original m.e. müller acetabular reinforcement ring...3 | original m.e. müller® acetabular...
TRANSCRIPT
Original M.E. Müller® Acetabular Reinforcement Ring
Surgical Technique
Table of Contents
Preoperative Planning .............................................................................................. 2
Surgical Technique ................................................................................................... 5
Implants .................................................................................................................... 8
Instruments ............................................................................................................ 11
2 | Original M.E. Müller® Acetabular Reinforcement Ring
Figure 1 Figure 2
The acetabular roof reinforcement ring is fixed with 3 to 6 cancellous bone screws. These are positioned in the os ilium in the direction of the iliosacral joint and are inclined approximately 20° medially and posteriorly in relation to the long axis of the body. The polyethylene cup has an inclination of approximately 40° which corresponds in most cases with the position of the ring (Fig. 1, 2).
Implant ConceptThe Acetabular Roof Reinforcement Ring was designed by Prof. Maurice E. Müller. Reinforcement of the acetabulum using an acetabular roof reinforcement ring is indicated in total hip replacement in cases of osteoporosis, rheumatoid arthritis, acetabular roof cysts, simultaneous bone grafting, small dysplastic hips, after arthrodeses and in socket revision.
An acetabular roof reinforcement ring is also recom-mended in combination with polyethylene cups with low wall thickness.
After the preparation of the acetabulum, an acetabular roof reinforcement ring with a diameter of 4 mm smaller than the last reamer is normally used. The implant is wedged into the acetabulum with the metal impac-tor. The ring is positioned correctly if its lateral rim lies on the border of the acetabulum. It is imperative that the area of the screw holes and the lower border of the ring should have sufficient bone contact.
3 | Original M.E. Müller® Acetabular Reinforcement Ring
Use a Müller low-profile cup of the same size as the ring (i.e. cup size 50 mm) for a cement mantle of 1 mm thickness. For a 2 mm cement mantle use a low- profile cup of a size 2 mm smaller than the ring (i.e. cup size 48 mm).
Sizing Principle of the Acetabular Roof Reinforcement Ring (ARRR)Ream the acetabulum with the appropriate size acetabular reamer (i.e. 54 mm). Implant a ring 4 mm smaller than the last reamer used, which yields a pressfit of 2 mm (i.e. ring size 50 mm).
1 with a 2-mm cement layer, 2 with a 1-mm cement layer
Ref.
Number
Ring Outer
Diameter
(mm)
Ring Inner
Diameter
(mm)
PE Cup
Diameter
(mm)
Sulene® PE
22 mm
Sulene PE
28 mm
Sulene PE
32 mm
Durasul® PE
28 mm
Durasul PE
32 mm
Durasul PE
36 mm
36 97.36.49 42 38 362 63.22.36 – – – – –
38 97.38.49 44 40 361
382
63.22.3663.22.38
––
––
––
––
––
40 97.40.49 46 42 381
402
63.22.3863.22.40
––
––
––
––
––
42 97.42.49 48 44 401
422
63.22.4063.22.42
–63.28.42
––
–01.00284.042
––
––
44 97.44.49 50 46 421
442
63.22.4263.22.44
63.28.4263.28.44
–63.32.44
01.00284.04201.00284.044
–01.00324.044
––
46 97.46.49 52 48 441
462
63.22.4463.22.46
63.28.4463.28.46
63.32.4463.32.46
01.00284.04401.00284.046
01.00324.04401.00324.046
––
48 97.48.49 54 50 461
482
63.22.4663.22.48
63.28.4663.28.48
63.32.4663.32.48
01.00284.04601.00284.048
01.00324.04601.00324.048
–05.95001.050
50 97.50.49 56 52 481
502
63.22.4863.22.50
63.28.4863.28.50
63.32.4863.32.50
01.00284.04801.00284.050
01.00324.04801.00324.050
05.95001.05005.95001.051
52 97.52.49 58 54 501
522
63.22.5063.22.52
63.28.5063.28.52
63.32.5063.32.52
01.00284.05001.00284.052
01.00324.05001.00324.052
05.95001.05105.95001.052
54 97.54.49 60 56 521
542
63.22.5263.22.54
63.28.5263.28.54
63.32.5263.32.54
01.00284.05201.00284.054
01.00324.05201.00324.054
05.95001.05205.95001.053
56 97.56.49 62 58 541
562
63.22.5463.22.56
63.28.5463.28.56
63.32.5463.32.56
01.00284.05401.00284.056
01.00324.05401.00324.056
05.95001.05305.95001.054
58 97.58.49 64 60 561
582
63.22.5663.22.58
63.28.5663.28.58
63.32.5663.32.58
01.00284.05601.00284.058
01.00324.05601.00324.058
05.95001.05405.95001.055
Original M.E. Müller Low-Profile CupsOriginal M. E. Müller Ring
4 | Original M.E. Müller® Acetabular Reinforcement Ring
The size of the implant, as well as the localization of the screws in the flange, can be determined by directing the screws towards the iliosacral joint. The definitive size of the implant, the po sitioning and the number of screws re quired can only be determined intra-operatively. Finally, one must evaluate the need for bone grafting.
