Metabloc Stem System

Product Information Surgical Technique

One Instrument Set for Two Different Anchorage Philosophies.

Disclaimer
This document is intended exclusively for experts in the field, physicians in particular, and it is not intended for laypersons. Information on the products and procedures contained in this document is of a general nature and does not represent medical advice or recommendations. Because this information does not constitute any diagnostic or therapeutic statement with regard to any individual medical case, examination and advising of the respective patient are absolutely necessary and are not replaced by this document in whole or in part. Information contained in this document was gathered and compiled by medical experts and qualified Zimmer employees to the best of their knowledge. The greatest care was taken to ensure the accuracy and approachability of the information used and presented. Zimmer does not assume any liability, however, for the accuracy, completeness or quality of the information. Zimmer is not liable for tangible or intangible losses that may be caused by the use of this information.

Metabloc Stem System Product Information and Surgical Technique

Product Information Surgical Technique Metabloc Stem System

Table of Contents
Metabloc Stem Cemented and Uncemented Metabloc Design Preoperative Planning Planning Stages Operative Procedure Postoperative Treatment Example of a Cemented Metabloc Stem Example of an Uncemented Metabloc Stem 4 6 7 8 10 13 14 15

Ordering information
Implants Instruments without Rasp Handle Rasp Handle 16 17 18

Metabloc Stem System Product Information and Surgical Technique

Metabloc Stem Cemented and Uncemented

Philosophy
The Metabloc system combines the characteristics of well-known hip replacement designs which have proven themselves for many years and also meets the requirements of modern total hip arthroplasty. The stem is available in both cemented and uncemented versions. It therefore covers a very broad range of indications. The stem fills the metaphysis, ensuring proximal transmission of forces. The neck length and CCD angle increase as the stem length increases. This means that physiological conditions are achieved in the hip joint as regards the lever arm. The instruments are identical for both prostheses. The modular-shaped rasps are used as test stems. This makes instrumentation simpler and also makes it possible to change over intraoperatively from cemented to uncemented fixation and vice versa.

Metabloc Stem System Product Information and Surgical Technique

Fixation Principle
The Metabloc stem interlocks mainly in the metaphysis thanks to its threedimensional conical form. This produces a physiological transmission of forces for both stem versions. A gap of at least 1 mm should remain between the stem and the cortex. This means that distal fixation is minimized with the uncemented stem and a circular cement coat is obtained with the cemented stem.

Indications
The range of indications for the Metabloc stem is considerably broader than for stem systems currently available. The reasons for this are principally the option of a cemented or uncemented version, the proximal stem configuration and the wide range of sizes. The decision on whether to use a cemented or uncemented prosthesis depends above all on the age, sex, cancellous bone quality and cortex index. The prosthesis is suitable for young and old patients. It can also be used for less severely dysplastic hips or in cases of revision where there is still sufficient proximal bone stock.

Metabloc Stem System Product Information and Surgical Technique

Metabloc Design
Cemented Metabloc Stem Uncemented Metabloc Stem

Metaphyseal structure of the cemented Metabloc stem

Shape of the ribs

Metaphyseal structure of the uncemented Metabloc stem

Shape of the ribs

The proximal thickening with the rounded ribs ensures optimum distribution of forces in the cement coat and also a high degree of rotational stability. The conical stem design produces self-centring in the medullary cavity as well as proximal interlocking. In this way, an undesirable varus position can be avoided. The cemented stem is made of a forged steel alloy (FeCrNiMnMoNbN/ Protasul-S30) which was developed specially for use with cement. The nickel content is only about half that of earlier alloys. The relatively high rigidity of Protasul-S30 reduces unfavourable tension points in the cement coat. The surface of the prosthesis is finely blasted. This ensures a good bond between the implant and the cement.

The sharp-edged longitudinal ribs on the proximal third of the stem become anchored deep in the metaphyseal cancellous bone, thus guaranteeing good primary stability. The ribs extend as far as the diaphyseal transition area, thus optimizing osseointegration. The tapering of the distal third of the stem prevents contact with the cortex. This prevents distal transmission of forces. The prosthesis is made of a forged titanium alloy (Ti6Al7Nb/Protasul-100). This alloy has proven its value for uncemented implant fixation many times over the years. The coarse-blasted titanium surface promotes secondary implant fixation by means of osseointegration.

Metabloc Stem System Product Information and Surgical Technique

Preoperative Planning
Aims
Preoperative planning permits selection of the appropriate stem size and the correct position of the femoral components. As soon as the anatomical acetabular cup centre and the height of the centre of the head have been determined, the centre of rotation and leg length, which should be the same on both sides, can be established. If the cup centre is positioned higher for technical reasons to obtain fixation, the centre of the head must be raised to correspond. Operative planning is carried out using prosthetic preoperative templates on a standard X ray of the pelvis.

