Surgical Technique

1

SL-PLUS™ MIA

Nota Bene

The technique description herein is made available to the healthcare professional to illus-trate the authors’ suggested treatment for the uncomplicated procedure. In the final anal-ysis, the preferred treatment is that which addresses the needs of the patient.

Table of Contents

Indications/Contraindications ................................................................................ 2

Preoperative Planning ........................................................................................... 4

Surgical Technique ................................................................................................ 5

Postoperative Treatment ...................................................................................... 14

Explantation of the SL-PLUS MIA Stem ..................................................................15

Dimensions ..........................................................................................................16

Implants .............................................................................................................. 18

Instrumentation ................................................................................................... 20

Sterilization ......................................................................................................... 24

2

Indications/Contraindications

Indications

All femur types can be treated with the SL-PLUS™ MIA stem, with the exception of those with extreme curvature, e.g. after angulation osteotomies. In these cases, a prio corrective ostetomy could be considered.

• Advanced degeneration of the hip joint as a result of degenerative, post-traumatic or rheumatoid arthritis

• Fracture or avascular necrosis of the femoral head

• Conditions resulting from previous operations, such as osteosynthesis, joint reconstruction, arthrodesis, hemiarthroplasty or hip total prosthesis

Contraindications

• Acute or chronic infections, local or systemic

• Severe muscle, nerve, or vascular diseases that endanger the respective limb

• Lacking bone substance or inadequate bone quality that endangers a stable seating of the prosthesis

• All concomitant diseases that may endanger the function of the implant, such as: - Any allergies to implant materials - Renal insufficiency - Cardiac insufficiency (e.g. as a result of increased metal/ions concentration in the blood)

• Revision with extensive bone defects

3

SL-PLUS™ MIA

In cases of a Coxa Vara the CCD angel is smaller than normal (126°). In such cases the implantation of a stem with a CCD angle of 131° or more can result in a medialisation and/or elongation of the leg.

The lateral stem makes it possible to reconstruct the lever arms in such a way that the strength of the pelvic-trochanter muscle will be restored. At the same time an optimal tension of the soft tissue is achieved. This minimizes the risk of insufficient gait and, in extreme cases, the danger of a luxation.

The trumpet shape of the proximal femur (champagne flûte) is a technical challenge for surgery with most of the standard stems and cannot be optimally resolved in all cases. The narrow Isthmus femoris requires a small stem with a relatively short neck taper. The peculiarity of the trumpet shape femur is, however, a long femoral neck and a large femoral head. A conventional stem with a relatively short neck taper, therefore, tends to restore the anatomical structural conditions sub optimally with a mediali-sation of the femur stem as a consequence. SL-PLUS™ MIA Lateral makes the restoration of the anatomical conditions possible by elongating the neck section. Thus it is possible to avoid the tightening of the pelvicotrochantal muscle system by implanting prosthesis with an extra-long neck or which extends beyond the trochanter on the proximal side and may lead to a shortening of the leg.

4

Preoperative Planning

For implantation of the SL-PLUS MIA the following sets are required:

• Basis Set 75200838/0942010

• Trial Broaches Set: 75200199/0943030

x

Preoperative planning is recommended to properly choose the size and orientation of the prosthesis. The offset and neck length achieved with the SL-PLUS™ MIA prosthesis are determined by overlaying X-ray templates (enlarged by 15%) on plain radiographs (AP and axial views).

To determine the appropriate entry point for access of instruments to the medullary canal, it is recommended that the surgeon draw the femoral shaft axis on the AP radiograph and extend it proximally. This line indicates how far laterally it is necessary to place the box chisel to open up the canal. This entry point is easy to locate during surgery.

It is also helpful to define the position of the SL-PLUS MIA stem within the canal. This is defined by the distance from the shoulder of the stem to the greater and lesser trochanters, and can serve as an additional intra operative check of correct stem placement.

