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ZIMMER MIS™
MINI-INCISION
FOR TOTAL HIP
REPLACEMENT
AnterolateralApproachSurgical Technique
1
MIS MINI-INCISION FOR TOTAL HIP REPLACEMENT
ANTEROLATERAL APPROACHSURGICAL TECHNIQUE
THIS SURGICAL TECHNIQUE
WAS DEVELOPED
IN CONJUNCTION WITH:
Richard Berger, M.D.
Rush-Presbyterian-St. Luke’s Medical Center
Chicago, IL
CONTENTS
INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . .2
PREOPERATIVE PLANNING . . . . . . . . . . . . . . .2
SURGICAL TECHNIQUE . . . . . . . . . . . . . . . . . . .4
Exposure . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
Preparation of the Acetabulum . . . . . . . .8
Preparation of the Femur . . . . . . . . . . . . .10
CONCLUSION . . . . . . . . . . . . . . . . . . . . . . . . . . .13
INTRODUCTIONTotal hip arthroplasty (THA) can be performed
on most patients using an anterolateral mini-
incision approach. Notable exceptions include
patients with retained hardware, such as a
dynamic hip screw, that must be removed via a
longer incision, and patients with Crowe 4 hip
dysplasia that requires a subtrochanteric
osteotomy. As the surgeon embarks to learn
how to perform a mini-incision total hip
arthroplasty, start with the incision the surgeon
is currently performing and gradually shorten
the skin incision with improved confidence and
skill. Incisions smaller than 4.5” will require
specialized retractors and instrumentation that
are now readily available. As with many new
techniques, start with patients who are generally
smaller and less muscular, have minimal
deformity, and few osteophytes. Later, improved
confidence and skill allow the surgeon to
expand the indications of mini-incision THA to
almost all patients. Again, gradually decrease
the incision size until you have achieved a true
mini-incision THA (2.5” to 3.5”) on almost all
patients. It is important to note that a mini-
incision THA is not simply a standard approach
done through a small incision; instead, it is a
modified approach that transects less muscle
and tendon in addition to a small incision.
The following is a detailed description of a
technique designed to perform an anterolateral
mini-incision total hip arthroplasty.
PREOPERATIVE PLANNINGThe importance of preoperative planning and
templating cannot be overemphasized. This is
particularly true in the case of a mini-incision
total hip arthroplasty where visualization of
extra-articular landmarks is limited. The
objective of preoperative planning is to enable
you to gather anatomic parameters that will
allow accurate intraoperative placement of the
femoral and acetabular implants. Optimal
femoral and acetabular component fit, the level
of the femoral neck cut, the prosthetic neck
length, and the femoral component offset can be
evaluated through preoperative radiographic
analysis. Preoperative planning also allows the
surgeon to have the appropriate implants
available at surgery.
Determining preoperative leg length is essential
for restoration of the appropriate leg length
during THA. As in all total hip arthroplasties,
preoperative templating using an
anterior/posterior (A/P) view of the pelvis is
usually the most accurate method of determining
proper leg length. Only in extremely unusual
cases is a scanogram or CT evaluation of leg
length helpful. From the clinical and radiographic
information about leg lengths, determine the
appropriate correction, if any, to be achieved
during surgery. Standard osteotomy guides can
be easily used through a mini-incision procedure.
A number of intraoperative leg length
confirmation systems may be used with this
mini-incision approach.
Although rare, it may not be possible to restore
offset in patients with an unusually large
preoperative offset or with a severe varus
2
3
deformity. In such cases, lengthening the limb
can increase the tension in the abductor
muscles. This method is especially useful when
the involved hip is shorter than the contralateral
hip. However, in these cases there is usually no
choice but to lengthen the hip and leg. With
lengthening, patient dissatisfaction may result;
however, in some uncommon cases where
stability and leg length can’t be optimized, it is
more important to achieve hip stability than leg
length equality.
The initial templating begins with the A/P
radiograph (Fig 1). Superimpose the acetabular
templates sequentially on the pelvic x-ray film
with the acetabular component in approximately
45° of abduction. Assess several sizes to
estimate which acetabular component will
provide the best fit for maximum coverage. Mark
the acetabular size and position, and the center
of the head on the x-ray films. Note the superior
coverage of the acetabular component in 45° of
abduction, reproduce this during surgery to
assure proper component abduct and avoid
vertical positioning. Next, select the appropriate
femoral template. To estimate the femoral
implant size, assess both the distal stem size
and the body size on the A/P radiograph, and
then check the stem size on the lateral
radiograph. The stem of the femoral component
should fill, or nearly fill, the medullary canal in
the isthmus area on the A/P x-ray film. Next,
assess the fit of the stem body in the
metaphyseal area. The medial portion of the
body of the component should fill the proximal
metaphysis as fully as possible.
