S-ROM Modular

Hip System
Surgical Technique
The S-ROM® Modular Hip System offers
extensive metaphyseal and diaphyseal
geometries, making it versatile for a
wide range of patient anatomies. The
S-ROM Stem has clinical heritage dating
back to 1984.
The S-ROM Modular Hip System provides
solutions for a variety of surgical scenarios
(from primary THA to complex revisions,
and for the challenges of Development
Dysplasia of the Hip) by offering the
modularity of independent neck and
sleeve options. The S-ROM System utilizes
a straightforward surgical technique
involving: 1) Distal Reaming, 2) Proximal
Reaming and 3) Calcar Reaming. The
streamlined S-ROM® MACH1™
Instrumentation features color-coding,
instrument-implant consistency throughout
and an efficient procedural flow.

This surgical technique was developed in cooperation with:

• James V. Bono, M.D. •  obert L. Buly, M.D.

R
Boston, Massachusetts New York, New York

•  ugh U. Cameron, M.B.Ch.B., F.R.C.S.(C).

H •  ichael J. Christie, M.D.
M
Toronto, Ontario Nashville, Tennessee

• Douglas A. Dennis, M.D. •  ayne M. Goldstein, M.D.

W
Denver, Colorado Chicago, Illinois

•  avid A. Mattingly, M.D.

D
Boston, Massachusetts

Surgical Technique S-ROM® Modular Hip System DePuy Synthes 3

S-ROM System Surgical Technique Quick Reference

Neck Osteotomy (90 degrees) IM Initiator Step 1 – Distal Ream

Perform a preliminary resection of the Open the femoral canal by penetrating Begin axial reaming with the end-cutting
femoral neck using the biomechanical the superior femoral cortex with the reamer and work up sequentially until
femoral neck resection template as a IM Initiator or box osteotome (not cortical contact is achieved.
guide (not shown). The hole in the shown). To protect against varus
neck of the resection template is positioning, enter the medullary canal In keeping with pre-operative
located at the center of the femoral by beginning at the posterior margin planning, the final straight reamer
head. of the junction of the neck resection should be a half-millimeter larger than
and the complementary cut at the the minor distal diameter of the
The notch on the medial aspect of the trochanteric fossa. selected femoral stem.
template indicates the most distal
point for making the neck resection. The appropriate reamer depth has
been established when the witness
mark on each distal reamer aligns with
the tip of the greater trochanter.

The diameter of the final distal reamer

will dictate the color of the
instrumentation selected for the
remaining surgical steps.

4 DePuy Synthes S-ROM® Modular Hip System Surgical Technique

Step 2 – Proximal Ream Step 3 – Calcar Trial Final Implantation
Prepare the proximal or Ream/Mill Using the sleeve introducer, Introduce the sleeve
“cone” portion of the Select the appropriate size insert the appropriate trial implant with the sleeve
sleeve implant. miller shell based on the sleeve (that matches the introducer. Place the stem
final proximal/cone reamer cone diameter and spout introducer onto the femoral
A set of triple-banded, color- utilized. Attach the size reamed). Assemble the implant, and implant using
coded cone reamers are appropriate color-coded trial implant by snapping the pin punch for version
available for preparing the pilot shaft to the distal end the chosen neck onto the control. The taper is locked
proximal canal. The proximal of the miller shell. Numeric appropriate size distal when the stem will no
diameter of each conical markings of the proximal stem trial. longer advance.
reamer is marked on one diameter are found on cone
side. On the opposite side, reamers and miller shells for Introduce prior to trial
the three proximal sleeve cross reference verification. reduction. The trial neck can
sizes (B, D, and F) are marked be adjusted in 10-degree
with the corresponding Use the appropriate size increments or “clicks”. Use
sleeve configuration. The triangle mill/drill to prepare the nut tightener to lock the
location of each color band the femur to accommodate trial when the desired
moves from distal to the calcar spout of the final version is obtained.
proximal as the proximal sleeve (S, L, or XXL).
diameter increases. Mark version and remove
the trials.
Attach the appropriate color-
coded pilot shaft to the distal
end of the proximal reamer,
and ream until cortical
contact is achieved.

