Surgical Technique - media.medacta.com · Rv Suld Athro Teaded B Surgical Technique 8 12. If the measured depth is significantly longer than 35mm, remove the k-wire and reposition

Sports MedJoint Spine

Surgical Technique

COMPLETE, CONVERTIBLE, INNOVATIVE

REVERSE SHOULDER ARTHROPLASTY THREADED BASEPLATE

Reverse Shoulder Arthroplasty Threaded Baseplate Surgical Technique

2

3

INDEX1. INTRODUCTION 4

1.1 Indications of use 41.2 Contraindications 41.3 Pre-Operative Planning 41.4 Surgical Approach 4

2. HUMERAL DIAPHYSIS PREPARATION 52.1 Humeral head resection 52.2 Medullary canal opening 52.3 Humeral canal preparation 52.4 Cut protection 6

3. GLENOID PREPARATION AND BASEPLATE IMPLANT 73.1 Exposure of the glenoid 73.2 Definitionofglenoidcentre,baseplateandglenospheresize 73.3 Glenoidbaseplatereaming 83.4 Glenoid glenosphere reaming 93.5 Central hole drilling 93.6 Bone Tapping 93.7 Glenoidbaseplateimpaction 103.8 Screwholepreparation 103.9 Screwplacementandlocking 113.10 Trialglenosphereinsertion 12

4. HUMERAL METAPHYSIS PREPARATION 124.1 Trial humeral diaphysis insertion 124.2 Humeral reaming 124.3 Trial Humeral Reverse Metaphysis insertion 134.4 Trial Humeral Reverse Liner insertion 134.5 Record values and remove trials 13

5. GLENOSPHERE IMPLANT 145.1 Glenosphere insertion and impaction 145.2 Glenospherefixation 15

6. HUMERAL IMPLANT 166.1 ReverseStembacktableassembly 166.2 Reverse Stem insertion and impaction 166.3 Reverse Liner impaction 17

7. IMPLANTS AND INSTRUMENTS NOMENCLATURE 18

8. COMPATIBILITY TABLE BASEPLATES - GLENOSPHERES 21

9. INSTRUMENTS COLOUR CODING INSTRUCTIONS 22


4

1. INTRODUCTION

Thissurgicaltechniquedescribeshowtoperformareversetotal shoulder arthroplasty implanting a threaded glenoid baseplate.

CAUTION Federallaw(USA)restrictsthisdevicetosaledistributionandusebyorontheorderofphysician.

1.1 INDICATIONS OF USE

The Reverse Shoulder Prosthesis is indicated for treatment of humeral fractures and for primary or revision total shoulderreplacementinpatientswithagrosslyrotatorcuffdeficient shoulder joint, severe arthropathy or a previously failedjointreplacementwithagrosslyrotatorcuffdeficientshoulder joint.

Thepatient’s jointmustbeanatomicallyandstructurallysuitedtoreceivetheselectedimplant(s),andafunctionaldeltoid muscle is necessary to use the device.

The glenoid baseplate is intended for cementlessapplicationwiththeadditionofscrewsforfixation.

1.2 CONTRAINDICATIONS

Total joint replacement is contraindicated in cases of:

• Local or systemic infection or sepsis;

• Insufficientbonequalitywhichmayhinderthestabilityof the implant;

• Muscular,neurological,orvasculardeficiencies,whichcompromise the affected extremity;

• Any concomitant disease and dependence that might affect the implanted prosthesis;

• Materials(metals,etc.)sensitivityorallergy;

• Loss of ligamentous structures that will preventstabilisationand/orfunctionofthedeviceinvivo;

• Non-functional deltoid muscle.

1.3 PRE-OPERATIVE PLANNING

For planning purposes, standard X-rays are used. The recommendedviewsare:

• Antero-posteriorviewininternalrotation;• Antero-posteriorviewinexternalrotation;• Axillaryview;• MorrisonorBernageauview.

A CT-Scan with a three dimensional reconstruction issuggestedforfracturecases.Furtherinformationonbonedeficitandonmuscle/capsulequalitycanbegatheredwithan MRI, recommended in osteoarthritis and osteonecrosis cases.

Aneurological investigationcouldbehelpful, forpatientconditions assessment, especially in post-traumatic cases suchasspecialcasesofdisabledshoulder.

Templates are used in all osteoarthritic and osteonecrosis cases;theycanalsobeusedinfracturecasesbutmaynotbesufficientforthoroughplanning,dependingonthetypeof fracture.

The X-ray templates have a 115% scale; different magnificationsanddigitaltemplatesarealsoavailableonrequest.

