EP-FIT PLUS® - CMM SL

Know-how brings motion back to life. SM
EP-FIT PLUS ®
Non-cemented
press-fit Acetabular Cup System
Surgical Technique

Table of Contents
1 Foreword 3
2 Indications 4
3 Contraindications 4
4 Case Study 5
5 Preoperative Planning 5
6 Surgical Technique 6
7 Postoperative Treatment 18
8 Sterilisation 18
9 References 19
10 Implants 20
11 Instrumentation 26

1. Foreword
Shells conceived on the basis of the press-fit principle
offer a number of advantages for total hip
replacement, including ease of manipulation and a
minimum degree of bone resection. In an acetabulum
that is not deformed, the implantation of a
hemispherical press-fit shell without oversizing
results in a large percentage of the mechanical load
being borne by the central region of the acetabulum.
Moreover, the peripheral ring – especially its lower
section – will in part remain free of loading. For this
reason hemispherical shells often have a limited
stability. Additional measures to improve stability, for
instance the use of screws or mandrels and/or the
use of shells with oversizing (Lachiewicz et al., 1989),
can introduce other problems.
In contrast, a hemispherical press-fit shell will bring
greater stability in a patient with protrusio acetabuli.
Here, the mechanical loading is primarily on the
peripheral zone (Adler et al., 1992). It is therefore a
logical step to optimise the intrinsic stability of the
press-fit shell by reproducing the protrusio situation.
We have therefore developed a shell that is not
spherical throughout, with a patented Triple Radius
Profile and which has proven itself over years of use
of the EPF ® -PLUS‚ and PLUS-FIT TM acetabular cups.
EP-FIT PLUS ® is the latest generation of both these
cup systems with direct anchorage for hard articulating
surfaces and with a greater surface roughness.
After implantation of the shell, the Triple Radius
Profile results in a gap of approximately 2 mm
between the roof of the shell and the hemispherical
reamed acetabulum. The actual dimensions of the
gap will vary, however, depending on the quality
and elasticity of the bone. This results in a close contact
in the peripheral zone of the shell and a relatively
low contact in the pole region, yielding a favorable
prestressing of the wall of the acetabulum.
These stress gradients, declining from the rim towards
the dome of the acetabulum, result in a large percentage
of the mechanical loading being transferred
to the wall of the acetabulum. This is in contrast to
oversized hemispherical cups, where only a narrow
area along the acetabular rim is subject to loading,
and so may result in overloading of the bone in this
area.
In summary, the EP-FIT PLUS ® system has the advantage
of reducing the risk of fracture of the acetabulum
during implantation, whilst maintaining excellent
primary stability through connection to bone
over a large area along the wall of the acetabulum.
3

2. Indications
All forms of osteoarthritis.
Progressive loss of function of the hip joint as a result of a degenerative post-traumatic or
inflammatory/rheumatic destruction of the joint.
Femoral head necrosis.
Proximal femoral fractures (especially femoral neck).
Status following earlier operations such as osteosynthesis, intertrochanteric osteotomies,
arthrodesis or failed joint replacement.
3. Contraindications
Acute or chronic infections, local or systemic.
Severe damage to muscles, nerves or vessels that are a risk to the affected extremity.
Severe bone defects or poor bone quality, endangering the stability of the implant.
Associated disorders that could interfere with the functioning of the implant.
Remark
Using hard-hard pairings, it is imperative to follow the specifications in the particular chapters.
The above-mentioned indications and contraindications apply for both primary interventions
and revisions.
If a revision is performed then preferably an oversized implant should be chosen. Multihole
cups can be used for difficult cases.
4

4. Case Study
Preoperative
Postoperative
Female patient with dysplastic hip with OA.
EP-FIT PLUS ® shell with SL-PLUS ® stem in a female
patient with dysplastic hip with OA.
Restoration of leg length.
5. Preoperative Planning
The surgeon uses the radiographic template (15% enlarged) to plan
The intended size of the implant.
The ideal position of the shell in relation to the acetabular teardrop figure.
Note
Exact determination of the size of a shell preoperatively using radiographic templates is only
possible to a certain degree.
In general, the removed femoral head gives a good indication of the size of the acetabular cup.
With a normal acetabulum, the definitive size of the shell is 4 – 6 mm larger than the anteroposterior
diameter of the removed femoral head.
The correct shell size is finally judged on the basis of the definitive reamer size/the correct
trial shell.
5

