Surgical Technique Smith Amp Nephew-Books Pdf

Surgical Technique Smith amp Nephew
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REDAPT Revision Femoral System,Surgical Technique, Smith Nephew would like to acknowledge the contributions of the following. surgeons with whom we designed the REDAPT Revision Femoral System. Mathias Bostrom MD,New York NY,Fares S Haddad BSc MCh FRCS. London NW United Kingdom,Stephen Incavo MD,Houston TX. John Masonis MD,Charlotte NC,Ari Pressman MD,Pittsburgh PA. Nota Bene The technique description herein is made available to the healthcare. professional to illustrate the suggested treatment for the uncomplicated procedure. In the final analysis the preferred treatment is that which addresses the needs. of the patient, This surgical technique is for informational and educational purposes only It is.
not intended to serve as medical advice It is the responsibility of the treating. physicians to determine and utilize the appropriate products and techniques. according to their own clinical judgment for each of their patients For more. information on the products shown in this surgical technique including indications. for use contraindications effects precautions and warnings please consult the. Instructions for Use IFU for the product, The REDAPT Revision Femoral System by Smith Nephew is uniquely designed to. address the challenges in today s revision hip arthroplasty fixation in various bone. types achievement of joint stability predictable stem position and surgical efficiency. It all starts with ROCKTITE flutes which are intended to provide rock solid distal. fixation in all bone types, Surgeons have shown that REDAPT offers reproducible stem position which is. achieved by the combination of ROCKTITE fixation and highly efficient easy to use. instrumentation When a surgeon requires the benefits of a modular stem to best. meet individual patients needs the REDAPT Modular Revision Femoral System. allows for a seamless intraoperative transition This allows the surgeon to customize. the proximal distal mismatch for the best stem fit without compromising stem. strength Further the surgeon is able to achieve joint stability through independent. adjustment of neck angle height offset and version For additional information on. the REDAPT Modular implants or technique please see 7138 1674 REDAPT Revision. Surgical Technique,Indications, 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 noninflammatory 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 Revision Femoral System components are intended for single use only and. are to be implanted without bone cement, REDAPT is a tapered forged titanium stem with proprietary ROCKTITE distal flutes for. improved diaphyseal fixation, The 190mm Sleeveless stem Figure 1 is available in sizes 12 21 in 1mm increments.
and available in sizes 12 27 in 1mm increments in lengths of 240mm and 300mm. REDAPT Sleeveless Stem,12 14 Head taper,Compatible with all Smith Nephew heads. Circulotrapezoidal shape for increased,range of motion. 2 Offset options Standard and High,Forged Titanium tapered fluted design with. proprietary ROCKTITE flutes,Diameters 12 27mm 1mm increments. 190mm available 12 21mm,Lengths 190mm 240mm and 300mm.
Stem length is measured from 0 head,center at the at the top of the stem to distal. tip of the stem,Sizing options,Sizes 12 21mm Sizes 12 27mm Sizes 12 27mm. Standard and high offset Standard and high offset Standard and high offset. Offset options, Each neck is made with a 12 14 taper for use with compatible cobalt chrome ceramic. and OXINIUM heads The circulotrapezoidal neck is designed for increased range of. motion The following table and illustrations show the total offset and height for each. REDAPT stem,Offset option standard is 0 head center. SO Neck HO Neck,Size mm Height mm Offset mm Height mm Offset mm.
12 15 33 37 33 45,16 27 35 42 35 50,Instruments, REDAPT instruments are designed to maximize surgical efficiency and improve. accuracy and reproducibility of implant position during the procedure This is. accomplished by reaming and trialing over the top of the distal reamers Distal and. proximal reamers are color coded to provide easy identification of implant sizes and. reduce unnecessary instruments, Distal reamers are intended to allow the surgeon to prepare and size the canal for. optimal fit of the tapered fluted distally fixed stem When used in conjunction with. trial bodies and necks the distal reamers function as intramedullary trials which. should provide the surgeon with an accurate assessment of implant positioning. while reducing the number of instruments and trial components Distal reamers are. available in diameters of 10mm to 21mm in 1 0mm increments in lengths of 190mm. and diameters of 10mm to 27mm in lengths of 240mm and 300mm. The proximal reamers are uniquely designed to be used over the distal reamers By. reaming over the top the surgeon is preparing for the proximal aspect of the stem. based on the location of the distal reamer During canal preparation over the top. reaming allows the surgeon to maintain the relative position of the proximal and distal. reamed cavities to accept the implant of choice Proximal reamers are available in. sizes which correspond to the Sleeveless stem size. Proximal reamer color code chart, Distal reamer Color of reamer Proximal Reamers by number. implant size and implant,Starter 1 2 3 4 5,12 Purple PF. 13 Purple PF,14 Black PF,15 Black PF,16 Blue PF,17 Blue PF.
