A P R I C O T

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A P R I C O T

S Y S T E M

TABLES OF CONTENTS

Thanks to Dr. Herv Olivier Hospital Saint Michel, Paris, France for the collaboration in the development of the surgical technique.

1 2 3 4

PRE-OPERATIVE PLANNING SURGICAL APPROACHES FEMORAL NECK OSTEOTOMY ACETABULAR STAGE

4 4 5 5 5 5 5 5 5 7 7 8 8 8 9 9 10 10 10 11 11 12 13 13 13 13 14 14 15

4.1

ACETABULAR STAGE: PE CUP

4.1.1 Reaming 4.1.2 Trials 4.1.3 Cement laying 4.1.4 Pe CUP setting

4.2

ACETABULAR STAGE: PRESS-FIT CUP

4.2.1 Reaming 4.2.2 Trials 4.2.3 Impaction of the metal black 4.2.4 Drilling guide setting 4.2.5 Fixation screw 4.2.6 Liner type selection (0 or 10) 4.2.7 Insertion of definitive liner

5
PREAMBLE
This document describes the Surgical Technique of the total hip replacement Apricot System successfully implanted since 1989. The Apricot System product range includes cemented and cementless stems and cups offering different per operative solutions. Carefully read the instruction for use and for any questions concerning product compatibility contact Medacta .

FEMORAL STAGE

5.1

FEMORALLAR STAGE: CEMENTED FEMORAL STAGE

5.1.1 Femoral preparation 5.1.2 Tests 5.1.3 Removal of the trial - broach 5.1.4 Cemented laying and final stem setting 5.1.5 Neck legth final selection

5.2

FEMORALLAR STAGE: CEMENTLESS FEMORAL STAGE

5.2.1 Femoral preparation 5.2.2 Tests 5.2.3 Removal of the trial-broach 5.2.4 Final implant 5.2.5 Neck legth final selection

6 7 8

FINAL HEAD SELECTION INSTRUMENTATION NOMENCLATURE IMPLANT NOMENCLATURE

15 16 23

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PRE-OPERATIVE PLANNING
Careful pre-operative planning is essential. The surgeon can select the optimal implant sizes that restores the patients anatomy. In addition, by using the set of X-ray templates scaled at 1.20:1 over an X-ray of the same magnification it will be possible to estimate preoperatively: -Implant size; -The ideal position of the acetabular cup; -The level of the neck cut; -Head size; -The center of rotation of the new hip.

OR

WARNING The final implants will be defined per-operatively, because of possible discrepancies between actual conditions and templating.

2 3

SURGICAL APPROACHES
Most approaches can be used, however the choice of the surgical approach is up to the surgeon.

FEMORAL NECK OSTEOTOMY

4
45

ACETABULAR STAGE

4.1

ACETABULARE STAGE: PE CUP

4.1.1 Reaming 4.1.2 Trials

The level of the neck cut is determined during preoperative planning using the x-rays templates. The femoral neck osteotomy is at an angle of 45to the diaphyseal axis of the femur. The resection is performed with an oscillating saw, taking care to maintain the above angle. The femoral head is removed using an extractor.

After arthrotomy and osteotomy of the femoral neck, expose and prepare the acetabulum cavity, remove osteophytes. WARNING Please note that the reamers have to be ordered separately from the Apricot System general instrumentation. The ideal reaming axis has an inclination angle of 40/45 and an anteversion angle of 15/20. For the anterior approach, we recommended an anteversion angle of 5. Reaming of the acetabulum starts with the smallest reamer and increases in increments of 2 mm, until a perfectly regular hemispherical cavity has been obtained, in presence of bleeding subchondral bone.

Assemble the trial cup with the multifunction handle. The trial cup has the same diameter as the last reamer. Insert the trial cup into the reamed cavity in order to estimate the depth and the orientation of the acetabular component. OPTION An orientation guide is available to aid in the positioning: assemble the 45 multifunction handle with the orientation device (inclined at 45 to the multifunction handle).
4.1.3 Cement laying

After a satisfactory trial, the final cup can be positioned. The definitive cup size will be one size less than the final reamer size. Accurately clean the acetabulum and then introduce the cement into the acetabular cavity.

