ZIMMER MIS™

MINI-INCISION

FOR TOTAL HIP

REPLACEMENT

AnterolateralApproachSurgical Technique

1

MIS MINI-INCISION FOR TOTAL HIP REPLACEMENT

ANTEROLATERAL APPROACHSURGICAL TECHNIQUE

THIS SURGICAL TECHNIQUE

WAS DEVELOPED

IN CONJUNCTION WITH:

Richard Berger, M.D.

Rush-Presbyterian-St. Luke’s Medical Center

Chicago, IL

CONTENTS

INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . .2

PREOPERATIVE PLANNING . . . . . . . . . . . . . . .2

SURGICAL TECHNIQUE . . . . . . . . . . . . . . . . . . .4

Exposure . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4

Preparation of the Acetabulum . . . . . . . .8

Preparation of the Femur . . . . . . . . . . . . .10

CONCLUSION . . . . . . . . . . . . . . . . . . . . . . . . . . .13

INTRODUCTIONTotal hip arthroplasty (THA) can be performed

on most patients using an anterolateral mini-

incision approach. Notable exceptions include

patients with retained hardware, such as a

dynamic hip screw, that must be removed via a

longer incision, and patients with Crowe 4 hip

dysplasia that requires a subtrochanteric

osteotomy. As the surgeon embarks to learn

how to perform a mini-incision total hip

arthroplasty, start with the incision the surgeon

is currently performing and gradually shorten

the skin incision with improved confidence and

skill. Incisions smaller than 4.5” will require

specialized retractors and instrumentation that

are now readily available. As with many new

techniques, start with patients who are generally

smaller and less muscular, have minimal

deformity, and few osteophytes. Later, improved

confidence and skill allow the surgeon to

expand the indications of mini-incision THA to

almost all patients. Again, gradually decrease

the incision size until you have achieved a true

mini-incision THA (2.5” to 3.5”) on almost all

patients. It is important to note that a mini-

incision THA is not simply a standard approach

done through a small incision; instead, it is a

modified approach that transects less muscle

and tendon in addition to a small incision.

The following is a detailed description of a

technique designed to perform an anterolateral

mini-incision total hip arthroplasty.

PREOPERATIVE PLANNINGThe importance of preoperative planning and

templating cannot be overemphasized. This is

particularly true in the case of a mini-incision

total hip arthroplasty where visualization of

extra-articular landmarks is limited. The

objective of preoperative planning is to enable

you to gather anatomic parameters that will

allow accurate intraoperative placement of the

femoral and acetabular implants. Optimal

femoral and acetabular component fit, the level

of the femoral neck cut, the prosthetic neck

length, and the femoral component offset can be

evaluated through preoperative radiographic

analysis. Preoperative planning also allows the

surgeon to have the appropriate implants

available at surgery.

Determining preoperative leg length is essential

for restoration of the appropriate leg length

during THA. As in all total hip arthroplasties,

preoperative templating using an

anterior/posterior (A/P) view of the pelvis is

usually the most accurate method of determining

proper leg length. Only in extremely unusual

cases is a scanogram or CT evaluation of leg

length helpful. From the clinical and radiographic

information about leg lengths, determine the

appropriate correction, if any, to be achieved

during surgery. Standard osteotomy guides can

be easily used through a mini-incision procedure.

A number of intraoperative leg length

confirmation systems may be used with this

mini-incision approach.

Although rare, it may not be possible to restore

offset in patients with an unusually large

preoperative offset or with a severe varus

2

3

deformity. In such cases, lengthening the limb

can increase the tension in the abductor

muscles. This method is especially useful when

the involved hip is shorter than the contralateral

hip. However, in these cases there is usually no

choice but to lengthen the hip and leg. With

lengthening, patient dissatisfaction may result;

however, in some uncommon cases where

stability and leg length can’t be optimized, it is

more important to achieve hip stability than leg

length equality.

The initial templating begins with the A/P

radiograph (Fig 1). Superimpose the acetabular

templates sequentially on the pelvic x-ray film

with the acetabular component in approximately

45° of abduction. Assess several sizes to

estimate which acetabular component will

provide the best fit for maximum coverage. Mark

the acetabular size and position, and the center

of the head on the x-ray films. Note the superior

coverage of the acetabular component in 45° of

abduction, reproduce this during surgery to

assure proper component abduct and avoid

vertical positioning. Next, select the appropriate

femoral template. To estimate the femoral

implant size, assess both the distal stem size

and the body size on the A/P radiograph, and

then check the stem size on the lateral

radiograph. The stem of the femoral component

should fill, or nearly fill, the medullary canal in

the isthmus area on the A/P x-ray film. Next,

assess the fit of the stem body in the

metaphyseal area. The medial portion of the

body of the component should fill the proximal

metaphysis as fully as possible.