6. Surgical Technique
Note
Users of minimally invasive surgical techniques, please work through the following surgical
instructions additionally: postero-lateral approach (Lit. No. 1426); antero-lateral approach
(Lit. No. 1483); anterior approach (Lit. No. 1494).
1. Position of patient and approach
Surgery is performed with the patient in an extended
supine or lateral position.
Surgical approach – lateral or dorsolateral – is determined
on the basis of the patient data established in
advance and preference of the surgeon.
2. Removal of the femoral head
An osteotomy of the femoral neck is performed in
accordance with the preoperative planning for the
corresponding stem system.
3. Preparation of the acetabulum
The joint capsule is opened and sufficiently resected,
fully if necessary.
The acetabulum is exposed to allow a good view and
sufficient room for reaming instruments.
6

4. Assembly of the reamer
The reamer is placed on the drive shaft using pressure
and turned clockwise until the locking mechanism
snaps in.
5. Reaming of the acetabulum
The acetabulum is reamed using a spherical original
Plus Orthopedics reamer with increasing diameter
until the cartilage layer is fully removed and the subchondral
bone bleeds uniformly.
Note
It is recommended to begin with a reamer size equal to or 2 mm smaller than the head size
and that reaming is continued down to the base of the fovea acetabuli (teardrop figure).
As much hard sclerotic bone as possible should be removed from the pole region, but retained
in the peripheral zone. It may be advisable to choose a reamer that is in relation to the cup
size 1 mm larger to avoid fissures and ensure optimal seating.
Excessive reaming of the periphery should at all times be avoided as this would result in a
level of bone loss, especially at the anterior and posterior columns of the acetabulum, that is
too high.
The bone slurry that remains in the last reamer can be used to fill in the gap between the
acetabulum and the implant later on.
Reamers with 1 mm increments are available (see page 37).
7

6. Determination of the implant size using the
trial shell
Screw the trial shell onto the shell inserter (130707).
An alignment guide (130728) may be used for orientation
purposes relative to the cup position. The
assembled alignment guide is mounted on the shell
inserter with the trial shell.
The aim is an anteversion of 10° and an inclination
of 45°. Align the shell inserter in such a way that rod
(1) is perpendicular to the coronal plane and rod (2)
is perpendicular to the sagittal plane of the patient.
If the patient is lying in the supine position (see illustration,
here: using the example of a right hip) the
long edge of the table can serve as an orientation
guide.
The trial shell is placed in the reamed acetabulum by
exerting pressure on the shell inserter (but without
using an impacting tool).
Verification of correct seating in the acetabulum. After removal of the shell inserter the cup
position and depth can be checked. The trial shell is then removed with the shell inserter
screwed back in.
Note
In contrast to the original implants the trial shells are not oversized. If the desired degree of
stability is not attained then the depth of the bone bed has to be increased (see No. 5. Reaming
of the acetabulum) or the next largest size of trial shell chosen.
8

7. Implantation of the titanium shell with trial shell inserter
Bone slurry from the last reaming procedure can be
uniformly distributed in the acetabulum to compensate
for possible gaps.
Mount the shell, of predetermined size, on the shell
inserter (130707).
If necessary, mount the alignment guide (130728)
on the shell inserter.
Position the cup shell in the acetabulum and align
the shell inserter as described in No. 6.
The inclination should ideally be 40 – 50º and anteversion
10 – 20º to achieve optimum results. Final
acetabular component orientation must also consider
the position of the femoral implant, the stability and
degree of bone coverage as well as correct soft tissue
tensioning, to achieve the optimal result for each
patient. Any inclination of the shell greater than 50º
must be avoided because of possible impingement
and/or a tendency towards dislocation. It may be
advantageous to use a reliable navigation system to
position the cup as this would considerably improve
the accuracy of positioning.
If no screws are used the cup should be oriented
with screw holes inferiorly. The implant is inserted
into the acetabulum by impaction with the shell
inserter and the impaction/extraction hammer
(130705).
Note
The information on the use of ceramic, metal and
PE inserts must be followed without fail (see nos. 13
to 15).
9

8. Implantation of the titanium shell using the
shell inserter (US version)
The shell inserter (130987) can be used instead of
the trial shell inserter.
9. Verification of position in the acetabulum
The distance (1 –2 mm) between the implant and
the acetabulum is measured using the depth gauge
for shell (130731) through the apex hole.
Note
Additional fixation of the EP-FIT PLUS ® press-fit shell
by screws is not routinely necessary, but may be
required routinely in certain circumstances.
10. Fixation of the shell with screws
The procedure is the same as for No. 7 above, but
the screw-holes should be aligned in a superolateral
position upon insertion of the shell.
Drill the intended holes using the drill guide
(130847) and flexible drill shaft (130490).
Insert the screws into the pelvis with the screwdriver
(130710). An anterior or central position of
the screws must at all times be avoided as this could
result in damage to the large pelvic vessels and
nerves.
Note
Only Plus Orthopedics cancellous bone screws
(25281 – 25286) with a low head profile are to be
used.
10

