsonConnection

48390110NBG Reamer Handle with AOConnection

02881010Hudson female / Jacobs maleAdaptor

48496060ABGII Cup Impactor/Orientator

48496080ABGII Orientator Ring

48491000Cup Extractor

48496070Cup Holder Screwdriver

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Femoral Instrumentation for ABG®II Stems

7300001Hexagonal Screwdriver for ABGIIBroach Holder (Anterior)

48421000Femoral Impactor

48422000Reduction Guide

48498001Plastic Modular Femoral Extractorfor V40™ Spigot

48498002Metal Modular Femoral Extractorfor V40™ Spigot

48496300ABGII Femoral Instrumentation Box(empty)

"Classic" BroachesLeft Size Length (mm) Right4845-0-921 1 103 4845-0-9114845-0-922 2 103 4845-0-9124845-0-923 3 113 4845-0-9134845-0-924 4 118 4845-0-9144845-0-925 5 123 4845-0-9154845-0-926 6 128 4845-0-9164845-0-927 7 138 4845-0-9174845-0-928 8 148 4845-0-918

Modified "anti-varus" BroachesLeft Size Length (mm) Right4845-2-921 1 121 4845-2-9114845-2-922 2 121 4845-2-9124845-2-923 3 131 4845-2-9134845-2-924 4 141 4845-2-9144845-2-925 5 146 4845-2-9154845-2-926 6 151 4845-2-9164845-2-927 7 166 4845-2-9174845-2-928 8 176 4845-2-918

ABG®II Femoral Instrumentation Storage Box

49011540Anterior Approach ABGII BroachHolder Handle (V40™ Spigot)

49011600New Posterior Approach ABGIIBroach (V40™ Spigot)

ABGTP01E02ABGII Stem 100% Magnification




Modular Hollow Chisels forBroach-holder HandleITEM SIZE

48498008 8mm

48498012 12mm

48498016 16mm

ABG Flexible Reamers Length 400mm

ITEM DIAMETER

02224006 8mm

02224008 9mm

02224010 10mm

02224012 11mm

02224014 12mm

02224016 13mm

02224018 14mm

02224020 15mm

02224022 16mm

02224024 17mm

02224026 18mm

49001530Flexible Reamer Guide ø3.2mm,L 520mm

0252-0-010Trinkle female/Jacobs male Adaptor

44000420Trinkle female/AO male Adaptor

48424002Diameter Gauge for ABGII Broachesand Flexible Reamers

Pre-operative Templates

The information presented in this brochure is intended to demonstrate the breadthof Stryker product offerings. Always refer to the package insert, product labeland/or user instructions before using any Stryker product. Products may not beavailable in all markets. Product availability is subject to the regulatory or medicalpractices that govern individual markets. Please contact your Stryker representativeif you have questions about the availability of Stryker products in your area.

Products referenced with ™ designation are trademarks of Stryker.Products referenced with ® designation are registered trademarks of Stryker.

Literature Number: ABGOT01E02BEN14898/REF 1 09/05

Copyright © 2005 StrykerPrinted in the UK

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Stryker Europe, Middle East & AfricaStryker SACité-CentreGrand-Rue 921820 MontreuxSwitzerlandTel: +41 21 966 12 01Fax : +41 21 966 12 00E-Mail : [email protected] : http://www.europe.stryker.com

http://www.abg2hip.com

1. On the Material and Tribology of Alumina-Alumina Coupling for Hip Joint Prostheses -

A. Walter - Clinical Orthopaedics and Related Research 282 p31-46, 1992.

2. Role of Ceramic Implants Design & Clinical Success with Total Hip Prosthetic Ceramic-to-Ceramic Bearings - I.C. Clarke - Clinical Orthopaedics and Related Research 282 p. 19-30,September 1992.

References

Joint Replacements ABG II Cementless Surgical Technique · ABG®II Pre-operative planning 3...

Documents

Transcript of Joint Replacements ABG II Cementless Surgical Technique · ABG®II Pre-operative planning 3...