Revision Acetabular System Acetabular Augments · the authors’ suggested treatment for the...

Surgical Technique

Revision Acetabular SystemAcetabular Augments

The following technique is for informational and educational purposes only. It is not intended to serve as medical advice. It is the responsibility of the treating physician to determine and utilize the appropriate products and techniques according to their own clinical judgment for each of their patients. For more information on any product referenced herein, including indications for use, contraindications, effects, precautions and warnings, please consult the product’s Instructions for Use (IFU) prior to use.

Nota Bene: The technique description herein is made available to the healthcare professional to illustrate the authors’ suggested treatment for the uncomplicated procedure. In the final analysis, the preferred treatment is that which addresses the needs of the patient.

Smith & Nephew thanks the following surgeons for their participation as part of the REDAPT™ Revision Acetabular System design team:

Dr. Robert BourneLondon Health SciencesUniversity of Western OntarioLondon, Ontario

Dr. Richard McCaldenLondon Health SciencesUniversity of Western OntarioLondon, Ontario

Dr. Andrew ShinarVanderbilt OrthopaedicsNashville, TN

Dr. Scott MarwinNYU-Hospital Joint DiseasesNew York, NY

Dr. Steven WeedenThe Texas Hip & Knee CenterFort Worth, TX

Dr. Mathias BostromHospital for Special SurgeryNew York, NY

Dr. John Masonis OrthoCarolinaCharlotte, NC

Dr. James Waddell University of Toronto, St. Michael’s HospitalToronto, Ontario

Dr. Craig Della ValleMidwest Orthopaedics at RUSHChicago, IL

Mr. Stephen JonesUniversity Hospital of Wales and University Hospital LlandoughCardiff, UK

Dr. David Campbell Wakefield Orthopaedic ClinicAdelaide, South Australia

Prof. Christian GötzeAuguste-Viktoria-KlinikBad Oeynhausen, Germany

Design surgeon list

Indications

Contraindications

1. Conditions that would eliminate or tend to eliminate adequate implant support or prevent the use of an appropriately-sized implant, eg:

a. Blood supply limitations

b. Insufficient quantity or quality of bone support, eg, osteoporosis or metabolic disorders which may impair bone formation and osteomalacia

c. Infections or other conditions which lead to increased bone resorption

2. Mental or neurological conditions which tend to impair the patient’s ability or willingness to restrict activities

3. Physical conditions or activities which tend to place extreme loads on implants, eg, Charcot joints, muscle deficiencies, multiple joint disabilities, etc.

4. Skeletal immaturity

5. In revision surgery, inadequate proximal implant support is contraindicated. There is an increased risk of implant failure in revision cases where proximal support is not achieved, poor bone quality exists, and smaller sized implants are utilized. The lower the implant fixation point in the femur (distance from the head center) the greater the risk of implant fracture and/or re-revision.

6. Morbid obesity.

Contraindications may be relative or absolute and must be carefully weighed against the patient’s entire evaluation and the prognosis for possible alternative procedures such as non-operative treatment, arthrodesis, femoral osteotomy, pelvic osteotomy, resection arthroplasty, hemiarthroplasty and others.

The REDAPT™ Porous Augments are indicated for:

• Hip components are indicated for individuals undergoing primary and revision surgery where other treatments or devices have failed in rehabilitating hips damaged as a result of trauma or non-inflammatory degenerative joint disease (NIDJD) or any of its composite diagnoses of osteoarthritis, avascular necrosis, traumatic arthritis, slipped capital epiphysis, fused hip, fracture of the pelvis, and diastrophic variant.

• Hip components are also indicated for inflammatory degenerative joint disease including rheumatoid arthritis, arthritis secondary to a variety of diseases and anomalies, and congenital dysplasia; treatments of nonunion, femoral neck fracture and trochanteric fractures of the proximal femur with head involvement that are unmanageable using other techniques; endoprosthesis, femoral osteotomy, or Girdlestone resection; fracture-dislocation of the hip; and correction of deformity.

REDAPT™ Augments are intended for single use only and are to be implanted with bone cement to themating acetabular shell and without bone cement to the bone interface.

