Accolade System SurgicalTechnique - Stryker MedEd

1 Ste p 2 Ste p 3 LimbLengthMeasurementA SteinmanPin is insertedinto the infra -coty loid gro ove of the acetab ulum and held verticallyagainst the fem ur (Figure 3). A locator mark ismade on the pos te rior portionof the grea ter tr ochan ter .The pos ition of the limbs in slight adduc tion ,fl exion and externalrotationis identifi edand reco rded on th e drapes .32B2 ALoc ator markc1 Acc ola de SystemSur gical Tec hni queYo ur SkillOu r Te chn olog yTh ei r Qu ali ty of Li feAchi evi ng Per fect Balan ceAc col ade CCem en ted Hip Syst emTh e Powerof Per fo Powerof lad e HF xCe mentle ss Hip SystemAcco lad e TM ZFCe ment le ss Hip SystemSurgi cal Te chn iqu eStryk er Or tho paed ics wis hes to tha nk the fol lowi ngor th opaed ic su rgeon s for the ir exp erti se in the devel op mentof the Ac co la de Sys tem Surg ical Techni qu es :Ch itran ja n S. Ra naw at , re cto r, Ort hop aed ic Su rger y and Rana wat Or tho paed ic CenterLeno x Hi ll Hos pit alNew York ,NYRicha rd an , , Ph.

2 R, Roth man Inst itu teJa mes Edwa rds Prof essor andChai rma nDepa rtme nt of Orth opa edi cSurg er yThom as Je ff er son Univ ersi tyHosp ita lPhil adel ph ia,Pe nn sylvan iaWill ia mJ. Hoza ck , r, Joi ntRepla ce mentServi cePr ofesso r, Departmen tof Orth opa ed icSur ge ryThom as Je ff er son Univ ersi tyHosp ita lPhil adel ph ia,Pe nn sylvan iaAc co lade Syst emFem oral Hi p Syst emIndi cat io ns: Noni nf lamm ato ry deg ene rati ve joint disease,inclu din g oste oarthritisand av ascular necro sis; Rheu mat oid arthrit is; Corre ctio n of fu nct iona l def orm ity; Revisio n pr oced ure s whe re othe r tre atmentsor de vices hav e faile d; an d, Tre atm en t of no nun ions, femor al neck fr ac tu res, and troc hantericfr ac tures of the proximalfemu r with hea d invo lvem ent that are un man ageabl e using other techn iqu esCon tr aindications: Acti ve inf ectio n or susp ec ted late nt infec tion in or abou t the hip join t; Bone sto ck that is ina de quate for su pport or fixationof the prosthesis; Skel eta l immaturity.

3 Any men tal or neuro musc ul ar disord er that wou ld create an un ac cep tabl e risk of prosthesisin sta bil it y, pro sthe sis fixation failure ,or complications in postop er ative s and Pr ecautio ns:Se e packa ge in sert for warnings,pre cau tion s, adverseeffec ts an d other essentialproductinf orm ation .Tab le of Con tentsAc co lade CCeme nted Surgi cal Tech niq ue .. 2 Pre -opera tiv e Pl anning and X- Ray Ev aluati on .. 2 Surgi ca lAppr oa ch and Expo su re ..3Li mb Len gth Mea .. 3Ne ck Len gth and Offs et Me as urement ..4Ne ck Re secti on ..5 Box Chis el ..6 Sta rt er Rea mer ..6 Align men t Rod ..7 Trocha nter ic Rea mer ..7 Bro achi ..8 Cal car Pl an ing ..8 Tria l ..9Si zing of the Dis tal Ca nal ..11Cl ean ing the Ca nal and Cem ent -Plug Inserti on ..11 Final Ca nal Pr epar ati on and CementDelivery ..12 Ste m Pr epar ati on and Hea d Selecti.

