Versys Fiber Metal Taper Hip Prosthesis Surgical Technique
Versys Fiber Metal Taper Hip Prosthesis Surgical Technique
Versys Fiber Metal Taper Hip Prosthesis Surgical Technique
Surgical Technique
VerSys® Fiber Metal Taper Hip Prosthesis Surgical Technique 1
Surgical Technique 5
Incision 5
Exposure of the Hip Joint 5
Determination of Leg Length 5
Osteotomy of the Femoral Neck 5
Preparation of the Femur 7
Intramedullary Reaming (Optional) 8
Attachment of the Rasp Alignment Tip (Optional) 10
Femoral Rasping 10
Trial Reduction 11
Insertion of the Femoral Component 12
Attachment of the Femoral Head 12
Wound Closure 12
Postoperative Management 12
Determination of Abductor Component Size Selection/ Large patients and obese patients
Muscle Tension and Femoral Templating may have magnification greater than
Offset Preoperative planning for insertion 20 percent because their osseous
Once the requirements for establishing of a cementless femoral component structures are farther away from the
the desired postoperative leg length requires at least two views of the surface of the film. Similarly, smaller
have been decided, the next step is to involved femur; an anterior/posterior patients may have magnification less
consider the requirement for abductor (A/P) view of the pelvis centered at the than 20 percent. To better determine
muscle tension. When the patient has pubic symphysis, and a frog leg lateral the magnification of any x-ray film, use
a very large offset between the center view on an 11x17-inch cassette. Both a standardized marker at the level of
of rotation of the femoral head and the views should show at least 8 inches of the femur. (Templates of 15 and 10
line that bisects the medullary canal, the proximal femur. In addition, it may percent magnification can be obtained
the insertion of a femoral component be helpful to obtain an A/P view of the by special order.)
with a lesser offset will, in effect, involved side with the femur internally
Preoperative planning is important
medialize the femoral shaft. To the rotated. This compensates for
in choosing the optimal acetabular
extent that this occurs, laxity in the naturally occurring femoral anteversion
component, and in providing an
abductors will result. and provides a more accurate
estimation of the range of acetabular
representation of the true medial to
VerSys Fiber Metal Taper stems are components that might ultimately be
lateral dimension of the metaphysis.
offered in two offsets (standard and required.
extended) in a 135-degree neck angle. When templating, magnification of
The initial templating begins with the
This versatility in offset and length the femur will vary depending on the
A/P roentgenogram. Superimpose the
enables the surgeon to reproduce distance from the x-ray source to the
acetabular templates sequentially on
almost any offset encountered. film, and the distance from the patient
the pelvic x-ray with the acetabular
to the film. The VerSys Hip System
Although rare, it may not be possible component in approximately 40
templates (Fig. 1) use standard 20
to restore offset in patients with an degrees of abduction. Range of motion
percent magnification, which is near
unusually large preoperative offset or and hip stability are optimized when
the average magnification on most
with a severe varus deformity. In such the socket is placed in approximately
clinical x-rays.
cases, the tension in the abductors can 35 to 45 degrees of abduction. Assess
be increased by lengthening the limb, a several sizes to estimate which
method that is especially useful when acetabular component will provide the
the involved hip is short. If this option best fit for maximum coverage. In most
is not advisable and if the disparity is cases, select the largest component
great between the preoperative offset possible, being certain that the
and the offset achieved at surgery by outside diameter isn't too large to seat
using the longest head-neck implant completely in the acetabulum. (Refer to
possible, some surgeons may choose the various Zimmer Acetabular System
to osteotomize and advance the greater surgical techniques for specific details
trochanter to eliminate the slack in the on acetabular reconstruction.)
abductor muscles. Technical variations
in the placement of the acetabular
components can also reduce the
differences in offset.
Fig. 1
4 VerSys® Fiber Metal Taper Hip Prosthesis Surgical Technique
Consider the position and thickness The specific objectives in templating Next, check the fit of the stem on the
of the acetabular component in the femoral component include: lateral x-ray. If the lateral x-ray reveals
estimating the optimum femoral neck that the A/P dimension of the isthmus
1) determining the anticipated size of
length to be used. (To simplify this, the is greater than the medial-lateral (M/L)
the implant to be inserted, and
acetabular templates are on a separate dimension shown on the A/P film,
acetate sheet from the femoral 2) determining the height of the it may be advantageous to increase
templates.) Mark the acetabular size implant in the femur and the the size of the stem to better fill the
and position, and the center of the location of the femoral neck isthmus. Template the next larger size
head on the x-rays. This allows any osteotomy. Now select the femoral component on the A/P x-ray to
femoral component to be matched appropriate femoral template. determine the amount of cortical bone
with the desired acetabular component The VerSys Fiber Metal Taper Hip that would be removed by reaming to
by placing the femoral template over Prosthesis is available in twelve this size. The cortical thickness of the
the acetabular template. This will standard body sizes (9 through walls must be great enough to allow
provide the best estimation of femoral 20mm) and ten large metaphyseal for additional reaming. If a larger
component size and head-neck length (LM) sizes (11 through 20mm). stem would better fill the isthmus, it
necessary to achieve the correct leg is preferable to insert the larger stem.
