6568 OPT MS 30 engl - hi

Modern shaft concept for cemented anchoring

MS-30® StemCemented

Surgical Technique

Introduction 3

Preoperative PlanningPlanning objectives 4Determining leg length 4Templates 5Cement mantle 6Planning steps in the case of unilateral coxarthrosis 7

Variants of the Surgical Technique 10Lateral Approach – Surgical technique according to Professor E.W. Morscher 11Posterior Approach – Surgical technique according to Professor L. Spotorno 19Case Studies 26

Ordering informationImplants 28Instrumentation 29

Disclaimer This document is intended exclusively for experts in the field, i.e. physicians in particular, and is expressly not for the information of laypersons.The information on the products and/or procedures contained in this document is of a general nature and does notrepresent medical advice or recommendations. Since this information does not constitute any diagnostic or therapeuticstatement with regard to any individual medical case, individual examination and advising of the respective patientare absolutely necessary and are not replaced by this document in whole or in part.The information contained in this document was gathered and compiled by medical experts and qualified Zimmeremployees to the best of their knowledge. The greatest care was taken to ensure the accuracy and ease of understanding of the information used and presented. Zimmer does not assume any liability, however, for the up-to-dateness, accuracy, completeness or quality of the information and excludes any liability for tangible or intangible losses that maybe caused by the use of this information.In the event that this document could be construed as an offer at any time, such offer shall not be binding in any eventand shall require subsequent confirmation in writing.MS-30®, Press-Fit™ and Protasul® are registered trademarks of Zimmer GmbH.

The philosophy of the MS-30 stem features a cemented anchorage. The three-dimensional tapered designwithout corners or edges maintains the strength of the cement mantle in thevarious Gruen zones. The geometry of the cement mantle isestablished during the preoperativeplanning.

The highly polished surface, togetherwith the hollow space design of the distal centralizer, permits debonding inthe uninterrupted cement mantle.

For good long-term results for cement-ed stems, particular attention shouldbe paid to the cementing technique1:Fundamental factors are insertionunder pressure and ensuring a stablecement mantle particularly in thecalcar region.

Different offset options allow the creation or restoration of normal anato-my and biomechanics. The standardversion and the lateral version of theMS-30 stem allow the surgeon greaterintraoperative flexibility.

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MS-30® Stem CementedIntroduction

1 Barrack RL, Mulroy RD, Harris WH: Improved cementing techniques and femoralcomponent loosening in young patients with hip arthroplasty. A 12-year radiographicreview. J Bone Joint Surg 74B: 385–389,1992

2 Berli B, Elke R, Morscher EW: The cementedMS-30 stem in total hip replacement, matte versus polished surface: minimum offive years of clinical and radiographic resultsof a prospective study. In: Winters GL, Nutt MJ (ed): Stainless steels for medical andsurgical applications. ASTM STP 1438,2003: 249–261

3 Spotorno L, Grappiolo G, Penenberg BL,Burastero G: Eight to eleven years review ofhybrid THA using a femoral stem andcementless titanium acetabulum. AAOS Dallas, 2002

4 Berli B, Schäfer D, Dick W: 100% 10-yearsurvival of a hybrid total hip replacement(MS-30 cemented stem and Morscher Press-Fit cup). EFORT Helsinki, 2003

With the MS-30 stem, one can choosethe surgical technique of ProfessorMorscher for a lateral approach, or thatof Professor Spotorno for a posteriorapproach.

Hip arthroplasties using the MS-30stem have been carried out since 1990.The MS-30 stem with a mat surfacewas introduced on the market in 1992;in 1994, the MS-30 stem with a polished surface2 was launched inter-nationally.

Since 1992, over 100,000 stems have been implanted worldwide withexcellent ten-year results 3, 4.

With these characteristics, the MS-30stem fulfills the demanding require-ments of modern endoprosthetics.

Preoperative planning supports thework of the surgical team and allowsthe surgeon optimum preparation for the operation, as well as for thepurpose of self-monitoring. The objectives of preoperative planningare to determine the stem size, the ideal anchorage of the stem in themedullary cavity, and the optimumposition of the acetabular and femoralcomponents for the restoration of leglength.

Preoperative Planning

Determining leg length

Three horizontal lines are drawn on the AP X-ray of the pelvis: the tangentof both ischia forms the base line.

A second line is drawn over the roofs of the acetabula, and the third betweenthe lesser trochanters.