11. Optionally: trial reduction using trial insert
(standard 130826 – 130837/ hooded 130850 – 130857)
The trial stem is inserted in the femur after the femur
has been prepared (see corresponding surgical procedure).
Disassemble the inserter (130818).
Inner section
Outer section
Screw the corresponding size of trial insert (standard
and hooded) into the inner section of the seating
instrument.
Insert the trial insert into the implanted shell.
Unscrew the inner part of the inserter. Check the
seating of the insert in the shell, reduce and manipulate.
Check the correct positioning of the PE insert within
the shell.
Screw the internal part of the seating instrument
back into the trial insert, then loosen and remove it
through a gentle tilting action.
12. Thoroughly rinse the implanted shell and carefully remove the bone debris.
11

13.a Placement of the standard polyethylene
insert using the inserter/impactor
To position the polyethylene insert, it is recommended
to use the inserter/impactor (130818).
The inserter/impactor must be reassembled to do so.
Screw the adapter for the PE insert and the impactor
head onto the inserter/impactor. Retract the internal
section of the inserter/impactor and mount the PE
insert on the three nipples.
Insert the PE in the shell by impacting the inner section
of the inserter/impactor.
Optionally
Check the fit of the PE insert in the shell using a raspatory.
Note
The PE insert must not be re-used.
Rim osteophytes must be carefully removed to prevent
anterior or lateral impingement, tendencies to
dislocation or restriction of movement.
12

13.b Insertion of the hooded polyethylene insert using the inserter/impactor
It is recommended to insert the hooded polyethylene insert using the inserter/impactor (130818).
The procedure for the hooded polyethylene insert and the inserting device is analogous to the
description under 13.a.
Note
The position of the shoulder of the hooded PE inserts can be changed in 30º increments.
14. Use of the BIOLOX ® forte ceramic insert
Indications and contraindications
The same indications and contraindications apply to the use of the BIOLOX ® forte cup inserts
as for total hip arthroplasty with other articulating surfaces.
The following additional contraindications apply to ceramic inserts:
The inclination should not be substantially above or below the range 40 – 50º.
The anteversion must not be above or below the range 10 – 20º.
If the angle of inclination is below 30º or above 50º BIOLOX ® forte insert must not be used.
Plus Orthopedics standard and hooded PE inserts are available for such cases.
Ceramic cup inserts should similarly not be used for cups in a retroversion mode.
Risk of impingement should at all times be avoided.
Implantation
A trial insert should be used before a ceramic insert is implanted. Trial heads of the intended
diameter must then be used to ensure an adequate range of motion (ROM) in all directions and
to check the stability of the joint. The artificial joint must not dislocate in the course of movement
or subluxate through impingement of the implant components or soft tissue.
The alignment guide (130728) should always be used with BIOLOX ® forte ceramic inserts in
order to obtain the necessary level of accuracy.
It is advisable to use computer-assisted navigation systems intra-operatively for documentation
and verification of the implant position and to get exact information on the ROM.
13

Placement of the ceramic insert
The procedure for the trial insert is the same as
described under No. 11.
Before insertion it must be ensured that the inner
surface of the metal shell is dry and free of any
debris.
Remove the BIOLOX ® forte ceramic insert with the
premounted CeraLock ® insertion aid from its packaging.
Remove the transparent Plexiglas triggering
protection and dispose of it.
Place the CeraLock ® insertion aid on the front face of
the metal shell so that all 3 arms lie on the edge and
the BIOLOX ® forte ceramic insert cannot tilt.
Exert force on the CeraLock ® plateau and press the
BIOLOX ® forte ceramic insert home into the shell.
The instrument will have now released the
BIOLOX ® forte insert. Remove the CeraLock ® insertion
aid and dispose of it. It is intended for single
usage only and must not be resterilised.
The correct position of the insert in the metal shell
must be checked. Using the tip of the fingers, touch
the 2 front faces of the insert and metal shell. If the
position of the insert over its entire circumference is
level to the metal edge then it is correctly positioned
in the shell.
14

Note
To ensure that the BIOLOX ® forte ceramic insert is inserted correctly, it is supplied with a premounted
CeraLock ® insertion aid.
If the patients anatomy does not allow or limit the use of the CeraLock ® to a certain degree,
the ceramic insert can be carefully placed in the cup by hand and pressed home.
Prevention of fracture of a ceramic component
If a ceramic component damage is discovered intraoperatively or a damage is suspected for
good reasons, a ceramic insert must not be used. If already implanted, it must be removed.
A new ceramic inlay must only be used if the internal cone of the shell is free of damage.
Revision involving a broken ceramic insert
In case of acetabular cup revision in which a broken conically fixed ceramic insert is removed a
ceramic insert must not be used again. The cone of the cup may have been damaged during
the reoperation and would then no longer satisfy the requirements placed on plug connections
for conically fixed ceramic inserts. The risk of a fracture is above average.
A polyethylene insert should be used as an alternative.
Revision of a broken ceramic femoral head
On a femoral prosthesis left in situ after revision of a ceramic femoral head, Plus Orthopedics
recommends the use of a BIOLOX ® OPTION (Material: BIOLOX ® delta) femoral head with metal
sleeve (Material: TiAl6V4) to be inserted. The BIOLOX ® OPTION system can be used with any
acetabular insert of the BIOLOX ® family as well as with Plus Orthopedics Polyethylen/Rexpol ®
inserts.
If both components (ball head and insert) are made of ceramic, in case of revision following a
fracture of one of the two components both the insert and the ball head have to be replaced.
15