Surgical Technique S-ROM® Modular Hip System DePuy Synthes 5

Preoperative Planning

Preoperative Planning Goals

Preoperative planning enables the surgeon to prepare
for the case and anticipate situations that may arise
during surgery. A thorough preoperative plan
incorporates elements from the patient’s history, physical
examination and radiographic analysis.

1. Determine preoperative leg length discrepancy

2. Assess acetabular component size and placement

3. Determine femoral component size, position and fit

4. Assess femoral offset

Radiographs
The first step in accurate templating is obtaining high-
quality radiographs using a standardized protocol with
known magnification. Use magnification markers
attached to the patient’s leg at the level of the greater
trochanter to verify magnification.

The S-ROM Modular Hip System templates (Cat. No.

XRT142) incorporate 15 percent magnification.

Obtain an anterior/posterior (A/P) view of the pelvis with

both extremities in 15 degrees of internal rotation to
position the head and neck parallel to the coronal plane.
A direct lateral radiograph should also be obtained to
determine desired femoral fixation.

6 DePuy Synthes S-ROM® Modular Hip System Surgical Technique

Preoperative Planning

Determination of Leg Length Discrepancy

To determine preoperative leg length, perform a clinical
evaluation in conjunction with a radiographic analysis.
Use both to determine intraoperative leg length
management.

As an estimate of leg length discrepancy

radiographically, draw a reference line along the inferior
aspect of the ischial tuberosities (Figure A). Measure the
distance from the lesser trochanter landmark to the
reference line on each side. The difference between the
two is the radiographic leg length discrepancy.

The tip of the greater trochanter may be used as an

alternative reference mark in conjunction with the lines Figure A
along the inferior aspect of the ischial tuberosities.

Acetbular Cup Size and Position

Most sizing predictions are made on the A/P radiograph
of the hip. Determine the optimal position for the
acetabular component and predict the size using
template overlays. The acetabular teardrop can be
referenced as the inferior margin of the acetabular
reconstruction.

The goal in cementless acetabular fixation is to maximize

bone contact. Once this is determined, mark the
intended center of rotation of the bearing surface on the
A/P radiograph (Figure B).

Figure B

Surgical Technique S-ROM® Modular Hip System DePuy Synthes 7

Preoperative Planning

Cementless Femoral Component Selection

Select the femoral component template size that will fit
the distal femur and equalize leg lengths (Figure C). The
distal stem diameter determines the range of possible
ZTT® Sleeves that can be used proximally. The
appropriate ZTT Sleeve will allow for proximal fit and fill
for stable fixation.

The femoral template should be in line with the long axis

of the femur and the neck resection line drawn at the
point where the selected stem provides the desired
amount of leg length (Figure C). The vertical distance
between the planned center of rotation of the
acetabular component and the center of rotation of the
femoral head constitutes the distance the leg length will
be adjusted. The level of neck resection depends on the
stem size and the desired leg length, with the goal of
using a non-skirted modular head to optimize range of
motion prior to prosthetic impingement.

A lateral radiograph should also be obtained as part of

preoperative planning. To help properly position the
template on the lateral radiograph, estimate the distance
between the tip of the greater trochanter and the neck
resection line of the stem using the A/P radiograph.
Verify that the stem size chosen in the A/P plane also fits
in the lateral plane. The lateral radiograph of a properly
sized implant will typically exhibit appropriate fixation.

Figure C

8 DePuy Synthes S-ROM® Modular Hip System Surgical Technique

Preoperative Planning

Sleeve Selection
Overlay the ZTT Sleeve template cone size that
corresponds to the selected stem and provides adequate
proximal bone fill (Figure D). Position the sleeve template
using the centerline of the stem, the centerline of the
sleeve and the horizontal resection line. The ZTT Sleeve
is estimated most accurately from the lateral endosteum
(i.e., the metaphyseal A/P diameter).

Offset Requirements
The S-ROM Cementless Femoral Components are
available in a range of offsets and calcar options.
Through templating and intraoperative trialing,
determine which option restores proper offset by
matching the cup’s center of rotation with the desired
head center of rotation (Figure D).

