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Trinity™ - surgical technique
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Catalog excerpts

Trinity™ - surgical technique - 1

Trinity™ Advanced Bearing Acetabular System Surgical technique

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Contents Operative summary Overview Introduction Pre-operative planning Acetabular preparation Operative technique 1. Acetabular reaming Reamer guide 2. Acetabular shell trial 3. Acetabular liner trial 5. Acetabular shell implantation 7. Final trial reduction 8. Final reduction and closure Appendix A: Screw insertion Appendix B: Liner extraction Compatibility guide Ordering information Indications Contraindications References

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The advanced solution for acetabular hip replacement Responsible Innovation

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Operative summary c. Acetabular liner trial e. Acetabular shell implantation b. Acetabular shell trial g. Final trial reduction

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Overview Trinity UHMWPE LINER Neutral Offset Neutral Offset 4mm EPW Gauge Point Introduction The Trinity™ advanced bearing acetabular system offers surgeons a wide range of high performance bearings within a versatile system which includes a titanium hemispherical shell overlaid with vacuum plasma sprayed pure titanium and Biomimetic Cementless Technology coating. Pre-operative planning The radiograph is assessed using the Trinity™ X-ray templates for the position of the acetabular component and the optimal size for the patient’s hip anatomy. The Trinity™ X-ray templates are available...

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Initially a reamer of 6-8mm smaller than the anticipated size should be used to deepen the acetabulum to bleeding subcondral bone and the level determined by pre-operative templating. Subsequent reamers should be used to centre and deepen the socket until it becomes a true hemisphere. Hemispherical acetabular reamers are available in 1mm increments. The Trinity™ shell, including coating, is 1mm larger than the nominal size (as labelled). To achieve a 1mm press-fit in hard bone the acetabulum should be reamed line to line with the nominal cup size. In order to achieve a 2mm press-fit, it is...

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Rigid hex screwdriver Ball ended screwdriver 3. Acetabular liner trial 5. Acetabular shell implantation Following seating of the acetabular shell trial, the appropriate liner trial (ceramic or polyethylene) can be inserted. The straight rigid hex screwdriver or the ball ended screwdriver is used to lock this into position via the apical screw hole. The appropriate femoral head trial is used to perform a trial reduction, taking the hip through a full range of motion and stability assessment with all trial components in position. Once the position of the shell trial is correct diathermy can...

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6. Liner insertion When inserting the ceramic liner the sucker should be used to ensure accurate alignment of the liner within the shell. The liner should be positioned centrally on the introducer. Following insertion of the femoral component, the required liner is selected (ceramic or polyethylene). Ensure the shell is free from any tissue or debris, and that the screws have been correctly countersunk before placing the liner in the correct position in the shell. For the polyethylene liner verify that the anti-rotational tabs are correctly orientated in the shell before fully seating using...

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7. Final trial reduction 8. Final reduction and closure A final trial reduction is performed to assess the range of motion, hip stability and limb length using a trial modular head. The required head size and length is selected. Before placing the definitive head on the stem, thoroughly rinse the stem taper and carefully dry, ensuring it is free from debris. The head is then placed on the stem taper by twisting lightly and using axial manual pressure until it is seated firmly. Place the plastic head impactor on to the pole of the head, and impact lightly with the hammer in an axial...

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Screw insertion The acetabular cluster shell and non-occluded shell in the the Trinity™ range have three screw holes. In the cluster shell these holes are each pre-sealed with an occluder that must be removed before screw placement (either before the cup is implanted or when it is in situ) using the universal-joint (UJ) screwdriver*. These holes should be positioned appropriately in the posterior/superior quadrant, shown as the shaded region of Fig 1. * The UJ screwdriver found in the screw tray is only intended for removing occluders and the implantation of cancellous bone screws. The...

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Liner extraction Repeat steps 1 to 6 for a second or third screw as required. Once all of the required screws are in situ a final check should be made to ensure that they are securely seated within the recess without overtightening. If the polyethylene liner needs to be extracted, the polyethylene liner extractor can be used. The longer arm of the extractor is placed inside the bearing and the shorter arm clamped to the outside rim. The extractor wheel is then turned to extract the polyethylene liner If the ceramic liner needs to be extracted the ceramic liner extractor rod is attached to...

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Compatibility guide Note: Trinityfl™ compatible with BIOLOX® delta and ECiMa™ only Trinity™ shell outer diameter Taper size Ceramic liner Polyethylene liner (UHMWPE, HXLPE and ECiMa™) Polyethylene liner (HXLPE and ECiMa™ only)

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Acetabular cluster shells (titanium plasma and Biomimetic Cementless Technology coating) (Shells are packed with an apical occluder and screw hole occluders are pre-assembled in the shells) 46mm Taper size 2 TrinityH™ 48mm Taper size 2 50mm Taper size 2 46mm Taper size 2 TrinityH™ 48mm Taper size 2 50mm Taper size 2 50mm Taper size 3 Trinityll™ 52mm Taper size 3 54mm Taper size 3 50mm Taper size 3 TrinityH™ 52mm Taper size 3 54mm Taper size 3 54mm Taper size 4 TrinityH™ 56mm Taper size 4 58mm Taper size 4 54mm Taper size 4 TrinityH™ 56mm Taper size 4 58mm Taper size 4 60mm Taper size 5 62mm...

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Medium Medium Medium Medium Long Long Long Long Extra long Extra long Extra long Extra long BIOLOX® delta ceramic modular heads (12/14) Medium Medium Medium Medium BIOLOX® delta ceramic liner UHMWPE neutral offset liner UHMWPE +4mm offset oblique liner UHMWPE neutral offset 4mm EPW liner HXLPE neutral offset liner HXLPE +4mm offset oblique liner HXLPE neutral offset 4mm EPW liner

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