To assist with periacetabular osteotomy and hip ...synthes.vo.llnwd.net/o16/LLNWMB8/INT...

To assist with periacetabular osteotomy and hip impingement procedures

Set for Hip Preservation SurgerySurgical Technique

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This description alone does not provide sufficient background for direct use of DePuy Synthes products. Instruction by a surgeon experienced in handling these products is highly recommended.

Processing, Reprocessing, Care and MaintenanceFor general guidelines, function control and dismantling of multi-part instruments, as well as processing guidelines for implants, please contact your local sales representative or refer to:http://emea.depuysynthes.com/hcp/reprocessing-care-maintenanceFor general information about reprocessing, care and maintenance of DePuy Synthes reusable devices, instrument trays and cases, as well as DePuy Synthes processing of Synthes non-sterile implants, please consult the Important Information leaflet (SE_023827) or refer to: http://emea.depuysynthes.com/hcp/reprocessing-care-maintenance

Set for Hip Preservation Surgery Surgical Technique DePuy Synthes 1

Table of Contents

Introduction Set for Hip Preservation Surgery 2

The AO Principles of Fracture Management 4

Surgical Technique Hip Impingement 5

Periacetabular Osteotomy 7

Product Information Instruments 13

Set for Hip Preservation Surgery (01.100.300) 16

Also Available 18

2 DePuy Synthes Surgical Technique Set for Hip Preservation Surgery

Set for Hip Preservation Surgery. To assist with periacetabular osteotomy and hip impingement procedures.

The Set for Hip Preservation Surgery contains retractors, osteotomes, chisels, and femoral head templates to assist the surgeon with periace-tabular osteotomy and hip impinge-ment procedures.


Osteotomes• Twelve osteotomes• Different shaped tips for diverse

approaches• Striking-cap on each osteotome

for transfer of force from hammer strikes and durability (except 399.850 and 399.860)

• The working end of each osteo-tome is etched in 5 mm increments to help the surgeon determine the depth in the bone

• The distance from the first etched line to the tip of the blade measures 10 mm, unless it has been sharpened

Aluminium Retractors• Eight aluminium retractors• Enables visualization under

fluoroscopy• Radiolucent properties• Reduced weight due to aluminium

facilitates handling• Also available in stainless steel

Templates for Femoral Head• Nine templates with diameters

from 42 mm to 58 mm• To check the sphericity of the fem-

oral head• Templates for femoral head are

nearly transparent, to facilitate identifying points of interest in the femoral head

Chisel Blades• Eight different blades• To cut or resect bone


Fracture reduction andfixation to restoreanatomical relationships.

MissionThe AO’s mission is promoting excellencein patient care and outcomes in traumaand musculoskeletal disorders.

The AO Principles of Fracture Management

Fracture fixation provid-ing absolute or relative stability, as required by the “personality” of the fracture, the patient, and the injury.

Preservation of the blood supply to soft-tissues and bone by gentle reduction techniques and careful handling.

Early and safe mobiliza-tion and rehabilitation of the injured part and the patient as a whole.

3 4

AO Principles 1,2

1 2

1 Müller ME, M Allgöwer, R Schneider, H Willenegger. Manual of Internal Fixation. 3rd ed. Berlin, Heidelberg, New York: Springer. 1991

2 Buckley RE, Moran CG, Apivatthakakul T. AO Principles of Fracture Management: 3rd ed. Vol. 1: Principles, Vol. 2: Specific fractures. Thieme; 2017.


Hip Impingement

1. Patient positioning

Position the patient laterally.


2. Hip impingement correction

Instruments

03.100.342 – Templates for Femoral Head03.100.358 B 42 – 58 mm

399.540 Chisel Handle

399.550 – Chisel Blades399.580 5 mm, 10 mm, 16 mm, 25 mm widths

399.555 – Chisel Blades, long399.585 5 mm, 10 mm, 16 mm, 25 mm widths

Use the templates for femoral head to guide the head/neck osteoplasty to restore normal offset and sphericity (where possible).

Use the chisel with the appropriate chisel blade to make the necessary correction.

Note: Ensure that the edge of the chisel blade is properly positioned on the bone to prevent slippage.