1.4 SURGICAL APPROACH

The patient is usually placed in a beach chair position.Maintain free space for shoulder extension and adduction. Two surgical approaches aremost frequently used forreverse shoulder prosthesis: delto-pectoral approach or deltoid split. Both can be used with the standardinstrumentationprovided,whichhasbeenoptimized fordelto-pectoral approach. The basic steps of the delto-pectoralapproacharedescribedbelow:

• Incision - anincision ismadefollowingthelineofthedelto-pectoral groove

- a10-15cmincisionisusual,butshouldbemadeinaccordancewiththesurgicalneedandsizeof thepatient

• Superficial dissection - the delto-pectoral fascia is encountered first; the cephalicveinissurroundedbyalayeroffatandisusedto identify the interval; the cephalic vein can bemobilised eithermedially or laterally, depending onpatient factors and surgeon preference.

- fibers of the deltoid are retracted laterally and thepectoralis major is retracted medially

• Deep dissection - theshortheadofthebicepsandcoracobrachialisarisefrom the coracoid process and are retracted medially. Themusculocutaneousnerveentersthebiceps5-8cmdistal to the coracoid process; caremust be takenwhenretractingtheconjointtendon.

- the fascia on the lateral side of the conjoint tendon is incisedtorevealthesubscapularis;externalrotationstretchesthesubscapularisfibers.Thesubscapularismay be released from its insertion on the lessertuberositythroughthetendonorviaanosteotomy

- thecapsule is then incised(asneeded) toenter thejoint

Exposureof thehumeralheadcanbeachieved throughextension, external rotation and adduction.

This operating technique is independent of the chosen approach.

5

2. HUMERAL DIAPHYSIS PREPARATION

2.1 HUMERAL HEAD RESECTION

Exposetherelevant landmarkssuchasthemostmedialinsertionlineofthesupraspinatus,thebicipitalgrooveandtheestimatedoriginallocationoftheanatomicalneck.

Position the extramedullary humeral cutting guide so that theresectionisflushwiththemostmedialinsertionlineofthesupraspinatusandtheshaftthatfollowsthehumeraldiaphysis.Thiswillresultinanapproximateinclinationcutof 135°.

1.

Check the cut inclination and retroversion using theHumeralSickleandtheRetroversionRod.Oncethedesiredpositionisfound,fixtheguidewithtwoØ2mmpins.

2.

Performthecutusinganoscillatingsaw.

2.2 MEDULLARY CANAL OPENING

Connect the T-handle to the Medullary Canal Opener and useittoopenthehumeralcanal.Start8mmposteriortothedeepestpointofthebicipitalgrooveandclosetothemedial insertion of the supraspinatus.

3.

2.3 HUMERAL CANAL PREPARATION

UsetheIntramedullaryReamerstosizethedistalmedullarycanalandthebroachestodefinethebestfitproximally.

Connect the smallest reamer to the T-handle and start hand reaming. Incrementally increase the size until it fits thedistal part of the medullary canal.

4.

Toavoidundersizingandvaruspositioningof thestem,removetheproximalmetaphysealcancellousboneusingthe Metaphyseal Chisel.


6

5.

AttachthesmallestBroach(size6)totheHumeralBroachHandle: insert the lateral tip of the handle into the dedicated slot of the Broach and close the lever to insert the medial tipandlocktheBroach.Usetheretroversionrodtocontrolthe broach insertion alignment perpendicular to theepicondylesaxis(0°and20°optionsavailable).

6.

Startpreparingthecanalbylightlyhammeringontheanvil.

StophammeringwhenthesuperiorplaneoftheBroachisalignedwith the humeral resection.Continuebroachingwithincrementallylargersizes.

The largest size that fits with its proximal portion fullyseatedinthecanaldeterminesthefinalstemsize.

7.

WARNING Do not try to introduce a Broach larger than the last Intramedullary Reamer. This might lead to a diaphyseal humeral fracture.

2.4 CUT PROTECTION

Place the Cut Protector on the resection plane. Choose the sizewhichoffersthebestcoverage.FixitbyscrewingittothebroachusingtheHEX3.5screwdriver.

8.

7

3. GLENOID PREPARATION AND BASEPLATE IMPLANT

3.1 EXPOSURE OF THE GLENOID

Twodifferentoptionsareavailabletoexposetheglenoid:1. External rotationandabductionof thehumerus.This

implies antero-inferior capsular resection and release of the coracohumeral ligament.

2. Alternatively, expose the glenoid trough humeral flexion, internalrotationandslightabduction,aimingatpostero-inferior dislocation of the humerus. This implies circumferential capsular resection and release of the coracohumeral ligament.

3.2 DEFINITION OF GLENOID CENTRE, BASEPLATE AND GLENOSPHERE SIZE

Connect the Glenoid Multi-purpose Handle to the Reverse GlenoidAimingDevice.Positiontheassembledinstrumenton the glenoid vault so that the convex surface is in contact withthebone.

The presence of osteophytes may lead to incorrect positioning. It is highly recommended to remove them prior topositioningtheK-wire.

9.

