This publication is not intended for distribution in the USA. PRODUCT RATIONALE AND SURGICAL TECHNIQUE Distally-Interlocked Modular Femoral Reconstruction Prosthesis

INTRODUCTION The REEF™ implant is based on the four following basic principles: • Distal diaphyseal anchorage • A modular system which makes it possible to adapt, at the intraoperative stage, to almost any situation encountered • Total hydroxyapatite coating to achieve biological anchorage, reconstruction and support1 CORAIL Revision • Distal interlocking screws to ensure initial mechanical stability before osteointegration takes place2,3 The REEF femoral implant is reserved for cases of major femoral deficiency (Paprosky types 3A, 3B and 4). This implant is not to be used in less severe revision...

PRODUCT RATIONALE The REEF prosthesis is a modular femoral implant which allows flexibility during intraoperative assembly of the different components thanks to the range of available stem lengths and diameters. The REEF implant offers a customised solution for most joint reconstruction problems being faced. Primary stability is provided by virtue of a distal press-fit which is further facilitated by distal interlocking screws.2,3 The fully HA coated stem allows osteointegration throughout the stem affording long term secondary fixation.1,5,6 The REEF stem should not be used with cement. MetaphysealDiaphyseal...

Trochanteric Component and dedicated locking screw (16 mm) Trochanteric Component and dedicated locking screw (26 mm) Anteversion Witness Marks Lateral Wings Materials The REEF range of implants are made from forged titanium alloy TiAl6V4 ELI ASTM F 136 and ISO5832-3. Hydroxyapatite Coating The REEF implant utilises the same HA coating as the well established CORAIL range which has over 25 years of clinical heritage and a minimum purity of 98% and has an average thickness of 150μm.7 Due to its bioactivity, this coating encourages bone on-growth and promotes fast and efficient osteointegration,...

SURGICAL TECHNIQUE Preoperative planning makes it possible to: 1. Identify the lower level of the extended trochanteric osteotomy (ETO) required to fully remove the failed primary implant and any cement; this involves taking measurements in relation to several reference points (the top of the greater trochanter and the lesser trochanter, the femoral condyle, and any osteosynthesis material still in place). 2. Locate the level of implantation of the REEF stem, which can be measured from the reference point for the metaphyso-diaphyseal junction of the stem, as marked on the X-ray template, and...

APPROACH Extended Trochanteric Osteotomy Regardless of the initial approach selected (posterior, lateral or anterior), it is obligatory that the approach be made via the transfemoral route (Wagner technique), with a large flap that includes the greater trochanter (Figure 1) instead of a simple trochanterotomy which is insufficient to expose any existing bone lesions and explant the failed hardware. There must be no interference with the vascularisation when handling the muscles and their insertions. The distal border of the osteotomy is made using a saw, around the lateral hemi-circumference...

TRIAL IMPLANTS Once the distal diaphysis has been carefully reamed, a trial stem is selected, either of the same diameter or next size available. Stability is assessed using the following criteria: • Distal stem position with regards to height (distance between the groove on the trial stem, marking the metaphyso-diaphyseal junction, and the lower part of the flap). The distance ‘D’ is checked using the ruler (Figure 3). • Stem primary stability in both the axial and rotational planes is achieved (note: should adequate press-fit not be achieved with the original size selection, a stem of the next...

FINAL IMPLANTS Assembly of the Targeting Frame The final stem corresponding to the trial implant in terms of length and diameter is mounted on the corresponding targeting frame (right/left). Using the “ANTE” and “POST” marking ensure the stem is correctly orientated before assembly with the targeting frame. When assembling the final Implant & the targeting frame, ensure the locking screw of the frame is aligned and fully seated in the corresponding hole on the distal stem. In addition, the orientation ‘’key’’ on the targeting frame should seat entirely into the corresponding recess in the stem,...

FINAL IMPLANTS Distal Screw Placement If not already attached, the appropriate targeting frame (right or left) replaces the handle. It is positioned on the cone and firmly locked in place. Again, ensure both surfaces are flush and the ‘locking key’ is seating in the corresponding recess in the implant. Should any gap occur here, the offset will incurs misalignment of the drill guides and the implant holes. Holes in the targeting device are designed to accept the drill guides and drill bits used to prepare the femoral cortices for the locking screws (Figure 7). For greater precision, screw placement...

Placement of the trial trochanteric component and wing At this point, the trial trochanteric component and wing may be re-fitted in order to confirm that the length of the limb, stability of the prosthesis and anteversion have been restored (Figure 9). Before assembling any components care must be taken to ensure both surfaces are free from any debris or fluid that could interfere with the stability and strength of the taper connection. Surfaces must be cleaned and dried before assembly and impaction. The trial locking screws are differentiated from the implantable locking screws by a laser marked...

FINAL IMPLANTS Warning: Use only the screw supplied with the definitive trochanteric component. Do not implant the trial screws (i.e. L93507 and L93510 supplied in the same sterile packaging. (Figure 10) Femoral Head Impaction After carefully cleaning and drying the stem taper, the appropriate femoral head is positioned and lightly impacted with the dedicated impactor (L93206) to engage the taper. A final reduction of the assembly is then performed. Femoral Reconstruction Reconstruction of the femoral shaft around the final implant is then undertaken. Re-attachment of the osteotomy is achieved...