Precautions:• Instruments may have sharp edges or moving

joints that may pinch or tear user’s glove or skin.• Handle devices with care and dispose worn bone

cutting instruments in an approved sharps con-tainer.

Hip Impingement


Periacetabular Osteotomy

1. Patient positioning

Position the patient supine. Sterile prep and drape the abdomen and ipsilateral hip in a single surgical field.


2. Ischial osteotomy

Instrument

03.100.038 Pelvic Osteotomy Chisel, curved, width 15 mm, length 309 mmor03.100.039 Pelvic Osteotomy Chisel, curved, width 20 mm, length 309 mm

Through the medial portion of the Smith Peterson ap-proach, place a curved osteotomy chisel beneath the cotyloid fossa against the ischium.

As the cut progresses from anterior to posterior, drop the handle of the osteotomy chisel to direct the cut above the spine of the ischium.

Note: Ensure that the edge of the pelvic osteotomy chisel is properly positioned on the bone to prevent slippage.



3. Pubic root osteotomy

Instrument

03.100.300 Pelvic Osteotome, straight, 15 mmor03.100.301 Pelvic Osteotome, straight, 20 mm

Use a high speed burr to remove the first cortex.

Insert the straight osteotome into the opening, to the cortex protecting the obturator canal.

Note: Ensure that the edge of the pelvic osteotome is properly positioned in the opening to prevent slip-page.


4. Posterior column osteotomy

Instrument

03.100.300 Pelvic Osteotome, straight, 15 mmor03.100.301 Pelvic Osteotome, straight, 20 mm

Alternative instruments

03.100.305 Pelvic Osteotome, bayonet-shaped, 15 mm

03.100.306 Pelvic Osteotome, bayonet-shaped, 20 mm

03.100.307 Pelvic Osteotome, flag-shaped, 20 mm

Use a high speed burr to initiate the posterior column osteotomy along a line directed down the quadrilateral surface approximately 1.5 cm anterior to the greater sci-atic notch.

Drive the straight osteotome through the bone and through the opening parallel to the greater sciatic notch, to intersect the first osteotomy.

Notes• Ensure that the edge of the pelvic osteotome is

properly positioned in the opening to prevent slippage.

• Take care not to damage adjacent structures.



5. Iliac osteotomy

Instruments

03.100.302 Pelvic Osteotome, angled, 15 mmor03.100.303 Pelvic Osteotome, angled, 20 mm

519.170 Saw Blade 90/69 2 27 2 0.8/0.6 mm, for Oscillating Saw with AO/ASIF Coupling

Alternative instrument

03.100.304 Pelvic Osteotome, short, angled, 15 mm


Cut the iliac wing to intersect the posterior columnosteotomy (the third osteotomy) using an oscillating saw.

Note: Ensure that the edge of the oscillating saw is properly positioned on the bone to prevent slippage.

Protect the tensor fasciae latae and gluteals from saw injury by placing a retractor along the external inominate surface, parallel to the osteotomy path.

Note: Ensure the position of the retractor protects adjacent muscles.

Use the angled osteotome at the pelvic brim to ensure that the osteotomy is complete.

Note: Ensure that the edge of the pelvic osteotome is properly positioned in the opening to prevent slip-page.



Instruments

Retractors, malleable, length 330 mm03.100.015 width 20 mm03.100.016 width 30 mm03.100.017 width 40 mm

Pelvic Osteotomy Chisels, curved, length 309 mm

03.100.038 width 15 mm03.100.039 width 20 mm

03.100.107 Radiolucent Pelvic Retractor, blunt, length 274 mm, Aluminium

Radiolucent Hohmann Retractors, Aluminium

03.100.108 width 35 mm, length 275 mm03.100.109 width 18 mm, length 240 mm03.100.110 width 24 mm, length 267 mm