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4.1.4 PE Cup setting

4.2
When the cup positioning is satisfactory, it is possible to replace the cup setting guide with the spherical cup setting guide, to decrease parasitic stress and strains before cement polymerisation. Cup setting guide and spherical cup setting guide for 28 mm head are available on the cup trays. For 32 and 22 mm use extension trays.

ACETABULAR STAGE: PRESS-FIT CUP

4.2.1 Reaming

The cup is positioned using the multifunction handle fitted with the insert setting guide. WARNING An orientation guide is available to aid in the positioning: assemble the 45 multifunction handle with the orientation device (inclined at 45 to the multifunction handle).

After arthrotomy and osteotomy of the femoral neck, expose and prepare the acetabulum cavity and remove osteophytes. The ideal reaming axis has an inclination angle of 40/45 and an anteversion angle of 15/20. For the anterior approach, we recommended an anteversion angle of 5. Reaming of the acetabulum starts with the smallest reamer and increases in increments of 2 mm, until a perfectly regular hemispherical cavity has been obtained, in presence of bleeding subchondral bone. WARNING During final reaming, avoid changing the reamer axis, in order not to make the reaming oval, which may affect or prevent primary seating. Please note that the reamers have to be ordered separately from the Apricot System general instrumentation.

Take care to retain, as far as possible, the bone stock up to the level of anterior and posterior columns. Reamed bone may be saved for void filling between implant and acetabulum. It is extremely important to perfectly clean the acetabular cavity surrounding area in order to avoid any soft tissue interposition during the metal back positioning.
4.2.2 Trials

Assemble the trial cup with the multifunction handle. The trial cup has the same diameter as the last reamer. Insert the trial cup into the reamed cavity in order to estimate the depth and the orientation of the acetabular component. OPTION An orientation guide is available to aid in the positioning: assemble the 45 multifunction handle with the orientation device (inclined at 45 to the multifunction handle).

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4.2.3 Impaction of the metal back

After a satisfactory trial, the final metal back can be positioned. Mount the metal back, whose size complies with the diameter of the last reamer, on the cup impactor. Rotate the cup impactor to position the cup slot towards the lower part of the acetabulum. OPTION Assemble the orientation rod with the rod support on the cup impactor. The rod is inclined at 45 to the cup impactor. Check the cup orientation and direction. Impact the metal back with the aid of an hammer, until fully seated and stabilised. The presence of locking wings on the upper cup border requires a constant control of the cup impactor axis during impactation, in order to avoid the increase of the inclination angle. When the cup is correctly seated in the acetabulum, the strain generation will lead to the slot closure.

WARNING Assemble the orientation rod with the rod support on the cup impactor. The rod is inclined at 45 to the cup impactor. Unscrew the cup holder from the metal back.
4.2.4 Drilling guide setting

4.2.5 Fixation screw (OPTIONAL)

4.2.6 Liner type selection (0 or 10)

The primary metal back stability can be strengthened with addition of screws. Mount the holding screw on the center of the drilling guide using the Torx screwdriver. Drill with the flexible drill holder (drill diameter = 3,2 mm). Remove the holding screw and the drilling guide. Position the screw with the Torx screwdriver: drilling through the guide must prevent any screw head protrusion inside the cup. Screws are medially and posteriorly positioned inside the acetabular roof and usually three screws are used.

This choice is made when the femoral trial-broach is correctly positioned. Use 0 and 10 hooded trial liners. In case of 10 hooded trial liner: mark with an electrocautery a reference point to fit the definitive liner in that same position.
4.2.7 Insertion of definitive liner

Mount the drilling guide with the same diameter as the metal back on the guide holder. Fit the 4 guide notches into the 4 locking pins, paying attention that the laser mark perfectly lays on the cup slot. As it leans against the cup peripheral surface, the drilling guide allows to perfectly fix the locking wings.