Figure D

Surgical Technique S-ROM® Modular Hip System DePuy Synthes 9

Femoral Preparation

Neck Osteotomy
With S-ROM Hip System, a higher, more conservative,
perpendicular neck osteotomy may be utilized. It is
recommended that preoperative templating be used to
make the neck cut (Figure 1).

Additionally, a preliminary resection of the femoral neck

can be performed using the biomechanical femoral neck
resection template (Cat. No. 2576-00-004) as a guide
(Figure 2). The hole in the neck of the resection template
is located at the center of the femoral head (28mm). The
notch on the medial aspect of the template indicates the
most distal point for making the neck resection. The
device is adjustable and can duplicate a range of lateral
offsets, leg lengths and head positions. Final neck Figure 1
Neck resection
preparation can be performed later in the procedure
(during calcar reaming).

Opening Canal
Open the femoral canal by penetrating the superior
femoral cortex with the Intramedullary (IM) initiator (Cat.
No. 2576-00-006) (Figure 3). Start the IM initiater at the
junction of the neck resection and the complementary
cut at the trochanteric fossa. To protect against varus
positioning, the circular box osteotome (not shown) (Cat.
No. 2576-00-002) can be used to remove additional
bone from the medial aspect of the greater trochanter.

Figure 2
Biomechanical femoral neck
resection template

Figure 3
Opening the femoral canal

11 DePuy Synthes S-ROM® Modular Hip System Surgical Technique

Distal Ream – Step 1

Distal Preparation TABLE 1. DISTAL REAMER SELECTION FOR STRAIGHT STEMS

The distal diameter determines the corresponding Color Code Stem Size
Final Distal Distal Flute
Reamer Outer Diameter
proximal stem diameter, which is always 5 mm larger
6 x 12 mm 6 or 6.5 mm 6.75 mm
than its distal diameter. The final distal diameter reamed Violet

will also dictate the color-coded instrumentation needed Violet 7 x 12 mm 7 or 7.5 mm 8 mm

for the remainder of the case (Table 1). 8 x 14 mm 8 or 8.5 mm 9 mm
Silver

Begin axial reaming with the smallest reamer in your set Silver 9 x 14 mm 9 or 9.5 mm 10 mm

(8 mm for the standard set and 6 mm for the Gold 11 x 16 mm 11 or 11.5 mm 12 mm

Developmental Dysplasia of the Hip (DDH) set) in
Green 13 x 18 mm 13.5 mm 14.25 mm
conjunction with the T-handle attachment. The smallest
15 x 20 mm 15.5 mm 16.25 mm
reamer in each set is end cutting, whereas all Blue

consecutive sizes are blunt-nosed side-cutting only. Black 17 x 22 mm 17.5 mm 18.25 mm

Continue to ream sequentially with increasing reamer 19 x 24 mm 19.5 mm 20.25 mm
Brown
diameters until cortical contact is achieved. In keeping
Silver 21 x 26 mm 21.5 or 22 mm 22.5 mm
with preoperative planning, the final straight reamer
should correspond to, or be a half millimeter larger than,
the minor diameter of the selected femoral stem (Table
1). The appropriate reamer depth has been established
when the witness mark on each distal reamer aligns with
the tip of the greater trochanter (Figure 4).

Press-fit can be achieved when over-reaming by 0.5 mm

because the distal flutes add 1.25 mm total to the
specified distal stem minor diameter on sizes 13, 17 & 19
mm. Distal stem size 21 mm has a 1.5 mm total of
Reamer line goes to level of
additional flute diameter. Distal stem sizes of 7, 8, 9, & the greater trochanter
11 mm have 1.0 mm total of additional flute diameter
The 6 mm DDH distal stem has 0.75 mm of additional
flute diamete (Table 1).

Caution: Before moving past any one of the final

distal reamer diameters listed in Table 1, make sure
you are comfortable reaching the next largest final
distal reamer diameter. For example, if you distally
ream past 13.5 mm, be confident that the anatomy
will allow you to reach to a minimum of 15.5 mm.