Prosthetic Templates
The Metabloc stem planning templates are drawn on the scale 1.15:1, corresponding to X ray magnification. Since the CCD angle and the length of the neck increase in line with increasing stem size in the Metabloc design, there is a template for each stem size. The prosthetic stem is shown along the physiological axis of the femur relative to the long axis of the body. The level of resection of the neck of the femur (R) is drawn in at an angle of 45 to the stems axis. The heights of the centre of the heads with short, medium, long and extra long neck lengths are marked S, M, L and XL. The lateral view allows the fit in the sagittal plane to be checked on the lateral X ray of the femur.

0cm

0cm 0cm

5cm 5cm 5cm

0cm 1 0cm 1 0cm 1

6 66
0 cm

0 cm 0 cm 0 cm 0 cm

5cm 1 5cm 1 cm 5 1

5 cm 5 cm5 cm 5 cm 5 cm

10cm

ation nificication Magnification Mag Magnif 5:1 1 . 1 5:1 1 . 1 5:1 1 . 1

0cm cm 0 cm 0

5cm 5cm 5cm

10cm

10cm

ented cem ed Stem cemented cement Stem Metabloc bloc oc Meta Metabl 132.5 -Angle gle 132.5 4, CCD CCD-Angle CCD-An 12/14, Cone the prosthesis Cone Cone12/1 ond to that of

corresp prosthesis Switzerland of the that hur,prosthesis to ce number must Wintert correspond to 4 that referen must correspond of the This number must This 49-06.6. reference number 35.00.49-06. This reference Ref.: r GmbH, CH-840 Switzerland 35.00. 35.00.49-0 Ref.: Winterthur, Switzerland Ref.: CH-8404 Winterthur, reserved, Zimme GmbH, CH-8404 rights Zimmer GmbH, All reserved, Zimmer All ted. rights reserved, implanted. be All rights to implan be implanted. to be to 03.000-WL 06.011 Lit.No. 4/2003, , Lit.No. 06.01103.000-WL Lit.No. 06.01103.000-WL 4/2003 4/2003,

18 7 6118 14 6380 7 611814 638018 7 611814 638018 cm cm 10 10 10 cm 10 cm 10 cm

66 66 6

Planning template cemented 06.01103.000

cm 15 15 cm cm 15 15 cm 15 cm

10 cm

ation nificication Mag Magnif Magnification Magnification Magnif ication :1 1.15 1.15:1 1.15:1 1.15:1 1.15:1

ted men unce ented uncem Stem Stem bloc oc uncemented Metabl Meta Metabloc Metabloc Metabl Stem uncemented oc .5 Stem uncem le 132 ented -Ang 132.5 gle 4, CCD CCD-An 12/1 132.5 the prosthesis 12/14, Cone Cone Cone Cone 12/14, CCD-Angle 12/14,CCD-Angle ond to that of 132.5 CCD-An corresp land r must gle of the prosthesis 132.5 to ce numbe correspond Winterthur, Switzer 4 that referen This reference number must This 49-06. 6. to that of the prosthesis GmbH, CH-840 Switzerland

0 cm 0 cm 0 cm 0 cm 0 cm

5 cm 5 cm 5 cm 5 cm 5 cm

10 cm
10 cm 10 cm

10 cm

correspond r must number 21.00. 21.00.49-0 reference This Winterthur, Zimme Ref.: Ref.: 21.00.49-06. d, Ref.: Ref.: CH-8404 21.00.49-06. 21.00.49-0All This reserve reference GmbH, number must correspond Zimmer 6. rights to that This of the prosthesis reference reserved, rights Switzerland number ted. All Winterthur, CH-8404 GmbH, must Zimmer implan reserved, correspond implanted. rights All be be to implanted. be to to that of the prosthesis to to be implanted. be -WL implanted. GmbH, 02.000 All Allrights Winterthur, Switzerland rightsreserved, 00-WL 06.011 reserved,Zimmer 06.01102.0 Zimmer GmbH,CH-8404 , Lit.No. Lit.No. CH-8404 Winterthur, 4/2003, Lit.No. 4/2003 4/2003, 4/2003, Lit.No. 06.01102.000-WL Lit.No.06.01102.000-WL Switzerland 06.01102.000-WL

25 7 6118 14 6380 7 611814 638025 7 611814 638025 7 611814 638025 7 611814 638025

Planning template uncemented 06.01102.000

Metabloc Stem System Product Information and Surgical Technique

Planning Stages
The planning stages are shown using the example of a case of unilateral osteoarthrosis in which the healthy hip serves as a reference side. The anatomical acetabular centre and the height of the centre of the head are reconstructed.