15. Use of the PLUSMET ® metal insert
Indications and contraindications
Basically the same indications, contraindications and recommendations applying for THR with
other articulating surfaces, also apply for PLUSMET ® metal inserts.
The following additional contraindications have to be considered for metal inserts:
Patients with chronic renal failure, renal insufficiency or on dialysis.
Patients with known allergies of any kind or occupational exposure to Cobalt, Chrome or
Molybdenum.
If angle of inclination is below 30º or above 50º, the PLUSMET ® metal insert must not be used.
If angle of anteversion underruns 10º or exeeds 20º the PLUSMET ® metal insert must not
be used. Plus Orthopedics standard and hooded PE inserts are available for such cases.
If a stable reduction cannot be achieved.
If cup is positioned in a retroversion mode.
Risk of impingement should at all times be avoided.
Implantation
A trial insert should be used before a metal insert is implanted. Trial heads of the intended
diameter must then be used to ensure an adequate range of motion (ROM) in all directions of
movement and to check the stability of the joint. The artificial joint must not dislocate in the
course of movement or subluxate through impingement of the implant components or soft tissue.
Pressure of the neck of the prosthesis at the edge of the metal insert may cause point loads
that increase the risk of abrasion.
The alignment guide (130728) should always be used with PLUSMET ® metal inserts in order to
obtain the necessary level of accuracy.
It is advisable to use computer-assisted navigation systems intraoperatively for documentation
and verification of the implant position, and to get exact information on the ROM.
16

Placement of the metal insert (ME)
Proceed with the trial insert as described in section 11.
Before insertion it must be ensured that the internal
surface of the metal shell is dry and free of any contamination.
Screw the adapter for ME-inserts (130989 – 130993)
and the impactor head onto the inserter/impactor.
Attach the implant onto the adapter.
Place the 3 arms of the adapter on the front face of
the metal shell so that the PLUSMET ® metal insert is
not tilting.
Insert it into the shell by gently hitting the inserter/
impactor.
Note
To impact the metal/insert only the above described
adapter respectively inserter/impactor must be used.
17

16. Revision of the metal/ceramic insert
Screw the extraction instrument for metal/ceramic
inserts onto the inserter/impactor (130818).
Position the extraction instrument on the edge of
the metal/ceramic insert with care. Fit the 3 tips into
the lateral recess in the shell – they are correctly
positioned when lateral torsion is not possible.
Release the metal/ceramic insert by impaction of the
inserter/impactor and remove it.
7. Postoperative Treatment
The treatment of the patient after surgery will depend on several factors (in particular the surgical
approach, the stem prosthesis used and any attendant diseases). If the patient has a good
bone quality and the primary implantation of both prosthesic components is stable, then it is
recommended that the patient use walking aids for 6 – 12 weeks after surgery.
However, the exact degree of walking assistance required will have to be decided by the physician
for each individual patient.
8. Sterilisation
Implants
All the implants described in this Operating Technique are sterile when they are delivered by
the manufacturer. Re-sterilisation is not allowed.
Instruments
System components and instruments are not sterile when they are delivered. Before use they
must be cleaned by the usual methods in accordance with internal hospital regulations and
sterilised in an autoclave in accordance with the legal regulations and guidelines applicable in
the relevant country. (For detailed information please refer to leaflet Lit. No. 1363.)
The correct settings are given in the instructions for use issued by the autoclave manufacturer.
Instrument manufacturers and dealers accept no responsibility for sterilisation of products by
the customer.
18