Clean the internal surface of the metal back. Insert the liner setting guide on the multifunction handle (different setting guides for flat and hooded liner). In the case of 10 hooded liner, the flat part on the liner setting guide provides the reference for the correct rotation positioning of the final liner (a possible positioning every 45). WARNING In case of 10 hooded liner make sure the setting guide is right positioned on the liner: the multifunction handle axis must be aligned with the liner axis.

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5.1.2 Tests

5.1.3 Removal of the trial-broach

FEMORAL STAGE
Since 2005 the Apricot (Version 2) stems were 3 updated with the Apricot (Version 3) stems: the micro threaded cone has been shortened, while the diameter 12/14 and the head centre remain the same; the range of motion has been increased; the two flat zones and the extractor hole in the neck have been eliminated in order to allow compatibility with the double mobility acetabular cup.
2

5.1

FEMORAL STAGE: CEMENTED FEMORAL STEM WARNING Since the instrumentation contains the same broach set for cemented and cementless prosthesis, remember that for the cemented femoral stem the final stem will correspond to the size indicated on the used trial-broach followed by a C.
5.1.1 Femoral preparation

Referring to the pre-operative planning, trial reductions are done. Trial neck of different lengths are available to perform trial reduction. Trial necks for 28 mm head are available on the stem tray. For 32 and 22 mm head use extension trays. To fit the trial neck on the trial-broach the operator has to push it on the stem base, while for its release, the head has to be simply pulled. WARNING The trial reduction tests are performed after placement of the trial or final acetabular component.

After checking and testing mobility, joint stability and lower limb length, remove the trial-broach. The removal will be possible by repositioning the broach handle. WARNING When it is no longer possible to use the broach handle, position the broach extractor and use the stem extractor. OPTION Screw the stem extractor handle on the stem extractor.

WARNING 2 Please pay attention that the Apricot stem CANNOT be associated with ceramic heads 28/32/36 BIOLOX Forte and Double Mobility Versafitcup .

The first broach determines the position of the successive broaches: it is essential to insert the broaches with the desired anteversion. Broaches of increasing sizes are introduced until complete locking. Remove the broach handle.

10

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5.1.4 Cement laying and final stem setting

5.2
Position the final prosthesis using the orientation puncher with a semilunar slot to control the stem rotation along the femoral canal. The reference line at the metaphysis proximal level rigorously corresponds to the trial-broach upper limit. WARNING Do not damage the necks microtreated while putting the final implant. It is recommended to not use the stem extractor to insert the final stem.
5.1.5 Neck length final selection

FEMORAL STAGE: CEMENTLESS FEMORAL STEM WARNING Since the instrumentation contains the same broach set for cemented and cementless prosthesis, remember that for the cementless femoral stem the final stem will correspond to the size indicated on the used trial-broach followed by a SC.
5.2.1 Femoral preparation 5.2.2 Tests

Remove any loose, unsupportive, cancellous bone from the canal with a curet or canal brush. Close the distal canal with a medullary plug at least 1 cm distal to the tip of the stem. Pay attention to the choice of the distal plug, to ensure that it can resist to the cement pressure. Clean the intramedullary canal with pulsative lavage and dry it: keep the canal packed until cement is ready to be injected. Introduce the cement into the canal retrograde using a cement gun. Pressurize the cement column to allow the cement to interdigitate into the cancellous bone. WARNING The final stem will correspond to the size indicated on the last used trialbroach followed by a C.

Referring to the pre-operative planning, trial reductions are done. Trial neck of different lengths are available to perform trial reduction. Trial necks for 28 mm head are available on the stem tray. For 32 and 22 mm head use extension trays. To fit the trial neck on the trial-broach the operator has to push it on the stem base, while for its release, the head has to be simply pulled. WARNING The trial reduction tests are performed after placement of the trial or final acetabular component.