Augments are intended to be used in primary and revision surgeries where the acetabulum has thedeficiencies of the acetabular roof, anterior or posterior pillar, medial wall deficiency, and/or protrusion as a result of the indications listed previously.

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Preoperative planning

The procedure should first begin with preoperative templating. Care should be taken to determine the degree of bone loss, any damaged/loose components and any difficult anatomical concerns. Factors such as leg length, and estimation of the hip center, etc. should be considered prior to surgery.

Acetabular exposure component removal

The surgeon should use the surgical approach with which he/she is comfortable.

Adequate exposure should be performed to accommodate the removal of existing components and insertion of the REDAPT™ Fully Porous Cup and Acetabular Augments.

This surgical technique will focus on the acetabulum. Removing a well-fixed cup can be facilitated with the RENOVATION™ Implant Removal System (7138-0701).

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Short Surgical Technique

1. Preoperative planning 2. Remove existing components

4. Ream defect

7. Pre-drill for screws 8. Screw insertion 9. Cement augment to shell, “unitizing the construct”

5. Acetabular trialing – insert Steinman Pin

6. Augment insertion

3. Initial acetabular trialing

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Prior to acetabular reaming, initial trialing should be performed to determine provisional cup and augment fit. The supplied trials can be inserted to verify size and position of the augment and cup. The surgeon should use the supplied augment holding forceps to hold the augment trial and assess appropriate orientation and size.

Acetabular trialing

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Acetabular reaming

If it is determined that the acetabular cup will need additional support, the acetabulum should be prepared to receive the REDAPT™ Acetabular Augments. The provided reamers should be used to carefully prepare the acetabular defect. Care should be taken to remove as little host bone as possible.

Note: Reaming should begin with a reamer smaller than the diameter of the cup that was removed. Then the surgeon should sequentially move up in reamer size until the acetabulum is sufficiently prepared to receive the desired REDAPT Acetabular Augment. The outer diameter of the REDAPT Acetabular Augments is 4mm less than the inner diameter.

See chart below for reaming guidance.

Surgical tips:

• Anticipate minimal reaming for revision procedures.

• Adhere to the preoperative plan and take care not to chase defects or ream beyond the width of the anterior or posterior columns.

• If fixation of the augment to the bone will require utilization of the internal holes on the REDAPT Augments (Slice Augment only), the “Augment First” technique should be used to ensure the internal holes are not blocked by the cup

Augment Reamer

50 46

56 52

62 58

68 64

74 70

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Secondary trialing

Assess the prepared defect with trial shells and trial augments. Once the desired cup and augment orientation and sizing is achieved, a Steinmann pin (up to 2mm) can be inserted into the small hole on the superior face of the augment trial. The trial can be slid over the Steinmann Pin leaving the Steinmann Pin in place to mark the desired position and orientation.

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Acetabular augment insertion

After acetabular component trialing is complete, select the corresponding size augment and affix to the augment holding forceps (7135-5366). Once the desired positioning of the augment is achieved, the augment can be further seated by using the R3 Hole Cover Impactor (73-2117) and a mallet to lightly impact the augment at the dimple (see image) just below the Steinman Pin hole. Note: 8mm thick augments may not have a driver dimple feature.

Steinmann Pin hole

Driver Dimple

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Instrument tips:

• The tip of the REDAPT drill guide must be fully seated in the screw hole.

Acetabular screw insertion

Screws should be used to secure the augment. For screw fixation, each screw hole must be pre-drilled. When drilling to prepare for screw holes, the REDAPT™ Drill Guide (7135-5121) must be used. If the tip is not fully seated, damage to the locking tabs may occur, the limits of angulation may be exceeded and the locking strength of the screws may be affected. After drilling the hole, use the depth gauge to verify appropriate screw length(s). The REDAPT Acetabular Augments provide multiple opportunities for screw fixation to host bone. Care should be taken to orient the augment so that the hole pattern aligns with desired points of fixation. Each hole can accept either a spherical head screw or a variable angle locking screw. Drilling through the porous structure to create additional fixation points or altering the shape of REDAPT Acetabular Augments should not be attempted as implant integrity may be compromised. Altering the shape of the implants should not be attempted.