9. References
Zwartelé RE, Brand R, Doets HC
Increased risk of dislocation after primary total hip arthroplasty in inflammatory arthritis –
prospective observational study of 410 hips
Acta Orthop Scand, 2004; 12
Adler E, Stuchin A, Kummer FJ
Stability of Press-Fit acetabular cup.
J Arthroplasty 1992; 7:295-301
Doets HC, Olsthoorn PGM, Schmotzer H
Medium-term results with the Enhanced Press-Fit Cup in osteoarthrosis, rheumatoid arthritis
and revision arthroplasty, 2003.
Engh CA, Griffin WL, Marx CL
Cementless acetabular components.
J Bone Joint Surg (Br) 1990; 72B:53-59
Lachiewicz PF, Suh PB, Gilbert JA
In vitro initial fixation of porous-coated acetabular total hip components. A biomechanical
comparative study.
J Arthroplasty 1989; 4:201-205
Lintner F, Zweymüller K, Brand G
Tissue reactions to titanium endoprostheses.
J Arthroplasty 1986; Vol. 1, No. 3:183-95
McKenzie JR, Callaghan JJ, Pedersen P, Brown TD
Areas of contact and extent of gaps with implantation of oversized acetabular components
in Total Hip Arthroplasty.
Clin Orthop 1984; 208:127-136
Snorrason F, Kärrholm PJ
Migration of fully threaded acetabular components.
A roentgen stereo-photogrammetic analysis.
J Bone Joint Surg 1990; 72B:647-652
19

10. Implants
Shells
Shell Ti-plasma,
without screwholes
Shell Ti-plasma with hydroxyapatite
coating, without screwholes
Art. No.
Size
Art. No.
Size
15300 40
15301 42
15302 44
15303 46
15304 48
15305 50
15306 52
15307 54
15308 56
15309 58
15310 60
15311 62
15340 40
15341 42
15342 44
15343 46
15344 48
15345 50
15346 52
15347 54
15348 56
15349 58
15350 60
15351 62
Shell Ti-plasma,
with screwholes
Art. No. Size No. of
holes
15320 40 2
15321 42 2
15322 44 2
15323 46 2
15324 48 2
15325 50 2
15326 52 2
15327 54 2
15328 56 3
15329 58 3
15330 60 3
15331 62 3
15332 64 3
15333 66 3
15334 68 3
Shell Ti-plasma with hydroxyapatite
coating, with screwholes
Art. No. Size No. of
holes
15360 40 2
15361 42 2
15362 44 2
15363 46 2
15364 48 2
15365 50 2
15366 52 2
15367 54 2
15368 56 3
15369 58 3
15370 60 3
15371 62 3
15372 64 3
15373 66 3
15374 68 3
20

Shell Ti-plasma, multi-hole
Art. No. Size No. of
holes
15410 56 6
15411 58 6
15412 60 6
15413 62 6
15414 64 6
15415 66 6
15416 68 6
21

Inserts
Note
All cup inserts must only be used in combination with the acetabular cup systems approved
by Plus Orthopedics.
PE inserts, standard
Art. No. Ø Size
15462 22 mm 40 – 44
15463 22 mm 46
15464 22 mm 48
15465 22 mm 50
15470 28 mm 46
15471 28 mm 48
15472 28 mm 50 – 52
15473 28 mm 54 – 56
15474 28 mm 58 – 68
15481 32 mm 50 – 52
15482 32 mm 54 – 56
15483 32 mm 58 – 68
PE inserts, hooded, 15°
Art. No. Ø Size
15486 28 mm 46
15487 28 mm 48
15488 28 mm 50 – 52
15489 28 mm 54 – 56
15490 28 mm 58 – 68
15491 32 mm 50 – 52
15492 32 mm 54 – 56
15493 32 mm 58 – 68
REXPOL TM , standard
Art. No. Ø Size
15570 28 mm 46
15571 28 mm 48
15572 28 mm 50 – 52
15573 28 mm 54 – 56
15574 28 mm 58 – 68
15582 32 mm 50 – 52
15583 32 mm 54 – 56
15584 32 mm 58 – 68
REXPOL TM , hooded 15°
Art. No. Ø Size
15500 28 mm 46
15501 28 mm 48
15502 28 mm 50 – 52
15503 28 mm 54 – 56
15504 28 mm 58 – 68
15512 32 mm 50 – 52
15513 32 mm 54 – 56
15514 32 mm 58 – 68
Note
Only a combination of BIOLOX ® forte/delta ball heads with cup inserts of BIOLOX ® forte/delta
is permitted. Any of the BIOLOX ® forte/delta family of ball heads may be used with any of the
ceramic inserts from the BIOLOX ® family, provided that the correct head/calotte diameter is
used.
Other components that have not been approved by Plus Orthopedics must not be used.
Pairings with 32 mm ball heads or bogger generally improve the range of motion and thus
reduce the risk of impingement and subluxation.
22

Metal inserts, standard
Art. No. Ø Size
15100 28 mm 46
15101 28 mm 48
15102 28 mm 50 – 52
15103 28 mm 54 – 56
15104 28 mm 58 – 68
Ceramic inserts, standard
Art. No. Ø Size
15140 28 mm 46
15141 28 mm 48
15142 28 mm 50 – 52
15143 28 mm 54 – 56
15144 28 mm 58 – 68
15149 32 mm 46
15150 32 mm 48
15151 32 mm 50 – 52
15152 32 mm 54 – 56
15153 32 mm 58 – 68
66021 44/36 mm 50 – 52
66022 48/36 mm 54 – 56
66023 52/36 mm 58 – 68
Note
EP-FIT PLUS ® metal inserts must only be used with PLUSMET ® metal ball heads for metal/metal
pairings. Ball heads from other manufacturers must not be used.
23