Figure 4
Distal reaming

Surgical Technique S-ROM® Modular Hip System DePuy Synthes 11

Proximal Ream – Step 2

 pon completion of distal reaming, prepare the proximal or

U
“cone” portion of the final sleeve to be implanted. A set of
+7
triple banded, color-coded cone reamers are available for +5
preparing the proximal canal (Figure 5). The proximal +3
diameter of each conical reamer is marked in large print.
On the opposite side, the three proximal sleeve sizes (i.e.,
23mm, 25 mm, & 27 mm) are marked with the
corresponding sleeve configuration (i.e., 20 B, 20 D, & 20 F,
respectively). The location of each color band moves from
distal to proximal as the proximal diameter increases. After
attaching the color-coded pilot shaft to the distal end of
the conical reamer, advance the reamer until the witness
marking of the desired neck length (either 30, 36 or 42
mm) aligns with the tip of the greater trochanter (Figure 6).
Consecutively proximally ream until cortical contact is
achieved in the proximal femur. Contact will be felt first in
the anterior femur in the subtrochanteric region. Do not
drive the reamer in reverse. Figure 5
The three proximal reamers available for the 15 mm x 20 mm stem
In the example shown in Figure 5, the final distal
diameter revealed that this patient required a 15 mm
distal stem corresponding to the blue instrumentation in
the MACH1 Instruments. Therefore, the three proximal
reamers with blue bands, as well as the blue pilot shafts
were selected (Figure 5). Pilot shafts MUST be screwed
into the distal end of the proximal reamers before the
reamer may be introduced into the femur.

Table 2 shows the stems (proximal reamer diameter at the

top and the distal stem diameters at the bottom) and how
these stems correlate with the available proximal sleeve sizes.

Caution: You must always place the appropriate size

color-coded pilot shaft on the distal end of the
proximal reamers.

TABLE 2. CONE SIZING CHART (mm)

"Proximal Reamer
15 17 17 19 21 23 25 27 29 31
Diameter"

14F 16F 18F 20F 22F 24F

Available Sleeves 12D 14D 16D 18D 20D 22D 24D

12B 14B 16B 18B 20B 22B 24B

"Distal Stem
6, 7 6, 7 8, 9 9, 11 9, 11, 13 11, 13, 15 13, 15, 17 15, 17, 19 17, 19, 21 19, 21
Diameter"

11 DePuy Synthes S-ROM® Modular Hip System Surgical Technique

Proximal Ream – Step 2

Begin proximal reaming with the smallest of the reamers.

In the case of a 15 mm X 20 mm stem, the first proximal
reamer used is the 20 B. Note that the first proximal
reamer has the color band most distal and is always
denoted as B, adding +3 mm to the proximal diameter. If
the surgeon feels that more cancellous bone should be
removed, a 20 D proximal reamer would be used, adding
+5 mm to the proximal diameter. Note that the blue
band is now in the middle of the proximal reamer for the
D option. Lastly, should the surgeon need to remove
even more proximal bone, a 20 F reamer would be
selected that would add +7 mm to the proximal
diameter. For the F proximal reamer, the color band is Alternative technique
most proximal on the reamer.

To summarize, for a 15 mm x 20 mm stem, blue instruments

are selected, the final proximal sleeve diameters for B, D and
F are 23, 25 and 27 mm respectively.

Alternative Technique: Depending on the osteotomy

cut and the ability to visualize the greater
trochanter, you may opt to simply line up the top of
the proximal reamer with the osteotomy surface as
shown by a blue arrow in Figure 6. Trialing would
then be critical for selecting the final implants that
best restore leg length and femoral offset.

Figure 6
Cone reaming

Surgical Technique S-ROM® Modular Hip System DePuy Synthes 11

Calcar Ream / Mill – Step 3

Lastly, the spout or triangle of the proximal sleeve must

be machined. Spout sizing comes in Small, Large or XX-
Large. The spout size on the ZTT Sleeve is proportional
to the diameter of the stem.

Use the triangle miller to prepare the femur to

accommodate the calcar spout of the final sleeve. In
most instances, the final triangle is placed in the medial
proximal femur. However, because the placement does
not dictate the neck version, the triangle can be rotated
360 degrees to place the sleeve in optimal bone. SPA
sleeves (without a spout) are also available in this system
to accommodate unusual anatomies. Spout preparation
will not be necessary if using a SPA sleeve.