After establishing the appropriate size of the
femoral component, determine the height of its
position in the proximal femur. If the leg length
is to remain unchanged, the center of the head
of the prosthesis should be at the same level as
the center of the femoral head of the patient’s
hip. This should also correspond to the center of
rotation of the acetabulum. To lengthen the
limb, raise the template proximally. To shorten
the limb, shift the template distally. Once the
height has been determined, note the distance
in millimeters from the collar or most proximal
aspect of the porous surface to the top of the
lesser trochanter.
Fig. 1
SURGICAL TECHNIQUEExposurePlace the patient in the lateral position. It is
important to use some form of pelvis-stabilizing
device other than a beanbag. Be aware that
some pelvis stabilizing devices may flex or roll
the pelvis; it is important to compensate for this.
Use a drape with a leg-holding bag, or create a
bag with a sterile sheet, to hold the leg when it
must be positioned anteriorly.
Once the patient is prepped and draped,
determine the landmarks for the surgical
incision. Mark the most proximal border of the
greater trochanter, and the anteroposterior
midline of the greater trochanter (Fig 2). Along
this midline, make a mark 1 inch distal to the tip
of the greater trochanter. This will identify the
midpoint of the incision. The intended length of
the incision will determine its orientation. The
following orientation guide is relative to the
femoral shaft. For a true mini-incision, make the
incision approximately 30° to the long axis of the
femur, beginning anterior and inferior, and
extending superiorly and posteriorly
approximately 2.5” to 3” so it passes through the
marked point. Half the incision should be
anterior and inferior to the mark 1 inch distal to
the tip of the greater trochanter, and half should
be superior and posterior. (In heavier patients
slightly more of the incision should be posterior.)
Divide the subcutaneous fat and use a Cobb
elevator to expose the fascia lata about 1cm on
either side of the incision. This will facilitate with
closure. Incise the fascia lata in an orientation
halfway between its fibers and the skin incision,
about 15-20° to the axis of the femoral shaft.
This aids closure. As the fascial incision is made,
a small portion of the gluteus maximus muscle
maybe encountered (Fig 3). Use the electro-
cautery to open the gluteus maximus muscle
posteriorly and superiorly within its fibers.
4
Fig. 2
Fig. 3
Table 1: Incision length and orientation
Length Orientation to femurOver 4.5” 0°
4” to 4.5” 10°
3.5” to 4” 20°
2.5” to 3.5” 30°
5
The trochanteric bursa will be exposed. If the
bursa is thickened, slide a finger anteriorly and
posteriorly to loosen the bursa and expose the
greater trochanter and gluteus medius muscle.
Place a Charnley retractor transversely across
the incision. Place the anterior arm of the
retractor first, then the posterior arm. It is
important to use a specialized long arm
retractor, which has been modified from the
standard Charnley retractors. The arms of a
standard Charnley retractor will not engage the
frame for mini-incision without significant
tension on the incision. Do not over-tighten the
Charnley retractor, as this will diminish the
exposure and cause skin compromise.
Find the anterior tip of the greater trochanter;
this is the point where the abductor is usually
entered for a standard Anterolateral approach,
taking about 50% of the abductor off the
trochanter. With the following technique only
about 20-25% of the abductor is taken off the
trochanter. From the tip of the trochanter, slide
anteriorly to the anterior ridge of the trochanter;
the confluence of the anterior and superior
trochanter (Fig. 4). Find this ridge and insert a
pair of curved Mayo scissors in the recess of the
gluteus medius muscle in line with its fibers
until the gluteus minimus muscle is felt with the
tip of the scissors. This will divide the anterior
20-25% of the gluteus medius muscle. Insert two
Army-Navy retractors to retract the gluteus
medius muscle and expose the gluteus minimus
tendon, which will be oblique to the opening in
the gluteus medius muscle (Fig. 5).