5

Surgical Technique

NoteThis technique was developed by Professor Dr. G. Pflüger and his colleagues at the Evangelisches Krankenhaus in Vienna for the anterolateral, minimally invasive approach performed in the supine position. Users of other (minimally invasive) approaches are requested to also consult the following operative instructions: posterolateral approach (Lit. No. 1426); anterior approach (Lit. No. 1494).

Skin incision

Previous clinical experience has shown that the SL-PLUS™ MIA stem may be successfully implanted via several skin incisions, including:

• A longitudinal incision along the anterior edge of the greater trochanter, extending from 2⁄3 proximally to 1⁄3 distally to the tip of the trochanter (Line 1)

• An oblique incision extending from the anterior edge of the greater trochanter in the direction of the anterior superior iliac spine (Line 2)

• A reverse oblique incision approximating the intertrochanteric line (Line 3)

• The fascial incision extends from the upper edge of the tip of the trochanter in the direction of the anterior superior iliac spine. Dorsal incision of the iliotibial band is optionally possible.

Capsular incision and dissection

After blunt lateral entry between the tensor fasciae latae and gluteus medius/minimus, the raspatory is used to dissect along the femoral neck.

Sharp lateral retractors and a blunt medial Hohmann retractor are used during the surgical exposure. The arc of the rectus tendon is visualized, underpinned, incised, and released from its capsule.

6

The femoral neck is exposed via an H-shaped incision of the joint capsule, consisting of:• a longitudinal incision, placed as far medially as possible, and extending from the acetabular

margin to the intertrochanteric line and

• a proximal transverse incision of the acetabular labrum, extending around the acetabular margin from approximately the nine o’clock to the three o’clock position and

• a distal transverse incision distal extending along the intertrochanteric line.

After the wing-like opening of the joint capsule, additional dissection of the capsule can be performed by extending the distal incision in the direction of the lesser trochanter and the proximal incision medially and/or laterally.

Two blunt Hohmann retractors are positioned intra-articularly. Problematic osteophytes on the acetabular rim are removed.

The technique used for the neck resection depends on the patient (coxa vara/valga) and is selected by the surgeon (single- incision or double-incision technique).

Capsule release

In order to facilitate alignment of the cup, an additional release of the posterior capsule is performed with the leg in the “Figure 4” position.

The leg is hyperextended, adducted approximately 30–40° and externally rotated by 90°. The leg being operated on is placed under the other leg in a “figure of 4” position.

The proximal femur is mobilized with two hooks: one placed lateral to the trochanter and the other placed on the medial side of the neck of the femur.

Capsule releases have to be carried out in the direction of the lesser trochanter and the trochanteric fossa to the trochanteric tip. Additional capsular release can also be carried out on the caudal rim of the acetabulum.

Surgical Technique

7

Inferior gemellus m.

Obturatorius internus m.

Superior gemellus m.

Piriformis m.

Stem preparation

The leg is hyperextended and adducted approx. 30–40°, and placed in 90° of external rotation, with the operative leg positioned under the opposite leg, in the “Figure 4” position.

In very muscular or obese patients, patients with a valgus femoral neck, or in cases where the proximal femur sits deep to the skin surface, further release of the posterior capsule or release of the piriformis tendon may be necessary to allow adequate mobilization of the femur prior to preparation of the implantation site.

Entry into the medullary cavity

With the lower thigh kept in a horizontal position, the box chisel is placed close to the posterior cortex at the resection level. The box chisel should be introduced along the femoral axis and a small square block of bone is removed. If the box chisel is not used to clear hard bone from the osteotomy site, fracture of the trochanter may occur during rasp insertion.

Driving the box chisel below the level of the resected bony surface should also be avoided.

The MIA curved rasp facilitates opening of the diaphyseal medullary cavity.

Further opening of the diaphyseal medullary cavity and probing of the diaphysis with corre-sponding awl is to be recommended.