Using the ischiometer, the center of rotation on the side that is not to beoperated on is established, and the distance to the teardrop figure is mea-sured. Finally, the pelvic axis is drawn,running through the symphysis andperpendicular to the line.

The difference in the distances measured between the connecting lineof the lesser trochanters and the baseline corresponds to the correctionneeded to obtain equal leg lengths.

2

3

1

2

3

1

Same leg lengthAll three lines run parallel.

Dysmetry caused by the femurThe first and second lines run parallel, whilst the bitrochantericline is divergent towards the longer leg.The leg length difference determined on the X-ray must be compared with the difference that is established clinically.

Planning objectives

� The choice and size of the implant�Optimum cement mantle in the

various Gruen zones� Position and height of the resection

of the neck of the femur� The offset and, thus, the decision

as to whether to use the standard orlateral version

� The choice of the corresponding prosthetis head

� The acetabulum, the establishmentof the center of rotation, the size andthe position of the acetabulum

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2

3

1

2

3

1

Templates

The MS-30 templates serve as a plan-ning aid. All sizes are clipped togetherto form one template set.The essential planning information forimplantation of the respective size canbe found on a planning transparency:Here, the stem contours are shownwith the resection line for both the stan-dard and the lateral version of the MS-30. Also shown are the markingsfor the cement mantle and the respective distal centralizers for eachstem size.

Planning templates for the MS-30 stemStandard and lateral

Scale 1.15:1 – Lit. no. 06.00959.0001.18:1 – Lit. no. 06.00969.000

Combined dysmetryAll three lines are divergent.

Dysmetry caused by the jointThe second and third lines run parallel, the first line deviates.

MS-30 Stem

Cemented, Cone 12/14, Head ∅ 28 mm

7 611814 604617

The reference number must correspond to that of the prosthesis to be implanted.

© All rights reserved, Centerpulse Orthopedics Ltd, a Zimmer Company,

CH-8404 Winterthur, Switzerland, 03/2004, Lit.No. 06.00959.000-WL

0 cm

10 cm

5 cm

15 cm

5 cm

10 cm

15 cm

Magnification

1.15:1

Distal Centralizer

Size 6/8

REF 01.00356.008

Size 6/10

REF 01.00356.010

Size 6

StandardREF 30.00.49-060

LateralREF 01.00351.001

MS-30 StemCemented, Cone 12/14, Head ∅ 28 mm

7 611814 604617The reference number must correspond to that of the prosthesis to be implanted.



0 cm

10 cm

5 cm

15 cm

5 cm 10 cm 15 cmMagnification 1.15:1

Distal Centralizer

Size 6/8

REF 01.00356.008

Size 6/10

REF 01.00356.010

Size 6




7 611814 604617

The reference number must correspond to that of the prosthesis to be implanted. © All rights reserved, Centerpulse Orthopedics Ltd, a Zimmer Company, CH-8404 Winterthur, Switzerland, 03/2004, Lit.No. 06.00959.000-WL

0 cm

10 cm

5 cm

15 cm

5 cm10 cm

15 cm

Magnification 1.15:1

Distal Centralizer

Size 6/8REF 01.00356.008

Size 6/10REF 01.00356.010

Size 6




7 611814 604617




0 cm

10 cm

5 cm

15 cm

5 cm

10 cm

15 cm


Distal Centralizer

Size 6/8REF 01.00356.008

Size 6/10REF 01.00356.010

Size 6StandardREF 30.00.49-060LateralREF 01.00351.001


7 611814 604617




0 cm

10 cm

5 cm

15 cm

5 cm

10 cm

15 cm


Distal Centralizer

Size 6/8REF 01.00356.008

Size 6/10REF 01.00356.010



7 611814 604617




0 cm

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5 cm

15 cm

5 cm

10 cm

15 cm


Distal Centralizer

Size 6/8REF 01.00356.008

Size 6/10REF 01.00356.010


5

Cement mantle

The optimum cement mantle for ahighly polished stem without a collar isasymmetrical. It should be stronger or thicker in the area of primary trans-mission of load, i.e. in the calcar region (Gruen zone 7), as well as in thedistal part of the prosthesis (zones 3and 5). Cement mantle thicknessesgreater than 7mm should, however, beavoided, since these not only makepressurization more difficult, but theycan also lead to bone necrosis as a

6

result of an increasing in heat duringpolymerization of the cement. Rotationalforces that encourage loosening areabsorbed by the proximal “wing”, e.g.through sharp edges of the prosthesis.

