JOINT RECONSTRUCTION tri-lock'JF BONE PRESERVATION STEM jjjfflr Featuring era/^T/OAf Technology Surgical Technique

Optimum implant geometry Extending proven TRI-LOCK® heritage The original TRI-LOCK Stem was introduced in 1981. This implant was the first proximally coated tapered-wedge hip stem available to orthopaedic surgeons and their patients. Since its introduction, the original TRI-LOCK Stem has demonstrated 98% survivorship at 10 years.1-4 Preserving the natural anatomy The reduced lateral shoulder, thin geometry and optimised length of the TRI-LOCK Bone Preservation Stem minimise the amount of bone removed from the patient. These same features, along with approach enabling instrumentation, allow the...

Determination of leg length discrepancy Perform a clinical evaluation in conjunction with a radiographic analysis to determine preoperative leg length discrepancy and use both to determine intraoperative leg length management. To estimate leg length discrepancy radiographically, draw a reference line across the bottom of the ischium. Measure the distance from the lesser trochanter (or greater trochanter) landmark to the reference line on each side. The difference between the two is the radiographic leg length discrepancy. Clinical examination should help determine the actual leg length irregularity....

Femoral stem selection The TRI-LOCK Bone Preservation Stem is designed to achieve intimate cortical contact proximally at the medial and lateral endosteal cortices. Select the template size that fits the proximal femur and equalises leg lengths. The femoral template should be in line with the long axis of the femur, and the neck resection line drawn at the point where the selected stem provides the desired amount of leg length. The vertical distance between the planned centre of rotation of the acetabular component and the centre of rotation of the femoral head constitutes the distance the leg...

Neck osteotomy Align the neck resection guide with the long axis of the femur. This establishes the angle of resection at a proper 50˚ from the femoral axis. Determine the resection level by aligning the top of the guide with the tip of the greater trochanter or by measuring a pre-operatively determined distance above the lesser trochanter. Mark the resection line using electrocautery or methylene blue. Resect the femoral head. Femoral canal initiation Use the modular box osteotome to enter the femoral canal and to establish version. If needed the box osteotome can be used to clear bone laterally....

Femoral canal preparation The TRI-LOCK Bone Preservation Stem offers several broach handles that enable the many surgical approaches for hip replacement. Select the handle that best suits the needs of the performed approach. Begin using a broach at least two sizes smaller than the preoperatively templated stem size. The starter broach can be used when needed for small femoral geometries, or for clearing bone laterally. While taking care to maintain proper alignment and version, sequentially advance the broaches down the femoral canal. Continue to increase broach size until intimate contact is...

Trial reduction Trial neck segments and trial heads are available to assess proper component position, joint stability, range-of-motion and leg length. Standard and high offset options are available for each stem size. Offset increases 6-8 mm (depending on stem size) from the standard to the high offset option, via direct lateralisation. With the final broach in-situ, attach the appropriate trial neck and trial head. Reduce the hip and assess what adjustments, if any, are required to ensure stability through a full range of motion. When stability is achieved, note the broach size and head/neck...

Femoral head impaction Following the final trial reduction, clean and dry the taper to ensure it is free of debris. Place the appropriate femoral head onto the taper. Using the head impactor, engage the head with light taps. Clean the bearing surfaces, and reduce the hip.

High Offset Size Standard Offset Size TRI-LOCK Bone Preservation Stem Case Broaches Size starter 0 1 2 3 4 5 6 7 8 9 10 11 12 Neck resection guide TRI-LOCK Bone Preservation Stem case Neck Segments Standard Offset Size High Offset Size Tissue Sparing Solutions Femoral Core Case 1 Case accommodates two sets of PINNACLE trial heads Case accommodates any two broach handles Tissue Sparing Solutions Femoral Core Case 2 Standard straight broach handle Long straight broach handle Curved broach handle Dual-Offset broach handle (left) Dual-Offset broach handle (right) Modular box osteotome Universal...

References 1. Burt CF et al. A Femoral Component Inserted without Cement in Total Hip Arthroplasty. A Study of the TRI-LOCK Component with an Average Ten Year Duration of Followup. J. Bone Joint Surg. 1998;80-A:952-60. 2. Purtill JJ et al. Total Hip Arthroplasty Using Two Different Cementless Tapered Stems. Clinical Orthopaedics and Related Research. 2001;393:121-127. 3. Teloken MA et al. Ten to Fifteen Year Follow-up After Total Hip Arthroplasty with a Tapered Cobalt-Chromium Femoral Component (TRI-LOCK) Inserted without Cement. J. Bone Joint Surg. 2002;84-A:2140-2144. 4. Sakalkale DP et al....