After establishing the appropriate size of the

femoral component, determine the height of its

position in the proximal femur. If the leg length

is to remain unchanged, the center of the head

of the prosthesis should be at the same level as

the center of the femoral head of the patient’s

hip. This should also correspond to the center of

rotation of the acetabulum. To lengthen the

limb, raise the template proximally. To shorten

the limb, shift the template distally. Once the

height has been determined, note the distance

in millimeters from the collar or most proximal

aspect of the porous surface to the top of the

lesser trochanter.

Fig. 1

SURGICAL TECHNIQUEExposurePlace the patient in the lateral position. It is

important to use some form of pelvis-stabilizing

device other than a beanbag. Be aware that

some pelvis stabilizing devices may flex or roll

the pelvis; it is important to compensate for this.

Use a drape with a leg-holding bag, or create a

bag with a sterile sheet, to hold the leg when it

must be positioned anteriorly.

Once the patient is prepped and draped,

determine the landmarks for the surgical

incision. Mark the most proximal border of the

greater trochanter, and the anteroposterior

midline of the greater trochanter (Fig 2). Along

this midline, make a mark 1 inch distal to the tip

of the greater trochanter. This will identify the

midpoint of the incision. The intended length of

the incision will determine its orientation. The

following orientation guide is relative to the

femoral shaft. For a true mini-incision, make the

incision approximately 30° to the long axis of the

femur, beginning anterior and inferior, and

extending superiorly and posteriorly

approximately 2.5” to 3” so it passes through the

marked point. Half the incision should be

anterior and inferior to the mark 1 inch distal to

the tip of the greater trochanter, and half should

be superior and posterior. (In heavier patients

slightly more of the incision should be posterior.)

Divide the subcutaneous fat and use a Cobb

elevator to expose the fascia lata about 1cm on

either side of the incision. This will facilitate with

closure. Incise the fascia lata in an orientation

halfway between its fibers and the skin incision,

about 15-20° to the axis of the femoral shaft.

This aids closure. As the fascial incision is made,

a small portion of the gluteus maximus muscle

maybe encountered (Fig 3). Use the electro-

cautery to open the gluteus maximus muscle

posteriorly and superiorly within its fibers.

4

Fig. 2

Fig. 3

Table 1: Incision length and orientation

Length Orientation to femurOver 4.5” 0°

4” to 4.5” 10°

3.5” to 4” 20°

2.5” to 3.5” 30°

5

The trochanteric bursa will be exposed. If the

bursa is thickened, slide a finger anteriorly and

posteriorly to loosen the bursa and expose the

greater trochanter and gluteus medius muscle.

Place a Charnley retractor transversely across

the incision. Place the anterior arm of the

retractor first, then the posterior arm. It is

important to use a specialized long arm

retractor, which has been modified from the

standard Charnley retractors. The arms of a

standard Charnley retractor will not engage the

frame for mini-incision without significant

tension on the incision. Do not over-tighten the

Charnley retractor, as this will diminish the

exposure and cause skin compromise.

Find the anterior tip of the greater trochanter;

this is the point where the abductor is usually

entered for a standard Anterolateral approach,

taking about 50% of the abductor off the

trochanter. With the following technique only

about 20-25% of the abductor is taken off the

trochanter. From the tip of the trochanter, slide

anteriorly to the anterior ridge of the trochanter;

the confluence of the anterior and superior

trochanter (Fig. 4). Find this ridge and insert a

pair of curved Mayo scissors in the recess of the

gluteus medius muscle in line with its fibers

until the gluteus minimus muscle is felt with the

tip of the scissors. This will divide the anterior

20-25% of the gluteus medius muscle. Insert two

Army-Navy retractors to retract the gluteus

medius muscle and expose the gluteus minimus

tendon, which will be oblique to the opening in

the gluteus medius muscle (Fig. 5).