The first broach determines the position of the successive broaches: it is essential to insert the broaches with the desired anteversion. Broaches of increasing sizes are introduced until complete locking. Remove the broach handle.

12

Another check of the final head length could be done using trial heads. Trial heads for 28 mm are available on the stem tray. For 32 and 22 mm heads use extension trays.

13

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5.2.3 Removal of the trial-broach

5.2.4 Final implant

5.2.5 Neck length final selection

After checking and testing mobility, joint stability and lower limb length, remove the trial-broach. The removal will be possible by repositioning the broach handle. WARNING When it is no longer possible to use the broach handle, position the broach extractor and use the stem extractor.

Put the final prosthesis into place. The final prosthesis corresponds to the size of the last broach used followed by SC. WARNING Do not damage the necks microthread while putting the final implant. Insert the implant into the femoral cavity, using the stem impactor (with or without) semilunar slot to push down the stem. WARNING The implant anteversion cannot be changed at this stage. The coating upper limit rigorously corresponds to the trial broach upper limit. Final impactation is done carefully with a hammer.

Another check of the final head length could be done using trial heads. 28 mm trial heads are available on the stem tray. For 32 and 22 mm head use extension trays. WARNING Check the head product range avaibility. The L, XL, XXL are not avaible for all typologies of implant head.

FEMORAL STAGE

Mounting of the final head: the stem cone must be thoroughly cleaned before placing the prosthetic head. Lightly impact the head using the head impactor assembled with the stem impactor. Reduce the hip. WARNING In case of ceramic on ceramic bearing it is recommended to use ceramic of femoral heads compatible with ceramic of liners. WARNING 2 Apricot (Version 2) stems are NOT compatible with BIOLOX Forte 3 ceramic heads. Apricot (Version 3) stems are compatible with all Medacta heads with 12/14 taper.

OPTION Screw the stem extractor handle on the stem extractor.

14

15

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INSTRUMENTATION NOMENCLATURE

25090.0005 EXTENSION HEAD 22 INSTRUMENT SET (TRAY N 4)

25090.0001 STEM INSTRUMENT (TRAY N 1)

1(x9) 9(x5) 37

TRAY N TRAY N (from 1 to 11)

5 10(x5) 7 6 4 3 2

(from 36 to 39)
36 39 38

25090.0002 CEMENTED PE CUP INSTRUMENT SET (TRAY N 2)

13 15

14

25090.0006 EXTENSION HEAD 32 INSTRUMENT SET (TRAY N 5)

TRAY N

(from 12 to 17)

17

16

12(x9)

TRAY N

(from 36 to 39)

42

25090.0003 PRESS-FIT CUP INSTRUMENT SET (TRAY N 3.1, TRAY 3.2)

40(x5)

43(x5)

23 20 19 25

24

41

TRAY N

(from 18 to 29)

22 21

28

26

27

29

18(x9)

01.20.300 REAMER INSTRUMENT SET (TRAY N 6). ONLY ON REQUEST

30

32

31

01.08.10.0100 APRICOT TEMPLATE

TRAY N

(from 30 to 35)

34(x8)

33(x8)

35(x8)

16

17

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TRAY 1 STEM INSTRUMENT SET

S Y S T E M

A P R I C O T

S Y S T E M

TRAY 2 CEMENTED PE CUPINSTRUMENT SET

REF
I05.T3200 I05.T3201 I05.T3202 I05.T3203 I05.T3204 I05.T3205 I05.T3206 I05.T3207 I05.T3208

Description
Trial-broach # 0 SC Trial-broach # 1 SC / # 0 C Trial-broach # 2 SC / # 1 C Trial-broach # 3 SC / # 2 C Trial-broach # 4 SC / # 3 C Trial-broach # 5 SC / # 4 C Trial-broach # 6 SC / # 5 C Trial-broach # 7 SC / # 6 C Trial-broach # 7 C