Ball heads
Ceramic ball heads, BIOLOX ® forte
Art. No. Ø Cone Neck length
16151 28 mm 12/14 S
16152 28 mm 12/14 M
16153 28 mm 12/14 L
16161 32 mm 12/14 S
16162 32 mm 12/14 M
16163 32 mm 12/14 L
66011 36 mm 12/14 S
66012 36 mm 12/14 M
66013 36 mm 12/14 L
66014 36 mm 12/14 XL
Metal ball heads, PLUSMET ®
Art. No. Ø Cone Neck length
16181 28 mm 12/14 S
16182 28 mm 12/14 M
16183 28 mm 12/14 L
16184 28 mm 12/14 XL
16185 28 mm 12/14 XXL
16186 28 mm 14/16 S
16187 28 mm 14/16 M
16188 28 mm 14/16 L
16189 28 mm 14/16 XL
16190 28 mm 14/16 XXL
24

Ceramic ball heads, BIOLOX ® OPTION (for revisions)
Art. No. Ø Cone Neck length
CE3849717693581 28 mm 12/14 S
CE3849717693582 28 mm 12/14 M
CE3849717693583 28 mm 12/14 L
CE3849717693584 28 mm 12/14 XL
CE3849717694581 32 mm 12/14 S
CE3849717694582 32 mm 12/14 M
CE3849717694583 32 mm 12/14 L
CE3849717694584 32 mm 12/14 XL
Note
Before the BIOLOX ® forte/delta/OPTION, PLUSMET ® ball head is placed on the stem it must be
ensured that the cone is free of contaminating particles such as bone fragments, metal or
cement, and that it is not damaged.
Cancellous bone screws
Art. No. Description Ø Length
25281 Cancellous bone screw 6,5 mm 20 mm
25282 Cancellous bone screw 6,5 mm 25 mm
25283 Cancellous bone screw 6,5 mm 30 mm
25287 Cancellous bone screw 6,5 mm 35 mm
25284 Cancellous bone screw 6,5 mm 40 mm
25288 Cancellous bone screw 6,5 mm 45 mm
25285 Cancellous bone screw 6,5 mm 50 mm
25289 Cancellous bone screw 6,5 mm 55 mm
25286 Cancellous bone screw 6,5 mm 60 mm
EP-FIT PLUS ® , PLUSMET ® , PLUS-FIT TM and SL-PLUS ® are trademarks of Plus Orthopedics AG, Switzerland, registered in Switzerland
and other selected countries.
CeraLock ® , BIOLOX ® forte, BIOLOX ® OPTION and BIOLOX ® delta are registered trademarks of CeramTec AG, Germany.
25

11. Instrumentation
Case 1
1 A Basic Case: Instruments and trial shells
Art. No. Description Size
130994 Basic Case I (without cover)
130999 Cover for EP-FIT PLUS ® case
130707 Shell Inserter, standard version
130705 Insertion/Extraction hammer
130728 Shell alignment guide, standard version
130731 Depth gauge for shell
130734 Trial shell 40
130735 Trial shell 42
130712 Trial shell 44
130713 Trial shell 46
130714 Trial shell 48
130715 Trial shell 50
130716 Trial shell 52
130717 Trial shell 54
130719 Trial shell 56
130720 Trial shell 58
130721 Trial shell 60
130723 Trial shell 62
130724 Trial shell 64
130736 Trial shell 66
130737 Trial shell 68
130820 Extraction instrument for metal/ceramic insert to 130818 46
130794 Extraction instrument for metal/ceramic insert to 130818 48
130795 Extraction instrument for metal/ceramic insert to 130818 50 – 52
130796 Extraction instrument for metal/ceramic insert to 130818 54 – 56
130797 Extraction instrument for metal/ceramic insert to 130818 58 – 68
26

3
3
5
4 2
6 1
27

1 B Tray: Reamer (2 mm increments) and inserter/impactor for PE inserts
Art. No. Description Size
130996 Tray to Case 130994
130870 Drive shaft, with Synthes-coupling
130871 Reamer 40
130873 Reamer 42
130875 Reamer 44
130877 Reamer 46
130879 Reamer 48
130881 Reamer 50
130883 Reamer 52
130885 Reamer 54
130887 Reamer 56
130889 Reamer 58
130891 Reamer 60
130893 Reamer 62
130895 Reamer 64
130897 Reamer 66
130899 Reamer 68
130822 Impactor head 22
130823 Impactor head 28
130824 Impactor head 32
130848 Impactor head 36
130818 Inserter/Impactor
130802 Adapter for PE insert, standard, to 130818 40 – 44
130803 Adapter for PE insert, standard, to 130818 46 – 48
130804 Adapter for PE insert, standard, to 130818 50 – 68
130806 Adapter for PE insert, hooded, to 130818 46 – 48
130807 Adapter for PE insert, hooded, to 130818 50 – 68
28