Preoperative PlanningPreoperative planning is done with the aid of a template that serves to determine the size and position of the ring before the operation. By using this method, potential difficulties that might occur during the operation can be foreseen and complications avoided. Adequate radiographs and, if indicated, CT or MRI imaging should allow the eva l uation of the condition of the acetabulum. The planning should aim to restore the center of rotation of the hip, which should be calculated by taking the contralateral side into account.
X-ray template REF 06.00806.000X
+H84406008060001/$130201B13O
Original M.E.Müller® Ring, Uncemented
These reference numbers must correspond to
those of the prostheses to be implanted.
© 2013. All rights reserved, Zimmer GmbH,
Sulzerallee 8, CH-8404 Winterthur, Switzerland
Lit. No. 06.00806.000 – Ed. 2013-02
20 cm
15 cm
5 cm
10 cm
5 cm 10 cm 15 cm
Magnification 1.15:1
LeftRight
Size 58 – REF 97.58.49Size 50 – REF 97.50.49Size 42 – REF 97.42.49
585042
Size 56 – REF 97.56.49Size 48 – REF 97.48.49Size 40 – REF 97.40.49
564840
Size 54 – REF 97.54.49Size 46 – REF 97.46.49Size 38 – REF 97.38.49
544638
Size 52 – REF 97.52.49Size 44 – REF 97.44.49Size 36 – REF 97.36.49
524436
5 | Original M.E. Müller® Acetabular Reinforcement Ring
Insertion of the Ring
Use the metal impactor to place the acetabular roof re inforcement ring (usually 4 mm smaller than the last reamer) (Figure 5).
Implantation of the Acetabular Roof Reinforcement RingReaming of the Acetabulum
After removing all debris, use the acetabular reamers to create a even, rounded acetabular floor. The last reaming is done by hand (Figure 3).
Insertion of the Trial Ring
Use the Original M.E. Müller Trial Rings to examine correct implant sizing. In addition, check if bone quality, especially near screw holes, suffices to ensure primary stability (Figure 4).
Figure 3
Figure 5
Surgical Technique
Figure 4
6 | Original M.E. Müller® Acetabular Reinforcement Ring
Testing the Cup Size
Check the cup position with the test cup (cup and ring usually correspond in size). (Figure 10)
Anchoring
Drill of the first screw hole medially using the flexible shaft and drill guide. (Figure 6)
To utilize the full length of the drill bit, hold the bit with the drill guide. (Figure 7)
Determining the depth of the screw hole with the depth gauge. (Figure 8)
Insert and tighten the cancellous bone screw with the cardan joint screwdriver or the extra-long screwdriver. (Figure 9)
Figure 6 Figure 7 Figure 8
Figure 9 Figure 10
7 | Original M.E. Müller® Acetabular Reinforcement Ring
Alignment of the Cup
Position of the cup with an inclination of 40° and an anteversion of 12°; in most cases, identical to the position of the ring (Figure 13).
Apply pressure to the cup using the impactor without the metal top. Press the cement in with the cement pusher (Figure 14).
Cementing the Cup
Insert the cement and implant the cup. Push the cup horizontally and as far medially as possible (Figure 11).
Remove excess cement (Figure 12).
