Secur-Fit Advanced: Surgical Technique
Secur-Fit Advanced: Surgical Technique
Secur-Fit Advanced: Surgical Technique
ADVANCED
Orthopaedics
Surgical
Technique
TABLE OF CONTENTS
Pre-Operative Planning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Femoral Neck Resection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Preparing the Femoral Canal . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Trochanteric Reaming. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Broaching. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Trial Reduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Implanting the Stem. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Final Reduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Extraction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Implant and Instrument Information. . . . . . . . . . . . . . . . . . . . . . .16
Indications Contraindications
Indications for use include: • active infection or suspected latent infection in or about the
• Noninflammatory degenerative joint disease including hip joint;
osteoarthritis and avascular necrosis; • bone stock that is inadequate for support or fixation of the
• Rheumatoid arthritis; prosthesis;
• Correction of functional deformity; • skeletal immaturity patients; and,
• Revision procedures where other treatments or devices have • any mental or neuromuscular disorder that would create an
failed; and, unacceptable risk of instability, prosthesis fixation failure or
• Nonunions, femoral neck and trochanteric fractures of the complications in postoperative care.
proximal femur with head involvement that are unmanageable
using other techniques.
Warnings and Precautions
Additional indication specific to use of Secur-Fit Advanced Hip See package insert for warnings, precautions, adverse effects
Stems with compatible Howmedica Osteonics Constrained Liners: and other essential product information. Before using Secur-Fit
• When the stem is to be used with compatible Howmedica Advanced Stem instrumentation, verify:
Osteonics Constrained Liners, the device is intended for use in • Instruments have been properly disassembled prior to cleaning
primary or revision patients at high risk of hip dislocation due and sterilization;
to a history of prior dislocation, bone loss, soft tissue laxity,
neuromuscular disease, or intra-operative instability. • Instruments have been properly assembled post-sterilization;
• Instruments have maintained design integrity; and,
Secur-Fit Advanced Hip Stems are intended for cementless use • Proper size configurations are available.
only and are intended for total and hemiarthroplasty procedures.
For Instructions for Cleaning, Sterilization, Inspection and Maintenance of Orthopaedic Medical Devices, refer to LSTPI_B.
Secur-Fit
®
ADVANCED
Femoral Hip System
The stem is designed for use with Stryker V40 femoral heads and
their compatible acetabular components.
Pre-operative planning aids in the Optimal femoral stem fit, prosthetic marking is superior to the center of
determination of probable implant neck length, angle and version rotation marking of the acetabular
style and size. The pre-operative can be more closely evaluated component, leg lengthening is
planning process should take with the use of pre-operative X-ray predicted. The desired change in
qualitative and quantitative factors analysis. The following parameters leg length is determined by the
(including patient bone quality, should be determined using an A/P radiographic leg length inequality
density, and morphology) into radiograph: Stem Size, Femoral that was previously determined with
consideration in order to evaluate Offset, Leg Length, Neck Angle, an A/P bilateral film. If 8mm of leg
and select the appropriate and Center of Rotation. lengthening is required in order to
instrument/implant system for equalize the leg lengths, the center
the patient. The Secur-Fit Advanced has two of rotation marking of the femoral
offset options: the standard offset component should be positioned
Place an acetabulum template 132° neck angle and the high 8mm superior to the center of
over the area on the X-ray. Be sure offset 127°neck angle (Sizes 4 and rotation marking on the acetabular
that the cup is well centered within 5 are available in the 132° neck component. The stem size and
the acetabulum and the size fills angle only). Choose the Secur-Fit head offset that most closely meets
between the tear drop and the Advanced template for which the this goal is chosen. The predicted
superior rim. After templating the stem size achieves medio-lateral change in offset is also considered
acetabulum for size, mark the center cortical engagement at the proximal by comparing the relative medial/
of rotation (represented by the green two-thirds of the stem and recreates lateral position of the center of
dot (Figure 1)). the desired leg length and offset rotation markings of the femoral
(Figure 2). For both the 132° and and acetabular components.
127° offset options, the template The templates should be used to
has markings that indicate the estimate the final components that
center of the femoral head for a most closely restore the normal
range of head offset options. offset of the patient’s hip.
The predicted change in leg length Once the final estimated stem size
and offset is determined by the and position is determined, the neck
relative positioning of the center of resection level should be noted
Templates rotation markings on the femoral (Figure 3). This will be used as a
and acetabular components. reference during intra-operative neck
Secur-Fit Advanced For example, if a given femoral resection.
Acetate Templates
Lit# LTEM106 component center of rotation
39°
Figure 4
Instrument
3
Step 3
Preparing the Femoral Canal
Figure 5
Instruments
Figure 6 Tip
5
Step 3
Trochanteric Reaming
Continued
Figure 7
Medial
Resection
Point
Instruments
Size 7
Size 8
Figure 8
8 7-8
9 9-10
10 9-10
Tip
11 11-12
Due to the aggressive cutting
12 11-12 nature of the reamer, distal
reaming should not exceed the
templated size.