Fig. 4
Fig. 5
Fig. 6
Next, make an L-shaped incision in the gluteus
minimus tendon, beginning the incision
proximally in line with the fibers and extending
it to the incision in the gluteus medius muscle.
Then transect approximately 0.5 cm-1.0 cm of
the gluteus minimus tendon in line with the
gluteus medius muscle (Fig. 6). Then remove the
Army-Navy retractors.
Place the leg in slight external rotation. Use
electrocautery to detach the fascia over the
vastus ridge where it blends with the gluteus
medius tendon. You do not need to violate the
vastus muscle. Following the contour of the
greater trochanter proximally transecting the
gluteus medius tendon. Leave the posterior half
of the tendon attached to the greater trochanter,
and the anterior half attached to the muscle.
While slowly externally rotating the hip, use
electrocautery to detach the anterior 20-25% of
the gluteus medius and gluteus minimus
muscles from the greater trochanter. Distally,
find the interval between the capsule and the
gluteus minimus tendon over the bursa of the
quadriceps muscle. Open this interval and follow
it proximally; insert a single point large retractor
(Fig. 7). The tendon will likely be confluent to the
capsule. Use electrocautery to separate the
gluteus minimus tendon from the capsule. Move
the single point large retractor anteriorly and
cephalad, placing it on the superior/anterior rim
of the acetabulum. This will expose the capsule.
6
Fig. 7
Fig. 8
7
Additionally, a small portion of the quadriceps
muscle may be detached from the capsule with
the electrocautery. The release can extend as far
anteriorly and inferiorly as necessary to expose
the antero-inferior capsule. Abduction, flexion,
and externally rotating the leg can facilitate this
process. Avoid invading the muscle, this will
cause bleeding.
When the anterior capsule is exposed, excise the
anterior/inferior portion of the capsule. Then
fully extend and slightly externally rotate the
limb. Excise the anterior/superior capsule to
expose the femoral head. About one quarter of
the capsule should be excised. Check to be sure
that the anterior capsule is freed inferiorly to
allow the femoral head to be dislocated.
Alternatively, the capsule may be retained
and simply incised.
Establish landmarks and obtain measurements
before dislocating the hip so that, after
reconstruction, a comparison of leg length and
femoral shaft offset can be obtained. From this
comparison, adjustments can be made to
achieve the goals established during
preoperative planning. There are several
methods to measure leg length, dependent on
individual surgeon preference.
Apply traction and insert a hip-skid retractor in
the joint space. This will aid in dislocating the
hip (Fig. 8). Remove all the retractors and insert
a bone hook around the femoral neck. The hip
should be flexed to only 45° with slight
adduction, in this position the assistant should
externally rotate the leg as the surgeon applies
anterior and lateral traction with the bone hook.
This will dislocate the hip without injury to the
remaining abductor (Fig 9).
This technique of only detaching about 20-25%
of the abductor off the trochanter improves
rehabilitation and post-operative limp. However,
there are two points in this procedure that the
additional preserved abductor can be injured or
torn; these points are during dislocation and
femoral preparation. The most common time of
abductor injury is during dislocation. If the hip is
flexed more than 45° with significant external
rotation to dislocate the hip, the abductor can be
stretched and the anterior portion is torn.
Limiting hip flexion to 45° and using a bone
hook will help prevent this problem.
The second time of abductor injury is during
femoral canal preparation; hyper-external
rotation during femoral preparation will prevent
abductor injury.
After dislocation it is usually easier to make a
provisional neck cut high on the neck to remove
the bulk of the femoral head. This will facilitate
seeing the lesser trochanter and making the
actual femoral neck cut. Some of the inferior
capsule can be released to expose the lesser
trochanter if necessary. Make the final neck cut
from the level of the lesser trochanter as
determined from the preoperative templating.
An osteotomy guide may be used. To prevent
possible damage to the greater trochanter, stop
the cut as the saw approaches the greater
trochanter. Remove the saw and use a sagittal
saw to finish the cut superiorly. Excise the
posterior synovium, and remove the final
neck segment.
Fig. 9
Approximately 180° to the ischium, place the
single point large retractor through the interval
between the capsule and the anterosuperior
acetabulum. Use this retractor to hold the
anterior portions of the gluteus medius and
gluteus minimus muscles anteriorly (Fig 10).
Insert a single point retractor over the
anteroinferior rim of the acetabulum to hold the
anterior capsule and iliopsoas tendon anteriorly.