20 Copper PF,21 Copper PF,22 Gray PF,23 Gray PF,24 Brown PF. 25 Brown PF,26 White PF,27 White PF,PF Sleeveless Stem. Preoperative planning and templating,Templating, Preoperative templating accomplishes several goals The primary goal is to determine. the intended diameter and length of the revision stem and the remaining femoral. bone to support the conical fluted stem While all revision situations are unique in. general 5 7cm of conical reaming of distal cortical bone is desired. Preoperative planning for a revision total hip arthroplasty requires at a minimum a. standard set of radiographs which includes an antero posterior A P radiograph of. the pelvis and a lateral radiograph of the affected hip Depending on the length of. the existing femoral component several additional radiographs may be necessary. Specifically the A P and lateral radiographs should include the entire femoral. component On occasion a full length A P radiograph of the entire femur may be. necessary As part of the preoperative work up the surgeon may consider other. imaging modalities such as bone scans and computerized tomography CT However. these are not typically necessary for preoperative templating. Determine the appropriate classification for the femoral revision for example the. Paprosky Revision Classification 1 This will aid in determining the appropriate type. size and position of the revision stem you will need. An important goal of templating is achieving the optimal leg length and offset As. with primary THA preop planning establishing proper leg length requires assessment. of a number of clinical and radiographic parameters Establishing the proper reference. lines requires using a horizontal line between the inferior portion of the teardrop as. well as a horizontal line between the inferior margin of the obtruator foramen and. ischial tuberosity Due to the often distorted anatomy in revision cases utilizing all. three reference lines may be necessary, Similarly due to bony defects on the femoral side a combination of anatomic. landmarks such as the superior margin of the greater trochanter and inferior margin. of the lesser trochanter must be utilized These obviously need to be compared to. similar points in the contralateral side using the A P radiograph Any pelvic obliquities. and or spinal deformity must also be taken into account based on radiographic. and clinical assessments The consideration of all relevant factors is necessary to. successfully restore the patient s proper leg length. Surgeon tip The use of simple wooden blocks during the preoperative physical. examination of the patient is very useful as is a discussion of the patient s perceived. length elicited during their preop interview, Standardized A P radiographs is also critical in assessing proper.
femoral offset If there is a native hip on the contralateral side. the proper offset can be determined by the horizontal distance. between the center of rotation of the head and anatomic axis of. the femur If there is a well functioning total hip prosthesis on the. contralateral side a similar assessment can be made using. the REDAPT templates, Difficulties sometimes arise when the contralateral hip is. deformed or has a malfunctioning THA Additional problems. may be encountered if the ipsilateral acetabulum has failed or. has a protrusio deformity In these cases it is up to the surgeon. to determine intraoperatively what the proper offset should be. so as to achieve a hip that is stable without impingement in all. physiological positions, Once the bone stock has been assessed and proper leg length. and offset have been determined the surgeon should template. the femur to determine the appropriate stem size If there is any Figure 3. compromise in the diaphyseal femoral bone it is recommended. that the implant bypass the deficient bone by approximately. 5 7cm and that it engages in good diaphsyeal bone, REDAPT templates are available in digital and acetate formats. Figure 3 Consult your Smith Nephew representative for. assistance in obtaining templates, Surgeon tip After the preliminary femoral stem size is determined. physically draw these on the A P radiograph in proper position. Drawing is valuable when selecting the proper implant in. conjunction with the intraoperative findings so as to establish the. proper implant position,Abbreviated Surgical Technique.
Starter ream Distal ream Proximal ream Trial Implant. Surgical Technique,The following technique should be used when. implanting REDAPT Sleeveless monolithic,implants Before surgery review instrument. sets to ensure all instruments are present and,working properly. Removal of a well fixed femoral stem,The removal of a well fixed femoral stem can at. times be accomplished using thin osteotomes,starting at the proximal portion of the implant.
If the ingrowth region of the implant is not,abutting cortical bone this is more likely to be. successful Often however the ingrowth region,of the stem is more distal and abuts the cortical. bone and advancing an osteotome may fracture,the femur A proximal opening osteotomy. typically an extended trochanteric osteotomy,ETO greatly facilitates stem removal Once. the stem is exposed over the lateral surface,a saw or burring device can be used to disrupt.
the anterior and posterior surfaces The medial,surface can then be disrupted using a Gigli. saw This maneuver may be tedious and require,multiple saws Once this is accomplished the. ETO is replaced to its original position and held,in place with cerclage wires or cables. Templating is useful in determining the length,of the ETO identifying angular deformities which. may require corrective osteotomy or planning,removal of other retained hardware.
Surgeon tip Before performing an ETO,reaming trialing and inserting a new stem. place a cable or cerclage wire slightly distal,to the osteotomy or the existing stem before. reaming trialing and inserting the stem to,minimize risk of propagating a crack or fracture. Surgical Technique continued,Neck resection technique when using the. stem in a challenging primary application,The femoral neck resection may need to.
be modified in some challenging primary,applications such as angular and rotational. deformity The conical fluted design is,particularly well suited for these cases due to. the stability that is possible with this design,The shoulder of the implant is intended to match. the center of the femoral head for average,anatomy and this should correspond to the tip of. the greater trochanter Templating will determine,the proper level of the prosthesis with respect.
to the greater trochanter Individual adjustments,should be made as necessary. Causes of proximal femoral deformity or,dysplasia may require trochanteric osteotomy or. femoral osteotomy The final level of the shoulder,of the prosthesis may have to be adjusted in. these cases Placement of the box osteotome,and insertion of the canal finder may have to be. modified in these cases,Femoral preparation,The starter.
Surgical Technique This surgical technique is for informational and educational purposes only It is not intended to serve as medical advice It is the responsibility of the treating physicians to determine and utilize the appropriate products and techniques according to their own clinical judgment for each of their patients For more

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