Surgical Technique

8

Medial

1 2 3 4 5 6

Markings of the implant shoulder

Optional: Use of the pilot rasp

The MIA guide rasps are used to make neu tral alignment of the rasp easier to achieve, thereby preventing varus positioning of the implant. The MIA guide rasp should be introduced into the canal in the desired degree of anteversion, matching the target rotation of the stem.

The rasp depth can be controlled using the line markings on the shaft. These markings corre-spond to the position of the shoulder for each stem size. During insertion of the MIA guide rasp, care should be taken to restrict its depth of insertion to one or two sizes higher than the shoulder position of the planned implant.

When placing the rasp onto the slap hammer or the rasping machine, please ensure that the side marked “MEDIAL” is indeed oriented medially. If the medial and lateral sides are inadvertently reversed, the rasp handle may impinge on the medial aspect of the greater trochanter, preventing neutral alignment.

For correct stem alignment, the rasp must be seated in alignment with the canal axis. Please note that any deviation of the rasp from this axis may lead to varus positioning of the final implant during stem insertion.

After the MIA guide rasp has been introd uced to the desired depth, the detachable rasps are used to create an implantation site of the correct size and alignment for the femoral implant. This procedure is described below.

Surgical Technique

9

The rasp cuts longitudinal grooves within the femoral cortex. The goal of canal preparation is to make the area of contact between the prosthesis and the cortex as large as possible. By gradually extending the depth of rasping within the medullary cavity, the area of contact increases, along with the resistance to advancement of the rasp in the canal. Once the rasp is fully engaged within cortical bone, the pitch of the hammer blows increases and traces of pale cortical bone appear within the cutting teeth along the corner edges. To ensure correct sizing of the stem it is critical that the surgeon establishes the expected size of implant through preoperative planning prior to the surgical procedure.

The initial rasp must be size 01 when prepar-ing the canal for implants of size 4 or smaller. For larger implants (size 5 onwards), the sur-geon may start with a rasp of size 1.

ImportantThe first rasp determines the position of all the following rasps. This is why its orientation is important for an exact positioning of the stem.

Bone loss in calcar arch

At the start of the rasping process, the rasp must not be inserted below the level of the estimated final position of the implant. It is extremely important to understand that the femoral osteotomy has no relationship to the final position. There is a tendency for surgeons to implant the starting smaller size rasps too deeply into the femur. This will result in an excessive enlargement of the implantation site and lead to gaps around the medial aspect of the final implant position.

Surgical Technique

10

The subsequent rasp is introduced into the cavity along a slightly arc-shaped path until resistance is felt. The rasp is then driven laterally and distally into the femur with the help of a manual slap hammer or a power-driven rasping machine. This process is repeated with sequential rasp sizes until the final rasp is seated at an acceptable depth and further up-sizing is not possible. When using the double offset adapters (Art. No. 600923/600924), care should be taken to select the instruments corresponding to the side of the operative extremity.

Because the first rasp determines the posi-tion of all subsequent rasps, proper orienta-tion of the first rasp is necessary to ensure correct positioning of the femoral stem.

Attention should be paid to the anteversion and varus/valgus alignment of the rasping machine with respect to the femoral axis. Insertion of the rasps or the stem in a varus inclination increases the risk of perforation and fracture of the lateral cortex of the femur.

Rasping is carried out using the slap hammer or the rasping machine. The weight of these instruments helps to ensure the longitudinal alignment of the rasp within the femur. It is important that a lateral force is continuously applied to the rasping machine to ensure that the rasp moves in line with the axis of the canal and does not seat in a varus position.

Unlike the SL-PLUS™ stem, the SL-PLUS™ MIA rasp does not enter and exit the canal along the femoral axis, but rather along a curved arc.

Surgical Technique

11

The shoulder of the rasp corresponds to the height of the implant, measured at the shoulder of the prosthesis and should correspond to the preoperatively determined distance to the greater trochanter (marked x).