The fiberoptic lights in these retractors augment
visualization (Fig. 10). Additional remaining
anterior or inferior capsule may be resected if
needed; however, be careful to avoid the
peritenon of the iliopsoas tendon. Then resect
the acetabular labrum circumferentially.
Osteophyte resection may be performed before
or after the acetabular shell has been inserted. It
is often easier to remove osteophytes once the
component has been inserted. Use a curved
osteotome. Remove the Hohmann retractor and
leave the two opposing large retractors.
Preparation of the AcetabulumSpecially designed Low-Profile acetabular
reamers facilitate passing the reamers between
the opposing retractors (Fig. 11). Begin reaming
the acetabulum with the largest Low-Profile
acetabular reamer that will fit into the
acetabulum. These reamers are designed to
be used in this manner. They have square teeth
that are aggressive. The shells of the Low-Profile
acetabular reamers are more than hemi-
spherical. The perimeter edge extends an
additional 15° beyond the level of a hemisphere.
This reams peripheral osteophytes facilitating
the acetabular component being fully seated.
Moreover, this design (more than a full
hemisphere), is forgiving; the reamer can be up
to 15° off the acetabular component axis and
still reams a perfect hemisphere for the final
acetabular component’s position. The
acetabulum is generally reamed to 2mm less
than the size of the selected acetabular
component.
To retract the femur posteriorly, an Offset Double
Point retractor is used to straddle the ischium
approximately 1cm posterior to the posterior
wall of the acetabulum (Fig. 10). Special
retractors, with built in fiberoptic lights are very
helpful. To facilitate placement of this retractor,
the hip is flexed to 45°, abducted to 25°, and
externally rotated to 30°. This retractor is placed
intracapsular, which retracts the capsule and
avoids sciatic nerve injury. A few gentle taps sets
the retractor and holds it in place. The assistant
should avoid vigorous retraction, as this will
dislodge the retractor or injure the skin.
8
Fig. 10
Fig. 11
9
Check to make sure the patient is correctly
positioned on the table. Connect the final
prosthesis to the offset shell inserter (Fig 12a).
This offset design helps avoid vertical cup
placement, which is common in mini-incision
total hip replacement. Insert the shell into the
prepared acetabulum. The alignment frame
achieves 45° abduction and 20° forward flexion
(Fig. 12b). Impact the cup in place, assuring the
shell is fully seated (Fig 13). Acetabular screws
may be used for additional fixation. The
polyethylene liner is inserted. Remove the two
large retractors around the acetabulum.
Fig. 12a
Fig. 13
Fig. 12b
A Box Osteotome and tapered awl is used to
gain access to the canal. Side cutting reamers
(Mini-incision instrument set) can be used to
remove the medial portion of the lateral
trochanter. The smooth bullet tip is designed to
engage in the upper diaphysis to assure neutral
alignment of the component. A straight rasp
handle during rasping minimizes impingement
of the handle with the proximal pole of the skin
incision. In addition, there is a tendency for the
proximal pole of the incision to apply an
anteverting force onto the rasp handle, which is
minimized with the straight rasp handle. To
facilitate control of the handle, a bar can be
inserted into one of the three holes in the
handle. These holes (0°, 7.5°, and 15°) can also
be used to check anteversion. The femoral canal
is prepared for the intended prosthesis by
matching the rasp to the anteversion of the
metaphysis (Fig 15). While a cementless tapered
design will be shown, any design can be used
with this approach: cemented, proximally coated,
splined, or fully coated.
Preparation of the FemurPosition the long femoral elevator on the lateral
greater trochanter, lateral to the abductors. This
elevates the proximal femur out of the wound
and protects the proximal pole of the incision
(Fig 14). Placing the leg into the sterile bag, the
hip is positioned in flexion, adduction, and
hyper-external rotation (135°). Place the double
point large lit retractor over the medial border of
the calcar. This keeps the proximal metaphysis
exposed and well lit. Lastly, place a straight
Hohmann retractor in the piriformis fossa to hold
the abductors posteriorly (Fig. 14). As noted
earlier, the hyper-external rotation of the hip
moves the abductor posteriorly; thereby avoiding
injury or maceration of the abductor during
femoral canal preparation.