Fig. 4

Fig. 5

Fig. 6

Next, make an L-shaped incision in the gluteus

minimus tendon, beginning the incision

proximally in line with the fibers and extending

it to the incision in the gluteus medius muscle.

Then transect approximately 0.5 cm-1.0 cm of

the gluteus minimus tendon in line with the

gluteus medius muscle (Fig. 6). Then remove the

Army-Navy retractors.

Place the leg in slight external rotation. Use

electrocautery to detach the fascia over the

vastus ridge where it blends with the gluteus

medius tendon. You do not need to violate the

vastus muscle. Following the contour of the

greater trochanter proximally transecting the

gluteus medius tendon. Leave the posterior half

of the tendon attached to the greater trochanter,

and the anterior half attached to the muscle.

While slowly externally rotating the hip, use

electrocautery to detach the anterior 20-25% of

the gluteus medius and gluteus minimus

muscles from the greater trochanter. Distally,

find the interval between the capsule and the

gluteus minimus tendon over the bursa of the

quadriceps muscle. Open this interval and follow

it proximally; insert a single point large retractor

(Fig. 7). The tendon will likely be confluent to the

capsule. Use electrocautery to separate the

gluteus minimus tendon from the capsule. Move

the single point large retractor anteriorly and

cephalad, placing it on the superior/anterior rim

of the acetabulum. This will expose the capsule.

6

Fig. 7

Fig. 8

7

Additionally, a small portion of the quadriceps

muscle may be detached from the capsule with

the electrocautery. The release can extend as far

anteriorly and inferiorly as necessary to expose

the antero-inferior capsule. Abduction, flexion,

and externally rotating the leg can facilitate this

process. Avoid invading the muscle, this will

cause bleeding.

When the anterior capsule is exposed, excise the

anterior/inferior portion of the capsule. Then

fully extend and slightly externally rotate the

limb. Excise the anterior/superior capsule to

expose the femoral head. About one quarter of

the capsule should be excised. Check to be sure

that the anterior capsule is freed inferiorly to

allow the femoral head to be dislocated.

Alternatively, the capsule may be retained

and simply incised.

Establish landmarks and obtain measurements

before dislocating the hip so that, after

reconstruction, a comparison of leg length and

femoral shaft offset can be obtained. From this

comparison, adjustments can be made to

achieve the goals established during

preoperative planning. There are several

methods to measure leg length, dependent on

individual surgeon preference.

Apply traction and insert a hip-skid retractor in

the joint space. This will aid in dislocating the

hip (Fig. 8). Remove all the retractors and insert

a bone hook around the femoral neck. The hip

should be flexed to only 45° with slight

adduction, in this position the assistant should

externally rotate the leg as the surgeon applies

anterior and lateral traction with the bone hook.

This will dislocate the hip without injury to the

remaining abductor (Fig 9).

This technique of only detaching about 20-25%

of the abductor off the trochanter improves

rehabilitation and post-operative limp. However,

there are two points in this procedure that the

additional preserved abductor can be injured or

torn; these points are during dislocation and

femoral preparation. The most common time of

abductor injury is during dislocation. If the hip is

flexed more than 45° with significant external

rotation to dislocate the hip, the abductor can be

stretched and the anterior portion is torn.

Limiting hip flexion to 45° and using a bone

hook will help prevent this problem.

The second time of abductor injury is during

femoral canal preparation; hyper-external

rotation during femoral preparation will prevent

abductor injury.

After dislocation it is usually easier to make a

provisional neck cut high on the neck to remove

the bulk of the femoral head. This will facilitate

seeing the lesser trochanter and making the

actual femoral neck cut. Some of the inferior

capsule can be released to expose the lesser

trochanter if necessary. Make the final neck cut

from the level of the lesser trochanter as

determined from the preoperative templating.

An osteotomy guide may be used. To prevent

possible damage to the greater trochanter, stop

the cut as the saw approaches the greater

trochanter. Remove the saw and use a sagittal

saw to finish the cut superiorly. Excise the

posterior synovium, and remove the final

neck segment.

Fig. 9

Approximately 180° to the ischium, place the

single point large retractor through the interval

between the capsule and the anterosuperior

acetabulum. Use this retractor to hold the

anterior portions of the gluteus medius and

gluteus minimus muscles anteriorly (Fig 10).

Insert a single point retractor over the

anteroinferior rim of the acetabulum to hold the

anterior capsule and iliopsoas tendon anteriorly.