In rare situations, the prosthesis size determined intraoperatively is in disagreement with the size derived from preoperative templating. If this difference is two sizes or more, the rasp may not have reached the neces sary depth because of incorrect angulation or the presence of an obstacle within the canal. In such cases, the implanted prosthesis is too small to provide stable long-term fixation. In these situations, intraoperative fluoroscopy or an intraoperative radiograph should be obtained to evaluate the obstruction.

The offset adapter is removed from the detachable rasp.

Surgical Technique

12

Trial reposition

The modular neck is attached to the detachable rasp manually.

The trial ball head can be attached to the modular neck in advance or in situ.

In each case, there is a standard modular neck for the detachable rasps of sizes 01–0, 1–6 and 7–12. The “lateral” modular necks are available to suit the detachable rasps of sizes 1–6 and 7–12.

Care should be taken that the modular neck is correctly seated on matching surface of the detachable rasp and engages properly.

The joint is repositioned and leg length, soft-tissue tension, and range of motion are checked by the surgeon. During the initial operations, it is recommended that the surgeon obtain AP and lateral intraoperative radiographs to verify the size and position of the rasp within the femur.

If necessary, the trial ball head and/or the modular neck (standard or lateral) should be changed until a satisfactory result is achieved.

The modular neck can be uncoupled either by hand or with a Kocher clamp from the detachable rasp.

The offset adapter is linked with the detachable rasp. The detachable rasp is removed from the canal using the slap hammer or rasping machine. Removal of the rasp, as with its introduction, must be performed along a curved arc to minimize disturbance of the bone bed and to avoid fractures of any overhanging bone in the trochanteric region.

Surgical Technique

13

Implantation of the stem

The correct size SL-PLUS™ MIA stem is introduced manually as deep as possible into the canal, and is then seated with the impactor, using appropriately measured strokes to minimize the risk of fracture of the femur.

Important

Pressing the stem in solely by hand is inadequate.

During impact, the protective cover remains positioned on the cone.

Once the stem is firmly seated, attempts to drive it further down the canal or to adjust its alignment within the femur cannot be per formed without fracturing the bone.

Before repositioning the original ball head, the tapered trunnion is carefully cleaned by hand.

The ball head is then attached to the trun nion with a slight turning motion and permanently fixed with a blow delivered with the plastic hammer.

Surgical Technique

14

Metal objects must never be used to deliver impact to prosthetic heads. If a metal hammer is used, a plastic coupling or the head impactor must be used to protect the head from direct contact with the hammer.

ImportantPressing the prosthetic head onto the trunnion solely by hand provides inadequate fixation.

Each femoral stem has a standard 12/14 trunnion to allow coupling with OXINIUM™, ceramic or metal heads supplied by Smith & Nephew Orthopaedics AG resp. Smith & Nephew Inc.

Wound closureReposition and check joint tension and mobility on all sides. Insert Redondrains, closure of the surgical wound. Place the leg in slight ab duction and internal rotation in a foam-padded splint.

Postoperative TreatmentPostoperative rehabilitation should be completed in accordance with each hospital’s own practices. The SL-PLUS™ MIA stem, similar to the SL-PLUS stem, is immediately capable of bearing weight. The definitive osseointegration does not occur until 3 months postoperatively.

Surgical Technique

15

The SL-PLUS MIA stem can be removed using the extraction screw M6.

If this causes difficulties, the extraction screw M8 and an extractor block are available.

ImportantEnsure an axial alignment of extraction screw with internal thread.