10
Fig. 14 Fig. 15
11
Fig. 16
Specially designed provisional necks and
provisional heads, which can be inserted from
the side, facilitate the trial reduction. Insert the
provisional head and neck and perform a trial
reduction. Check the leg length and offset of the
femur by referencing the lengths measured
before the hip was dislocated. Adjust the neck
length by changing femoral head provisionals to
achieve the desired result. When satisfactory leg
length, offset, range of motion, and stability have
been achieved, dislocate the hip. Remove the
rasp and insert the femoral component (Fig 16).
Insert the femoral component until the
prosthesis is fully seated or until the implant will
no longer advance.
Use the provisional head inserter to sequentially
seat the side-loading slotted provisional heads
on the femoral neck until appropriate leg length,
joint tension, and joint stability have been
achieved. Seat the actual head that corresponds
to the trial head selected (Fig 17). Reduce the
hip, and assess leg length, range of motion,
and stability and abductor tension for the
final time (Fig 18).
NOTE: Ensure tapers are clean and dry.
Fig. 17
Fig. 18
12
Closure is important to maintain muscle
function and expedite recovery. To facilitate
closure, replace the Charnley retractor and
internally rotate and abduct the hip. Predrill the
lateral trochanter; do not drill through to the
anterior portion. Insert two heavy Mersilene
sutures from lateral to anterior. Pass the
Mersilene sutures under the gluteus minimus
and gluteus medius muscles. Place one or two
non-absorbable sutures through the gluteus
minimus muscle, closing it to itself (Fig19).
Next, tie the Mersilene sutures tightly to return
the gluteus minimus and gluteus medius
muscles back to the trochanteric bed. Lastly, use
number one Ethibond sutures to perform an
end-to-end anastomosis of the gluteus medius
tendon. This completely and securely reattaches
the gluteus minimus and gluteus medius back to
the greater trochanter (Fig 20).
Remove the Charnley retractor. With the hip
slightly abducted, close the fascia lata using
non-absorbable sutures. Then close the
remaining layers with 2.0 Vicryl, followed by
staples or subcuticular closure. Apply a
sterile dressing.
Fig. 20Fig. 19
13
CONCLUSION:The mini-incision exposure can be used in most
primary total hip arthroplasty (THA) patients. As
the surgeon begins to perform mini-incision total
hip arthroplasty, gradually shorten the skin
incision with improved confidence and skill. A
true mini-incision THA (2.5” to 3.5”) requires
specialized retractors and instrumentation such
as the Mini-incision instrument set. Following
the above outline will not only result in a smaller
incision, but also will transect less muscle and
tendon. This less invasive approach can result in
a shorter length of stay, less pain, less
rehabilitation transfers, quicker recovery, and
better cosmesis. All of these combine to produce
a more satisfied THA patient.
14
GENERAL INSTRUMENTS
Prod. No. Description00-7804-000-01 MIS Hip General Instrument Set