In order to avoid metal/bone contactwherever possible, above all in thezones of higher stress 3, 5 and 7, a distal centralizer is an integral part ofthe MS-30 stem. Reaming of the medullary canal andusing the distal centralizer and possiblythe proximal positioner bring the stem into a neutral position.

Optimum positioning of the MS-30 stem in the various Gruen zones.

12

3

8 9

10

1413

12

6

5

7

4 11

2 mm 2 mm

4 –7 mm

The proximal positioner creates acement mantle of at least 4 mm in Gruenzone 7: with the aid of the distal centralizer, a cement mantle of 2 mm is created in both, the a/p and the lateral/ medial aspect.

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Planning steps in the case of unilateral coxarthrosis

1. Determine the possible differencein leg length, the prosthesis size andthe position of the cupThe three horizontal lines, the pelviclongitudinal axis (in this example thereis no dysmetry), the center of rotation(measured on the opposite, healthyhip) and the horizontal and vertical distance of the center from the base of the teardrop are drawn in. The template is then placed on top, withthe limit of the acetabulum (ideally as a rule the subchondral bone layer),the height of the teardrop and theplanned inclination of 40–45° beingtaken into account.

2. Trace the hemipelvis and the cupTracing paper is placed on the X-rayand the template, with the longitudinalaxis parallel to the vertical pelvic axis.The hemipelvis and the cup implant aredrawn in.

7 611814 631545

The reference number must correspond to that of the prosthesis to be implanted. © All rights reserved, Centerpulse Orthopedics Ltd, a Zimmer Company, CH-8404 Winterthur, Switzerland, 5/2003, Lit.No. 06.01041.000-WL

0 cm

0 cm

0 cm

0 cm 0 cm


3. Determine the size and position ofthe stemThe approriate template is placed onthe femur. If possible, a space of 4–7mm proxi-mally (calcar) and 2mm distally (tipof the prosthesis) should remainbetween the stem and the inner cortexlayer in order to create an optimumcement thickness. This is the point atwhich the choice of prosthesis size and offset (standard or lateral version)is made. One of the four T-lines thatrun through the center of rotation shouldlie at the height of the greater trochanter.As a rule, the osteotomy level of theneck of the femur is 16–20mm abovethe tip of the lesser trochanter.

4. Pelvis levelWithout removing the femoral template,the tracing paper used in step 2 isplaced in position, so that the inside ofthe cup corresponds to the mean neck length. The bitrochanteric andischiatic lines must be parallel. If, in the case of residual dysmetry, thelines diverge and a leg lengthening is indicated, the following options areavailable: using a prosthesis head with a long neck, higher femur neckresection, or driving the tip of the prosthesis stem less deeply into thefemoral canal.

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MS-30 Stem




CH-8404 Winterthur, Switzerland, 03/2004, Lit.No. 06.00969.000-WL 7 611814 607250

0 cm

10 cm

5 cm

15 cm

5 cm10 cm

15 cmMagnification 1.15:1

Distal Centralizer

Size 8/10

REF 01.00358.010

Size 8/12

REF 01.00358.012

Size 8






CH-8404 Winterthur, Switzerland, 03/2004, Lit.No. 06.00969.000-WL 7 611814 607250

cm

5 cm

cm

15cmMagnificcation

DistalCentralizer

010

Size 8/12

REF 01.00358.012

Size 8

Standardd dREF 30.00.49-080


9

5. Determine the size of the distalcentralizerWhen determining the optimum size ofthe two sketched centralizers on the template, one should select the onethat ensures lateral cortical contactwhen the tip of the prosthesis is centeredin the medullary cavity.

6. Result of preoperative planningThe femur, femoral stem, distal central-izer and medullary plug are drawn on the tracing paper. The medullary plugshould be placed 1–2cm below the tip of the centralizer. The extension ofthe lateral limit of the stem up to thegreater trochanter is sketched in. Thisline determines the lateral limit of the cancellous bone to be removed in order to avoid positioning in a varusposition.