Figure 11 Figure 12
Figure 13
Figure 14
8 | Original M.E. Müller® Acetabular Reinforcement Ring
Original M.E. Müller Acetabular Roof Reinforcement Ring
Cancellous Bone Screws
Product Description Size (mm) Part Number
CP titanium (Protasul® Ti) 363840424446485052545658
97.36.4997.38.4997.40.4997.42.4997.44.4997.46.4997.48.4997.50.4997.52.4997.54.4997.56.4997.58.49
Product Description Size (mm) Part Number
Countersunk Cancellous Bone Screw ∅ 6.5 mm Protasul 100
15 202530354045505560
42.19.1542.19.2042.19.2542.19.3042.19.3542.19.4042.19.4542.19.5042.19.5542.19.60
Cancellous Bone Screw ∅ 6.5 mm Protasul 100
20253035 4045 50 5560
02.03147.02002.03147.02502.03147.03002.03147.03502.03147.04002.03147.04502.03147.05002.03147.05502.03147.060
sterile packed
HEX
HEX
Implants
9 | Original M.E. Müller® Acetabular Reinforcement Ring
Low-Profile Cups
Product Description Size (mm) Part Number
Original M.E.Müller Low-Profile Cup, cemented UHMW Polyethylene (Sulene PE) Radiological mark CP Titanium (Protasul Ti)
36* 38* 40* 42 44 46 48 50 52 54 56 58
63.22.3663.22.3863.22.4063.22.4263.22.4463.22.4663.22.4863.22.5063.22.5263.22.5463.22.5663.22.58
Original M.E.Müller Low-Profile Cup, cemented UHMW Polyethylene (Sulene PE) Radiological mark CP Titanium (Protasul Ti)
42*4446485052545658606264
63.28.4263.28.4463.28.4663.28.4863.28.5063.28.5263.28.5463.28.5663.28.5863.28.6063.28.6263.28.64
Original M.E.Müller Low-Profile Cup, cemented UHMW Polyethylene (Sulene PE) Radiological mark CP Titanium (Protasul Ti)
44*46*485052545658606264
63.32.4463.32.4663.32.4863.32.5063.32.5263.32.5463.32.5663.32.5863.32.6063.32.6263.32.64
22 mm
32 mm
28 mm
* Must be implanted with an acetabular roof reinforcement ring, an acetabular roof reinforcement ring with hook or a Burch-Schneider® Reinforcement Cage.
sterile packed
sterile packed
sterile packed
Implants (cont.)
10 | Original M.E. Müller® Acetabular Reinforcement Ring
Low-Profile Cups
Product Description Size (mm) Part Number
Durasul PE Low-Profile Cup, cementedDurasul Radiological mark CP Titanium (Protasul Ti)
424446485052545658606264
01.00284.04201.00284.04401.00284.04601.00284.04801.00284.05001.00284.05201.00284.05401.00284.05601.00284.05801.00284.06001.00284.06201.00284.064
Durasul PE Low-Profile Cup, cementedDurasul Radiological mark CP Titanium (Protasul Ti)
4446485052545658606264
01.00324.04401.00324.04601.00324.04801.00324.05001.00324.05201.00324.05401.00324.05601.00324.05801.00324.06001.00324.06201.00324.064
Durasul PE Low-Profile Cup, cementedDurasul Radiological mark CP Titanium (Protasul Ti)
485052545658606264
05.95001.05005.95001.05105.95001.05205.95001.05305.95001.05405.95001.05505.95001.05605.95001.05705.95001.058
sterile packed
sterile packed
sterile packed
28 mm
32 mm
36 mm
Implants (cont.)
11 | Original M.E. Müller® Acetabular Reinforcement Ring
Instruments
Basic Instruments for Reinforcement Cages and Rings
Product Description Label ∅ mm L mm Part Number
Case for Acetabular Roof Reinforcement, complete, see Product Catalogue
- - - ZS99.29.30-00
Case (empty) - - - 75.80.01
Insert (empty) - - - 75.80.03
Depth Gauge A - - 75.80.15
Flexible Shaft1 for REF 75.11.00-06, 75.11.00-07, 75.11.00-08
B - - 75.11.00-05
Hexagonal Wrench for REF 75.11.00-05, 75.11.40-25
C - - 75.11.00-04
Drill Bit1, to be used only with REF 75.11.00-05
D 3.53.53.5
405065
75.11.00-0675.11.00-0775.11.00-08
Drill Guide E 5.8/3.5 - 75.85.70
T-handle for Tap for REF 75.11.40-20 F - - 75.11.40-25
Tap1 for REF 75.11.40-25 G 6.5 - 75.11.40-20
Drill Bit H 3.5 195 75.85.25
A
B
D
E
F
G
H
1 For basic equipment, order 2 pieces.
12 | Original M.E. Müller® Acetabular Reinforcement Ring
Instruments (cont.)
Basic Instruments for Reinforcement Cages and Rings
Product Description Label ∅ mm L mm Part Number
Countersink I 9.0 - 75.80.27
Case for Cancellous and Cortical Bone Screws (empty)
J - - 75.85.34
Self-Holding Screw Forceps K - - 100.90.005
Screwdriver with Cardan Joint L - 300 75.80.34
Top for Screw Extraction M - - 75.80.28
M
L
I
J
K
13 | Original M.E. Müller® Acetabular Reinforcement Ring
Instruments for Trial Shells
Instruments for Low-Profile Cups
Product Description Size (mm) Part Number
Instrument Tray (complete) - ZS01.00239.100
Tray for Special Instruments (empty) - 74.01.82
Test Shell for Müller Ring 363840424446485052545658
01.00239.00101.00239.00201.00239.00301.00239.00401.00239.00501.00239.00601.00239.00701.00239.00801.00239.00901.00239.01001.00239.01101.00239.012
Handle for trial shell - 01.00239.000
Product Description Size (mm) Part Number
Tray Instruments for Low-Profile Cup (complete)
- ZS01.00245.626
Tray Instruments for Low-Profile Cup (empty)
- 01.00245.627
Insert for Tray Instruments for Low-Profile Cup (empty)
- 01.00245.628
Standard Tray Cover - 01.00029.031
Cup Impactor, Curved - 75.00.39
Cup Impactor, Straight - 75.00.49
Instruments (cont.)