Explantation of the SL-PLUS MIA Stem

16

SpecificationSize Stem

length IStem

length IIM/L

widthCCD

angle Standard

CCD angle

Lateral01 128 109 26 131

0 132 113 27 1311 137 117 28 131 1232 141 121 29 131 1233 145 124 30 131 1234 150 128 32 131 1235 154 132 33 131 1236 159 136 34 131 1237 163 140 35 131 1238 168 144 37 131 1239 173 148 39 131 123

10 178 152 40 131 12311 183 157 42 131 12312 188 162 44 131 123

Neck HeigthSize XS/–3 S/+0 M/+4 L/+8 XL/+12 XXL/+16

01 17 19 21 24 27 320 18 19 22 25 27 331 18 20 23 25 28 332 19 21 23 26 29 343 20 21 24 27 29 354 20 22 25 27 30 355 21 23 26 28 31 366 22 24 26 29 32 377 23 25 27 30 32 388 24 25 28 31 33 399 24 26 29 32 34 39

10 25 27 30 33 35 4011 26 28 31 34 36 4112 27 29 32 35 37 42

Neck Length StandardSize XS/–3 S/+0 M/+4 L/+8 XL/+12 XXL/+16

01 17 20 24 28 32 360 18 21 25 29 33 371 19 22 26 30 34 382 20 23 27 31 35 393 21 23 27 31 35 394 22 24 28 32 36 405 22 25 29 33 37 416 23 26 30 34 38 427 24 27 31 35 39 438 25 28 32 36 40 449 26 29 33 37 41 45

10 27 30 34 38 42 4611 29 31 35 39 43 4712 30 33 37 41 45 49

LateralSize XS/–3 S/+0 M/+4 L/+8 XL/+12 XXL/+16

01 0 1 26 29 33 37 41 452 27 30 34 38 42 463 28 31 35 39 43 474 29 32 36 40 44 485 30 33 37 41 45 496 32 34 38 42 46 507 33 36 40 44 48 528 34 37 41 45 49 539 35 38 42 46 50 54

10 37 40 44 47 52 5611 38 41 45 49 53 5712 39 42 46 50 54 58

Offset StandardSize XS/–3 S/+0 M/+4 L/+8 XL/+12 XXL/+16

01 28 30 33 36 39 420 29 31 34 37 40 431 30 32 35 38 41 442 31 33 36 39 42 453 32 34 37 40 43 464 33 35 38 41 44 475 34 37 40 43 46 496 36 38 41 44 47 507 37 39 42 45 48 518 38 41 44 47 50 539 40 42 45 48 51 54

10 41 43 46 49 53 5611 43 45 48 51 54 5712 44 46 50 53 56 59

LateralSize XS/–3 S/+0 M/+4 L/+8 XL/+12 XXL/+16

01 0 1 35 38 41 44 48 512 37 39 42 46 49 523 38 40 44 47 50 544 39 42 45 48 52 555 41 43 47 50 53 576 42 45 48 51 55 587 44 46 50 53 56 608 45 48 51 55 58 619 47 50 53 56 60 63

10 49 51 55 58 61 6511 51 53 56 60 63 6612 52 55 58 61 65 68

Dimensions All information in mm

* With Ø 28 mm ball head +12 ≠ XL!

** With Ø 28 mm ball head +16 ≠ XXL!

Offset Lateral

Neck lengthLateral

Neck lengthStandard

Offset Standard

M/L Width

Neck height

Stem length I CCD angle

XXL/+16

XL/+12

L/+8

M/+4

S/+0

XS/-3

Stem length II

17

Dimensions

Offset Lateral

Neck lengthLateral

Neck lengthStandard

Offset Standard

M/L Width

Neck height

Stem length I CCD angle

XXL/+16

XL/+12

L/+8

M/+4

S/+0

XS/-3

Stem length II

18

L

L

SAP No. Item No. Size Length (L)75001937 11000163 01 128 mm75001938 11000164 0 132 mm75001939 11000165 1 136 mm75001940 11000166 2 140 mm75001941 11000167 3 145 mm75001942 11000168 4 150 mm75001943 11000169 5 154 mm75001944 11000170 6 158 mm75001945 11000171 7 163 mm75001946 11000172 8 168 mm75001947 11000173 9 173 mm75001948 11000174 10 178 mm75001949 11000175 11 183 mm75001950 11000176 12 188 mm