3
5
2 1
4
6
29

Case 2
2 A Basic Case: Trial inserts
Art. No. Description Ø Size
131001 Basic Case II (without cover)
130999 Cover for EP-FIT PLUS ® case
130989 Adapter for ME insert, standard, to 130818 46
130990 Adapter for ME insert, standard, to 130818 48
130991 Adapter for ME insert, standard, to 130818 50 – 52
130992 Adapter for ME insert, standard, to 130818 54 – 56
130993 Adapter for ME insert, standard, to 130818 58 – 68
130826 Trial insert, standard 22 mm 40 – 44
130827 Trial insert, standard 22 mm 46
130828 Trial insert, standard 22 mm 48
130829 Trial insert, standard 22 mm 50
130830 Trial insert, standard 28 mm 46
130831 Trial insert, standard 28 mm 48
130832 Trial insert, standard 28 mm 50 – 52
130833 Trial insert, standard 28 mm 54 – 56
130834 Trial insert, standard 28 mm 58 – 68
130835 Trial insert, standard 32 mm 50 – 52
130836 Trial insert, standard 32 mm 54 – 56
130837 Trial insert, standard 32 mm 58 – 68
660121 Trial insert, standard 36 mm 50 – 52
660122 Trial insert, standard 36 mm 54 – 56
660123 Trial insert, standard 36 mm 58 – 68
130850 Trial insert, hooded 28 mm 46
130851 Trial insert, hooded 28 mm 48
130852 Trial insert, hooded 28 mm 50 – 52
130853 Trial insert, hooded 28 mm 54 – 56
130854 Trial insert, hooded 28 mm 58 – 68
130855 Trial insert, hooded 32 mm 50 – 52
130856 Trial insert, hooded 32 mm 54 – 56
130857 Trial insert, hooded 32 mm 58 – 68
30

3
1
2
31

2 B Tray: Bone screws and accessories
Art. No. Description Ø Length
130995 Tray to Case 131001
130490 Flexible drill shaft for quick coupling
130847 Drill guide for screws 3,2 mm
130708 Depth gauge for screws
130732 Screw-holding forceps
130710 Screwdriver, hexagon W 3,5 mm
130492 Twist drill 3,2 mm 56 mm
130493 Twist drill 3,2 mm 70 mm
130496 Cardan screwdriver, hexagon W 3,5 mm
131002 Container for cancellous bone screws to tray 130995
32

6
8
4
7
5
2
3 3
1
33

Case 3
3 A Basic Case: Instruments and trial shells (identical to 1A)
Art. No. Description Size
131000 Basic Case III (without cover)
130999 Cover for EP-FIT PLUS ® case
130707 Shell inserter, standard version
130705 Insertion/Extraction hammer
130728 Shell alignment guide, standard version
130731 Depth gauge for shell
130734 Trial shell 40
130735 Trial shell 42
130712 Trial shell 44
130713 Trial shell 46
130714 Trial shell 48
130715 Trial shell 50
130716 Trial shell 52
130717 Trial shell 54
130719 Trial shell 56
130720 Trial shell 58
130721 Trial shell 60
130723 Trial shell 62
130724 Trial shell 64
130736 Trial shell 66
130737 Trial shell 68
130820 Extraction instrument for metal/ceramic insert, to 130818 46
130794 Extraction instrument for metal/ceramic insert, to 130818 48
130795 Extraction instrument for metal/ceramic insert, to 130818 50 – 52
130796 Extraction instrument for metal/ceramic insert, to 130818 54 – 56
130797 Extraction instrument for metal/ceramic insert, to 130818 58 – 68
34

3
3
5 4
2
6
1
35

3 B Tray: Reamer (1 mm increments) Sizes 40 – 43 and 66 – 69
Art. No. Description Size
130998 Tray to Case 131000
130987 Shell Inserter
130975 Adapter, to 130987 40 – 44
130976 Adapter, to 130987 46
130977 Adapter, to 130987 48
130978 Adapter, to 130987 50 – 52
130979 Adapter, to 130987 54 – 56
130980 Adapter, to 130987 58 – 68
130897 Reamer 66
130898 Reamer 67
130899 Reamer 68
130900 Reamer 69
130871 Reamer 40
130872 Reamer 41
130873 Reamer 42
130874 Reamer 43
130822 Impactor head 22
130823 Impactor head 28
130824 Impactor head 32
130848 Impactor head 36
130802 Adapter for PE insert, standard, to 130818 40 – 44
130803 Adapter for PE insert, standard, to 130818 46 – 48
130804 Adapter for PE insert, standard, to 130818 50 – 68
130806 Adapter for PE insert, hooded, to 130818 46 – 48
130807 Adapter for PE insert, hooded, to 130818 50 – 68
130818 Inserter/Impactor
130858 Shell alignment guide (US version)
36

