This publication is not intended for distribution in the USA. PRODUCT RATIONALE AND SURGICAL TECHNIQUE Triple Tapered Stabilised Hip

Optimise Function: High Performance Bearings 4 Maximise Survivorship: Positive Bone Remodelling 6 Maximise Survivorship: 5th Generation Cementing Technique 8 C-STEM™ Triple Tapered Polished Stem: An Evolution Of Our Understanding 10 Pre-operative planning: X-ray templating 12 Step 1: Femoral Neck Resection 13 Step 2: Opening the Femoral Canal 14 Step 3: Metaphyseal Preparation 15 Step 4: Calcar Planing (Optional) 17 Step 5: Trial Reduction 18 Step 6: Cement Restriction 19 Step 7: Distal Centraliser 20 Step 8: Cementing Technique 21 Step 9: Femoral Stem Implantation...

The C-STEM AMT Triple Taper Stabilised Hip builds upon the clinical success of the original C-STEM Triple Taper Stabilised Hip and its unique triple tapered highly polished design. The functional intra-medullary geometry has been preserved. The extra-medullary geometry has been enhanced with a raised lateral shoulder, for better visualisation, and the addition of the 12/14 ARTICUL/EZE® mini-taper. This taper provides the surgeon with increased versatility due to its compatibility with the extensive DePuy Synthes Joint Reconstruction femoral head and acetabular portfolio. 8 Standard Offset C-STEM...

The C-STEM AMT Stem, combined with a sound modern cementing technique and proven bone cement,1 is designed to restore function to today’s patient population. It is apparent however, that implant design alone is not sufficient to assure success. A surgical technique that leads to proper implant placement and alignment and a consistent, reliable cement mantle is also essential. The following pages set out the steps that provide the surgeon with an established surgical technique for precise bone preparation, using correctly aligned instruments and appropriate use of fifth generation cementing techniques....

OPTIMISE FUNCTION HIGH PERFORMANCE BEARINGS Standard Offset High Offset The C-STEM AMT prosthesis now expands the options surgeons have to restore function. The introduction of the Mini ARTICUL/EZE 12/14 taper can more accurately address your choice of joint mechanics for each patient, including offset and ROM. Head diameters in the range of 22-36 mm in both metal and ceramic provide the surgeon with multiple patient treatment options using High Performance Bearings with PINNACLE® CERAMAX™ and MARATHON™. DePuy Synthes Product Rationale and Surgical Techniq

The polished neck and no skirted ARTICUL/EZE heads are designed to reduce wear debris generation secondary to prosthetic impingement. Product Rationale and Surgical Technique DePuy Synthes

MAXIMISE SURVIVORSHIP POSITIVE BONE REMODELLING With the triple tapered stem design “...there is a potential to translate the promising early results of the C-STEM into the future and expect similar long-term success. The future potential for inward calcar loading and trabecular thickening may be realised as predicted by the stem design.”2 DePuy Synthes  C-STEM AMT  Product Rationale and Surgical T

In a cohort of 500 C-STEMS, follow-up studies have shown clear evidence of positive bone remodelling in 20% of cases after seven years.3 This has continued to improve to almost 22% after 10 years.4 The mean age of patients was 55.5 years, (range 17 to 89 years) and the mean follow-up was 5.2 years (1 to 10 years). The radiographic evidence of denser cancellous bone has been observed to appear at different stages post-operatively, possibly influenced as much by the activity level of patients as by the time elapsed. At 5 years this improvement in cancellous bone quality is clearly evident. Immediate...

MAXIMISE SURVIVORSHIP 5TH GENERATION CEMENTING TECHNIQUE SOLUTIONS BY DEPUY SYNTHES Indicated by 2 year clinical RSA results Proximal-distal translation (Subsidence) SMARTSET® HV In a 2 year Radiostereometric Analysis (RSA) study, SmartSet HV demonstrated its statistical equivalence to Palacos R.1 The SMARTMIX™ CEMVAC® Vacuum Mixing System Prefilled with SmartSet (G) HV Bone Cement The SMARTMIX CEMVAC Vacuum Mixing System DePuy Synthes  C-STEM AMT  Product Rationale and Surgic

“Distal centralisers increase the likelihood of reproducibly achieving a complete cement mantle. Based on a study of these techniques, the Swedish Hip Register reported a 95% survivorship at 10 years.”6,7 Product Rationale and Surgical Technique DePuy Synthes

C-STEM TRIPLE TAPERED POLISHED STEM: AN EVOLUTION OF OUR UNDERSTANDING Cemented THA continues to evolve and improve as time and experience reveal which design features improve results. The original C-STEM implant established a taper slip stem that not only worked with the bone cement mantle, but was also the first stem to demonstrate positive bone remodelling through an even proximal load transfer.3,4 The C-STEM AMT stem builds upon the clinical success of the original C-STEM by maintaining the original intramedullary geometry and same triple taper stem geometry. The possible ROM is enhanced...

Design Features Available in standard and high offset to accurately restore patient anatomy. Optimised Mini ARTICUL/EZE taper to increase range of motion and reduce neck impingement when compared to the 9/10 taper. Narrow neck geometry to increase- range of motion (vs a standard neck). Deep medial profile to load the- proximal femur anatomically. Broad proximal medial to lateral dimensions to increase torsional stability. Triple taper stem section to load the — medial bone and optimise interface stresses designed to enhance bone remodelling. Highly-polished surface finish to- prevent "sandpapering"...

PRE-OPERATIVE PLANNING X-RAY TEMPLATING Make a thorough radiographic examination of the contralateral side, using both A/P and M/L projections, taking into consideration any anatomical anomalies, dysplasia or previous osteotomy. The radiographs should be at 20% magnification and the hips internally rotated to 15˚. They should clearly demonstrate the acetabular configuration, the endosteal and the periosteal contours of the femoral head, neck and proximal femur. Templating Femoral Implant Size The C-STEM AMT implant system offers a complete range of femoral templates. When the approximate size...