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Secur-FitADVANCED Femoral Hip SystemSurgicalTechniqueOrthopaedics

TABLE OF CONTENTSPre-Operative Planning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Femoral Neck Resection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Preparing the Femoral Canal . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Trochanteric Reaming. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Broaching. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Trial Reduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Implanting the Stem. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Final Reduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Extraction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Implant and Instrument Information. . . . . . . . . . . . . . . . . . . . . . .16IndicationsIndications for use include: Noninflammatory degenerative joint disease includingosteoarthritis and avascular necrosis; Rheumatoid arthritis; Correction of functional deformity; Revision procedures where other treatments or devices havefailed; and, Nonunions, femoral neck and trochanteric fractures of theproximal femur with head involvement that are unmanageableusing other techniques.Contraindications active infection or suspected latent infection in or about thehip joint; bone stock that is inadequate for support or fixation of theprosthesis; skeletal immaturity patients; and, any mental or neuromuscular disorder that would create anunacceptable risk of instability, prosthesis fixation failure orcomplications in postoperative care.Additional indication specific to use of Secur-Fit Advanced HipStems with compatible Howmedica Osteonics Constrained Liners: When the stem is to be used with compatible HowmedicaOsteonics Constrained Liners, the device is intended for use inprimary or revision patients at high risk of hip dislocation dueto a history of prior dislocation, bone loss, soft tissue laxity,neuromuscular disease, or intra-operative instability.Warnings and PrecautionsSee package insert for warnings, precautions, adverse effectsand other essential product information. Before using Secur-FitAdvanced Stem instrumentation, verify: Instruments have been properly disassembled prior to cleaningand sterilization; Instruments have been properly assembled post-sterilization; Instruments have maintained design integrity; and,Secur-Fit Advanced Hip Stems are intended for cementless useonly and are intended for total and hemiarthroplasty procedures. Proper size configurations are available.For Instructions for Cleaning, Sterilization, Inspection and Maintenance of Orthopaedic Medical Devices, refer to LSTPI B.

Secur-FitADVANCED Femoral Hip SystemThe Secur-Fit Advanced Hip Stem is intended for cementless,press-fit application. The proximal region of the stem is coatedwith PureFix HA over a commercially pure titanium plasma spraysubstrate. The Secur-Fit Advanced Hip Stem is suitable for varioussurgical approaches.The total system includes: 16 Implants Size 4 and 5 in 132 offset only Sizes 6-12, two anatomic offset angles of 132 and 127 The stem is designed for use with Stryker V40 femoral heads andtheir compatible acetabular components.This publication sets forth detailed recommended proceduresfor using Stryker Orthopaedics devices and instruments. It offersguidance that you should need, but, as with any such technicalguide, each surgeon must consider the particular needs of eachpatient and make appropriate adjustments when and as required.

Step 1-Pre-operative PlanningFigure 1Figure 2Figure 3Pre-operative planning aids in thedetermination of probable implantstyle and size. The pre-operativeplanning process should takequalitative and quantitative factors(including patient bone quality,density, and morphology) intoconsideration in order to evaluateand select the appropriateinstrument/implant system forthe patient.Optimal femoral stem fit, prostheticneck length, angle and versioncan be more closely evaluatedwith the use of pre-operative X-rayanalysis. The following parametersshould be determined using an A/Pradiograph: Stem Size, FemoralOffset, Leg Length, Neck Angle,and Center of Rotation.marking is superior to the center ofrotation marking of the acetabularcomponent, leg lengthening ispredicted. The desired change inleg length is determined by theradiographic leg length inequalitythat was previously determined withan A/P bilateral film. If 8mm of leglengthening is required in order toequalize the leg lengths, the centerof rotation marking of the femoralcomponent should be positioned8mm superior to the center ofrotation marking on the acetabularcomponent. The stem size andhead offset that most closely meetsthis goal is chosen. The predictedchange in offset is also consideredby comparing the relative medial/lateral position of the center ofrotation markings of the femoraland acetabular components.The templates should be used toestimate the final components thatmost closely restore the normaloffset of the patient’s hip.Place an acetabulum templateover the area on the X-ray. Be surethat the cup is well centered withinthe acetabulum and the size fillsbetween the tear drop and thesuperior rim. After templating theacetabulum for size, mark the centerof rotation (represented by the greendot (Figure 1)).TemplatesSecur-Fit AdvancedAcetate TemplatesLit# LTEM106Acetate templates include 20% magnification.2 secur-fit Advanced Surgical TechniqueThe Secur-Fit Advanced has twooffset options: the standard offset132 neck angle and the highoffset 127 neck angle (Sizes 4 and5 are available in the 132 neckangle only). Choose the Secur-FitAdvanced template for which thestem size achieves medio-lateralcortical engagement at the proximaltwo-thirds of the stem and recreatesthe desired leg length and offset(Figure 2). For both the 132 and127 offset options, the templatehas markings that indicate thecenter of the femoral head for arange of head offset options.The predicted change in leg lengthand offset is determined by therelative positioning of the center ofrotation markings on the femoraland acetabular components.For example, if a given femoralcomponent center of rotationOnce the final estimated stem sizeand position is determined, the neckresection level should be noted(Figure 3). This will be used as areference during intra-operative neckresection.