Quantity

REF
I05.0065 I05.0066 I05.0067 I05.0068 I05.0069 I05.0070 I05.0071 I05.0072 I05.0073

Description
Trial cup 44 Trial cup 46 Trial cup 48 Trial cup 50 Trial cup 52 Trial cup 54 Trial cup 56 Trial cup 58 Trial cup 60

Quantity

12

I05.T1002

Broach handle

I05.0074

Cup setting guide 28

13

I05.0034 I05.T5000 Stem impactor 1 3 I05.0033 I05.0035 I05.0039 I05.0081 I05.T1001 Stem extractor 1 7 I05.0090*

Spherical cup setting guide 28

14

I05.T5002 I05.0002 I05.T1000

Stem impactor with semilunar slot Broach extractor Stem extractor handle

1 1 1

4 5 6

Multifunction handle 45 Multifunction handle Orientation device for 45 Multifunction handle

1 1 1 1 1

15 16 17

Empty tray External tray for sterilization

I05.S0028 I05.S0108 I05.S0228 I05.S0328 I05.S0428

Trial Neck 28 size S 3.5 Trial Neck 28 size M 0 Trial Neck 28 size L+3.5 Trial Neck 28 size XL +7 Trial Neck 28 size XXL +10.5

I05.S1028 I05.S1108 I05.S1228 I05.S1328 I05.S1428

Trial Head 28 size S 3.5 Trial Head 28 size M 0 Trial Head 28 size L +3.5 Trial Head 28 size XL +7 Trial Head 28 size XXL +10.5

10

01.08.474

Head Impactor

11

I05.0080 I05.0090*

Empty tray External tray for sterilization

1 1

18

19

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TRAY 3 - PRESS FIT CUP SET
TRAY 3.1
REF
I05.0016 I05.0029 I05.0017 I05.0030 I05.0018 I05.0031 I05.0062 I05.0063

S Y S T E M

A P R I C O T

S Y S T E M

TRAY 3.2
Description
Drilling guide 48 Drilling guide 50 Drilling guide 42 Drilling guide 54 Drilling guide 56 Drilling guide 58 Drilling guide 60 Drilling guide 62

Quantity

REF

Description

Quantity

I05.0074 8 18 I05.0034

Cup setting guide 28

30

Spherical cup setting guide 28

31

I05.0026 I05.0011 I05.0012 I05.0040

Guide Holder Cup impactor Rod support at 45 (green) Universal Torx screwdriver

1 1 1 1

19 20

I05.0033

Multifunction handle

32

21

I05.0027

Standard Torx screwdriver

22

I05.0043 I05.0044 I05.0045 I05.0046 I05.0047 I05.0048 I05.0049 I05.0050

Trial liner 0 48 Trial liner 0 50 Trial liner 0 52 Trial liner 0 54 Trial liner 0 56 Trial liner 0 58 Trial liner 0 60 Trial liner 0 62

33

I05.0013

Orientation rod 45

23

I05.0003

Holding screw

24

I05.0053 I05.0054 I05.0055 I05.0056 I05.0057 I05.0058 I05.0059 I05.0060

Trial liner 10 48 Trial liner 10 50 Trial liner 10 52 Trial liner 10 54 Trial liner 10 56 Trial liner 10 58 Trial liner 10 60 Trial liner 10 62

34

I05.0076

Flexible drill holder

25

I05.0061 I05.0007

Drill 3.2 L 30 mm Drill 3.2 L 45 mm

1 1

26 27

I05.0067 I05.0068 I05.0069 I05.0070 I05.0071 I05.0072 I05.0073 I05.0075

Trial cup 48 Trial cup 50 Trial cup 52 Trial cup 54 Trial cup 56 Trial cup 58 Trial cup 60 Trial cup 62

35

I05.0015

Liner setting guide 0 28

28

I05.0082 I05.0036 Liner setting guide 10 28 1 29 I05.0091*

Empty tray External tray for sterilization

1 1

20

21

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TRAY 4 - EXTENSION HEAD 22
REF
I05.S0122 I05.0064

