Operation technique CORON-PressFit-Cup - tantum AG

Operation technique
PressFit-Acetabular-Cup
CORON

))) The tantum Total
Hip System at a glance
Bipolar Head Acetabular
Cup, cemented
Ceramic
Femoral Head
Metal
ENDON –
non cemented
Straight Stem
Mono Head
tantum · Operative technique CORON-PressFit-Cup
PressFit-Inlay PressFit-Inlay DYS 10°
CORON –
cemented
Straight Stem
PressFit-Cup
Modularity provides flexibility
Different components allow the optimal
choice for each indication
2

))) Operation technique
CORON-PressFit-Cup
40°
tantum · Operative technique CORON-PressFit-Cup
Features and benefits of the CORON-PressFit-Cup
Hemispheric titanium metal back with flattened top
provides low profile. Non-cemented anchorage by
press-fit design and micro-structured surface. Up to
three optional fixation screws ensure additional
primary anchorage. Reliable connection of the polyethylene
inlays by snap lock mechanism.
Indication
Primary and secondary coxarthrosis with sufficient
peripheal anchorage of the acetabular cup
Contraindication
– Severe osteoporosis
– Severe dysplasia coxarthrosis with significant defect
of the acetabulum
Implant selection
The CORON-PressFit-Cup is available in 13 sizes. There
are standard and 10° dysplasia inlays to choose from.
For optional primary anchorage of the PressFit-Cup,
fixation screws are available in 9 lengths.
The combination of the CORON-PressFit-Cup with
either the non-cemented ENDON Straight Stem or
with the cemented CORON-Straight Stem, as a hybrid
treatment, is recommended.
For implantation of the stem, please refer to separate
operative techniques for ENDON and CORON-Hip-
Endoprosthesis.
Preoperative planning
The size of the CORON-PressFit-Cup is determined in
ap-projection using X-ray Templates (Art.-No. 208-182).
The template is inclined approx. 40° according to the
acetabular cups entry level and then turned until the
acetabular cup is in correct anatomical position. The
acetabular cups perimeter is traced, its center marked.
When determining the size of the stem the center of
the acetabular cup is also the center of the femoral
head.
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Fig. 1
Fig. 2
tantum · Operative technique CORON-PressFit-Cup
1. Positioning and opening
The patient is positioned supine, the side to be operated
is gently lifted. The approach is performed
through a curved incision centered over the greater
trochanter and directed towards the anterior superior
iliac spine. Exposure of the gluteus medius muscle and
splitting along the direction of the muscle fibres. Two
Hohmann retractors are placed ventrally and dorsally
to the femoral neck. The joint capsule is opened, the
ventral parts are resected (Fig. 1).
2. Resection of the femoral neck
The Hohmann retractors are changed to an intraarticular
position. Depending on the fracture pattern,
the femoral head can either be luxated by a so-called
corkscrew and luxation-spoon or through traction and
external rotation of the leg. The femoral head is
resected beginning from the intertrochanteric line
in a descending orientation of approx. 45° medially.
Thereafter the femoral head is removed (Fig. 2).
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Fig. 3
Fig. 4
Fig. 5
~40°
~40°
~40°
tantum · Operative technique CORON-PressFit-Cup
3. Preparation of the acetabulum
The capsule is removed in the cranial and caudal part.
In order to minimize the bleeding, it is recommended
to leave the posterior part in place. The acetabulum is
exposed by a shaped Hohmann-retractor, its tip placed
behind the dorsal rim, and a second retractor positioned
on the anterior rim. Existing exophytes are
resected and cartilage of the acetabulum is removed
with the Grater (Art.-No. 207-111 to 207-123) with
Handle (Art.-No. 200-122). Starting with a small size
(44 mm) in medial direction (anteversion of 10-20°),
continuing parallel to the acetabular entry level (inclination
of approx. 40° towards the bony pelvis) until
the final acetabular size according to the preoperative
planning is reached (Fig. 3).
4. Checking of the reamed cavity
The joint is irrigated with Ringers solution. A PF Trial
Cup (Art.-No. 208-210 to 208-222) of the pre-determined
size is inserted by using the PF Cup Inserter
(Art.-No. 200-130). Orientation as described above.
Visual inspection of the reamed cavity for an exact fit
of the trial cup.
If necessary, re-reaming of the acetabulum (Fig. 4).
5. Implantation of the Acetabular-Cup
The PF-Cup (Art.-No. 102-320 to 102-332) is implanted
by using the PF Cup Inserter (Art.-No. 200-130).
Both correct anteversion and inclination should be
observed. The holes for the optional fixation screws
are oriented cranially (Fig. 5).
If necessary, moderate hammering can be applied to
achieve press fit of the PF Cup.
5