Spherical head screwsSpherical head screws can be used with REDAPT Cup Systems. Use the screw forceps to hold the screw. Attach the ball-joint or flexible screwdriver shaft to the end of the screw. Then introduce the screw into the hole and screw it into place using the ratcheting screwdriver handle. Make sure the screw is fully seated within the screw hole so that it will not impinge on the REDAPT Fully Porous Cup.

12º

Surgical tips:

• The REDAPT Drill Guide has two different tip angles. When using this guide, use whichever end of the drill guide provides optimal access to ensure it is fully seated in the selected screw hole.

• Many surgeons choose to place a non-locking screw first, then proceed to locking screws. At least one non-locking screw should be placed prior to placing locking screws.

• Screws have been shown to be a reliable method of ensuring fixation; however, it is important to avoid neurovascular complications by proper screw placement, avoiding the anterior/superior or anterior/inferior quadrants.

• Inspect each screw to ensure that screw heads are flush or below the inner diameter of the REDAPT Fully Porous Cup.

• The use of radiographic imaging may facilitate precise screw placement.

• Provisional but not final tightening of augment screws may be preferred in augments to ease the insertion of the acetabular cup. Final tightening of the screws should be performed prior to unitizing the construct.

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Locking screwsThe Torque Limiting Driver (7135-4299) should always be used to ensure a secure fit and prevent over-tightening. Over-tightening may result in damage to the locking screw tabs on the cup or augment.

Acetabular cup insertion

When satisfactory placement of the augment is achieved, the surgeon should begin preparation to implant the acetabular cup component. Care should be taken to ensure intimate contact between the augment and cup components. Implant the cup using the surgical technique described for the chosen acetabular cup component.

Note: If augment screws were provisionally tightened, final tightening of the augment screws will be required after the acetabular cup is fully seated.

Acetabular component assembly

The augment and cup must be fixed together using bone cement.

Mix bone cement according to suggested manufacturer’s instructions allowing appropriate cure time.

The Tapered Cement Nozzle (7127-0081) supplied with Smith & Nephew RALLY™ cement kit features a nozzle that easily interfaces with the cement ports on the face of the REDAPT Acetabular Augments to help with filling the interface between the cup and augment. A Toomey syringe can be filled with uncured cement and inserted into the cement ports. It is important to alternate between the cement ports to ensure an adequate fill of the cement channels. Inject cement slowly but steadily. Insure the nozzle remains fully seated within the cement port in the REDAPT Acetabular Augment. Remove any excess uncured cement. Augment/shell interface must be cemented prior to liner cementing to ensure proper cement flow through the tapered nozzle.

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The REDAPT™ Augments can also be placed after the REDAPT Cup is implanted. For this approach, follow the surgical technique for the type of cup being implanted. Once the cup is implanted, trial assessments of the defect can be performed to determine the size and orientation of REDAPT Augment that will be implanted.

Note: This technique will not permit the utilization of the internal screw holes on the REDAPT Slice Augment. The REDAPT Staple Augment may be a preferred option for this technique.

After acetabular component trialing is complete, select the corresponding size augment and affix to the augment holding forceps (7135-5366). Once the desired positioning of the augment is achieved, the augment can be further seated by using the R3™ Hole Cover Impactor (73-2117) and a mallet to lightly impact the augment at the dimple (see image) just below the K-wire hole.

Note: Smaller size augments may not have a driver dimple feature

The augment and cup must be fixed together using bone cement.

Mix bone cement according to suggested manufacturer’s instructions allowing appropriate cure time.

The nozzle supplied with Smith & Nephew RALLY™ cement kit features a nozzle that easily interfaces with the cement ports on the face of the REDAPT Acetabular Augments to help with filling the interface between the cup and augment. A Toomey syringe can be filled with uncured cement and inserted into the cement ports. It is important to alternate between the cement ports to ensure an adequate fill of the cement channels. Inject cement slowly but steadily. Insure the nozzle remains fully seated within the cement port in the REDAPT Acetabular Augment. Remove any excess uncured cement.