S Y S T E M

A P R I C O T

S Y S T E M

8
Quantity
1 1

IMPLANT NOMENCLATURE

Description
Trial neck 22 Size M 0 Trial cup 40

N
36

STEM
CEMENTED 25012.0200* 25012.0201 25012.0202 25012.0203 25012.0204 25012.0205 25012.0206 25012.0207 SIZE CEMENTLESS 0* 25010.0500* 1 25010.0501 2 25010.0502 3 25010.0503 4 25010.0504 5 25010.0505 6 25010.0506 7 25010.0507

I05.0032

Cup setting guide 22

37

I05.0077

Spherical cup setting guide 22

38

I05.S1122 SP 589

Trial head 22 Size M 0 Empty Tray

38

*Limited use body weight non exeeding 65 kg

CEMENTLESS PRESS-FIT CUP

DIAMETER 48 50 52 54 56 58 60 62 PRESS FIT LINERS FOR 28 HEAD METAL BACK 0 Flat PE liner 10 Hooded PE liner 25074.0548 25075.2848 25076.2848 25074.0550 25075.2850 25076.2850 25074.0552 25075.2852 25076.2852 25074.0554 25075.2854 25076.2854 25074.0556 25075.2856 25076.2856 25074.0558 25075.2858 25076.2858 25074.0560 25075.2860 25076.2860 25074.0562 25075.2862

TRAY 5 - EXTENSION HEAD 32

REF
I05.S0032 I05.S0132 I05.S0232 I05.S0332 I05.S0432 I05.0079

Description
Trial neck 32 Size S -3.5 Trial neck 32 Size M 0 Trial neck 32 Size L +3.5 Trial neck 32 Size XL +7 Trial neck 32 Size XXL +10.5 Cup setting guide 32

Quantity

N
40

41

CEMENTED PE CUP
DIAMETER 40 44 46 48 50 52 54 56 58 60 Heads 22 25070.2240 25070.2244 25070.2246 25070.2248 25070.2250 25070.2252 Heads 28 25070.2844 25070.2846 25070.2848 25070.2850 25070.2852 25070.2854 25070.2856 25070.2858 25070.2860 Heads 32

I05.0078

Spherical cup setting guide 32

42

I05.S1032 I05.S1132 I05.S1232 I05.S1332 I05.S1432 SP 589

Trial head 32 Size S -3.5 Trial head 32 Size M 0 Trial head 32 Size L +3.5 Trial head 32 Size XL +7 Trial head 32 Size XXL +10.5 Empty Tray

43

TRAY 6 - REAMER INSTRUMENT SET (ONLY ON REQUEST)

REF
01.30.10.3142* 01.30.10.3144* 01.30.10.3146* 01.30.10.3148* 01.30.10.3150* 01.30.10.3152* 01.30.10.3154* 01.30.10.3156* 01.30.10.3158* 01.30.10.3160* 01.30.10.3162* 01.11.10.0600*

*On request

25070.3248 25070.3250 25070.3252 25070.3254 25070.3256 25070.3258 25070.3260

Description
Reamer 42 Reamer 44 Reamer 46 Reamer 48 Reamer 50 Reamer 52 Reamer 54 Reamer 56 Reamer 58 Reamer 60 Reamer 62 Reamer Handle

Quantity

SCREWS 6.5
Length [mm] 20 30 35 40 45 25080.6520 25080.6530 25080.6535 25080.6540 25080.6545

11

Note for sterilisation: The instrumentation is not sterile upon delivery. It must be cleaned before utilisation and sterilised in an autoclave respecting the statutory requirements of the country EU, directives where applicable and following the instruction for use of the autoclave manufactures.
Vesafitcup, Medacta are registered trademarks of Medacta International SA, Castel San Pietro, Switzerland Biolox is trademarks of CeramTec AG, Plochingen, Germany

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