Select the miller shell that has the identical

Alternative technique
color band pattern as was present on the final cone reamer
used in the proximal reaming step (Figure 7). Numeric
markings of the proximal diameter are found on cone
reamers and miller shells for cross reference verification.

After attaching the miller shell and the miller frame to

the appropriate pilot shaft, gently lower the triangle
miller. Align the desired neck length witness mark with
the tip of the greater trochanter (Figure 7).

The ring of the miller frame can be rotated so that it

targets the best available host bone (Figure 8).

Caution: You must always place the appropriate

color-coded pilot shaft on the distal end of the
triangle miller frame.

Alternative Technique: You can line up the top of

Figure 7
the miller frame bevel to the level of the osteotomy
Positioning of triangle
surface as shown by the blue arrow in Figure 7 to miller shell
ensure that the sleeve will fit in the proximal femur.
Trialing will be critical for selecting the final
implant components that best restore leg length and
femoral offset.

Figure 8
Positioning of triangle
miller frame

11 DePuy Synthes S-ROM® Modular Hip System Surgical Technique

Calcar Ream / Mill – Step 3

Recess to the top of the groove in the triangle miller for

the desired spout size as shown by the red arrow in
Figure 9. If using a B or D cone, be careful to not allow
the triangle milling to go to XXL, since XXL spouts are
not available for these cone sizes.

Select the appropriate size miller drill that corresponds

to the color-coding used throughout the procedure.

Pass the miller drill through the ring and load the drill tip
into the guide hole before starting the drill. Lower the
miller frame so that the miller drill makes contact with
the cancellous bone to be milled (Figure 9).

Mill on power until desired cortical bone has been

exposed. To determine the final spout size (Small, Large,
or XXL), make note of the size indicated where the
markings on the miller frame align with the top of the
miller shell as shown by the red arrow in Figure 9.

Caution: Before proceeding from one spout size to

the next, confirm that there is enough calcar bone to
accommodate 4 mm of additional reaming to reach
the next spout size (i.e., Small to Large or Large to
XXL). Please review the Triangle Spout Sizing Chart
for more detail.

TRIANGLE SPOUT SIZING CHART

Small
Extends 9.5 mm from the cone
Large
Extends 13.5 mm from the cone Figure 9
Calcar reaming
XX-Large
Extends 17.5 mm from the cone

Surgical Technique S-ROM® Modular Hip System DePuy Synthes 11

Trial

Trial Sleeve
Secure the sleeve introducer handle (Cat. No. 53-5801)
onto the appropriate size sleeve introducer
corresponding to the selected sleeve size. As an
example, a proximal sleeve trial designated 20 D large is
a sleeve that will fit a 15 x 20 stem with a D outer
diameter (adding 5 mm to the proximal diameter) and a
large spout (extending 13.5 mm). Proximal sleeve trials
are color coded. Attach the appropriate colored pilot
shaft onto the sleeve introducer and slide on the sleeve.

Note: The trial sleeve is not secured / retained on

the sleeve introducer so care must be taken to Bolt must
face toward
prevent the trial sleeve from falling off the
the spout
introducer.

Gently impact the trial sleeve into the prepared

metaphysis (Figure 10). Seat the trial sleeve completely
and withdraw the introducer handle (Figure 11). At this
point, evaluate the sleeve in relation to its final position.

Caution: Make sure that the bolt on the sleeve

introducer handle is facing toward the spout. If the
bolt cannot be seen, the handle could disconnect
from the sleeve introducer attachment.

Figure 10 Figure 11
Trial sleeve insertion Trial sleeve position

11 DePuy Synthes S-ROM® Modular Hip System Surgical Technique

Trial

Trial Stem Tip: The opposite end of the nut tightener will
Restoring patient biomechanics is achieved with a wide thread onto the stem trial for extraction, should that
range of neck options (Table 3). be necessary.

