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DURALOC
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CEMENTLESS ACETABULAR RECONSTRUCTION Surgical Technique never stop moving- Z^Z^ZZ^L

Templating and Pre-Operative Planning 2 Trial Sizing and Impaction of the Shell 5 Trial sizing and Impaction of the Polyethylene Liner 8 Polyethylene Line Extraction 9

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Templating and Pre-Operative Planning npin inrNO niWinai The primary goal of total hip arthroplasty is the anatomic reconstruction of the hip joint, resulting in favourable prosthetic joint load and function. Mechanically, the goals are to create a stable articulation with an optimised range of motion, restore biomechanics for muscular efficiency and equalise limb lengths. Meeting these goals begins with a thorough analysis of the hip with comparison to the contralateral side in anteroposterior (A/P) and lateral projections The desired magnification for all imaging should be 15 percent,...

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The radiographs should clearly demonstrate the acetabular configuration and the endosteal and periosteal contours of the femoral head, neck and proximal femur (Figure 2). DURALOC templates allow assessment of the most likely size of cup to be implanted. The acetabular component should be placed on structurally sound bone to optimise the opportunity for bone ingrowth. The cup should be placed so that the head centre is as near to the anatomical position as possible and the most inferior part of the cup should normally be at the level of the bottom of the Figure 2

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Preparation of the Acetabulum After removal of the femoral head, a capsulectomy is performed. The surgeon should ensure complete exposure of the entire acetabular rim. Any excess soft tissues and osteophytes should be removed from the rim and bed of the acetabulum. The acetabulum may now be reamed starting with the smallest reamer to remove soft tissues in the bed. A range of reamers are available in 1 mm increments. The reamers should be introduced in either 35° – 40° or 45° of abduction (Figure 4), 40˚ - 45˚ depending on the cup selected and 15° – 20° of anteversion (Figure 5). In a...

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Trial Sizing and Impaction of the Shell Following preparation of the acetabulum, a Cup Trial of 1 – 2 mm larger in diameter than the last reamer is inserted to assess the coverage of the acetabular component and gauging the seating depth of the actual cup. The rim fit of the fully seated trial should be tight enough to make it difficult to alter its position. The inferior rim of the trial should be level with the bottom of the teardrop and its position should match the templated position. The DURALOC Cup Trials have indicators marked on the rim that match those marked on the definitive...

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Cup Positioning Peer reviewed publications highlight the importance of acetabular component positioning in relation to short and long term outcomes during total hip arthroplasty for all types of bearing materials.1-4 Cup positioning should be varied to optimise fixation, range of motion and dislocation resistance and minimise the likelihood of subluxation, impingement and edge loading. This may be assessed during pre-operative planning, acetabular preparation and cup trialling. Sub-optimal component positioning may lead to edge loading, dislocation, increased wear and polyethylene...

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Trial Sizing and Impaction of the Shell The cup is oriented so that the rim markers are correctly aligned to ensure the screw holes are positioned in the safe zone for screw fixation. (Figure 9). Apex Hole Joint Stability The seating level of the cup can be verified through the apex hole in the cup after removal of the Impactor (Figure 10).

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Trial sizing and Impaction of the Polyethylene Liner A trial liner is inserted and the femoral side is prepared. After completion of the femoral side, the screw-in trial liner can be used to assess joint stability and range of motion. If the hip shows a tendency to dislocate, an angled or hooded trial liner can be chosen to provide additional coverage of the head. The optimum position of the hood may be marked with diathermy on the rim of the acetabulum for later reference. The trial liner is removed and the apex hole may be closed using an apex hole plug. Soft tissues at the acetabular rim...

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Polyethylene Liner Extraction If required, the polyethylene liner can be removed using the polyethylene liner extractor. The blunt jaw is located on the rim of the shell while the ‘claw’ jaw is used to bite into the liner, breaking the seal and allowing extraction to be completed (Figure 14). Warning: An extracted liner should not be re-used.

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1220-28-148 DURALOC Marathon 10° Liner 28 mm x 48 mm 1220-28-150 DURALOC Marathon 10° Liner 28 mm x 50 mm 1220-28-152 DURALOC Marathon 10° Liner 28 mm x 52 mm 1220-28-154 DURALOC Marathon 10° Liner 28 mm x 54 mm 1220-28-156 DURALOC Marathon 10° Liner 28 mm x 56 mm 1220-28-158 DURALOC Marathon 10° Liner 28 mm x 58 mm Bantam Enduron™ 10° Liners 22.225mm (38 - 46 mm) 1220-28-160 DURALOC Marathon 10° Liner 28 mm x 60 mm 1241-38-526 DURALOC Enduron 10˚ Liner 22.225 mm x 38 mm 1220-28-162 DURALOC Marathon 10° Liner 28 mm x 62 mm 1241-40-526 DURALOC Enduron 10˚ Liner 22.225 mm x 40 mm 1220-28-164...

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Constrained Enduron Liners 32 mm (52 - 66 mm) 1242-12-527 DURALOC Constrained Liner 32 mm x 52 mm DURALOC Constrained Liner 32 mm x 54 mm DURALOC Constrained Liner 32 mm x 56 mm DURALOC Constrained Liner 32 mm x 58 mm DURALOC Constrained Liner 32 mm x 60 mm DURALOC Constrained Liner 32 mm x 62 mm DURALOC Constrained Liner 32 mm x 64 mm DURALOC Constrained Liner 32 mm x 66 mm Option LPW liners 22.225 mm, 28 mm and 32 mm Available for revisions Apex Hole Eliminators 1246-03-000 Apex Hole Eliminator Cancellous Bone Screws 1172-20-000 Cancellous Bone Screw 6.5 mm x 20 mm Cancellous Bone Screw...

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References 1. Udomkiat P, Dorr LD, Wan Z. Cementless hemispheric porous-coated sockets implanted with press-fit technique without screws: average ten-year follow-up. J Bone Joint 1. ... Surg. 2002;84A:1195-200. 2. Schmalzried TP, Guttmann D, Grecula M, Amstutz H. The relationship between the design, position, and articular wear of acetabular components inserted without cement and the development of pelvic osteolysis. J Bone Joint Surg. 1994;76A:677-688. 3. Kennedy JG, Rogers WB, Soffee KE, et al. Effect of acetabular component orientation on recurrent dislocation, pelvic osteolysis,...

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