Fig. 6
Fig. 7
Fig. 8
(a)
(b)
tantum · Operative technique CORON-PressFit-Cup
6. Placement of cranial fixation screws
In order to enhance primary stability, up to three fixation
screws can be inserted into the acetabular roof.
The holes for the screws for the PressFit-Cup (Art.-No.
102-340 to 102-148) are prepared using the Drill Guide
(Art.-No. 205-121) and the flexible Drill d=3.2 (Art.-No.
203-123) (Fig. 6).
The length of the fixation screws is determined using
the Screw Gauge (Art.-No. 208-103).
The screws for PF-Cup are inserted with the
Screwdriver SW 3.5 (a) (Art.-No. 201-141). With difficult
approaches, the Universal-Joint-Screwdriver (b)
(Art.-No. 201-142) may be used (Fig. 7).
Moistened gauze is placed into the cup´s cavity.
7. Implantation of the prosthesis´ stem
The femur is prepared according to the operative
technique of the prothesis stem. The gauze is removed
from the cup´s cavity and the PF Trial Inlay (Art.-No.
208-190 to 208-202) is inserted into the PF-Cup. Trial
reduction of the prosthesis into the PF-Cup and determination
of the correct femoral head neck length.
After implantation of the prosthesis stem another
trial reduction is performed and the final femoral
head is assembled.
8. Implantation of the final inlay
The PF Trial Inlay is removed and the PF-Inlay (Art.-No.
102-350 to 102-362) is inserted. In case of luxation tendency
a PF Dysplasia Inlay (Art.-No. 102-370 to 102-
382) is inserted. The inlay is pressed into the PF-Cup by
using the Impactor for PF-Inlay (Art.-No. 205-136) with
the tip for the Inlay Impactor (Art.-No. 205-137) (Fig. 8).
Final functional control. Two Redon drains are inserted
dorsally and laterally. The wound is closed in layers.
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Fig. 9
Fig. 10
tantum · Operative technique CORON-PressFit-Cup
9. Implantation in situ
Illustration of the CORON-PF-Cup (here with noncemented
ENDON Straight Stem) in frontal and lateral
views (Fig. 9 and Fig. 10).
10. Postoperative care
Mobilisation beginning on the first postoperative day.
No weight-bearing ambulation for the first six weeks
postoperatively.
Note: In the postoperative course, the position of the
implant should be checked periodically. With signs of
complications, counter-measures can be taken.
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CORON-PressFit-Instruments
200-122 Handle for Grater Grater
Ø 44 mm 207-111
Ø 46 mm 207-112
Ø 48 mm 207-113
Ø 50 mm 207-114
Ø 52 mm 207-115
Ø 54 mm 207-116
200-130 PF-Cup Inserter
Ø 56 mm 207-117
201-141 Screwdriver
201-142 Universal-Joint-Screwdriver
203-123 Drill, flexible
205-121 Drill Guide
205-136 Impactor for PF-Inlay
205-137 Tip for Inlay Impactor
208-103 CORON Screw Gauge
PF Trial Inlay
InnerØ: 28 mm
Ø 44 208-190
Ø 46 208-191
Ø 48 208-192
Ø 50 208-193
Ø 52 208-194
Ø 54 208-195
Ø 56 208-196
PF Trial Cup
Ø 44 mm 208-210
Ø 46 mm 208-211
Ø 48 mm 208.212
Ø 50 mm 208-213
Ø 52 mm 208-214
Ø 54 mm 208-215
Ø 56 mm 208-216
tantum · Operative technique CORON-PressFit-Cup
Ø 58 mm 207-118
Ø 60 mm 207-119
Ø 62 mm 207-120
Ø 64 mm 207-121
Ø 66 mm 207-122
Ø 68 mm 207-123
208-183 PF Cup X-ray Template (1 set), without fig.
Ø 58 208-197
Ø 60 208-198
Ø 62 208-199
Ø 64 208-200
Ø 66 208-201
Ø 68 208-202
Ø 58 mm 208-217
Ø 60 mm 208-218
Ø 62 mm 208-219
Ø 64 mm 208-220
Ø 66 mm 208-221
Ø 68 mm 208-222
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CORON-PressFit-Components
PF Cup, sterile
Material: Titanium (ISO 5832-3)
OuterØ Art.-No.
44 mm 102-320
46 mm 102-321
48 mm 102-322
50 mm 102-323
52 mm 102-324
54 mm 102-325
56 mm 102-326
Screw for PF Cup, sterile
Material: Titanium (ISO 5832-3)
Length Art.-No.
L 20 102-340
L 25 102-341
L 30 102-342
L 35 102-343
L 40 102-344
tantum AG
Memellandstr. 2
D-24537 Neumünster
Fon +49 4321-2 00 59 0
Fax +49 4321-2 00 59 19
info@tantum-ag.de
OuterØ Art.-No.
58 mm 102-327
60 mm 102-328
62 mm 102-329
64 mm 102-330
66 mm 102-331
68 mm 102-332
Length Art.-No.
L 45 102-345
L 50 102-346
L 55 102-347
L 60 102-348
PF Inlay DYS, sterile
Material: PE (ISO 5834-2)
Titanium (ISO 5832-3)
Dysplasia 10°
InnerØ: 28 mm
For outerØ Art.-No.
44 mm 102-370
46 mm 102-371
48 mm 102-372
50 mm 102-373
52 mm 102-374
54 mm 102-375
56 mm 102-376
PF Inlay, sterile
Material: PE (ISO 5834-2)
Titanium (ISO 5832-3)
InnerØ: 28 mm
for outerØ Art.-No.
44 mm 102-350
46 mm 102-351
48 mm 102-352
50 mm 102-353
52 mm 102-354
54 mm 102-355
56 mm 102-356
tantum · Operative technique CORON-PressFit-Cup
B 04/23.0
For outerØ Art.-No.
58 mm 102-377
60 mm 102-378
62 mm 102-379
64 mm 102-380
66 mm 102-381
68 mm 102-382
for outerØ Art.-No.
58 mm 102-357
60 mm 102-358
62 mm 102-359
64 mm 102-360
66 mm 102-361
68 mm 102-362
The figures shown are schematic and not equivalent to the original measurements.
Technical changes may occur without prior notice. September 2004