4
8
8
8
3
1
5
2
7
6
37

3 C Tray: Reamer (1 mm increments) Sizes 44 – 45
Art. No. Description Size
130997 Tray to Case 131000
130870 Drive shaft
130875 Reamer 44
130876 Reamer 45
130877 Reamer 46
130878 Reamer 47
130879 Reamer 48
130880 Reamer 49
130881 Reamer 50
130882 Reamer 51
130883 Reamer 52
130884 Reamer 53
130885 Reamer 54
130886 Reamer 55
130887 Reamer 56
130888 Reamer 57
130889 Reamer 58
130890 Reamer 59
130891 Reamer 60
130892 Reamer 61
130893 Reamer 62
130894 Reamer 63
130895 Reamer 64
130896 Reamer 65
Note
Case 1 may be replaced by case 3 if a reamer with 1 mm increments is required.
38

2
1
39

40
Notes

Distribution
Sales Partners in:
Australia
Baltic countries (EE, LT, LV)
Belarus
Bosnia
Brazil
Bulgaria
India
Indonesia
Iran
Croatia
Kuwait
Malaysia
Norway
Russia
Slovakia
Slovenia
South Africa
South Korea
Thailand
Czech Republic
Turkey
Belgium
Plus Orthopedics Belgium Sprl
Rue du Bosquet, 2, P.I Nivelles Sud, 1400 – Nivelles
Phone +32 67 879 500, Fax +32 67 646 640
China
Plus Orthopedics (Beijing) Co., Ltd.
7th Floor, Modern Palace, No. 20 Daluyuan
Dongsanhuan Nanlu, Chaoyang District
Beijing 100022, P.R. China
Phone +86 10 8778 3322, Fax +86 10 6776 3622
Germany
Plus Orthopedics GmbH
Mainstrasse 2, 45768 Marl
Phone +49 2365 91 81 0, Fax +49 2365 91 81 10
France
Plus Orthopedics France Sarl (new address from 1 st April, 2006)
14, Villa des Fleurs, 92400 Courbevoie
Phone +33 1 49 97 04 60, Fax +33 1 47 68 09 36
Greece
Plus Orthopedics Hellas S.A.
Kleanthous Street 8, GR 16346 Ilioupoli, Athina
Phone +30 2 10 99 13 190, Fax +30 2 10 99 31 809
United Kingdom
Plus Orthopedics (UK) Limited
Barbury House, Stonehill Green, Westlea, Swindon SN5 7HB
Phone +44 1793 719 222, Fax +44 1793 619 222
Italy
Plus Orthopedics Italy Srl
Via Archimede 76, 20041 Agrate Brianza (MI)
Phone +39 039 657 921, Fax +39 039 657 92 35
Japan
Plus Orthopedics K.K.
Tomigaya-Ogawa Bldg. 2-41-12, Tomigaya
Shibuya-ku, Tokyo 151-0063
Phone +81 3 3467 5581, Fax +81 3 3467 5582
The Netherlands
Plus Orthopedics Netherlands BV
Postbus 785, 2700 AT Zoetermeer
Phone +31 793 41 7071, Fax +31 793 42 5601
Austria
Plus Orthopedics GmbH
Grenzgasse 38a, 2340 Mödling
Phone +43 (0)2236/48 407-0, Fax +43 (0)2236/41 149-4
Switzerland
Plus Orthopedics Schweiz AG
Erlenstrasse 4a, 6343 Rotkreuz
Phone +41 (0)41 798 41 11, Fax +41 (0)41 798 41 00
Spain
Plus Orthopedics España S.A.
c/Islas Aleutianas n 4, 28035 Madrid
Phone +34 91 376 86 20, Fax +34 91 376 86 21
USA
Plus Orthopedics USA, Inc.
10188 Telesis Court, San Diego, CA 92121
Phone +1 858 550 3800, Fax +1 858 457 56 18
Switzerland
Plus Orthopedics AG (Manufacturer)
Erlenstrasse 4a, 6343 Rotkreuz
Phone +41 (0)41 798 41 11, Fax +41 (0)41 798 41 00
info@plusorthopedics.com
www.plusorthopedics.com
Technical changes reserved
Lit. No. 1258-e Ed. 09/05 1000 Ex. 03/06