The following dimensions are includedin the drawing and measured:

� Lesser trochanter – osteotomy level� Lesser trochanter – medial edge

of the prosthesis neck�Medullary plug – inner cortex layer of

the osteotomy of the femur neck � Connecting line between the center

of rotation and the tip of the greatertrochanter

Distal stCentralizernt

.010

Size 8/12

EF 01 00358.012

Size 8iz

StandardtREFF 30.00.49-0808

LateralaREFF 01.00351.0021

141

mm

58 mm

18 mm

Surgical technique using a lateralapproach, according to Professor E.W. Morscher

The medullary canal is prepared with rasps of ascending size. The lastrasp to be used is always one size larger than the stem size that was deter-mined in the preoperative planning.Through this, sufficient space is createdfor an uninterrupted circumferentialcement mantle. The rasp also serves asa test prosthesis: The modular handleof the rasp is removed and a correspond-ing test head is mounted. After trialreduction, the test head and the rasp areremoved, the medullary plug is insertedand the medullary canal is filled withcement, under pressure. A MS-30 stem one size smaller thanthe last rasp used is inserted.

Surgical technique using a posteriorapproach, according to Professor L. Spotorno

The medullary canal is prepared withrasps of ascending size. The last rasp to be used, which is driven in asfar as the osteotomy level, correspondsto the stem size that was determined in the preoperative planning. The rasphandle is then removed and the testhead is placed on the cone of the mod-ular rasp. After trial reduction, the testhead is removed and the rasp is drivenin deeper, up to the second marking.

The Spotorno technique creates spacefor the cement mantle in that the rasp isdriven in deeper after trial reduction.

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Variants of the Surgical Technique

1. Patient in dorsal position, pelvis elevated with a flat cushion. Skin incision extends laterally starting 4 cmabove the tip of greater trochanterextending distally along the femoralshaft.

2. Separation of the fascia lata is per-formed. Incision and longitudinal separating of the gluteus medius andthe vastus lateralis muscles on the latero-ventral circumference of thegreater trochanter. The incision is extended proximally inthe direction of the fibers of the tendonand dissects by bluntly pulling apart the muscle fibers of the gluteus mediusmuscle.

3. Preparation of the front wall of thecapsule and insertion of a Hohmannlever at the front rim of the acetabulum.Scalpel detachment of the fibersattached to the capsule from the gluteusminimus muscle cranially and the vastus intermedius muscle distally. Inser-tion of a Hohmann lever respectively at the cranial and at the caudal circum-ference of the neck of the femur. Afterinsertion or adjustment of the Hohmannlever at the rim of the acetabulum, the utmost care must be taken that thetip of the lever does not lie in the muscle tissue or tendinous tissue, butunder it (femoral artery, vein, nerve!).The joint capsule is then incised lon-gitudinally on the ventral circumference,and removed ventro-cranially and ventro-caudally through H-shaped extensionsof the incision. The cranial and caudalHohmann levers are moved to intra-articular positions.

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Lateral ApproachSurgical technique according to Professor E.W. Morscher

4. An osteotomy of the femoral neck is perfomed at an angle of 30° with theleg in external rotation.

5. Using the osteotome, the femurhead is mobilized in the osteotomy andis extracted with the femoral headextractor (REF 75.00.21).

6. The joint capsule is detached fromthe psoas tendon. Insertion of aHohmann lever under the ventro-caudalrim of the acetabulum or under the caudal acetabular rim osteophytes.Implantation of the cup.

7. The leg is adducted and externallyrotated.

8. The Hohmann lever that was insertedat the start of the operation in the front of the pubic ramus remains in this position throughout the entire procedure. Where necessary, dorsalcapsule excision is completed with the leg externals rotation.

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9. An important step is the resection of the cranio-lateral base of the femoralneck, in order to gain lateral space.Through this, insertion of the rasp andthe prosthesis in a varus position isavoided.

10. The level of the osteotome neck isassessed by measuring the distancebetween the tip of the lesser trochanterand the medio-dorsal resection edge of the femoral neck (Ruler, REF 95.00.03).Further resection of the femoral neckmay be necessary.

11. A long curette is inserted into themedullary cavity (REF 75.13.33), in orderto correctly establish the rasp directionin a neutral axis. The complete removal of all cancellous bone on the inner sideof the medial femoral neck base usinga bone curette is very important.

12. Opening of the medullary cavitywith the straight awl with T-handle, in order to ensure neutral positioning of the femoral shaft.

13

13. Insertion of the smallest rasp (no. 6), already taking account of thedesired antetorsion (as a rule, 10–15°).Checking the resection level, whichshould lie at a right angle to the raspadapter.