Alternate technique

Acetabular component assembly

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Augment Sizes

Staple Slice8mm 12mm 18mm 12mm 18mm 24mm

50mm

56mm

62mm

68mm

74mm

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Augment/Cup Compatability

REDAPT Staple Augment

REDAPT Slice Augment

Augment catalog item Compatible Porous Cups

7135-4411 REDAPT™ Slice Augment 50mm x 12mm

7135-4228 REDAPT Porous Cup 48mm7135-4229 REDAPT Porous Cup 50mm7135-4231 REDAPT Porous Cup 52mm

7135-4416 REDAPT Slice Augment 50mm x 18mm


7135-4436 REDAPT Staple Augment 50mm x 8mm
























7135-4415 REDAPT Slice Augment 74mm x 12mm7135-4242 REDAPT Porous Cup 72mm7135-4243 REDAPT Porous Cup 74mm7135-4244 REDAPT Porous Cup 76mm7135-4245 REDAPT Porous Cup 78mm7135-4246 REDAPT Porous Cup 80mm





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REDAPT™ Variable Angle Locking Screws

Cat. no. Length (mm)7135-4502 157135-4503 207135-4504 257135-4505 307135-4506 357135-4507 407135-4508 457135-4509 50

Spherical Head ScrewsCat. no. Length (mm)7133-2515 157133-2520 207133-2525 257133-2530 307133-2535 357133-2540 407133-2545 457133-2550 50

Catalog

REDAPT™ Augments

Item Description

7135-4641 REDAPT™ Slice Augment Trial 50 x 12mm

7135-4642 REDAPT Slice Augment Trial 56 x 12mm














Continued on next page

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Catalog continued

REDAPT™ Augments continued

Item Description

7135-4657 REDAPT Staple Augment Trial 50 x 8mm














7135-5366 REDAPT Augment Holding Forceps

7135-5368 REDAPT Straight Shaft Drill 15mm




7135-5374 REDAPT Revision Acetabular Slice Augment Trials Tray

7135-5375 REDAPT Revision Acetabular Staple Augments Trials Tray

7135-5115 REDAPT Revision Acetabular Gen Instrument Tray

7136-2915 REFLECTION Flexible Drill 15mm




7135-4299 REDAPT Torque Limiter

7135-5121 REDAPT Drill Guide

7135-5119 REDAPT Revision Acetabular Tray Lid

7136-2293 Straight Shaft Screwdriver

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R3™ Straight Shell Impactor/PositionerCat. no. 7136-4450

R3 Impactor Replacement TipCat. no. 7136-8570

R3 Depth GaugeCat. no. 7136-4451

X-BarCat. no. MT-2201

Screw ForcepsCat. no. 7136-2298

Ball Joint ScrewdriverCat. no. 7136-2295

REDAPT™ Drill GuideCat. no. 7135-5121

Reamer HandleCat. no. 7136-2279

Flexible Screw DrillsCat. no. Length (mm)7136-2915 157136-2925 257136-2935 357136-2950 50

Captured Flexible Screwdriver ShaftCat. no. 7136-2291

Captured U-Joint Screwdriver ShaftCat. no. 7136-2292

Torque LimiterCat. no. 7135-4299

Trial Shell HandleCat. no. 7136-2297

Flexible ScrewdriverCat. no. 7136-2290

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Ratchet HandleCat. no. 7136-2294

Small Slap HammerCat. no. 7136-7541

Straight Shaft ScrewdriverCat. no. 7136-2293

Power Adaptors (not shown)Cat. no. 7136-2781 7136-2782 7136-2783

Tapered Cement NozzleCat. no. 7127-0081

RALLY™ Medium Viscosity Bone CementCat. no. 7127-1580

R3™ Primary Reamer SetCat. no. 7136-0673

R3 Large Reamer SetCat. no. 7136-2230

R3 Jumbo Reamer SetCat. no. 7136-2160

R3 Primary Trial Shell SetCat. no. 7136-0674

R3 Jumbo Trial Shell SetCat. no. 7136-2170

R3 Acet Dome Screw SetCat. no. 7133-4100

Catalog continued

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Smith & Nephew, Inc.1450 Brooks RoadMemphis, TN 38116USA

Telephone: 1-901-396-2121Information: 1-800-821-5700Orders and Inquiries: 1-800-238-7538

www.smith-nephew.com

©2018 Smith & Nephew, Inc. 08153-us V2 71381770 REVA 09/18™ Trademark of Smith & Nephew.

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Revision Acetabular System Acetabular Augments · the authors’ suggested treatment for the...

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