Radiolucent Pelvic Retractors, Aluminium

03.100.111 medium, length 268 mm03.100.112 large, length 323 mm

03.100.114 Radiolucent Hohmann Retractor, width 8 mm, length 220 mm, Aluminium


03.100.119 Radiolucent Hohmann Retractor, width 22 mm, length 250 mm, Alumin-ium

Pelvic Osteotomes, straight03.100.300 width 15 mm03.100.301 width 20 mm

Pelvic Osteotomes, angled03.100.302 width 15 mm03.100.303 width 20 mm

03.100.304 Pelvic Osteotome, short, angled, width 15 mm

Pelvic Osteotomes, bayonet-shaped03.100.305 width 15 mm03.100.306 width 20 mm

03.100.307 Pelvic Osteotome, flag-shaped, width 20 mm

Instruments


Templates for Femoral Head03.100.342 B 42 mm03.100.344 B 44 mm03.100.346 B 46 mm03.100.348 B 48 mm03.100.350 B 50 mm03.100.352 B 52 mm03.100.354 B 54 mm03.100.356 B 56 mm03.100.358 B 58 mm


Chisel Blades399.550 width 10 mm399.560 width 16 mm399.570 width 25 mm399.580 width 5 mm

Chisel Blades, long399.555 width 10 mm399.565 width 16 mm399.575 width 25 mm399.585 width 5 mm

Pelvic Osteotomy Chisels, length 304/134 mm

399.850 width 15 mm 399.860 width 20 mm


Set for Hip Preservation Surgery (01.100.300)

Graphic Case60.100.300 Graphic Case for Hip Preservation Set

Instruments Pelvic Osteotomes, straight03.100.300 width 15 mm03.100.301 width 20 mm

Pelvic Osteotomes, angled03.100.302 width 15 mm03.100.303 width 20 mm

03.100.304 Pelvic Osteotome, short, angled, width 15 mm

Pelvic Osteotomes, bayonet-shaped03.100.305 width 15 mm03.100.306 width 20 mm

03.100.307 Pelvic Osteotome, flag-shaped, width 20 mm

Pelvic Osteotomy Chisels, curved, length 309 mm

03.100.038 width 15 mm03.100.039 width 20 mm

Pelvic Osteotomy Chisels, length 304/134 mm

399.850 width 15 mm399.860 width 20 mm


Templates for Femoral Head03.100.342 B 42 mm03.100.344 B 44 mm03.100.346 B 46 mm03.100.348 B 48 mm03.100.350 B 50 mm03.100.352 B 52 mm03.100.354 B 54 mm03.100.356 B 56 mm03.100.358 B 58 mm

Radiolucent Pelvic Retractors, Aluminium

03.100.111 medium, length 268 mm03.100.112 large, length 323 mm

Retractors, malleable, length 330 mm03.100.015 width 20 mm03.100.016 width 30 mm03.100.017 width 40 mm

03.100.107 Radiolucent Pelvic Retractor, blunt, length 274 mm, Aluminium

Radiolucent Hohmann Retractors, Aluminium 03.100.114 width 8 mm, length 220 mm03.100.119 width 22 mm, length 250 mm03.100.108 width 35 mm, length 275 mm03.100.109 width 18 mm, length 240 mm03.100.110 width 24 mm, length 267 mm


Chisel Blades399.550 width 10 mm399.555 width 10 mm, long399.560 width 16 mm399.565 width 16 mm, long399.570 width 25 mm399.575 width 25 mm, long399.580 width 5 mm399.585 width 5 mm, long


Also Available

Pelvic Retractors03.100.011 medium, length 268 mm03.100.012 large, length 323 mm

Curved Chisel Blades03.100.116 width 10 mm03.100.117 width 16 mm03.100.118 width 25 mm

398.550 Pelvic Retractor, blunt

Bone Levers 399.200 short narrow tip, width 8 mm399.250 with wide tip, width 22 mm399.260 with wide tip, width 35 mm399.270 long narrow tip, width 18 mm399.280 with long, wide tip, width 24 mm

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Synthes GmbHEimattstrasse 34436 OberdorfSwitzerlandTel: +41 61 965 61 11www.jnjmedicaldevices.com

Not all products are currently available in all markets.

This publication is not intended for distribution in the USA.

All surgical techniques are available as PDF files at www.depuysynthes.com/ifu ©

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To assist with periacetabular osteotomy and hip ...synthes.vo.llnwd.net/o16/LLNWMB8/INT...

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