7
Step 4
Broaching
Quick
Release
Button
Locking
Arm
Figure 9
Locking
Assemble the Broach to the Broach the broach has axial and rotational
Hook Handle by inserting the alignment stability. With proper cortical contact,
tab on the distal end of the Broach the broach should not twist or
Handle onto the Broach. Closing the move relative to the femur. If there is
locking arm until an audible click is movement, a larger size broach may
heard secures the Broach onto the be needed.
Broach
Alignment Broach Handle.
Tab
Generally, if a broach sinks below the
Using a mallet with short, controlled level of the neck resection, advance
strokes, begin broaching and to the next larger broach. If the neck
sequentially broach up until the resection is deemed higher than
desired size is reached. Throughout desired, remove the broach and
broaching, continue to ensure neutral perform a new neck resection at a
alignment of the broach to the long lower level.
axis of the femur.
Upon reaching the final size and
Correct fit will be denoted by a depth of the broach, detach the
change in pitch, tactile resistance, or broach handle from the broach,
when the broach ceases to advance. leaving the broach fully seated in the
Verify a secure fit and ensure that femoral canal.
Instruments
Secur-Fit Advanced Broach Handle Secur-Fit Advanced Low Profile Secur-Fit Advanced Broach Size 4-12
1601-1100 Broach Handle 1601-3100 1601-10XXA
Figure 10
Calcar planing creates a final resection Initiate power prior to contacting the
plane and angle to optimize stem fit. femur and slowly advance the Calcar
Caution
There are two calcar planers in the set Planer toward the broach. Align the
(standard, large). Select the size that tab within the broach body and press
Proper insertion depth of
the broach in the canal is fits the cut surface of the neck. Each down to plane the calcar to desired
achieved when it seats tightly calcar planer includes a spring-loaded level. Failure to operate the Calcar
within the canal based on alignment tab that provides controlled Planer in accordance with these
visual and auditory clues. The alignment and engagement with the instructions may result in damage
surgeon’s clues to confirm broach. to the femur.
implant fixation include
increased pitch of sound
with blows to broach handle
and increased resistance to
advancement. Reliance only
on the neck cut may lead to
improper sizing, inadequate
component fixation, and
femoral fracture.
9
Step 5
Trial Reduction
neck neck
length length
stem (mm) (mm)
Image depicts size 127° 132°
improper use (GOLD) (SILVER)
of the Secur-Fit
4 — 26
Advanced neck trial.
It is important to ensure 5 — 26
the neck trial is placed
6 28 26
properly onto the broach
to avoid improper ROM and 7 32 30
joint stability assessment.
8 32 30
9 36 34
10 36 34
Instruments 11 40 38
12 40 38
Secur-Fit Advanced Monolithic Secur-Fit Advanced Monolithic
Neck Trial, 132 Degree Neck Trial, 127 Degree
(Silver) 1601-XX132 (Gold) 1601-XX127
Figure 13
Instrument Note
11
* For additional Acetabular and Head Compatibility information please see page 17.
Step 6
Implanting the stem
Option 1 Option 2
Option 3
Instruments
Instruments
Orthonomic Modular Modular Threaded Stem Inserter Modular Offset Quick Connect Modular Stem Impactor
Handle 1020-1800 Inserter 1020-1870
1020-2900 1020-1860
13
Step 7
Final Reduction
Figure 18
Instruments
Instruments
Figure 19
Stem
Extraction
Warning
Warning
15
Secur-Fit ADVANCED
®
IMPLANTS
Table 6: Secur-Fit Advanced Stem Offset Table
Stem Catalog Neck Angle Stem Size Stem Length Neck Length Femoral Distal Tip
Number (°) (mm) (mm) Offset with Diameter*
+0mm Head (mm)
(mm)
* The distal diameter is taken at the location where the stem transitions from a square cross-section to a circular cross-section
Offset
Warning
Ne
ck +5mm heads are the maximum head
Le offset allowed for the size 4.
ng
th +12mm heads are the maximum
head offset allowed for
the size 5-12 stem.
Nec
k
An
le
g
Stem Length
Figure 20
17
Secur-Fit ADVANCED
®
instrumentation
1601-5005 Secur-Fit Advanced Femoral Preparation Tray
5900-8114 Case
instrumentation
1601-5006 Secur-Fit Advanced Procedural Tray 1
instrumentation
1601-5007 Secur-Fit Advanced Procedural Tray 2
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A surgeon must always rely on his or her own professional clinical judgment when deciding whether to use a particular product
when treating a particular patient. Stryker does not dispense medical advice and recommends that surgeons be trained in the
use of any particular product before using it in surgery.
The information presented is intended to demonstrate the breadth of Stryker product offerings. A surgeon must always refer to
the package insert, product label and/or instructions for use before using any Stryker product. The products depicted are CE
marked according to the Medical Device Directive 93/42/EEC. Products may not be available in all markets because product
availability is subject to the regulatory and/or medical practices in individual markets. Please contact your Stryker representative if
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affiliated entities own, use or have applied for the following trademarks or service marks: ADM, Crossfire, Exeter, Howmedica,
LFIT, MDM, Osteonics, PCA, PSL, PureFix, Restoration, RimFit, Secur-Fit, Stryker, Stryker Orthopaedics, Trident, Unitrax, V40, X3.