14. This is followed by the step-wiseexpansion of the medullary space usinglarger rasps. Torsional movementsmust be avoided while impacting therasps. The largest rasp is impacted as far as the marking that correspondsto the osteotomy level. The modularrasp simultaneously serves as a testprosthesis.

15. After the modular rasp adapter has been removed, the appropriate trial head is mounted. If the plan is to use the lateral version of the MS-30 prosthesis, the eccentrictest head is used. It is important thatthe eccentric test head is placed so thatit enlarges the offset of the stem.In order to facilitate correct positioning,the test head is marked «cranial».

16. Trial reduction: The height from the tip of the lesser trochanter to the center of rotation of the femoral head is checked. The risk of dislocation is checked by inward and outwardrotational movements in flexion andextension. At the same time, the headcontainment is verified. The position of the psoas tendon is checked. Underno circumstances may this rub on therim of the artificial cup.

14

17. The leg lengths are checked.

18. On the MS-30 prosthesis to beimplanted, measure is taken with theintroducing rod for the position of the medullary plug, measured from theshoulder of the prosthesis. With regardto the depth of deployment, it must be noted that the distal centralizer must be mounted on the stem, and the dis-tance between the tip of the centralizerand the medullary plug must be approx-imately 1–1.5 cm. At the same time, the size of the cen-tralizer is established. If the plug of thenext size after the stem size fits, thedistal centralizer with the correspondingnumber is used. Experience shows that this is the right combination. In thecase of larger medullary spaces, thesecond number of the distal centralizeris used. Thus, for a size 10 stem and amedullary cavity into which the plug 12fits, a distal centralizer of size 10/12should be used. In the case of a widermedullary canal, size 10/14 is used.

19. The trial rasp is removed. Thefemoral medullary cavity is rinsed, andthe diameter of the medullary space is checked.

20. The medullary plug is inserted.

15

21. Rinse and dry the medullary canal.

22. Insert of the drain.

23. The appropriate distal centralizer isassembled to the prosthesis. The distal centralizer comprises fourwings, one of which is longer than theothers. The longer wing must be posi-tioned on the lateral side of the stem.

24. The proximal positioner is mounted.First of all, this is inserted into the extrac-tion hole and only then it is brought to its final position. It is not mandatory touse the proximal positioner. However, it facilitates the generation of the optimumcement mantle thickness.

16

25. The bone cement is introducedslowly under maximum pressure. Thecement is introduced antegrade, usinga drain and a silicon disk for the com-pression. Alternatively, the cement ispressed in retrograde. This procedurerequires neither a compression disk nora drain. The planned proximal and distalcement thickness is achieved byimplanting a prosthesis that is one sizesmaller than the final rasp.

26. With the setting device or impactor,the MS-30 stem is inserted. Particularcare must be taken to ensure thatmedially on the femur neck (calcar),between the cortex layer and the stem, there is a cement layer of 4 –7mmthickness.

27. Until the cement has completelycured, the pressure with the impactormust be maintained. Immediately beforefinal polymerization, the stem should not be impacted any further in order to prevent fractures of the cement mantle.As soon as the cement has hardened,all three legs of the proximal positioner are cut off using the scalpel or Luer’spliers (REF 100.01.840).

17

18

28. Excess cement is carefullyremoved.

29. The head is mounted using a rotational movement, and is lockedthrough a light hammer blow on the repositioning lever.

30. Reduction of the prosthesis. Intra-articular insertion of a Redon drain.

31. Reinsertion of the longitudinallyseparated tendon of the gluteus mediusmuscle, including that of the gluteusminimus muscle and the vastus lateralismuscle, with strong, non-absorbablethread. Closure of the incision on the anterolat-eral circumference, using individualover-and-over sutures. Insertion of aRedon drain subfascially, and closureof the iliotibial tract. Insertion of a subcutaneous Redondrain, subcutaneous sutures, skinsutures.

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1. Patient in a strict lateral position.Posterolateral incision according toAustin Moore.

2. Incision of the fascia lata and partialnotching of the femoral insertion of gluteus maximus muscle. Insertion ofa Hohmann lever under the gluteusmedius muscle on a level with thefemoral neck. Exposure and division ofthe outer rotators and of the dorsalarticular capsule.

3. Dislocation of the hip by a combinedmovement with inward rotation, flexion and adduction. Resection of theresidual capsule and osteotomy of the femoral neck after measuring thelevel in accordance with the preop-erative plan. The resection level startsabout 15–20mm proximally of the lesser trochanter (running obliquely,with a 30° inclination).