14 | Original M.E. Müller® Acetabular Reinforcement Ring
Instruments for Trial Shells (cont.)
Product Description Size (mm) Part Number
Positioning Guide 40°Positioning Bar
--
75.85.1975.85.00
Cup-inserting Device for Cemented Cups with inner ∅ 22mm
- 75.00.33
Top for Impactor (black)Top for Impactor (blue)Top for Impactor (green)Top for Impactor (green)
22283236
78.22.51*78.28.5178.32.5105.95001.060*
Positioning Top for Low-Profile Cups (Blue)Positioning Top for Low-Profile Cups (Green)Positioning Top for Low-Profile Cups (Black)
283236
75.28.9475.32.94* 05.95001.059*
Positioning top for Low-Profile Cups, Black 22 75.22.94
Test Cup, Low Profile 36 38 40 42 44 46 48 50 52 54 56 58 60 62 64
54.36.0854.38.0854.40.0854.42.0854.44.0854.46.0854.48.0854.50.0854.52.0854.54.0854.56.0854.58.0854.60.0854.62.0854.64.08
Instruments (cont.)
* On special request
15 | Original M.E. Müller® Acetabular Reinforcement Ring
X-Ray Templates
Product Description Size (mm) Part Number
Original M.E. Müller Ring, Uncemented 115%
- 06.00806.000X
Instruments (cont.)
Cement Pushers
Product Description Size (mm) Part Number
Cement pusher, small - 75.00.50
Cement pusher - 75.00.41
16 | Original M.E. Müller® Acetabular Reinforcement Ring
Instruments (cont.)
Acetabular Reamers
Product Description Label Size (mm) Part Number
Acetabular Reamers Instrument Tray (empty)
- - 01.00209.400
Standard Tray Cover, Grey - - 01.00029.031
EZ Clean Straight Reamer Handle (AO Connection)
A 312 T2227
4-Strut Spherical Reamer B 404244464850525456586062646668
00-1206-090-4000-1206-090-4200-1206-090-4400-1206-090-4600-1206-090-4800-1206-090-5000-1206-090-5200-1206-090-5400-1206-090-5600-1206-090-5800-1206-090-6000-1206-090-6200-1206-090-6400-1206-090-6600-1206-090-68
4-Strut Spherical Reamer(extra small / extra large)
C 3638707274
00-1206-090-3600-1206-090-3800-1206-090-7000-1206-090-7200-1206-090-74
Adapter AO-3 jaw Chuck D - 5637
B
C
D A
All content herein is protected by copyright, trademarks and other intellectual property rights, as applicable, owned by or licensed to Zimmer Biomet or its affiliates unless otherwise indicated, and must not be redistributed, duplicated or disclosed, in whole or in part, without the express written consent of Zimmer Biomet.
This material is intended for health care professionals. Distribution to any other recipient is prohibited.
For indications, contraindications, warnings, precautions, potential adverse effects and patient counselling information, see the package insert or contact your local representative; visit www.zimmerbiomet.com for additional product information.
Not for distribution in France. Check for country product clearances and reference product specific instructions for use.
Zimmer Biomet does not practice medicine. This technique was developed in conjunction with health care professionals. This document is intended for surgeons and is not intended for laypersons. Animations and virtual reality are provided as a visual guide based on surgical techniques; a written copy of the surgical technique is available at www.zimmerbiomet.com or from your local representative. Each surgeon should exercise his or her own independent judgment in the diagnosis and treatment of an individual patient, and this information does not purport to replace the comprehensive training surgeons have received. As with all surgical procedures, the technique used in each case will depend on the surgeon’s medical judgment as the best treatment for each patient. Results will vary based on health, weight, activity and other variables. Not all patients are candidates for this product and/or procedure.
Caution: Federal (USA) law restricts this device to sale by or on the order of a surgeon. Rx only.
©2019 Zimmer Biomet.
2756.1-GLBL-en-REV1019
Legal ManufacturerZimmer GmbHSulzerallee 88404 Winterthur, SwitzerlandTelephone +41/ (0)52 262 60 70Fax +41/ (0)52 262 01 39
www.zimmerbiomet.com
2797
CE mark on a surgical technique is not valid unless there is a CE mark on the product label.