The fiberoptic lights in these retractors augment

visualization (Fig. 10). Additional remaining

anterior or inferior capsule may be resected if

needed; however, be careful to avoid the

peritenon of the iliopsoas tendon. Then resect

the acetabular labrum circumferentially.

Osteophyte resection may be performed before

or after the acetabular shell has been inserted. It

is often easier to remove osteophytes once the

component has been inserted. Use a curved

osteotome. Remove the Hohmann retractor and

leave the two opposing large retractors.

Preparation of the AcetabulumSpecially designed Low-Profile acetabular

reamers facilitate passing the reamers between

the opposing retractors (Fig. 11). Begin reaming

the acetabulum with the largest Low-Profile

acetabular reamer that will fit into the

acetabulum. These reamers are designed to

be used in this manner. They have square teeth

that are aggressive. The shells of the Low-Profile

acetabular reamers are more than hemi-

spherical. The perimeter edge extends an

additional 15° beyond the level of a hemisphere.

This reams peripheral osteophytes facilitating

the acetabular component being fully seated.

Moreover, this design (more than a full

hemisphere), is forgiving; the reamer can be up

to 15° off the acetabular component axis and

still reams a perfect hemisphere for the final

acetabular component’s position. The

acetabulum is generally reamed to 2mm less

than the size of the selected acetabular

component.

To retract the femur posteriorly, an Offset Double

Point retractor is used to straddle the ischium

approximately 1cm posterior to the posterior

wall of the acetabulum (Fig. 10). Special

retractors, with built in fiberoptic lights are very

helpful. To facilitate placement of this retractor,

the hip is flexed to 45°, abducted to 25°, and

externally rotated to 30°. This retractor is placed

intracapsular, which retracts the capsule and

avoids sciatic nerve injury. A few gentle taps sets

the retractor and holds it in place. The assistant

should avoid vigorous retraction, as this will

dislodge the retractor or injure the skin.

8

Fig. 10

Fig. 11

9

Check to make sure the patient is correctly

positioned on the table. Connect the final

prosthesis to the offset shell inserter (Fig 12a).

This offset design helps avoid vertical cup

placement, which is common in mini-incision

total hip replacement. Insert the shell into the

prepared acetabulum. The alignment frame

achieves 45° abduction and 20° forward flexion

(Fig. 12b). Impact the cup in place, assuring the

shell is fully seated (Fig 13). Acetabular screws

may be used for additional fixation. The

polyethylene liner is inserted. Remove the two

large retractors around the acetabulum.

Fig. 12a

Fig. 13

Fig. 12b

A Box Osteotome and tapered awl is used to

gain access to the canal. Side cutting reamers

(Mini-incision instrument set) can be used to

remove the medial portion of the lateral

trochanter. The smooth bullet tip is designed to

engage in the upper diaphysis to assure neutral

alignment of the component. A straight rasp

handle during rasping minimizes impingement

of the handle with the proximal pole of the skin

incision. In addition, there is a tendency for the

proximal pole of the incision to apply an

anteverting force onto the rasp handle, which is

minimized with the straight rasp handle. To

facilitate control of the handle, a bar can be

inserted into one of the three holes in the

handle. These holes (0°, 7.5°, and 15°) can also

be used to check anteversion. The femoral canal

is prepared for the intended prosthesis by

matching the rasp to the anteversion of the

metaphysis (Fig 15). While a cementless tapered

design will be shown, any design can be used

with this approach: cemented, proximally coated,

splined, or fully coated.

Preparation of the FemurPosition the long femoral elevator on the lateral

greater trochanter, lateral to the abductors. This

elevates the proximal femur out of the wound

and protects the proximal pole of the incision

(Fig 14). Placing the leg into the sterile bag, the

hip is positioned in flexion, adduction, and

hyper-external rotation (135°). Place the double

point large lit retractor over the medial border of

the calcar. This keeps the proximal metaphysis

exposed and well lit. Lastly, place a straight

Hohmann retractor in the piriformis fossa to hold

the abductors posteriorly (Fig. 14). As noted

earlier, the hyper-external rotation of the hip

moves the abductor posteriorly; thereby avoiding

injury or maceration of the abductor during

femoral canal preparation.