4. Removal of the head and neck of the femur, insertion of a Hohmannlever and exposure of the acetabulum.

5. Implantation of the selected cup.

Posterior ApproachSurgical technique according to Professor L.Spotorno

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6. Using the boxed chisel, the trape-zoidal segment of the cancellous bone is removed from the bulb as faras the lateral limit, in accordance with the preoperative planning. This permits correct insertion of therasp, avoiding a varus position.

7. Opening of the medullary cavityusing the awl, and removal of the can-cellous bone.

8. The first rasp is impacted, startingwith the smallest size, and already taking account of the desired antetorsionof 10–15°.

9. The final rasp is impacted up to theosteotomy level.

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10. The modular rasp simultaneouslyserves as a test prosthesis. Determina-tion of the correct depth of impaction(distance between the lesser trochanterand the medial edge of the prosthesisneck as planned preoperatively), and ofthe correct positioning.

11. Mounting of the test head, trialreduction and assessment of leglength, muscle tension, stability andextent of movement.If the plan is to use the lateral version of the MS-30 prosthesis, the eccentrictest head for the MS-30 is used. It is important that the eccentric testhead is placed so that it enlarges the offset of the stem. In order to facili-tate correct positioning, the test headis marked “cranial” (if the test head iswrongly placed in the opposite direction[180°], the result is a reduced offset,this means a medialization).

12. Removal of the test head anddeeper impaction of the rasp until thesecond marking. The additional space that is generated by deeperimpaction produces proximally acement mantle thickness of at least 4mm for the proximal positioner.

13. In the case of inadequate bonequality, the isthmus and the adjacentcancellous bone are removed with acurette.

22

14. On the MS-30 prosthesis to beimplanted, measure is taken with theintroducing rod for the position of the medullary plug, measured from theshoulder of the prosthesis. With regardto the depth of deployment, it must be noted that the distal centralizer mustbe mounted on the stem, and the dis-tance between the tip of the centralizerand the medullary plug must beapproximately 1–1.5cm.

At the same time, the size of the centralizer is established. If the plug ofthe next size after the stem size fits, thedistal centralizer with the correspond-ing number is used. Experience showsthat this is the right combination. In the case of larger medullary spaces, thesecond number of the distal centralizeris used. Thus, for a size 10 stem and a medullary cavity into which the plug12 fits, a distal centralizer of size 10/12 should be used. In the case of awider medullary canal, size 10/14 isused.

15. Insertion of the introducing rod with plug to determine the size of the distal centralizer and of the medullary plug (the likely size has already been determined in the course of preoperative planning).

16. Insertion of the medullary plug.

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17. The medullary canal is rinsed anda hemostatic tamponade is inserted.This is removed and a drain is inserted.

18. The centralizer is mounted on the prosthesis, in accordance with theplanned size or the size determinedusing the introducing rod with plug.The centralizer must be carefullypushed onto the stem tip until it sitssecurely there.The distal centralizer comprises fourwings, one of which is longer than the others. As the stem tip is not sym-metrically round, the centralizer hasbeen designed to fit exactly. The longerwing must be positioned on the lateralside of the stem.

19. The proximal positioner is mounted. First of all, this is insertedinto the extraction hole and only then is it brought into its final position.It is not mandatory to use the proximalpositioner. However, it facilitates the generation of the optimum cementmantle thickness. It is particularly recommended in the case of a steepfemoral neck, where there is more likely to be a risk of a too thin cementmantle in zone 7, as well as a risk of direct bone/metal contact.

20. The bone cement is pressed inusing maximum pressure. The cementis introduced antegrade, using a drain and a silicon disk for compression.Alternatively, the cement can bepressed in retrograde. This procedurerequires neither a compression disk nor a drain.

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21. Insertion of the MS-30 stem withthe distal centralizer and the proximalpositioner.

22. With the setting device, the stem is pushed in a distal-lateral direction, in order to avoid a varus position.

23. When the proximal centralizer is used, particular care must be takenthat the stem is somewhat lateral and is not inserted too late in the poly-merization process. This procedureencourages the formation of a cementmantle with sufficient medial thickness.

In order to achieve this, the impactor is aligned obliquely in a lateral direction,and not strictly axially, during insertion. Until the cement has completely hard-ened, the pressure must be maintainedwith the impactor. Immediately beforefinal polymerization, the prosthesis mustunder no circumstances be impactedfurther, due to the risk of the cementmantle breaking. As soon as the cement has hardened,all three legs of the proximal positionerare removed using a scalpel or Luer’spliers.

