Z1™ Femoral Hip System

Surgical Technique
INTENDED USE

The Z1 Hip System is intended for total or hemi hip

arthroplasty. Z1 Hip System is for cementless use only.

INDICATIONS CONTRAINDICATIONS
1. Advanced wear of the joint due to degenerative, 1. Acute, chronic, local, or systemic infections.
post-traumatic or rheumatic diseases. 2. Severe muscular, neural, or vascular diseases
2. Failed previous hip surgery including joint that endanger the limbs involved.
reconstruction (osteotomy), arthrodesis, hemi- 3. Lack of bony structures proximal or distal to the
arthroplasty or total hip replacement (THR). joint, so that good anchorage of the implant is
3. Acute traumatic fracture of the femoral head or unlikely or impossible.
neck. 4. Total or partial absence of the muscular or
4. Avascular necrosis of the femoral head. ligamentous apparatus.
5. Any concomitant diseases that can jeopardize
the functioning and the success of the implant.
6. Allergy to the implanted material, especially to
metal (e. g., cobalt, chromium, nickel, etc.).
7. Local bone tumors and/or cysts.
8. Pregnancy.
9. Skeletal immaturity.
Table of Contents

Quick Reference Surgical Technique......................................................................... 1

System Overview....................................................................................................... 2

Pre-operative Planning.............................................................................................. 3

Digital Pre-operative Planning.................................................................................. 3

Patient Positioning/Surgical Exposure..................................................................... 4

Femoral Neck Resection............................................................................................ 4

Femoral Canal Opening............................................................................................. 5

Femoral Canal Preparation........................................................................................ 6

Calcar Preparation..................................................................................................... 6

Trial Reduction........................................................................................................... 7

Cementless Femoral Implant Insertion..................................................................... 8

Head Impaction......................................................................................................... 9

Intraoperative Stem Repositioning or Removal...................................................... 10

 1 | Z1™ Hip System Surgical Technique

Quick Reference Surgical Technique

Step 1: Step 2: Step 3:

Pre-operative Planning Femoral Neck Resection Femoral Canal Opening

Step 4: Step 5: Step 6:

Femoral Canal Preparation Calcar Preparation Trial Reduction

Step 7: Step 8:
Femoral Implant Insertion Femoral Implant Insertion
2 | Z1™ Hip System Surgical Technique

Cementless Collared Cementless Collarless

System Overview
The Z1 Hip System includes two different implant
bodies.
• Cementless Collared,
• Cementless Collarless,

The cementless implants come in Standard (135

degrees), High offset (135 degrees), and Coxa Vara
(126.5 degrees) neck options.
 3 | Z1™ Hip System Surgical Technique

Figure 1 Figure 2

Pre-operative Planning Digital Pre-operative Planning

The objectives of pre-operative planning are to define: Z1 Hip System digital templates are available through
various digital template providers. When using digital
• Pre-operative leg length
templating for a primary total or hemi hip arthroplasty,
• Acetabular component size and position it is necessary to use a magnification marker with a
• Femoral component size and neck variant known dimension. This is required to calculate the
• Femoral offset and center of rotation correct magnification.

The Z1 Hip System provides X-ray templates with Once the correct magnification has been established,
100%, 110%, 115%, and 120% magnification the digital templating system can be used to determine
(Figure 1). It is recommended to use a radiographic the optimal implant size and center of rotation
marker to assess the X-ray magnification and select (Figure 2).
the appropriate template. It is also recommended that
templates are positioned over the AP X-rays to best
decide the correct implant size and center of rotation.
4 | Z1™ Hip System Surgical Technique

Figure 3 Figure 4

Patient Positioning/
Surgical Exposure Femoral Neck Resection
The Z1 Hip System femoral components can be Depending on the surgeon’s preference and surgical
implanted using any of the standard approaches for approach, the neck cut can be made prior to or after
total or hemi hip replacement (Figure 3). dislocation. The neck cut can also be made at different
heights in line with the surgeon’s preoperative plan
(Figure 4).
 5 | Z1™ Hip System Surgical Technique

Figure 5 Figure 6 Figure 7 Figure 8

Femoral Canal Opening

Multiple instruments are available to initiate entry into Note: Use caution to not remove too much bone
the femoral canal including Modular Box Osteotome outside of the intended broach and implant
(Figure 5), Honey Badger Rasp (Figure 6), Starter Awl envelope.
(Figure 7), and Reverse Toothed Rasp (Figure 8).
6 | Z1™ Hip System Surgical Technique