(Includes one each of the following:)00-7803-022-01 Femoral Head Provisional -2.0x22 00-7803-022-02 Femoral Head Provisional +0x22 00-7803-022-03 Femoral Head Provisional +3.0x22 00-7803-026-01 Femoral Head Provisional -3.5x26 00-7803-026-02 Femoral Head Provisional +0x26 00-7803-026-03 Femoral Head Provisional +3.5x26 00-7803-026-04 Femoral Head Provisional +7.0x26 00-7803-026-05 Femoral Head Provisional +10.5x26 00-7803-028-01 Femoral Head Provisional -3.5x28 00-7803-028-02 Femoral Head Provisional +0x28 00-7803-028-03 Femoral Head Provisional +3.5x28 00-7803-028-04 Femoral Head Provisional +7.0x28 00-7803-028-05 Femoral Head Provisional +10.5x28 00-7803-032-01 Femoral Head Provisional -3.5x32 00-7803-032-02 Femoral Head Provisional +0x32 00-7803-032-03 Femoral Head Provisional +3.5x32 00-7803-032-04 Femoral Head Provisional +7.0x32 00-7803-032-05 Femoral Head Provisional +10.5x32 00-7804-035-00 Rasp Handle, qty. 2 00-7803-054-09 Cone Provisional 9/10 00-7803-054-11 Cone Provisional 11 00-7803-054-12 Cone Provisional 12/13 00-7803-054-14 Cone Provisional 14/15 00-7803-054-16 Cone Provisional 16/17 00-7803-054-18 Cone Provisional 18-22 00-7803-056-00 Provisional Neck Inserter 00-7803-057-00 Provisional Head Inserter 00-7803-058-00 Implant Driver 00-7804-015-00 Offset Shell Inserter 00-7804-018-00 Offset Head Seater 00-7805-070-00 MIS Hip General Instrument Case
SIDE CUTTING REAMERS
Prod. No. Description00-7804-000-02 MIS Side Cutting Reamer Set
(Includes one each of the following:) 00-7803-050-00 Skin Protector Tube00-7803-050-09 Side Cutting Reamer, 9mm 00-7803-050-11 Side Cutting Reamer, 11mm 00-7803-050-13 Side Cutting Reamer, 13mm 00-7803-050-15 Side Cutting Reamer, 15mm 00-7803-050-17 Side Cutting Reamer, 17mm 00-7804-017-01 Skin Protector Tube - Long00-7804-017-02 Skin Protector Tube - Extra Long00-7806-080-00 MIS Side Cutting Reamer Case
Prod. No. Description00-7804-000-05 MIS 2-Incision Hip Instrument Set
(Includes one of each of the following:)00-7804-001-00 Initial Incision Pointer 00-7804-002-01 Lit Anterior Retractor - Straight/Narrow 00-7804-003-01 Lit Anterior Retractor - Bent/Narrow - Qty. 200-7804-003-02 Lit Anterior Retractor - Bent/Wide - Qty. 200-7804-003-03 Lit Anterior Retractor - Bent/Extra Wide00-7804-004-00 Retractor Extenders - Qty. 200-7803-041-04 Anterior Retractor Curved00-7803-045-01 Curved Awl00-7803-066-00 Angled Hex Driver00-7803-069-00 Cable Passer00-7804-013-00 Ligamentum Teres Cutter00-7804-014-01 Corkscrew00-7804-014-02 Stabilizer00-7804-019-00 Bonehook00-7804-015-01 Supine Alignment Frame 00-7804-033-01 Light Pipe, Bent (Blue) - Qty. 400-7804-033-02 Light Pipe, Straight (Yellow)00-1714-000-00 Bandage Scissors 00-7806-095-00 MIS 2-Incision Hip Instrument Case
MINI INSTRUMENTS
Prod. No. Description00-7804-000-54 MIS Mini Instrument Set (replacement set 7804-00-04)
(Includes one each of the following:)00-7804-005-00 Lit Inferior Retractor00-7804-006-00 Lit Single Point Retractor - Sharp/Wide00-7804-007-00 Lit Single Point Retractor - Dull/Narrow00-7804-008-00 Lit Double Point Retractor - Even Points/Wide00-7804-010-03 Lit Offset Double Point Retractor - Left Long/Twisted00-7804-010-04 Lit Offset Double Point Retractor - Right
Long/Twisted00-7804-011-01 Lit Flanged Retractor Left00-7804-011-02 Lit Flanged Retractor Right00-7804-012-01 Contoured Femoral Elevator00-7804-012-02 Contoured Femoral Elevator - Deep00-7804-015-02 Lateral Alignment Frame00-7804-030-00 Bifurcated Light Cable (with Adapter A,B,C,D)00-7804-033-03 Light Pipe, Inferior (Black)00-7804-033-04 Light Pipe, Long (Green), qty. 400-7805-090-00 MIS Mini Instrument Case
Prod. No. Description00-7804-000-21 MIS Fork Set
(Includes one each of the following:)00-7804-001-01 Long Arm Contoured 4-Tooth Retractor 00-7804-001-02 Long Arm Contoured 5-Tooth Retractor, Deep00-7804-001-05 Contoured Small Blade 00-7804-001-06 Contoured Small Blade, Deep
Prod. No. Description00-7804-000-22 MIS Claw Set