All sizes also available with INTEGRATION-PLUS™ Ti-plasma/hydroxyapatite coating: SAP No. Item No. Size Length (L)75000172 11000422 01 128 mm75000173 11000423 0 132 mm75000174 11000424 1 136 mm75000175 11000425 2 140 mm75000176 11000426 3 145 mm75000177 11000427 4 150 mm75000178 11000428 5 154 mm75000179 11000429 6 158 mm75000180 11000430 7 163 mm75000181 11000431 8 168 mm75000182 11000432 9 173 mm75000183 11000433 10 178 mm75000184 11000434 11 183 mm75000185 11000435 12 188 mm

Implants standard

19

SAP No. Item No. Size Length (L)75001951 11000177 1 136 mm75001952 11000178 2 140 mm75001953 11000179 3 145 mm75001954 11000180 4 150 mm75001955 11000181 5 154 mm75001956 11000182 6 158 mm75001957 11000183 7 163 mm75001958 11000184 8 168 mm75001959 11000185 9 173 mm75001960 11000186 10 178 mm75001961 11000187 11 183 mm75001962 11000188 12 188 mm

All sizes also available with INTEGRATION-PLUS™ Ti-plasma/hydroxyapatite coating: SAP No. Item No. Size Length (L)75000186 11000436 1 136 mm75000187 11000437 2 140 mm75000188 11000438 3 145 mm75000189 11000439 4 150 mm75000190 11000440 5 154 mm75000191 11000441 6 158 mm75000192 11000442 7 163 mm75000193 11000443 8 168 mm75000194 11000444 9 173 mm75000195 11000445 10 178 mm75000196 11000446 11 183 mm75000197 11000447 12 188 mm

Implants lateral

L

L

20

SL-PLUS™ MIA Basic Set Set. No. SAP/Art. 75200838/0942010 SAP No. Item No. Description Size 75002198 110450 Case Basic Instruments1 75002319 110901 Slap hammer 2 75002320 110902 Extraction block3 75002325 110911 Extraction screw M8 4 75002165 110249 Extraction screw M6 5 75002160 110242 Head Impactor 6 5100839* 75100839 Trial Femoral Head 22 S/+0 75100840 75100840 Trial Femoral Head 22 M/+4 75100841 75100841 Trial Femoral Head 22 L/+8 75100842* 75100842 Trial Femoral Head 22 XL/+12 75100843* 75100843 Trial Femoral Head 28 XS/-3 75100844 75100844 Trial Femoral Head 28 S/+0 75100845 75100845 Trial Femoral Head 28 M/+4 75100846 75100846 Trial Femoral Head 28 L/+8 75100847 75100847 Trial Femoral Head 28 XL/+12 75100848 75100848 Trial Femoral Head 28 XXL/+16 75100849* 75100849 Trial Femoral Head 32 XS/-3 75100850 75100850 Trial Femoral Head 32 S/+0 75100851 75100851 Trial Femoral Head 32 M/+4 75100852 75100852 Trial Femoral Head 32 L/+8 75100853 75100853 Trial Femoral Head 32 XL/+12 75100854 75100854 Trial Femoral Head 32 XXL/+16 75100855* 75100855 Trial Femoral Head 36 XS/-3 75100856 75100856 Trial Femoral Head 36 S/+0 75100857 75100857 Trial Femoral Head 36 M/+4 75100858 75100858 Trial Femoral Head 36 L/+8 75100859 75100859 Trial Femoral Head 36 XL/+127 75007255 600621 MIA Stem Impactor8 75004495 21000138 MIA curved rasp* special size (optional)

Optional: SAP No. Item No. Description Size 75210292 75210292       SET 40 mm Trial Femoral Heads     XS/-4 to L/+8 75210293 75210293       SET 44 mm Trial Femoral Heads     XS/-4 to L/+8