Figure 9 Figure 10 Figure 11

Femoral Canal Preparation Calcar Preparation

Begin femoral preparation with the Starter Broach A calcar planer is available for use. With the final
paying attention to the native anteversion (Figure broach fully seated, place the calcar planer over the
9). Broach in sequential fashion and until stability broach post and advance it until reaching the broach
is achieved (Figure 10). Avoid excessive rotation of face (Figure 11).
the broach while entering and exiting the femoral
canal in order to limit removing excessive anterior and Note: Put the calcar planer in motion before
posterior cancellous bone. engaging it with the bone. Advance the planer
gently to avoid applying excessive force on the
bone.
 7 | Z1™ Hip System Surgical Technique

Figure 12 Figure 13

Trial Reduction
With the final broach in place, select the appropriate Once the provisional neck is in place, select the
provisional neck (Standard Offset, High Offset or Coxa correct provisional head size and position it onto
Vara) and assemble it onto the broach (Figure 12). the provisional neck (Figure 13). Perform the trial
reduction and if necessary, repeat the procedure with
Color Coding – Stem Variant different head offsets.
Gold Standard Offset (STD) (135˚)
Note: There is a 3.5 mm increase in neck lengths
Black High Offset (HO) (135˚)
between the core sizes (0 to 9) and macro sizes (10
Silver Coxa Vara (CV) (126.5˚)
to 12).
6mm
Horizontal Offset – Horizontal offset: 6 mm shift between STD and HO
or Coxa Vara.

– Vertical offset: 6 mm shift between STD and HO or

6mm
Leg Lenth Coxa Vara.

Note: Assemble the provisional head by hand. Do

not use an impaction force to seat the provisional
head onto the provisional neck.
Offset Management
8 | Z1™ Hip System Surgical Technique

Figure 14a Figure 14b

Cementless Femoral Implant

Insertion
The definitive implant must correspond to the last Make sure to drive the final implant into the femur
broach used. Start inserting the femoral component following the path of the prepared canal, using the
into the femoral canal by hand, and finish seating with preferred stem impactor until the stem is fully seated.
the preferred stem impactor (Figures 14a and 14b).
 9 | Z1™ Hip System Surgical Technique

Figure 15 Figure 16

Cementless Femoral Implant

Insertion (cont.) Head Impaction
If desired, a further trial reduction can be completed Before impacting the final femoral head, carefully
after implantation of the definitive femoral stem clean and dry the taper of the stem.
(Figure 15).
Fully seat the modular head by means of firm axial
Note: Assemble the provisional head by hand. Do impaction utilizing the femoral head impactor and
not use an impaction force to seat the provisional mallet (Figure 16).
head onto the stem during the trial reduction.
10 | Z1™ Hip System Surgical Technique

Figure 17a Figure 17b

Intraoperative Stem Repositioning

or Removal
Should a stem require intra-operative removal for re- Generic acetabular screw forceps and a 3.5 mm hex
implantation, only extraction instruments that engage driver can be used to aid in assembling the extractor
the M6 thread should be used. adapter to a stem.

To do this, assemble the M6 Extractor with Hex to the

slap hammer and the implant (Figure 17a). Pull out
the stem in line with the femoral axis by using the slap
hammer (Figure 17b).
 11 | Z1™ Hip System Surgical Technique

Notes
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Zimmer Biomet or its affiliates unless otherwise indicated, and must not
be redistributed, duplicated or disclosed, in whole or in part, without the
express written consent of Zimmer Biomet.
This material is intended for health care professionals. Distribution to any
other recipient is prohibited.
For product information, including indications, contraindications,
warnings, precautions, potential adverse effects and patient counseling
information, see the package insert and www.zimmerbiomet.com.
Please refer to the Instructions for Use and the package insert to the
products to be used with this Surgical Technique.
Zimmer Biomet does not practice medicine. This technique was
developed in conjunction with health care professionals. This document
is intended for surgeons and is not intended for laypersons. Each surgeon
should exercise his or her own independent judgment in the diagnosis
and treatment of an individual patient, and this information does not
purport to replace the comprehensive training surgeons have received.
As with all surgical procedures, the technique used in each case will
depend on the surgeon’s medical judgment as the best treatment for
each patient. Results will vary based on health, weight, activity and
other variables. Not all patients are candidates for this product and/or
procedure.
Caution: Federal (USA) law restricts this device to sale by or on the order
of a physician. Rx only.
For Ordering Information please refer to document 4740.X-US-en.
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4191.1-US-en-Issue Date 2024-09 www.zimmerbiomet.com