(Includes one each of the following:)00-7804-001-03 Long Arm Contoured Claw Retractor 00-7804-001-04 Long Arm Contoured Claw Retractor, Deep00-7804-001-05 Contoured Small Blade 00-7804-001-06 Contoured Small Blade, Deep
Prod. No. Description00-7804-000-25 MIS 2-Incision™ Hip Instrument Add-on Set
(Includes one each of the following:)00-7804-004-00 Retractor Extenders, qty. 200-7804-013-00 Ligamentum Teres Cutter00-7804-014-01 Corkscrew00-7804-014-02 Stabilizer00-7804-019-00 Bonehook00-7805-095-00 MIS 2-Incision Hip Instrument Case
ACETABULAR REAMERS
Prod. No. Description00-7803-000-07 MIS Low Profile Acetabular Reamer Set
(Includes all items listed below:) 00-7803-095-42 Low Profile Acetabular Reamer, Size 42 Through ↓ Through ↓00-7803-095-64 Low Profile Acetabular Reamer, Size 64 00-1206-090-10 Reamer Shaft, qty. 2 00-7806-085-00 MIS Low Profile Acetabular Reamer Case
Prod. No. Description00-7804-000-57 MIS Reamer Handle Set
(Includes one each of the following:) 00-7804-080-00 Offset Acetabular Reamer Handle 00-7806-087-00 Offset Acetabular Reamer Handle/Low
Profile Reamer Case
15
Prod. No. Description00-7804-000-17 36mm Slotted Head Provisionals Set
(Includes one each of the following:)00-7803-036-01 Slotted Head Provisional 12/14 36mm x -3.500-7803-036-02 Slotted Head Provisional 12/14 36mm x +000-7803-036-03 Slotted Head Provisional 12/14 36mm x +3.500-7803-036-04 Slotted Head Provisional 12/14 36mm x +700-7803-036-05 Slotted Head Provisional 12/14 36mm x +10.500-7806-099-20 36mm 12/14 Slotted Provisional Head Tray
Prod. No. Description00-7804-000-08 40mm Slotted Head Provisionals Set
(Includes one each of the following:)00-7803-040-01 Slotted Head Provisional 12/14 40mm x -3.500-7803-040-02 Slotted Head Provisional 12/14 40mm x +000-7803-040-03 Slotted Head Provisional 12/14 40mm x +3.500-7803-040-04 Slotted Head Provisional 12/14 40mm x +700-7803-040-05 Slotted Head Provisional 12/14 40mm x +10.500-7806-099-30 40mm 12/14 Slotted Provisional Head Tray
Prod. No. Description00-7804-000-06 Six Degree Taper Set
(Includes one each of the following:)00-7603-022-01 Slotted Head Provisional 6 deg. 22mm x +0.500-7603-022-02 Slotted Head Provisional 6 deg. 22mm x +3.500-7603-022-03 Slotted Head Provisional 6 deg. 22mm x +700-7603-022-04 Slotted Head Provisional 6 deg. 22mm x +1100-7603-022-25 Slotted Head Provisional 6 deg. 22mm x +2.500-7603-022-55 Slotted Head Provisional 6 deg. 22mm x +5.500-7603-026-01 Slotted Head Provisional 6 deg. 26mm x +000-7603-026-02 Slotted Head Provisional 6 deg. 26mm x +3.500-7603-026-03 Slotted Head Provisional 6 deg. 26mm x +700-7603-026-04 Slotted Head Provisional 6 deg. 26mm x +10.500-7603-026-05 Slotted Head Provisional 6 deg. 26mm x +1400-7603-028-01 Slotted Head Provisional 6 deg. 28mm x +000-7603-028-02 Slotted Head Provisional 6 deg. 28mm x +3.500-7603-028-03 Slotted Head Provisional 6 deg. 28mm x +700-7603-028-04 Slotted Head Provisional 6 deg. 28mm x +10.500-7603-028-05 Slotted Head Provisional 6 deg. 28mm x +1400-7603-032-01 Slotted Head Provisional 6 deg. 32mm x +000-7603-032-02 Slotted Head Provisional 6 deg. 32mm x +3.500-7603-032-03 Slotted Head Provisional 6 deg. 32mm x +700-7603-032-04 Slotted Head Provisional 6 deg. 32mm x +10.500-7603-032-05 Slotted Head Provisional 6 deg. 32mm x +1400-7806-099-10 6 Degree Slotted Head Provisional Tray
Prod. No. Description00-7804-000-10 Slotted Cone Provisionals 12/14 Extended Set
(Includes one each of the following:)00-7804-020-11 Slotted Cone Provisional -EXT 1100-7804-020-12 Slotted Cone Provisional -EXT 12/1300-7804-020-14 Slotted Cone Provisional -EXT 14/1500-7804-020-16 Slotted Cone Provisional -EXT 16/1700-7804-020-18 Slotted Cone Provisional -EXT 18-2200-7806-099-50 Slotted Cone Provisionals - EXT Tray