SAP No. Item No. Description Size9 75006420 41000030 SL-PLUS MIA Guide Rasp

Optional for users of the SL-PLUS MIA stem and SL-PLUS stem:

SAP No. Item No. Description SizeJ 75002203 110500 Adapter for trial rasp (SL-PLUS standard)

Instrumentation

21

Instrumentation

1

2

3

4

5

6

7

8

OPTIONAL

OPTIONAL

9

J

22

SL-PLUS™ MIA Trial Broaches with Adapter 10 mm Set. No. SAP/Art. 75200199/0943030

SAP No. Item No. Description Size 75007661 990019 Cover 75007312 600930 MIA Instrument case for SL 1 75004481 21000123 MIA Detachable rasp (Trial Broach) 01 75004482 21000124 MIA Detachable rasp (Trial Broach) 0 75004483 21000125 MIA Detachable rasp (Trial Broach) 1 75004484 21000126 MIA Detachable rasp (Trial Broach) 2 75004485 21000127 MIA Detachable rasp (Trial Broach) 3 75004486 21000128 MIA Detachable rasp (Trial Broach) 4 75004487 21000129 MIA Detachable rasp (Trial Broach) 5 75004488 21000130 MIA Detachable rasp (Trial Broach) 6 75004489 21000131 MIA Detachable rasp (Trial Broach) 7 75004490 21000132 MIA Detachable rasp (Trial Broach) 8 75004491 21000133 MIA Detachable rasp (Trial Broach) 9 75004492 21000134 MIA Detachable rasp (Trial Broach) 102 75004603 21000253 MIA modular neck for detachable rasp 01–0 Std. 75004604 21000254 MIA modular neck for detachable rasp 1–6 Std. 75004605 21000255 MIA modular neck for detachable rasp 7–12 Std.3 75004606 21000256 MIA modular neck for detachable rasp 1–6 Lat. 75004607 21000257 MIA modular neck for detachable rasp 7–12 Lat.4 75006419 41000029 MIA box chisel6 75007309 600922 MIA Offset Adapter 10 mm7 75007310 600923 MIA Double Offset Adapter left 17/13 mm8 75007311 600924 MIA Double Offset Adapter right 17/13 mm

SL-PLUS MIA optional instruments (Set No. 0942011):

SAP No. Item No. Description Size 75004493 21000135 MIA Detachable rasp (Trial Broach) 11 75004494 21000136 MIA Detachable rasp (Trial Broach) 125 75009352 SYS251374 Trochanter retractor SAP No. Item No. Description Size 75007307 600920 Offset adapter 25 mm 75200836 0943032 SET SL-PLUS MIA Trial Broach with Offset adapter 25 mm 75007308 600921 Offset adapter 40 mm 75200837 0943033 SET SL-PLUS MIA Trial Broach with Offset adapter 40 mm

Instrumentation

23

1

3

8

6

7

2

5

4

OPTIONAL

OPTIONAL

OPTIONAL

Instrumentation

24

Implants

All the implants described in this Surgical Technique are sterile when they are delivered by the manufacturer. Resterilization is not allowed.

Instruments

System components and instruments are not sterile when they are delivered. Before use, they must be cleanded by the usual methods in accordance with internal hospital regulations and sterilized in an autoclave in accordance with the legal regulations and guidelines applicable in the relevant country. (For detailed information please refer to leaflet Lit. No. 1363.)

The correct settings are given in the instructions for use issued by the autoclave manufacturer. Instrument manufacturers and dealers accept no responsibility for sterilization of products by the customer.

Sterilization Note

25

Note

0 1 2 3™Trademark of Smith & Nephew Lit. No. 00884-en (1524) V2 03/14

Manufacturer Contact

Smith & Nephew Orthopaedics AG

Oberneuhofstrasse 10d

6340 Baar

Switzerland