| Ordering Information
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- Ensure all implant and instrument kits are received and ready.
- PRZS – KIT2 Slotted PROFEMUR® Z Broach kit
- PATH - KIT3 PATH® General instruments
- PHRM – KIT1 PATH® Reamer baskets
- PRGI – KIT1 PROFEMUR® General Instruments - head and neck trials, etc
- PBFH – KIT1 PATH® BFH® Suction Impactor and Alignment Handles
- PZTA – KIT1 PROFEMUR® Z Tamps (if necessary)
- Have templates available at the surgery.
- 3802-XR15 BFH®/CONSERVE® Shell templates
- 3600-XR15 LINEAGE® Templates
- PRFZ-XR15 PROFEMUR® Z Templates
- Ensure sterile items have been ordered and are present.
- 20070031 Steinman pins – for use with pin retractors
- 2007ST20 Cannula – creates channel for reaming and shell impaction
- 20070057 Schantz screw – for removal of femoral head
- Other key items to have for a successful PATH® surgery.
- Reciprocating saw for neck resection
- Pituitary Ronguer for removal of labrum
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| Patient Positioning
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- Patient positioning is key. The patient must be positioned firmly in a true lateral decubitus position and moved as far forward/anterior to the edge of the table as possible. A peg board is helpful. (Peg Boards can be purchased through White Surgical – (901) 758-8768.)
- Pre-op templating is very helpful in planning for necessary sizing.
- It is recommended to measure from the tip of the Greater Trochanter when templating for stem insertion depth.
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| Incision
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- Incision template has a left and right side.
- Make sure that your incision is proximal to the Greater Trochanter extending in an oblique fashion approximately 30°-50°. This helps to expose the maximum length of the piriformis tendon.
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| Retractors
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- Use a Cobb Elevator to tease apart the fibers of the Gluteus Maximus.
- PINPOINT™ Steinman pin retractors and Gluteus retractors come in left and right versions.
- After insertion of Steinman pins into the PINPOINT™ Retractors, surgeons should bend the pins down out of the way. PINPOINT™ retractors are placed posteriorly on the ischium, between the capsule and labrum.
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| Neck Resection
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| The neck is resected first using an oscillating saw and then finished with a reciprocating saw. |
| Portal Placement Guide
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- Load a Trial Shell (2007-0152) or any other trial shell onto the end of the Alignment tower and drop down into the acetabulum.
- Load cannula on Trocar. Always use a scalpel to open the entry point for the sharp trocar. Once entry has been made with trocar, the cannula remains in the tissue providing a working channel for reaming and impaction.
- Cannula must be inserted posterior to the femur.
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| Acetabular Preparation
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- When entering the main incision with the reamer baskets and implant, turn reamers or implant inline with the incision, then rotate into position of the acetabulum.
- When using a CONSERVE® Shell suction impactor tip, dip suction head in sterile water, then apply cup implant, then apply suction to the alignment guide to help with suction seating for the implant.
- If necessary, you can tap on the sides of the suction impactor tips for minor corrections in cup orientation.
- Once cup implant is seated, remove suction from the alignment guide, then remove alignment guide from the acetabulum.
- It is recommended to take an intra-operative X-ray for each case to insure proper acetabular component positioning.
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| Femoral Preparation
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- Make sure that the hip is flexed to 45°-48° and internally rotated 45°-80° for maximum adduction.
- This helps protect the posterior skin
- Always use tissue protective sleeve for reaming the femur
- Broach depth is measured from the top of the lateral shoulder (of the broach) to the tip of the Greater Trochanter. This measurement should be within 5 mm of your pre-op templated range.
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