4 13Fe mora l Ste m Inserti on ..13Cl os ure ..14Ac co lade TMZF an dAccoladeHFx Su rgical Tech niqu ..15 Pre -opera tiv e Pl anning and X- Ray Ev aluati on ..15Ne ck Re secti on .. 16 Ope ni ng th e Fem oral Canal :Axia l Sta rt er Rea mer ..17 Ras pi ng the Fe mur ..18Se at in g Le vels ..18 Tria l .. 20Fe mora l Ste m Inserti on ..21Fe mora l Ste m Inserti on Opti on ..22He ad As sembl .. 22Cl os ure ..23 Instr umen tOrd ering Info .. 24 Impl ant Order ing ..26Ac col ade C Ce mentedHi p SystemCom pon ent Ord er ing Informa ti on .. 26Si mpl ex P Bo ne CementOr dering ..26Ac col ade TMZF and Accol ade HFx CementlessHip SystemCom pon ent Ord er ing Informa ti on .. 27 This publicationsets forth detailedrecommendedproceduresfor using offers guidancethat you should heed, but, as with any such technicalguide, each surgeonmustconsiderthe particularneeds of each patient and make appropriateadjustmentswhen and as p 1 Pre-OperativeConsiderationsPre- opera ti ve planningaids in the det ermination of probab le implantstyle and si ze and can faci lita te op era ting ro om prepa ra tio n.

5 The pre-ope ra tive pl an ni ng pro cess sho uld take qualitativeand quantitativefa ctors (including pa tie nt bo ne qua li ty, densi ty and mo rphol og y) intoco ns ide ra tio n in or der to ev alu ate and se lect the appropriateinst rument/implantsy st em for the pati ent .Al th ough qual it ati ve me thods such asrad iogra phi c an aly sis have be en well documented,th e use of supplemental metho ds ,such as bo ne dens ity (D EXA ) sca nni ng1,may beco ns ide red wh en ev aluatingthe use of a bro ach only Ye ung , Y. , MBB S, MRC SE, et . al., Asse ssme nt of th e Pro xima l Fe mora l Mor ph ology Using PlaneRadiograph- Can it Predictthe Bone Qual ity? Journal of Art hro plasty , Vol. 21, Number 4,20 06, pa ges X-RayEvaluationPr e-o per ati ve planningaid s in th e selecti on of th e app ropr iat e implantstyl e and size for the pati ent's hi p pathol ogy. Optima l fe mora l stem fit,pros the tic ne ck leng th, and neck offs et can be more clos el y evalu ate d with the use of pre- opera tiv e X-Ra y ana lysi s.

6 The app ropr ia te proximalbo dyan dstem lengt h sh ould be assessedin the A/P view. Determ inat ion of probab leim pla nt sty le and si ze ca n faci litate opera ti ng roo m preparationin or de r to have availablethe appr op ri at e size tomic anomalies tha t cou ld prev ent the int ra-o pe ra ti ve ach iev em ent of theest abl is he d pre -operat ive go als may also be detec ted throughsuch tho d:A st andar dA/P pelvis radi og ra ph is utili zed (Figure 1A ). Sup er im pos e th e X-R ay templat es (1 20% magnifi catio n) on the ra diogr aph,ali gni ng th e:1. Templat e to indicatethe ne ck res ecti on at a 45 ang le to th e pir ifo rm is fos sa (Fi gure 1B,#1)2. Med ial asp ect of the templ ate wi th the medial cort ex (Figu re 1B ,#2)3. Later al aspe ct of the templat e with the lat eral cortex unti l an opti mal fit is defi ned and th e appropri ate implantsize select ed (Figur e 1B,#3)4.