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24. The cement is carefully removedas far as the lower web of the proximalelement, i.e. as far as the resection level.

25. After careful cleaning of the cone,the prosthesis head is mounted using arotational movement.

26. The head is locked on the conethrough a light hammer blow on therepositioning lever.

27. Reduction and function check.

28. Redon drainage and closure of thewound.

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Preoperative

Postoperative 10 years postoperative

Case Study by Professor E.W. Morscher

63-year-old female patient withmarked coxarthrosisImplantation of a MS-30 stem and a Morscher Press-Fit™ Cup. At the timeof the ten-year follow-up, the patienthad no problems. The clinical evaluationshowed excellent mobility of the hipjoint.

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Case Study by Professor L. Spotorno

Primary osteoarthrosis in a 68-year-oldfemale patientThe one-month post-operative X-raydemonstrates excellent biomechanicalreconstruction of the hip, with a perfectlycemented MS-30 stem in combinationwith a Wagner Standard Cup. The X-raytaken at the follow-up examination 12 years later is impressive: it shows nochange over this period. From a clinicalpoint of view, there is neither restrictionwith regard to ability to walk, nor limpingor pain in this 80-year-old patient.

Preoperative

Postoperative (1 month) 12 years postoperative

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Implants

* U.S. Patent No. 6, 669, 734** U.S. Patent No. 6, 342, 077

MS-30® Schaft, StandardMS-30® Stem, standardTige MS-30®, standard

Protasul®-S30CementedE. Morscher /L. Spotorno

Size Offset L mm CCD REF

6 37.7 115.0 130 30.00.49-0608 38.9 132.0 131 30.00.49-080

10 40.1 136.0 132 30.00.49-10012 41.3 140.5 133 30.00.49-12014 42.3 146.0 134 30.00.49-14016 43.3 152.5 135 30.00.49-160

MS-30® Schaft, LateralMS-30® Stem, lateralTige MS-30®, latéral

Protasul®-S30CementedE. Morscher /L. Spotorno

Size Offset L mm CCD REF

6 42.2 115.0 124.3 01.00351.0018 43.6 132.0 125.3 01.00351.002

10 44.9 136.0 126.3 01.00351.00312 46.2 140.5 127.3 01.00351.00414 47.3 146.0 127.7 01.00351.00516 48.4 152.5 128.0 01.00351.006

Proximales PositionierelementProximal positioner*Elément de positionnement proximal

StandardGrösse/Size/Taille H mm REF

6 22.2 01.00356.0558 23.2 01.00358.055

10 24.2 01.00351.05512 25.2 01.00351.25514 26.2 01.00351.45516 27.2 01.00351.655

LateralGrösse/Size/Taille H mm REF

6 24.6 01.00356.0658 25.6 01.00358.065

10 26.6 01.00351.06512 27.7 01.00351.26514 28.7 01.00351.46516 29.7 01.00351.665

A

5

Distales ZentrierelementDistal centralizer**Centralisateur distal

Grösse/Size/Taille D mm REF

6/8 8.1 01.00356.0086/10 10.1 01.00356.0108/10 10.1 01.00358.0108/12 12.1 01.00358.01210/12 12.1 01.00351.01210/14 14.1 01.00351.01412/14 14.1 01.00351.21412/16 16.1 01.00351.21614/16 16.1 01.00351.41614/18 18.1 01.00351.41816/18 18.1 01.00351.61816/20 20.1 01.00351.620

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29

Instrumentation

MS-30® Kunststoffsieb (komplett)MS-30® plastic tray (complet)Plateau MS-30® en plastique (complet)

REF

99.27.00-00

MS-30® Kunststoffsieb (leer)MS-30® plastic tray (empty)Plateau MS-30® en plastique (vide)

REF

01.00359.100

Einsatz für MS-30® Kunststoffsieb(leer)

Insert for MS-30® plastic tray(empty)

Insert pour plateau MS-30® en plastique (vide)

REF

01.00359.200

Deckel für MS-30® KunststoffsiebCover for MS-30® plastic trayCouvercle pour plateau MS-30®

en plastiqueREF

01.00029.029

Reibahle zu 75.00.25Awl for 75.00.25Alésoir pour 75.00.25

REF

72.00.35

Handgriff mit SchnellkupplungHandle with quick couplingPoignée à verrouillage rapide