The femoral templates show the neck
length. This can be accomplished by enlarging
length and offset for each of the head/
the isthmus in the M/L dimension with
The VerSys Hip System includes several neck combinations (-3.5 to +10.5mm,
intramedullary drills. When a larger
head diameters. In most patients with depending on head diameter). Note
size is chosen to better fill the isthmus
an average-sized acetabulum, consider that skirts are present on +10.5mm
on the lateral x-ray, reevaluate the A/P
a femoral head with an intermediate heads, and on the +3.5mm size 22mm
x-ray to ensure that the fit of the
diameter, such as 28mm or 32mm. The head.
proximal and distal bodies is
intermediate femoral heads allow the
To estimate the femoral implant size, acceptable.
use of an acetabular component with
assess both the distal stem size and
an outside diameter small enough to Careful attention during this process
the body size on the A/P radiograph,
seat completely in the bone while also helps the surgeon achieve the goal
and then check the stem size on the
allowing for a polyethylene liner of of implanting a stem that will provide
lateral radiograph. Superimpose
sufficient thickness. maximum stability and contact with the
the template on the isthmus and
host bone.
In special circumstances, such as estimate the appropriate size of
the treatment of small patients the femoral stem. The stem of the
and patients with congenital hip femoral component should fill, or
dysplasia and small acetabular nearly fill, the medullary canal in the
volume, it is preferable to use a 22mm isthmus area on the A/P x-ray film.
diameter head to allow for adequate Next, assess the fit of the body in the
polyethylene thickness. metaphyseal area. The medial portion
of the body of the component should
fill the proximal metaphysis as fully as
possible, compatible with the anatomic
endosteal contours of that region.
VerSys® Fiber Metal Taper Hip Prosthesis Surgical Technique 5
After establishing the proper size of Surgical Technique Osteotomy of the Femoral Neck
the femoral component, determine A common technical error in total
the height of its position in the hip replacement surgery is insertion
proximal femur and the amount of Incision of the femoral component in a varus
offset needed to provide adequate In total hip arthroplasty, exposure position. The likelihood of this error
abductor muscle tension. Generally, if can be achieved through a variety can be reduced if visualization of the
the leg length and offset are to remain of methods based on the surgeon’s posterior femoral neck is improved.
unchanged, the center of the head of preference. The VerSys Fiber Metal To accomplish this, remove all of
the prosthesis should be at the same Taper Hip Prosthesis can be implanted the remaining soft tissue from the
level as the center of the femoral head using most surgical approaches. posterior femoral neck, exposing the
of the patient’s hip. This should also intertrochanteric crest and the junction
correspond to the center of rotation between the femoral neck and greater
of the templated acetabulum. To Exposure of the Hip Joint trochanter. Release some of the
lengthen the limb, raise the template Develop the exposure of the posterior inferior capsule to expose the lesser
proximally. To shorten the limb, shift capsule. To facilitate this, place trochanter. When the ideal position
the template distally. The extended the leg in internal rotation. The key of the appropriately selected femoral
offset option offers lateral translation of landmark for division of the short component was determined during the
5mm. This allows for an offset increase external rotators is the tendon of preoperative planning, the distance
of 5mm without changing the vertical the piriformis muscle. This tendon between the top surface of the lesser
height or leg length. The femoral head runs parallel to the posterior border trochanter and the level of the collar
lengths will also affect leg length and of the gluteus medius and can be was noted. In the example used, this
offset. readily palpated as it approaches the measurement was 15mm. Use this
posterior superior portion of the greater information to determine the level for
Once the height has been determined, trochanter. Retract the gluteus medius the femoral neck osteotomy.
note the distance in millimeters from superiorly and identify the tendon of
the underside of the collar to the top the piriformis.
of the lesser trochanter by using the
millimeter scale on the template. For
example, one might decide from the Determination of Leg Length
templating that a 52mm OD socket, Establish landmarks and obtain
with a size 15 prosthesis and a +3.5 x measurements before dislocation of
28mm diameter femoral head, placed the hip so that, after reconstruction, a
15mm above the lesser trochanter, are comparison of leg length and femoral
the appropriate choices. shaft offset can be obtained. From this
comparison, adjustments can be made
Proximal/distal adjustments in to achieve the goals established during
prosthesis position can reduce the preoperative planning. There are
need for a femoral head with a skirt. several methods to measure leg length.