7 Ce nter of the femoralhead to dete rmi ne the ap prop ria te neck ang le (127 / 13 2 ) tha t match es th e hip an ato my (Figur e 1B,#4).Not e: The Accol ad eHFx is only ava ila ble in a12 7 neck ang le .Ac col ade Cem entl es s Surgi cal TechniqueAc coladeTMZFand Ac col ade HF x1A1 BSize220%oversizetoallowforX-Raymagnific ationSize26020-0230(132 neckangle)6021-0230(127 neckangle)The AccoladeTMZFand Acc oladeHFx Hip SystemTh e Acc olad e Ce me ntl es s Instru ment System is extremelyversatile,offer ing surgeonsgrea t flexibilityand ease of use in approachingtheimpl an ta tion of the Accol ade Cemen tles sFem oral Com pone nt. Ea ch surg eon should use the su rgical ap proach for total hip arthro plasty with whichhe /s he is most familia tien tpositi oning, pr epara tion and dra pin g, ski nincision,soft tissu ediss ection and hip dislocationshould beperfo rme d acc or di ng to the surgeo n s preferredtechn ique, maki ng cer tain to adequ ately ex pose the acetab ulum and the prox imal t-op X-R aySte p 2 NeckResectionApro per neck res ec tio nlev el dire ctly af fec ts stem fit an dplacem ent.

8 By using anat omic land marks identifieddu ring templating,the NeckRese cti on Gui de shou ld be utilizedfo r prope r resectiondete rminat ion. The Ne ck Re sec tio nGuide is identicalin siz etoasiz e2imp lant bod y, thuspr ov id in gamean sof sim ul ating stem or ientat ion and pla cemen t. After carefu lpre-operativetem plating,the guid e is placed on theanteri or /po sterior asp ect of the exp ose dproximalfemur (by ali gni ng the tip of the gu ide with the piriformisfossa) and the plann ed fem or al neckcu t is mar ked using th e coagula tion curr ent. Ca re sh ould be taken to align the body of the guid ewith the axis of the femoralcana l(Figures2A and2B ).16Su rgeon s Note:Poo r exp osu re can oft en result in an antevertednec k resec tion. Don t hesitateto re-cutan in cor rect cut. Carefulor ient ation of the flexed kn ee per pendicularto the floo r he lpsto re duc e th e likel ih ood of this er ro r.

9 Cautionshould al so be used so as not to ex te ndla te ra lly int o th e greater tr ochant er. The axial resec tion is made at the medial bor der ofthe grea te r troch an ter to co nne ct it wit h the neck in iti al neck res ection lev el can be planne d by makinga meas urementfrom th egr eater tr ochant er to the Neck Rese ction Gu ide based on the pre-operativeanaly si th is mark is inscr ibe d, two blu nt tipped Hohmann Retractorsare place d aboutthe fem oral neck to pr ot ect the so ft tissu es. The head and nec k are then resectedusing apow er saw. Id ea lly ,the cut is made in neut ral ard H. Rot hma n, lli am J. Hozack, col ade Cem entl es s Sur gicalTe chniqueAc col ade TMZFand AccoladeHFx173A3C3B3 DSIZ E 8 SIZE 1St ep 3 Openingthe FemoralCanal:AxialStarterReamerTh eAxial Star ter Rea mer is ci rc umfe renti ally gradua ted along th e flut es in dicati ng both the depth (len gth) an d the width of the impla nt e fitting allows use wi th ei ther power equ ipm ent or wi th th e us e of th e T-h Axial Star ter Re amer is us ed to enter the e Star ter Rea mer has a sha rpened poi nt to fac ili tat e entry and sh oul d be ins erted to the depth of the final rasp (Figures3A and 3B ).

10 The properdep th of the Star ter Ream er ca n be deter mined by ali gning th e designat ed eng rav ed groo ves on th e ream er shaft (for the size templated) with themed ial calcar (Fi gu re 3C ). Lat era l pres sure on th e reame r wil l help to pr ovi de for a neu tr al orientationof the imp lan t (Figure 3D ).Not e:The prox ima l- most groove on the Sta rter Rea mer repr esents th edepth for the size distal-mostgrooverep resentsthedep th fo rthe size 1impla nt (a nd shouldalso be used to pr epar efor asize 0implant).When utilizingahalf size implantream to the whole sizebel ow what you inte nd touse .AccoladeTMZFandAccoladeHFxSt ep 4 Raspingthe FemurThere are 13 ras pbodi es that corre spon dto the 13 pro xim al bo dy geom etri es of the Acc olade TMZF System .*There are 8rasp bodies that corre spon dtothe 8proxim al bod ygeome trie sof the Acc olade HFx System .