10

Fig. 14 Fig. 15

11

Fig. 16

Specially designed provisional necks and

provisional heads, which can be inserted from

the side, facilitate the trial reduction. Insert the

provisional head and neck and perform a trial

reduction. Check the leg length and offset of the

femur by referencing the lengths measured

before the hip was dislocated. Adjust the neck

length by changing femoral head provisionals to

achieve the desired result. When satisfactory leg

length, offset, range of motion, and stability have

been achieved, dislocate the hip. Remove the

rasp and insert the femoral component (Fig 16).

Insert the femoral component until the

prosthesis is fully seated or until the implant will

no longer advance.

Use the provisional head inserter to sequentially

seat the side-loading slotted provisional heads

on the femoral neck until appropriate leg length,

joint tension, and joint stability have been

achieved. Seat the actual head that corresponds

to the trial head selected (Fig 17). Reduce the

hip, and assess leg length, range of motion,

and stability and abductor tension for the

final time (Fig 18).

NOTE: Ensure tapers are clean and dry.

Fig. 17

Fig. 18

12

Closure is important to maintain muscle

function and expedite recovery. To facilitate

closure, replace the Charnley retractor and

internally rotate and abduct the hip. Predrill the

lateral trochanter; do not drill through to the

anterior portion. Insert two heavy Mersilene

sutures from lateral to anterior. Pass the

Mersilene sutures under the gluteus minimus

and gluteus medius muscles. Place one or two

non-absorbable sutures through the gluteus

minimus muscle, closing it to itself (Fig19).

Next, tie the Mersilene sutures tightly to return

the gluteus minimus and gluteus medius

muscles back to the trochanteric bed. Lastly, use

number one Ethibond sutures to perform an

end-to-end anastomosis of the gluteus medius

tendon. This completely and securely reattaches

the gluteus minimus and gluteus medius back to

the greater trochanter (Fig 20).

Remove the Charnley retractor. With the hip

slightly abducted, close the fascia lata using

non-absorbable sutures. Then close the

remaining layers with 2.0 Vicryl, followed by

staples or subcuticular closure. Apply a

sterile dressing.

Fig. 20Fig. 19

13

CONCLUSION:The mini-incision exposure can be used in most

primary total hip arthroplasty (THA) patients. As

the surgeon begins to perform mini-incision total

hip arthroplasty, gradually shorten the skin

incision with improved confidence and skill. A

true mini-incision THA (2.5” to 3.5”) requires

specialized retractors and instrumentation such

as the Mini-incision instrument set. Following

the above outline will not only result in a smaller

incision, but also will transect less muscle and

tendon. This less invasive approach can result in

a shorter length of stay, less pain, less

rehabilitation transfers, quicker recovery, and

better cosmesis. All of these combine to produce

a more satisfied THA patient.

14

GENERAL INSTRUMENTS

Prod. No. Description00-7804-000-01 MIS Hip General Instrument Set

(Includes one each of the following:)00-7803-022-01 Femoral Head Provisional -2.0x22 00-7803-022-02 Femoral Head Provisional +0x22 00-7803-022-03 Femoral Head Provisional +3.0x22 00-7803-026-01 Femoral Head Provisional -3.5x26 00-7803-026-02 Femoral Head Provisional +0x26 00-7803-026-03 Femoral Head Provisional +3.5x26 00-7803-026-04 Femoral Head Provisional +7.0x26 00-7803-026-05 Femoral Head Provisional +10.5x26 00-7803-028-01 Femoral Head Provisional -3.5x28 00-7803-028-02 Femoral Head Provisional +0x28 00-7803-028-03 Femoral Head Provisional +3.5x28 00-7803-028-04 Femoral Head Provisional +7.0x28 00-7803-028-05 Femoral Head Provisional +10.5x28 00-7803-032-01 Femoral Head Provisional -3.5x32 00-7803-032-02 Femoral Head Provisional +0x32 00-7803-032-03 Femoral Head Provisional +3.5x32 00-7803-032-04 Femoral Head Provisional +7.0x32 00-7803-032-05 Femoral Head Provisional +10.5x32 00-7804-035-00 Rasp Handle, qty. 2 00-7803-054-09 Cone Provisional 9/10 00-7803-054-11 Cone Provisional 11 00-7803-054-12 Cone Provisional 12/13 00-7803-054-14 Cone Provisional 14/15 00-7803-054-16 Cone Provisional 16/17 00-7803-054-18 Cone Provisional 18-22 00-7803-056-00 Provisional Neck Inserter 00-7803-057-00 Provisional Head Inserter 00-7803-058-00 Implant Driver 00-7804-015-00 Offset Shell Inserter 00-7804-018-00 Offset Head Seater 00-7805-070-00 MIS Hip General Instrument Case