(The skirted heads allow less range One method is to fix a leg length caliper
of motion than the non-skirted heads to the wing of the ilium. Take baseline
which may increase the chance of measurements to a cautery mark at the
dislocation.) base of the greater trochanter while
marking the position of the lower limb
on the table.
6 VerSys® Fiber Metal Taper Hip Prosthesis Surgical Technique
This alignment of the Osteotomy Guide bring it in from the superior portion as viewed on the A/P and lateral
would be appropriate for most femurs of the femoral neck to complete the radiographs. This is usually in the area
that have a neck shaft angle of 135 osteotomy cut, or use an osteotome to of the piriformis tendon insertion in the
degrees. However, if the femur has finish the cut. junction between the medial trochanter
a neck shaft angle more than or less and lateral femoral neck. Use the Box
than 135 degrees, adjustments to Osteotome (Fig. 3), Trochanteric Router,
Preparation of the Femur
the position of the Osteotomy Guide or Burr to remove this medial portion
To appropriately insert the femoral
should be made. Since the desired of the greater trochanter and lateral
prosthesis, adequate exposure of the
position, in the example used, of femoral neck.
proximal femur must be obtained. The
the height of the femoral component
femur should extend out of the wound, The opening must be large enough for
is 15mm proximal to the top of the
and soft tissue should be removed the passage of each sequential Rasp to
lesser trochanter, adjust the template
from the medial portion of the greater ensure neutral rasp/implant alignment.
proximally and distally until that
trochanter and lateral portion of the However, the opening should not be
relationship has been established.
femoral neck. It is crucial to adequately significantly larger than the Rasp or
At that point, use electrocautery to
visualize this area so the correct implant. An insufficient opening may
inscribe a line across the femoral neck
insertion site for femoral reaming can result in varus stem positioning. Before
parallel to the under surface of the
be located. Refer to the preoperative using the next size Rasp, be sure that
Osteotomy Guide.
planning at this point. Identify the mid- the opening is large enough. If it is not,
Using the inscribed line as a guide, femoral shaft extension intraoperatively use the Box Osteotome again.
perform the osteotomy of the femoral
After removing the cortical bone, insert
neck. To prevent possible damage to
the Tapered Awl (Fig. 4) or Curette (Fig.
the greater trochanter, stop the cut
5) to open the medullary canal. This
as the saw approaches the greater
will provide a reference for the direction
trochanter. Remove the saw and either
of femoral rasping.
Fig. 6
Attachment of the Rasp Femoral Rasping NOTE: Do not use the VerSys Enhanced
Alignment Tip (Optional) Begin the rasping sequence with a Taper Rasps (7892-09/19-50) to
NOTE: The Rasp Alignment Tip is only standard Rasp that is at least two sizes implant the Fiber Metal Taper Hip
necessary if intramedullary reaming is smaller than the estimated implant Prosthesis.
performed. size. The VerSys Fiber Metal Taper stem
should be implanted with the VerSys
Before impacting a Rasp, attach the
System Rasps (7892-009/020), or LM
Rasp Alignment Tip to the end of the
Rasps (7892-011/020-30) (Figs. 8a
Rasp (Fig. 7a) ensuring that the tip
and 8b).
is fully engaged with the distal rasp
threads (Fig. 7b). The Rasp Alignment
Tips are labeled to correspond with
their mating Rasp (i.e., a 14mm
Rasp requires a 14mm Rasp Tip).
The purpose of the Rasp Alignment
Tip is to centralize the Rasp within
the reamed canal and minimize
malalignment of the Rasp which may
a. System Rasp b. LM Rasp
cause the prosthesis to be positioned
in varus or valgus. The Rasp Alignment
Tips measure 1mm in diameter less
than their labeled size to maintain
appropriate distal clearance with a
femoral canal while still centralizing the
rasp in a reamed canal.
a.
Fig. 8
b.