Step 2Femoral Neck ResectionA proper neck resection leveldirectly affects the final placementand fit of the femoral stem. Byusing the anatomic landmarksreferenced during pre-operativeX-ray templating, the pre-plannedneck resection is made with anoscillating saw and with the aidof the Neck Resection guide.Lay the Neck Resection Guideon the femur, using the lessertrochanter and the trochantericfossa as landmarks when makingthe final cut. Care should be takento align the axis line of the NeckResection Guide to the center axisof the femoral shaft; the scaleson the lateral flange or medialradius of the guide can be usedto reference the greater or lessertrochanter respectively whenmaking the final cut.Scale onResection Guidecorresponds toscale on thetemplates39 Use the ResectionGuide to determineresection pointbased on lessertrochanter39 Neck resection angleFigure 4InstrumentSecur-Fit Advanced Neck Resection Guide1601-13003

Step 3Preparing the Femoral CanalTo help ensure proper finalorientation of the stem, lateralbias during preparation for theimplant is preferred. Retraction ofthe gluteus medius and removal ofa portion of the lateral neck and/or piriformis fossa will permit trueaxial introduction of the instrumentsand implant. A Box Osteotome isuseful in removing bone from thisarea. Connect the Box Osteotomeattachment to the Modular Handle.Use a mallet to strike the end ofthe Modular Handle with carefulcontrolled blows to remove remnantsof the superior femoral neck andopen the medullary canal.TipA clear-out hole has beenplaced on the back of theBox Osteotome that allowsbone chips to be removedusing a curette or other ORinstruments in an action thatdoes not require a force tobe directed at the cuttingsurface.Figure 5InstrumentsModular Box Osteotome1601-12104 secur-fit Advanced Surgical TechniqueOrthonomic Modular Handle1020-2900Orthonomic T-Handle1101-2200

Distal ReamingThe Starter Reamer can be usedto enter the femoral canal throughthe trochanteric fossa. The StarterReamer has a point to facilitate entryand graduated markings along theshaft that correspond to onPoint54Figure 6Enter the canal with the StarterReamer attached to either a T-handleor powered instrument. Place theStarter Reamer on the exposedtrochanteric fossa and proceeddown into the shaft along its axisto the appropriate depth and alignto the center of the knee. TheStarter Reamer should be insertedsuch that the appropriate markingcorresponding to the pre-operativelyselected stem size correlates to thedepth of the medial resection point.TipDepth markings on the StarterReamer, which correspond to theTapered Reamer depth for eachstem, should be aligned with themedial aspect of the resectionplane.Secur-Fit Advanced Starter Reamer1601-15045

Step 3ContinuedTrochanteric ReamingFigure 7MedialResectionPointSelect and use the appropriateTrochanteric Reamer to removelateral proximal cortical bone. Thiswill further assist in establishingproper axial alignment. TheTrochanteric Reamer is availablein standard and large sizes. TheReamer should be inserted to adepth such that the distal end of thecutting flutes aligns with the medialresection point. Each TrochantericReamer is designed to prepare forthree stem sizes. See Table 1.OptionFor Sizes 4-6, the standardTrochanteric Reamer is optional andto be used according to surgeon’sdiscretion.Broach Only OptionTable 1: RecommendedTrochanteric Reamer Sizesstemsizetaperedreamer7-9Standard Trochanteric Reamer10-12Large Trochanteric ReamerThe fully toothed Broaches mayfacilitate preparation of the femoralcanal without the use of TaperedReamers. However, a narrow/tightdiaphyseal shaft (e.g. champagneflute femur) may result in broachresistance in the distal canal. Ifresistance is encountered, taperedreaming is recommended to minimizepotential for distal femoral fractures.If the Broach does not seat at thedesired height, ream upward until theBroach seats at the desired height.The option to skip any reaming stepis at the discretion of the surgeon.InstrumentsOrthonomic T-Handle1101-2200Secur-Fit AdvancedStandard TrochantericReamer 1601-15316 secur-fit Advanced Surgical TechniqueSecur-Fit AdvancedLarge Trochanteric Reamer1601-1532Secur-Fit Advanced 2 For 1Tapered Reamer Size 5-61601-1556

Tapered ReamingSize 7Size 8Figure 8Reamers are used to prepare thecanal distally where dense corticalbone exists, thereby aiding inbroaching. The Tapered Reamershould be inserted such that theappropriate marking correspondingto the stem size correlates to thedepth of the medial resection point.See Table 2 for a list ofrecommended reamer sizes for eachstem.Table 2: Recommended TaperedReamer Sizesstemsizetaperedreamer4*Starter reamer may be -Fit Advanced 2 For 1Tapered Reamer Size 7-81601-1578TipIf pre-operative templating resultsin an in-between size, ream to asmaller size.TipDue to the aggressive cuttingnature of the reamer, distalreaming should not exceed thetemplated size.Secur-Fit Advanced 2 For 1Tapered Reamer Size 9-101601-1590Secur-Fit Advanced 2 For 1Tapered Reamer Size 11-121601-15127