SIDE CUTTING REAMERS

Prod. No. Description00-7804-000-02 MIS Side Cutting Reamer Set

(Includes one each of the following:) 00-7803-050-00 Skin Protector Tube00-7803-050-09 Side Cutting Reamer, 9mm 00-7803-050-11 Side Cutting Reamer, 11mm 00-7803-050-13 Side Cutting Reamer, 13mm 00-7803-050-15 Side Cutting Reamer, 15mm 00-7803-050-17 Side Cutting Reamer, 17mm 00-7804-017-01 Skin Protector Tube - Long00-7804-017-02 Skin Protector Tube - Extra Long00-7806-080-00 MIS Side Cutting Reamer Case

Prod. No. Description00-7804-000-05 MIS 2-Incision Hip Instrument Set

(Includes one of each of the following:)00-7804-001-00 Initial Incision Pointer 00-7804-002-01 Lit Anterior Retractor - Straight/Narrow 00-7804-003-01 Lit Anterior Retractor - Bent/Narrow - Qty. 200-7804-003-02 Lit Anterior Retractor - Bent/Wide - Qty. 200-7804-003-03 Lit Anterior Retractor - Bent/Extra Wide00-7804-004-00 Retractor Extenders - Qty. 200-7803-041-04 Anterior Retractor Curved00-7803-045-01 Curved Awl00-7803-066-00 Angled Hex Driver00-7803-069-00 Cable Passer00-7804-013-00 Ligamentum Teres Cutter00-7804-014-01 Corkscrew00-7804-014-02 Stabilizer00-7804-019-00 Bonehook00-7804-015-01 Supine Alignment Frame 00-7804-033-01 Light Pipe, Bent (Blue) - Qty. 400-7804-033-02 Light Pipe, Straight (Yellow)00-1714-000-00 Bandage Scissors 00-7806-095-00 MIS 2-Incision Hip Instrument Case

MINI INSTRUMENTS

Prod. No. Description00-7804-000-54 MIS Mini Instrument Set (replacement set 7804-00-04)

(Includes one each of the following:)00-7804-005-00 Lit Inferior Retractor00-7804-006-00 Lit Single Point Retractor - Sharp/Wide00-7804-007-00 Lit Single Point Retractor - Dull/Narrow00-7804-008-00 Lit Double Point Retractor - Even Points/Wide00-7804-010-03 Lit Offset Double Point Retractor - Left Long/Twisted00-7804-010-04 Lit Offset Double Point Retractor - Right

Long/Twisted00-7804-011-01 Lit Flanged Retractor Left00-7804-011-02 Lit Flanged Retractor Right00-7804-012-01 Contoured Femoral Elevator00-7804-012-02 Contoured Femoral Elevator - Deep00-7804-015-02 Lateral Alignment Frame00-7804-030-00 Bifurcated Light Cable (with Adapter A,B,C,D)00-7804-033-03 Light Pipe, Inferior (Black)00-7804-033-04 Light Pipe, Long (Green), qty. 400-7805-090-00 MIS Mini Instrument Case

Prod. No. Description00-7804-000-21 MIS Fork Set

(Includes one each of the following:)00-7804-001-01 Long Arm Contoured 4-Tooth Retractor 00-7804-001-02 Long Arm Contoured 5-Tooth Retractor, Deep00-7804-001-05 Contoured Small Blade 00-7804-001-06 Contoured Small Blade, Deep

Prod. No. Description00-7804-000-22 MIS Claw Set

(Includes one each of the following:)00-7804-001-03 Long Arm Contoured Claw Retractor 00-7804-001-04 Long Arm Contoured Claw Retractor, Deep00-7804-001-05 Contoured Small Blade 00-7804-001-06 Contoured Small Blade, Deep

Prod. No. Description00-7804-000-25 MIS 2-Incision™ Hip Instrument Add-on Set

(Includes one each of the following:)00-7804-004-00 Retractor Extenders, qty. 200-7804-013-00 Ligamentum Teres Cutter00-7804-014-01 Corkscrew00-7804-014-02 Stabilizer00-7804-019-00 Bonehook00-7805-095-00 MIS 2-Incision Hip Instrument Case