TABLE 3. NECK SIZING CHART — ASSUMES USE OF +0 HEAD

(ALL NECKS HAVE AN INCLUDED ANGLE OF 135 DEGREES)
Leg Length
NeckLength Lateral Offset
Neck Style Adjustment
(mm) (mm)
(mm)
Standard 30 28 21
Standard 36 32 25
Standard 42 37 30
Standard + 4 Lat 30 32 21
Standard + 6 Lat 36 38 25

Standard + 8 Lat 36 40 25

Standard + 12 Lat 36 44 25

Figure 12 shows the neck shaft angle and how neck length,
lateral offset, and leg length adjustment are measured.

Figure 13
Trial stem insertion

135°

Each click on
trial is 10
degrees
Figure 12

Assemble the trial implant by snapping the chosen neck

onto the appropriate size distal stem trial. Align the
lateral laser marks in neutral initially and introduce the
trial neck and trial stem construct into the femoral canal
(Figure 13). The trial neck can be adjusted in 10-degree Figure 14
Version adjustment
increments until desired version is obtained (Figure 14).
Tighten the trial neck to the trial stem using the nut
tightener (Cat. No. 2576-52-100). Trial reduction can
Note: To record version, a Bovie may be utilized on
also be performed with Long, X-Long and XX-Long
an anatomic landmark.
distal stem trials.

Surgical Technique S-ROM® Modular Hip System DePuy Synthes 11

Final Implantation

You can separate the trial sleeve and trial stem using the
stem-sleeve separator (Cat. No. 53-6450). Remove the
trial stem and use the sleeve extractor (not shown), (Cat.
No. 2576-00-016) to remove the trial sleeve. The sleeve
extractor works by being placed on an extreme angle to
catch the distal lip of the sleeve.

Place the proximal sleeve implant onto the sleeve

introducer assembly and gently impact the sleeve into
the metaphysis (Figure 15).
Each line is
Again, note that the sleeve is not secured/ retained on 20 degrees
the sleeve introducer assembly.

Introduction of the femoral implant into the femoral

Canal can be done by hand initially until the distal flutes
begin to make cortical contact (Figure 16). A witness mark
located on the medial aspect of the femoral implant can
be aligned with the corresponding radial laser markings Figure 16
on the superior aspect of the sleeve implant to determine Stem insertion

anteversion. Each radial mark on the sleeve represents 20

degrees (Figure 16). Use these orientation lines on the
stem and sleeve to ensure that the final implant alignment
is consistent with trial alignment.

Bolt must
face toward
the spout

Figure 15
Sleeve insertion

11 DePuy Synthes S-ROM® Modular Hip System Surgical Technique

Final Implantation

Place the stem introducer handle (Cat. No. 53-2029) onto

the femoral implant and insert the pin punch (Cat. No. 53-
1500) into the rotational alignment hole in the femoral
neck (Figure 17). Using the pin punch as a version control
guide, impact the femoral implant until securely seated. The
taper is locked when the stem will no longer advance and
2-3 mm remains between the inferior aspect of the femoral
neck and the superior aspect of the implant sleeve.

Confirm the final placement of the S-ROM Implants using

the neck resection guide and/or preoperative templates.

Stem Removal Note: It is critical to first unlock the

taper between the stem and the sleeve using the stem-
sleeve separator (Cat. No. 53-6450). To extract the
stem, use the slap hammer instrumentation found in
the S-ROM Long Trials & Extraction Instruments
case. To assemble the slap hammer, slide the handle
(53-1207) into the side of the weight (53-1205), place
the weight through the shaft (53-1206). Screw the
extractor stem loop (53-4400) onto the end of the slide Figure 17
Stem insertion
hammer shaft. Place the extractor stem loop over the
head/neck of the stem until the loop engages the
trunion/head. Using appropriate force slide the slide
hammer weight up impacting the handle stop of the
slide hammer shaft until the stem is dislodged.