1. Determining the anatomical centre of the acetabulum and the height of the centre of the head
The teardrop line and the perpendicular through the pubic symphysis (bodys long axis) are indispensible for planning. Using a circular template, the centre of rotation is determined in the healthy hip. The long axis of the femur on the healthy side and the perpendicular to it at the level of the centre of the head are also sketched in. The distance measured from the centre of rotation to the teardrop or teardrop line are transferred to the hip to be operated, thus establishing the anatomical centre of the acetabulum. The height of the centre of the head is transferred in like manner.

2. Determining the stem size

The template of the probable stem size is laid over the femur to be operated, centring the stem in the medullary cavity and placing the M line at the level of the sketched line marking the centre of the head. The stem size is correct when there is still a gap of about 1 mm between the stem outline and the medial margin of the diaphyseal cortex.

0 cm

5 cm

6
10 cm

10 cm

15 cm

5 cm

0 cm

ati nific Mag : 1 1.15

on
esis d prosth erlan

ted of the r, Switz that thu men 2.5 nter nd to spo 4 Wi m ce gle 13 corre CH-840 ust c Ste CD-An bH, er m C ablo numb mer Gm nce Met 12/14, , Zim refere erved e res This Con -06. -WL rights
.49 .00 All 103.000 : 35 ted. .01 Ref. implan o. 06 to be 3, Lit.N 00 4/2

1 7 61

8 14

63 8

01 8

Metabloc Stem System Product Information and Surgical Technique

3. Drawing the prosthesis and the femur

A transparent drawing sheet is now laid over the template and the X ray film, the edge of which must be flush with the long edge of the template. The outline of the prosthetic stem with the line of the centre of the head (M) and the resection line for the neck of the femur (R) and the outline of the femur are transferred to the drawing paper.

0 cm

5 cm

6
10 cm

10 cm

15 cm

5 cm

0 cm

ation nific Mag :1 5 1.1

pro erl the ted Switz t of thur, men 132.5 ond to thaWi nter sp 4 m ce gle corre -840 c Ste CCD-An must bH, CH mber ablo r Gm , ce nu Zimme Met 12/14 , eren is ref reserved e Th n o C -06. rights 00-WL .49 All .00 103.0 : 35 ted. .01 Ref. implan o. 06 to be 3, Lit.N 00 4/2

sthes

is

a nd

1 7 61

8 14

63 8

01 8

4. Drawing the pelvis

The drawing sheet is laid parallel to the bodys long axis and the centre of the prosthetic head is placed over the sketched-in centre of the acetabulum. The outlines of the pelvis are now drawn in. At this stage of drawing, the selected cup is also tried anatomically for size and entered on the planning sketch.

5. Final drawing
All of the information needed for the operation (type and size of prosthetic components, measured distances and possible bone grafting) is finally noted on the planning sketch. The distances from the centre of the head to the tip of the greater trochanter and from the level of resection or from the end of the cone to the base of the lesser trochanter are measured using the template gauge (1.15:1).

10

Metabloc Stem System Product Information and Surgical Technique

Operative Procedure
Preparing the Medullary Cavity
The Metabloc stem can be inserted via all operative approaches with the patient in the supine or lateral position. The individual operative steps are shown below for the posterior approach with the patient in the lateral position. However, all of the technical details can be transferred analogously to other access routes.

Femoral neck osteotomy 45 to stem axis, slit-like opening of the medullary cavity with the gouge in about 1015 anteversion and sufficiently dorsolaterally.

Prepare the medullary cavity with the awl as far as the corresponding mark (prosthetic size), using the tip of the greater trochanter as reference point.

Widen the medullary cavity with shaped rasps in increasing order of size. Check anteversion. Drive in the rasps until the upper margin ot the teeth is at the level of resection. About 3 mm of cancellous bone should be preserved between the rasp and the cortex. If rotational forces applied on the rasp produce mobility between rasp and cancellous bone you can try to increase one rasp size to assure rasp torsional stability (respect 3 mm of cancellous bone). Otherwise, in cases of less than 3 mm cancellous bone stock or osteoporotic bone, change strategy to cemented stem. The removable trial neck is inserted into the rasp. There are three different trial necks, according to the rasp size. After the insertion of the trial neck, measure the distances from the end of the cone to the resection level and to the base of the lesser trochanter.

Metabloc Stem System Product Information and Surgical Technique

11

Cemented Metabloc Stem

Put on the test head for trial reduction. Check the height of the centre of the head with a Kirschner wire. Check the range of movement, stability, soft tissue tension and leg length.

Extract the test prosthesis (shaped rasp). Insert the bone plug. After placing a suction drain, insert the cement using a silicone gasket.

Insert the stem and remove the suction drain at the same time. Remove the silicone gasket and gradually drive home the stem to the planned level which has been confirmed by trial reduction.

Carefully clean the cone with water and gauze strips. Put on the head with a rotary movement and lock it with a light blow of the hammer on the repositioning lever.