Fig. 7
VerSys® Fiber Metal Taper Hip Prosthesis Surgical Technique 11
When inserting the Rasp (Fig. 9), be 1. Progress to the next larger rasp Trial Reduction
sure that it advances with each blow of size. This is recommended for Assemble the appropriately sized
the mallet. If the Rasp can be seated cases where adequate cancellous Porous/Enhanced Taper (POR/ET), or
at least 5mm below the osteotomy, bone is available on the anterior Extended Offset (EXT) Neck Provisional
progress to the next rasp size and and posterior sides of the proximal and Provisional Femoral Head to the
repeat until the predicted final rasp size femur and the distal medullary Rasp and perform a trial reduction
has been seated. If the predicted final canal has enough room to accept (Fig. 10).
rasp size can be countersunk more than the next larger size rasp. The distal
Check the leg length and offset of
5mm and adequate cancellous bone is canal may need to be reamed to a
the femur by referencing the lengths
available in the metaphysis region, two larger diameter to accept the next
measured prior to dislocation of the
choices are available for improved fit: size implant.
hip. It is important at this stage to
2. Progress to the same size large reposition the leg exactly where it was
metaphyseal (LM) Rasp. (LM during the first measurement. Adjust
Rasps are available in sizes 11mm the neck length by changing Provisional
through 20mm.) This option is Femoral Heads to achieve the desired
recommended for cases where there result. For the 28mm Femoral Head,
is at least 4mm of cancellous bone the VerSys Hip System has five neck
medially and adequate cancellous lengths (-3.5 to +10.5mm) which
bone on the anterior and posterior provide a total range of 14mm of neck
sides of the implant. Additional length. When satisfactory leg length,
reaming is not required to use the offset, range of motion, and stability
corresponding LM implant. have been achieved, dislocate the hip.
NOTE: Once the LM Rasp has been
inserted, a standard Rasp of any
size cannot be used to prepare the
canal and provide adequate fit with a
standard implant.
Fig. 9 Fig. 10
12 VerSys® Fiber Metal Taper Hip Prosthesis Surgical Technique
Insertion of the Femoral The Rasps and corresponding implants Attachment of the Femoral Head
Component are sized such that a press-fit is created Once the implant is fully seated in
Press the implant down the canal by proximally. The most distal portion the femoral canal, place the selected
hand until it will no longer advance of the porous surface (medial side) is Femoral Head Provisional onto the
(Fig. 11). flush with the implant and gradually taper of the implant. Perform a trial
increases to 0.5mm proud (per surface) reduction to assess joint stability,
Place the Stem Impactor in the implant
in the most proximal area. Thus, the range of motion, and restoration
insertion slot located on the stem
implant is 1mm larger than the Rasp of leg length and offset. When the
shoulder (Fig. 12). Begin to tap the
in both the A/P and M/L dimensions. appropriate femoral head implant is
Impactor Handle with a mallet until
This relationship can be seen on the confirmed, remove the Femoral Head
the prosthesis is fully seated or until
templates. Therefore when the implant Provisional and check to ensure that
the implant will no longer advance.
is seated, a 0.5mm press-fit per surface the 12/14 taper is clean and dry. Then
The prosthesis should be seated until
is achieved. Note that the metaphyseal place the selected Femoral Head on the
the most proximal part of the porous
press-fit engagement provides the taper and secure it firmly by twisting
surface is level with the osteotomy line.
implant with greater rotational stability it and striking it once with the Head
If the implant is not advancing with
than the Rasp. Impactor. Test the security of the head
each blow of the mallet, stop insertion
fixation by trying to remove by hand.
and remove the component. Then rasp
or ream additional bone from the areas NOTE: Do not impact the Femoral Head
that are preventing the insertion, and onto the taper before driving in the
insert the component again. prosthesis as the Femoral Head may
loosen during impaction.
Wound Closure
After obtaining hemostasis, insert a
Hemovac® Wound Drainage Device
and close the wound in layers.
Postoperative
Management
The postoperative management of
patients with a VerSys Fiber Metal Taper
implant is determined by the surgical
technique, patient’s bone quality,
fit of the implant, and the surgeon’s
judgment.
Fig. 11 Fig. 12
VerSys® Fiber Metal Taper Hip Prosthesis Surgical Technique 13
F
D
LM
A E
C
*The VerSys Fiber Metal Taper Hip Prosthesis is available with an HA/TCP coating. The product numbers for this option begin with a 65- prefix instead of a 00- prefix
This documentation is intended exclusively for physicians and is not intended for laypersons.
Information on the products and procedures contained in this document is of a general nature
and does not represent and does not constitute medical advice or recommendations. Because
this information does not purport to constitute any diagnostic or therapeutic statement with
regard to any individual medical case, each patient must be examined and advised individually,
and this document does not replace the need for such examination and/or advice in whole or
in part. Please refer to the package inserts for important product information, including, but not
limited to, contraindications, warnings, precautions, and adverse effects.
97-7862-102-00 Rev. 2 1012-H02 .5ML Printed in USA ©2001, 2005, 2007, 2011 Zimmer, Inc.