ACETABULAR REAMERS

Prod. No. Description00-7803-000-07 MIS Low Profile Acetabular Reamer Set

(Includes all items listed below:) 00-7803-095-42 Low Profile Acetabular Reamer, Size 42 Through ↓ Through ↓00-7803-095-64 Low Profile Acetabular Reamer, Size 64 00-1206-090-10 Reamer Shaft, qty. 2 00-7806-085-00 MIS Low Profile Acetabular Reamer Case

Prod. No. Description00-7804-000-57 MIS Reamer Handle Set

(Includes one each of the following:) 00-7804-080-00 Offset Acetabular Reamer Handle 00-7806-087-00 Offset Acetabular Reamer Handle/Low

Profile Reamer Case

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Prod. No. Description00-7804-000-17 36mm Slotted Head Provisionals Set

(Includes one each of the following:)00-7803-036-01 Slotted Head Provisional 12/14 36mm x -3.500-7803-036-02 Slotted Head Provisional 12/14 36mm x +000-7803-036-03 Slotted Head Provisional 12/14 36mm x +3.500-7803-036-04 Slotted Head Provisional 12/14 36mm x +700-7803-036-05 Slotted Head Provisional 12/14 36mm x +10.500-7806-099-20 36mm 12/14 Slotted Provisional Head Tray

Prod. No. Description00-7804-000-08 40mm Slotted Head Provisionals Set

(Includes one each of the following:)00-7803-040-01 Slotted Head Provisional 12/14 40mm x -3.500-7803-040-02 Slotted Head Provisional 12/14 40mm x +000-7803-040-03 Slotted Head Provisional 12/14 40mm x +3.500-7803-040-04 Slotted Head Provisional 12/14 40mm x +700-7803-040-05 Slotted Head Provisional 12/14 40mm x +10.500-7806-099-30 40mm 12/14 Slotted Provisional Head Tray

Prod. No. Description00-7804-000-06 Six Degree Taper Set

(Includes one each of the following:)00-7603-022-01 Slotted Head Provisional 6 deg. 22mm x +0.500-7603-022-02 Slotted Head Provisional 6 deg. 22mm x +3.500-7603-022-03 Slotted Head Provisional 6 deg. 22mm x +700-7603-022-04 Slotted Head Provisional 6 deg. 22mm x +1100-7603-022-25 Slotted Head Provisional 6 deg. 22mm x +2.500-7603-022-55 Slotted Head Provisional 6 deg. 22mm x +5.500-7603-026-01 Slotted Head Provisional 6 deg. 26mm x +000-7603-026-02 Slotted Head Provisional 6 deg. 26mm x +3.500-7603-026-03 Slotted Head Provisional 6 deg. 26mm x +700-7603-026-04 Slotted Head Provisional 6 deg. 26mm x +10.500-7603-026-05 Slotted Head Provisional 6 deg. 26mm x +1400-7603-028-01 Slotted Head Provisional 6 deg. 28mm x +000-7603-028-02 Slotted Head Provisional 6 deg. 28mm x +3.500-7603-028-03 Slotted Head Provisional 6 deg. 28mm x +700-7603-028-04 Slotted Head Provisional 6 deg. 28mm x +10.500-7603-028-05 Slotted Head Provisional 6 deg. 28mm x +1400-7603-032-01 Slotted Head Provisional 6 deg. 32mm x +000-7603-032-02 Slotted Head Provisional 6 deg. 32mm x +3.500-7603-032-03 Slotted Head Provisional 6 deg. 32mm x +700-7603-032-04 Slotted Head Provisional 6 deg. 32mm x +10.500-7603-032-05 Slotted Head Provisional 6 deg. 32mm x +1400-7806-099-10 6 Degree Slotted Head Provisional Tray

Prod. No. Description00-7804-000-10 Slotted Cone Provisionals 12/14 Extended Set

(Includes one each of the following:)00-7804-020-11 Slotted Cone Provisional -EXT 1100-7804-020-12 Slotted Cone Provisional -EXT 12/1300-7804-020-14 Slotted Cone Provisional -EXT 14/1500-7804-020-16 Slotted Cone Provisional -EXT 16/1700-7804-020-18 Slotted Cone Provisional -EXT 18-2200-7806-099-50 Slotted Cone Provisionals - EXT Tray