Reduce the joint and check the function of the components again. Wound closure, suction drain.

12

Metabloc Stem System Product Information and Surgical Technique

Uncemented Metabloc Stem

Put on the test head for trial reduction. Check the height of the centre of the head with a Kirschner wire. Check the range of movement, stability, soft tissue tension and leg length.

Remove the test prosthesis (rasp). Insert the prosthetic stem, parallel to the axis of the femur. Drive it in carefully with the impactor and hammer. If there is any contact between the stem and the cortex, the awl should be used again.

Carefully clean the cone with water and gauze strips. Put on the head with a rotary movement and lock it with a light blow of the hammer on the repositioning lever.

Reduce the joint and check the function of the components again. Wound closure, suction drain.

Metabloc Stem System Product Information and Surgical Technique

13

Postoperative Treatment
There is no significant difference in aftercare between the cemented and the uncemented Metabloc stems. With the cemented fixation, full weight-bearing is possible after the wound has healed. With the uncemented stem, avoidance of weight-bearing is advisable for two months so as not to interfere with osseointegration. During the rehabilitation period, assessment of the clinical course is indicated. X ray check-ups should later be done at intervals of 2 to 5 years.

14

Metabloc Stem System Product Information and Surgical Technique

Example of a Cemented Metabloc Stem

Preoperative. Bilateral osteoarthrosis with considerable restriction of function.

Postoperative. Metabloc stem cemented, Standard cup uncemented.

Metabloc Stem System Product Information and Surgical Technique

15

Example of an Uncemented Metabloc Stem

Preoperative. Unilateral osteoarthrosis with painful limitation of walking.

Postoperative. Uncemented total hip replacement: Metabloc stem, CLS cup.

16

Metabloc Stem System Product Information and Surgical Technique

Implants

Metabloc stem, cemented

Metabloc stem, uncemented

FeCrNiMnMoNbN Protasul-S30

Ti6Al7Nb Protasul-100

STERILE R

STERILE R

Size

Length

REF

Size

Length

REF

3 4 6 8 10 12 14

120 mm 126 mm 138 mm 150 mm 162 mm 174 mm 174 mm

35.00.49-03 35.00.49-04 35.00.49-06 35.00.49-08 35.00.49-10 35.00.49-12 35.00.49-14

3 4 5 6 7 8 9 10 11 12 13 14

120 mm 126 mm 132 mm 138 mm 144 mm 150 mm 156 mm 162 mm 168 mm 174 mm 174 mm 174 mm

21.00.49-03 21.00.49-04 21.00.49-05 21.00.49-06 21.00.49-07 21.00.49-08 21.00.49-09 21.00.49-10 21.00.49-11 21.00.49-12 21.00.49-13 21.00.49-14

Metabloc Stem System Product Information and Surgical Technique

17

Instruments without Rasp Handle

Metabloc plastic tray (complete, but does not include rasp handle)
REF

ZS01.00479.911 Metabloc plastic tray (empty)

REF

Repositioning lever
REF

Metabloc modular rasp

Size REF

75.01.38 Plastic top

REF

01.00479.902 Metabloc tray insert (empty)

REF

01.00479.901 Standard tray cover grey

REF

01.00029.031

3 4 5 6 7 8 9 10 11 12 13 14

01.00472.003 01.00472.004 01.00472.005 01.00472.006 01.00472.007 01.00472.008 01.00472.009 01.00472.010 01.00472.011 01.00472.012 01.00472.013 01.00472.011

78.00.38

Repositioning top mm 28 32

REF

78.00.38-28 78.00.38-32

Handle with quick coupling

REF

75.00.25 Metabloc trial neck

Size REF

Awl
REF

75.05.31

35 68 914 Awl for 75.00.25

Size REF

01.00471.015 01.00471.016 01.00471.017

small 49 medium 912 large 1214

71.00.49-14 71.00.49-16 71.00.49-18

Boxed chisel
REF

72.13.02-10

Trial heads
mm Size REF

28 28 28 28 32 32 32 32

S M L XL S M L XL

01.01559.128 01.01559.228 01.01559.328 01.01559.428 01.01559.132 01.01559.232 01.01559.332 01.01559.432

Extraction instrument
REF

75.85.75

18

Metabloc Stem System Product Information and Surgical Technique

Rasp Handle

Plastic tray for rasp handle (empty)

REF

01.06010.901 Standard tray cover grey

REF

01.00029.031

Straight rasp handle with strike plate

REF

01.00001.001

Long bar
REF

70.00.01

Double offset handle with strike plate

REF

right

01.00001.002

Double offset handle with strike plate

REF

left

01.00001.003

Contact your Zimmer representative or visit us at www.zimmer.com

Lit. No. 917401x Ed. 06/2006 WL

7 611814 392651

2006 by Zimmer GmbH Printed in Switzerland Subject to change without notice