Prod. No. Description00-7804-000-12 MIS 6 Degree Slotted Cone Provisionals Set
(Includes one each of the following:)00-7604-021-09 Slotted Cone Provisional - 6 deg. 9/1000-7604-021-11 Slotted Cone Provisional - 6 deg. 1100-7604-021-12 Slotted Cone Provisional - 6 deg. 12/1300-7604-021-14 Slotted Cone Provisional - 6 deg. 14/1500-7604-021-16 Slotted Cone Provisional - 6 deg. 1600-7806-099-60 6 Degree Slotted Cone Provisional Tray
Prod. No. Description00-7804-000-09 Liner Impactor Head Set
(Includes one each of the following:)00-7804-031-22 Liner Impactor Head — 22mm00-7804-031-26 Liner Impactor Head — 26mm00-7804-031-28 Liner Impactor Head — 28mm00-7804-031-32 Liner Impactor Head — 32mm00-7804-031-36 Liner Impactor Head — 36mm00-7804-031-40 Liner Impactor Head — 40mm00-7806-099-40 Liner Impactor Head Tray
REPLACEMENT ITEMSProd. No. Description00-4033-043-01 Frame00-7804-016-00 Osteotomy Guide*00-7804-018-02 Replacement Head Seater Cap00-7804-015-03 Replacement A-Frame Knob 00-7804-035-01 Replacement Adjustment Set Screw 00-7803-069-01 Small Cable Passer00-7803-070-04 Set Screw (Old Shell Inserter)00-7803-070-05 Threaded Shaft (Old Shell Inserter)00-7803-088-01 Light Cable Adapter A00-7803-088-02 Light Cable Adapter B00-7803-088-03 Light Cable Adapter C00-7803-088-04 Light Cable Adapter D00-7803-064-02 Offset Head Seater Cap (Old Style)00-7803-058-02 Torque Handle (For Rasp Handle)00-7803-070-06 Connecting Shaft (Old Shell Inserter)
Prod. No. Description00-7804-000-12 MIS 6 Degree Slotted Cone Provisionals Set
(Includes one each of the following:)00-7604-021-09 Slotted Cone Provisional - 6 deg. 9/1000-7604-021-11 Slotted Cone Provisional - 6 deg. 1100-7604-021-12 Slotted Cone Provisional - 6 deg. 12/1300-7604-021-14 Slotted Cone Provisional - 6 deg. 14/1500-7604-021-16 Slotted Cone Provisional - 6 deg. 1600-7806-099-60 6 Degree Slotted Cone Provisional Tray
Prod. No. Description00-7804-000-09 Liner Impactor Head Set
(Includes one each of the following:)00-7804-031-22 Liner Impactor Head — 22mm00-7804-031-26 Liner Impactor Head — 26mm00-7804-031-28 Liner Impactor Head — 28mm00-7804-031-32 Liner Impactor Head — 32mm00-7804-031-36 Liner Impactor Head — 36mm00-7804-031-40 Liner Impactor Head — 40mm00-7806-099-40 Liner Impactor Head Tray
REPLACEMENT ITEMSProd. No. Description00-4033-043-01 Frame00-7804-016-00 Osteotomy Guide*00-7804-018-02 Replacement Head Seater Cap00-7804-015-03 Replacement A-Frame Knob 00-7804-035-01 Replacement Adjustment Set Screw 00-7803-069-01 Small Cable Passer00-7803-070-04 Set Screw (Old Shell Inserter)00-7803-070-05 Threaded Shaft (Old Shell Inserter)00-7803-088-01 Light Cable Adapter A00-7803-088-02 Light Cable Adapter B00-7803-088-03 Light Cable Adapter C00-7803-088-04 Light Cable Adapter D00-7803-064-02 Offset Head Seater Cap (Old Style)00-7803-058-02 Torque Handle (For Rasp Handle)00-7803-070-06 Connecting Shaft (Old Shell Inserter)00-7803-086-00 Inflatable Pillow00-7803-088-00 Bifurcated Light Cable (Old Style)
* Limited availability depending on country release.
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Please refer to package insert for
complete product information, including
contraindications, warnings, precautions,
and adverse effects.
Contact your Zimmer Representative or
visit us at www.zimmer.com.
Anterolateral instruments developed in conjunction with:Richard Berger, M.D., Rush-Presbyterian, St. Luke’sMedical Center.