Prod. No. Description00-7804-000-12 MIS 6 Degree Slotted Cone Provisionals Set

(Includes one each of the following:)00-7604-021-09 Slotted Cone Provisional - 6 deg. 9/1000-7604-021-11 Slotted Cone Provisional - 6 deg. 1100-7604-021-12 Slotted Cone Provisional - 6 deg. 12/1300-7604-021-14 Slotted Cone Provisional - 6 deg. 14/1500-7604-021-16 Slotted Cone Provisional - 6 deg. 1600-7806-099-60 6 Degree Slotted Cone Provisional Tray

Prod. No. Description00-7804-000-09 Liner Impactor Head Set

(Includes one each of the following:)00-7804-031-22 Liner Impactor Head — 22mm00-7804-031-26 Liner Impactor Head — 26mm00-7804-031-28 Liner Impactor Head — 28mm00-7804-031-32 Liner Impactor Head — 32mm00-7804-031-36 Liner Impactor Head — 36mm00-7804-031-40 Liner Impactor Head — 40mm00-7806-099-40 Liner Impactor Head Tray

REPLACEMENT ITEMSProd. No. Description00-4033-043-01 Frame00-7804-016-00 Osteotomy Guide*00-7804-018-02 Replacement Head Seater Cap00-7804-015-03 Replacement A-Frame Knob 00-7804-035-01 Replacement Adjustment Set Screw 00-7803-069-01 Small Cable Passer00-7803-070-04 Set Screw (Old Shell Inserter)00-7803-070-05 Threaded Shaft (Old Shell Inserter)00-7803-088-01 Light Cable Adapter A00-7803-088-02 Light Cable Adapter B00-7803-088-03 Light Cable Adapter C00-7803-088-04 Light Cable Adapter D00-7803-064-02 Offset Head Seater Cap (Old Style)00-7803-058-02 Torque Handle (For Rasp Handle)00-7803-070-06 Connecting Shaft (Old Shell Inserter)

Prod. No. Description00-7804-000-12 MIS 6 Degree Slotted Cone Provisionals Set

(Includes one each of the following:)00-7604-021-09 Slotted Cone Provisional - 6 deg. 9/1000-7604-021-11 Slotted Cone Provisional - 6 deg. 1100-7604-021-12 Slotted Cone Provisional - 6 deg. 12/1300-7604-021-14 Slotted Cone Provisional - 6 deg. 14/1500-7604-021-16 Slotted Cone Provisional - 6 deg. 1600-7806-099-60 6 Degree Slotted Cone Provisional Tray

Prod. No. Description00-7804-000-09 Liner Impactor Head Set

(Includes one each of the following:)00-7804-031-22 Liner Impactor Head — 22mm00-7804-031-26 Liner Impactor Head — 26mm00-7804-031-28 Liner Impactor Head — 28mm00-7804-031-32 Liner Impactor Head — 32mm00-7804-031-36 Liner Impactor Head — 36mm00-7804-031-40 Liner Impactor Head — 40mm00-7806-099-40 Liner Impactor Head Tray

REPLACEMENT ITEMSProd. No. Description00-4033-043-01 Frame00-7804-016-00 Osteotomy Guide*00-7804-018-02 Replacement Head Seater Cap00-7804-015-03 Replacement A-Frame Knob 00-7804-035-01 Replacement Adjustment Set Screw 00-7803-069-01 Small Cable Passer00-7803-070-04 Set Screw (Old Shell Inserter)00-7803-070-05 Threaded Shaft (Old Shell Inserter)00-7803-088-01 Light Cable Adapter A00-7803-088-02 Light Cable Adapter B00-7803-088-03 Light Cable Adapter C00-7803-088-04 Light Cable Adapter D00-7803-064-02 Offset Head Seater Cap (Old Style)00-7803-058-02 Torque Handle (For Rasp Handle)00-7803-070-06 Connecting Shaft (Old Shell Inserter)00-7803-086-00 Inflatable Pillow00-7803-088-00 Bifurcated Light Cable (Old Style)

* Limited availability depending on country release.

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Please refer to package insert for

complete product information, including

contraindications, warnings, precautions,

and adverse effects.

Contact your Zimmer Representative or

visit us at www.zimmer.com.

Anterolateral instruments developed in conjunction with:Richard Berger, M.D., Rush-Presbyterian, St. Luke’sMedical Center.