REF

75.00.25

Abgekröpfter HohlmeisselDouble-curved gougeCiseau-gouge à double courbureGrösse/Size/Taille REF

9 mm 75.09.15

Griff zu modularen RaspelnHandle for modular raspsPoignée pour râpes modulaires

REF

70.00.94

Langer QuerstabLong barBarre longue

REF

70.00.01

Raspel MS-30®, modularRasp MS-30®, modularRâpe MS-30®, modulaireSize REF

6 72.13.94-0608 72.13.94-080

10 72.13.94-10012 72.13.94-12014 72.13.94-14016 72.13.94-16018 72.13.94-180

Testkopf für HTP, Konus 12/14Test head for THR, cone 12/14Tête d’essai pour PTH, cône 12/14Grösse/Size/Taille ø mm REF

S 28 01.01559.128M 28 01.01559.228L 28 01.01559.328XL 28 01.01559.428

ReponieraufsatzRepositioning topCalotte de réductionø mm REF

28 78.00.38-28

Exzentrischer Testkopf für lateralenSchaft MS-30®

Eccentric test head for MS-30® lateral Tête d’essai excentrique pour

MS-30® latéralGrösse/Size/Taille ø mm REF

S 28 01.00359.128M 28 01.00359.228L 28 01.00359.328XL 28 01.00359.428

30

Ein- /AusschlägerImpactor /extractorImpacteur /extracteur

REF

75.00.36

AusschlaginstrumentExtraction instrumentInstrument d’extraction

REF

75.85.75

Setzinstrument MS-30®

Setting device MS-30®

Instrument de pose MS-30®

REF

72.00.40

Zementstössel, kleinCement pusher, smallPoussoir pour ciment, petit

REF

75.00.50

MarkraumstösselIntroduction rod for medullary plugPoussoir pour cavité médullaire

REF

75.04.56

Messdorn zu MarkraumstösselPlug for introducing rodMandrin de mesure pour poussoir

pour cavité médullaireø mm REF

8 75.04.57-08010 75.04.57-10012 75.04.57-12014 75.04.57-14016 75.04.57-16018 75.04.57-180

ReponierhebelRepositioning leverLevier de réduction

REF

75.01.38

KunststoffaufsatzSynthetic topCalotte synthétique

REF

78.00.38

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Führungsinstrument MS-30®

Guiding device MS-30®

Instrument de guidage MS-30®

REF

01.00353.300

Handgriff HandlePoignée

REF

72.00.94-01

GewindestangeThreaded rodTige filetée

REF

72.00.94-02

StandardverriegelungsstückStandard boltPièce de verrouillage standard

REF

72.00.94-03

Laterales Verriegelungsstück Lateral bolt Pièce de verrouillage latérale

REF

01.00359.301

ZielgerätPositioning guideGuide de positionnement

REF

72.00.94-04

Auf AnfrageOn requestSur demande

Inbusschlüssel (für Messdorn)Allen key (for introducing plug)Clé inbus (pour mandrin de mesure)

REF

75.00.51

Testkopf für HTP, Konus 12/14Trial head for THR, cone 12/14Tête d’essai pour PTH, cône 12/14Grösse/Size/Taille ø mm REF

S 22 73.11.22-05M 22 73.11.22-06L 22 73.11.22-07

S 32 01.01559.132M 32 01.01559.232L 32 01.01559.332XL 32 01.01559.432

S 36 01.01559.136M 36 01.01559.236L 36 01.01559.336XL 36 01.01559.436

Exzentrischer Testkopf für lateralenSchaft MS-30®

Eccentric test head for MS-30® lateralTête d’essai excentrique pour

MS-30® latéralGrösse/Size/Taille ø mm REF

S 32 01.00359.132M 32 01.00359.232L 32 01.00359.332XL 32 01.00359.432

S 36 01.00359.136M 36 01.00359.236L 36 01.00359.336XL 36 01.00359.436

ReponieraufsatzRepositioning topCalotte de réductionø mm REF

22 78.00.38-2232 78.00.38-3236 78.00.38-36

Adapter AdapterAdaptateur

REF

70.00.50

KastenmeisselCiseau rectangulaireBoxed chisel

REF

72.13.02-10

Contact your Zimmer representative or visit us at www.zimmer.com

www.zimmer.com

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6568 OPT MS 30 engl - hi

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