The S-ROM Sleeve can

be placed in 360
degrees of version

Surgical Technique S-ROM® Modular Hip System DePuy Synthes 11

Implant Ordering Information
STEM FEMORAL NECKS
FEMORAL NECKS FEMORAL NECKS
DIAMETER CALCAR REPLACEMENT
STANDARD LATERALIZED
& LENGTHS & LATERALIZED

36 +21 36 +21
Neck Length 30 36 42 30 +4 36 +6 36 +8 36 +12 36 +21
+4 +8
Lateral Offset
w/ +0 Femoral 28 32 37 32 38 40 44 32 36 40
Head
Leg Adjustment
21 25 30 21 25 25 25 46 46 46
Length
12x6

115mm
N Standard
523206
12x7

115mm
N Standard
523207
14x8

130mm
N Standard
523208

130mm
523291 130mm 130mm
N Standard
150mm 523191 563514
523251
14x9

205mm 205mm
526514N 563214N 205mm
N,L,R Long
526514L 563214L 526614N
526514R 563214R
150mm 150mm 150mm 150mm 150mm
N Standard
523292 523192 563516 563517 526676
205mm 205mm 205mm
526516N 563216N 563016N
N,L,R Long
526516L 563216L 563016L
526516R 563216R 563016R
16x11

240mm
563036N
N,L,R X-Long
563036L
563036R
300mm
563056N
N,L,R XX-Long
563056L
563056R
160mm 160mm 160mm 160mm 160mm 160mm 160mm
N Standard
523293 523193 523393 563518 523418 563618 526678
215mm 215mm 215mm 215mm
526518N 526418N 563118N 563018N
N,L,R Long
526518L 526418L 563118L 563018L
526518R 526418R 563118R 563018R
18x13

255mm
255mm
563038N
N,L,R X-Long 563138L
563038L
563138R
563038R
315mm
315mm
563058N
N,L,R XX-Long 563158L
563058L
563158R
563058R
165mm 165mm 165mm 165mm 165mm
N Standard
523194 523394 523420 563620 526680
225mm 225mm 225mm 225mm
526520N 526420N 563120N 563020N
N,L,R Long
526520L 526420L 563120L 563020L
526520R 526420R 563120R 563020R
20x15

270mm
270mm
563040N
N,L,R X-Long 563140L
563040L
563140R
563040R
325mm
325mm
563060N
N,L,R XX-Long 563160L
563060L
563160R
563060R

22 DePuy Synthes S-ROM® Modular Hip System Surgical Technique

Implant Ordering Information

STEM FEMORAL NECKS

FEMORAL NECKS FEMORAL NECKS
DIAMETER CALCAR REPLACEMENT
STANDARD LATERALIZED
& LENGTHS & LATERALIZED

36 +21 36 +21
Neck Length 30 36 42 30 +4 36 +6 36 +8 36 +12 36 +21
+4 +8
Lateral Offset
w/ +0 Femoral 28 32 37 32 38 40 44 32 36 40
Head
Leg Adjustment
21 25 30 21 25 25 25 46 46 46
Length

165mm 165mm 165mm 165mm 165mm

N Standard
523195 523395 523422 563622 526682

230mm 230mm 230mm 230mm

526522N 526422N 563122N 563022N
N,L,R Long
526522L 526422L 563122L 563022L
526522R 526422R 563122R 563022R
22x17

275mm
275mm
563042N
N,L,R X-Long 563142L
563042L
563142R
563042R

325mm
325mm
563062N
N,L,R XX-Long 563162L
563062L
563162R
563062R

175mm 175mm 175mm 175mm 175mm

N Standard
523196 523396 523424 563624 526684

230mm 230mm 230mm

526424N 563124N 563024N
24x19

N,L,R Long
526424L 563124L 563024L
526424R 563124R 563024R

275mm
N,L,R X-Long 563144L
563144R
26x21

175mm 175mm
N Standard
523197 563626

*The S-ROM Stems have a 135 Degree Neck Angle

PROXIMAL SLEEVES ZTT™ / ZTT™ SPA

XX XX XX
Size Small Large Large SPA Size Small Large Large SPA Size Small Large Large SPA

12B 550570 550571 18B 521483 521485 535382 22B 521423 521425

12D 550572 550573 18D 550523 550524 535384 22D 550543 550544

14B 550501 550502 535342 18F 550525 550526 550530 535386 22F 550545 550546 550550

14D 550503 550504 535344 20F Oversized 550727 550728 550731 24F Oversized 550747 550748 550751

