TaperFit™ Cement-in-Cement Revision Femoral Stem
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Responsible Innovation Cement-in-Cement Revision Femoral Stem Surgical technique

2. Removal of cement above shoulder of implant 6 3. Assessment of proximal cement-bone interface and stem removal 6 4. Assessment of exposed cement mantle 7 5. Abrasion of exposed PMMA surface 7 6. Accommodation of the distal wingless void 7 7. Insertion of the trial stem with locating pin 7 8. Cleaning and drying the existing cement mantle 8 9. Introduction of bone cement 8 10. Implantation of revision stem and wingless void 8 12. Definitive head impaction 9

Design I History I Function Responsible Innovation

TaperFit™ Introduction If a primary cemented hip component fails, the polymethyl methacrylate (PMMA) bone cement mantle is often intact and well integrated with the cancellous bone. This is particularly the case when modern cementing techniques have been implemented during the index procedure. In appropriate circumstances the intra-operative advantages of cement-in-cement femoral revision include reduced bone loss, reduced blood loss and reduced operating time3,4,5,6. Should the cement mantle and cement-bone interface remain in this potentially viable condition following the removal of the...

Operative summary a. Stem removal c. Cement assessment d. Cement abrasion e. Stem trial f. Cement cleaning g. Cement introduction h. Stem implantation i. Trial reduction j. Head impaction Responsible Innovation

TaperFit™ Operative technique 1. Pre-operative planning A radiographic assessment is undertaken to determine the most likely cause(s) of failure. Co-existing biomechanical issues, such as leg length discrepancy or implant version, should also be considered at this time. The indications and contraindications for Corin’s TaperFit™ cement-in-cement revision femoral stems are found on page 10. Templating is extremely important at this stage as the cavity within the in situ cement mantle should be able to accommodate a similar sized cemented stem to the one being removed without the need for...

4. Abrasion of exposed PMMA surface Roughen and clean the PMMA surface using a high speed burr (as depicted), rasp or reamers using a light reciprocating action. This allows the new mix of bone cement, to be applied later in the procedure, to come into direct contact with any residual activator and residual monomer within the old cement mantle. This also improves the mechanical interlock between the existing PMMA and the new cement layer. 5. Accommodation of the distal wingless void If required, the calibrated 8mm diameter drill is used (see steps 1 and 4), in conjunction with irrigation,...

8. Introduction of bone cement In order to optimise the potential for re-polymerisation, early retrograde introduction of the liquid cement (bearing the cement manufacturer’s mixing instructions in mind) is recommended. A cement gun with a narrow nozzle should be used so that contemporary cement pressurisation techniques can be applied. 9. Implantation of revision stem and wingless void Make sure that the wingless void is fitted to the chosen stem and, having referred to the cement manufacturers instructions, insert the implant to the appropriate depth while maintaining proximal pressure...

11. Definitive head impaction Once the acetabular cup is implanted, but before placing the definitive head on the stem, the stem taper should be thoroughly rinsed and carefully dried to ensure that it is free from debris. The head is then placed on the stem taper by twisting lightly and applying axial manual pressure until it is seated firmly. The plastic head impactor is placed on the pole of the head and impacted with a light tap using a hammer in an axial direction. As long as there are no issues arising from acetabular considerations or other unforeseen complications, full weight...

TaperFit™ Ordering information TaperFit™ Cement-in-cement revision stem CoCr modular heads (12/14) BIOLOX® delta ceramic modular heads (12/14) from the Trinity™ acetabular system from the Trinity™ acetabular system Extra short Extra short Extra short Extra short Short Short Short Short Short Short Short Short Medium Medium Medium Medium Medium Medium Medium Medium Long Long Long Long Long Long Long Long 104.3215 Extra long 104.3615 Extra long 104.4015 Extra long TaperFit™ Cement-in-cement revision instruments 588.9038 588.9045 288.021 588.9200 38mm offset trial 45mm offset trial TaperFit™...

Sizing information The cement-in-cement revision femoral technique is suitable for both matt and polished cemented stems. ■■ Pre-existing cement mantle quality should ideally be intact and well-fixed along its entire length or intact and well-fixed distally (i.e. from the level of the lesser trochanter and below) Stem removal to facilitate: ■■ acetabular exposure ■■ exchange of damaged and/or broken components ■■ exchange of incompatible component combinations ■■ change of version ■■ change of length for the treatment of instability and/or leg length discrepancy ■■ revision for stem...

References 1. Greenwald AS, Narten NC, Wilde AH. Points in the technique of recementing in the revision of an implant arthroplasty. J Bone Joint Surg 1978: 60B: 1: 107-110. 2. Rosenstein A, MacDonald W, Iliadis A, McLardy-Smith P. Revision of cemented fixation and cement-bone interface strength. Proc Inst Mech Eng (H) 1992: 206: 1: 47-49 3. Leiberman JR, Moeckel BH, Evans BG, Salvati EA, Ranawat CS. Cement-within-cement revision hip arthroplasty. J Bone Joint Surg 75B: 6: 869-71 4. Mandziak DG, Howie DW, Neale SD, McGee MA. Cement-within-cement stem exchange using the collarless polished...