14F 550505 550506 20B 521403 521405 24B 550561 550562

16B 521463 521465 535362 20D 550533 550534 24D 550564 550565

16D 550513 550514 535364 20F 550535 550536 550540 24F 550567 550568 550569

16F 550515 550516 550520 535366 22F Oversized 550737 550738 550741 24D Undersized 550770 550771 550772

18F Oversized 550717 550718 550721 24F Undersized 550777 550778 550779

Surgical Technique S-ROM® Modular Hip System DePuy Synthes 22

Essential Product Information

Important Warnings and Precautions

This Essential Product Information sheet does not include S-ROM femoral heads with +12 neck length extension
all of the information necessary for selection and use of a cannot be used with the POLY-DIAL™ constrained liner.
device. Please see full labeling for all necessary information. Any S-ROM ceramic femoral head that has been impacted
or dropped should be discarded and another ceramic
Indications femoral head used. If a ceramic femoral head is removed
from the femoral stem after assembly, a new head should
Total Hip Arthroplasty (THA) is intended to provide
be used. The removed head should be discarded and under
increased patient mobility and reduce pain by replacing
no circumstances be reused. Do not use ceramic heads
the damaged hip joint articulation in patients where there
with constrained acetabular liners. The femoral head size
is evidence of sufficient sound bone to seat and support
and the inner diameter of the acetabular components must
the components. The components of the S-ROM Total
correspond. ZT and ZTT oversized proximal sleeves must be
Hip System are indicated for use in total hip replacement
used with S-ROM stems having a nominal proximal
procedures for patients suffering severe pain and disability
diameter 2 mm smaller than the nominal diameter of the
due to structural damage in the hip joint from rheumatoid
sleeve. For all other S-ROM proximal sleeves, the nominal
arthritis, osteoarthritis, post-traumatic arthritis, collagen
proximal stem diameter must correspond with the nominal
disorders, avascular necrosis, and nonunion of femoral
diameter of the sleeve. The trochanter screws and washers
fractures. Use of the prosthesis is also indicated for
must be used together with the S-ROM 36+21 calcar
revision of previous hip arthroplasty and for patients with
replacement neck femoral stem.
congenital hip dysplasia, protrusio acetabuli, slipped
capital femoral epiphysis, and disability due to previous
fusion. The ZTT Porous Coated Proximal Sleeves and SPA Adverse Events
Porous Coated Proximal Sleeves are indicated for Peripheral neuropathy, deep wound infection, and
cementless application only. heterotopic bone formation have been reported following
hip replacements. Subclinical nerve damage has also been
Contraindications reported. Dislocation, subluxation, muscle and fibrous
tissue laxity, and loosening may also occur.
Use is contraindicated in cases with active or recent joint
sepsis, insufficient bone stock, marked atrophy or The ceramic femoral heads are composed of new
deformity in the upper femur, skeletal immaturity, or ceramic materials with limited clinical histories. Because
where loss of musculature or neuromuscular disease of the limited clinical and preclinical experience, the
would render the procedure unjustifiable. long-term biological effects of these particulates are
unknown. Histological reactions have been reported as
an apparent response to exposure to a foreign material.

22 DePuy Synthes S-ROM® Modular Hip System Surgical Technique

Limited Warranty and Disclaimer: DePuy Synthes products are sold with a limited warranty to the original purchaser against defects in workmanship
and materials. Any other express or implied warranties, including warranties of merchantability or fitness, are hereby disclaimed.
Please also refer to the package insert(s) or other labeling associated with the devices identified in this surgical technique for additional information.
CAUTION: Federal Law restricts these devices to sale by or on the order of a physician.
Some devices listed in this surgical technique may not have been licensed in accordance with Canadian law and may not be for sale in Canada.
Please contact your sales consultant for items approved for sale in Canada.
Not all products may currently be available in all markets.

DePuy Orthopaedics, Inc.

700 Orthopaedic Drive
Warsaw, IN 46582
USA
Tel: +1 (800) 366-8143
Fax: +1 (800) 669-2530

www.depuysynthes.com

© DePuy Synthes 2018. All rights reserved.

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