With the aiming device it is possible to evaluate thecoverage of the Baseplate and the position of the Glenosphere:

• the black linemarked on the circular rim representsthemid-sizeBaseplate(Ø24.5mm),whiletheouterandinnerbordersrespectivelyshowthedimensionof theØ27andØ22Baseplates;

• theinferiorprofileoftheavailableGlenospheresizesisrepresentedbythelowerborderofthe“inferiorlegs”.

10.

The position of the glenoid centre normally corresponds to thedeepestpointoftheglenoidvault,wherethebestbonequality is normally found.

Once the glenoid centre, the baseplate size and theglenospheresizearedefined, insert theØ2.5mmK-wirethrough the central hole of the aiming device adjusting the drillingorientationtoobtainthecorrectangleasplanned.

11.

Remove the Reverse Glenoid Aiming device leaving the K-wire in place. Insert the Depth gauge for threadedbaseplatethroughtheK-wiretocheckthedistancebetweenthe surface and the anterior cortex of the spina scapulae, whichshouldcorrespondtotheimplantlength.


8

12.

If the measured depth is significantly longer than 35mm, remove the k-wire and reposition it aiming at a moreanteriororientation;incasethedepthissignificantlylowerthan25mm,repositionthek-wiremoreposteriorly.

Use the following picture as a guide for the implantselection.

K-WIRE TOO POSTERIOR L35 L30 L25

K-WIRE TOO POSTERIOR

Ø 24.5x25

Ø 24.5x30 or 27x30

Ø 27x35

13.

3.3 GLENOID BASEPLATE REAMING

Select the size of the Glenoid Reamer as previouslydetermined. Slide it on theK-wire and connect it to theReamerHandleasshowninthepicturesbelow.

14.

By visually checking the size of the reamer, the finalevaluationofthesizeoftheBaseplatetobeimplantedcanbemade.

Useapowertooltoreamtheglenoidtothedesireddepthconsideringthattheaimistonormalisetheversionwhilstavoidingexcessivethinningofthesubchondralboneplate.

15.

Usethedepthgaugeforthreadedbaseplatetoperformthefinalcheck.

9

3.4 GLENOID GLENOSPHERE REAMING

Ifdesired, it ispossibletotemporarilyremovetheK-wireand place the Trial Glenosphere on the glenoid cavity to confirmthesizeoftheGlenosphere.

ConnectthecorrespondingsizeofReamerforGlenospheretotheReamerHandle.Slidetheassembledinstrumentonthek-wireandmanuallyreamtheglenoidwiththehelpofa T-handle.

Themanualreamingiscompletedwhenaflatsurfaceallaround thebaseplate is obtainedanda fullmechanicalstop is reached.

16.

3.5 CENTRAL HOLE DRILLING

ConnecttheCentralPegReamerforthreadedbaseplatetotheReamerHandle.Slide theassembled reameron theK-wireand ream thecentral part of theglenoidusingapowertooluntilthemechanicalstopisreached.RemovetheK-wire.

17.

3.6 BONE TAPPING

Connect theTap for threaded baseplate to theReamerHandle and then to the T-handle.

Pushthetapagainsttheboneandstarttappingthecentralhole.Continuetappinguntilthemarkingcorrespondingtothe implant length previously determined is reached.

18.


10

3.7 GLENOID BASEPLATE IMPACTION

Select the size of the Baseplate implant as previouslydefined. Connect the Baseplate Impactor Tip of the correspondingsizetotheImpactorHandle.

19.

SlidetheM5FixationRodintotheassembledBaseplateimpactor.

20.

SecuretheBaseplatetotheimpactorbyscrewingtheroduntil fixed.

21.

ScrewtheThreadedbaseplateintotheboneuntilafullstopis reached and significant resistance is felt.

22.

3.8 SCREW HOLE PREPARATION

Connect the Glenoid Multi-purpose Handle to the Drill Guide forPolyaxialScrews.

InserttheDrillGuideforPolyaxialScrewsintooneofthespherical seats of the Baseplate. Orient the drill guide in the desireddirection,consideringthattheguideallowsfor15°of freedom in every direction. Insert the Drill Bit for Polyaxial Screwsintotheguideanddrillaholetothedesireddepthusingthemarkingsasareference.

23.

It isalsopossible touse theDepthGauge tocheck thedepth of the drilled holes.

Repeattheprocedureforeveryscrewused.Thesuperiorandtheinferiorscrewsareconsideredmandatorywhilsttheanteriorandtheposteriorscrewsareoptional.

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3.9 SCREW PLACEMENT AND LOCKING

Choosethedesiredscrewlength,aspreviouslymeasured.AssembletheGlenoidPolyaxialScrewdriverModularTipwiththeReamerHandleandthentotheT-handle.ConnectthescrewheadtoGlenoidPolyaxialScrewdriverModularTipasshownbelow:

24.

Insertthescrewintothebone.

25.

Continue to insert the screwuntil theGlenoidPolyaxialScrewdriverModularTipdisconnectsformthescrewhead.UsetheGlenoidPolyaxialScrewdrivertofullysittheheadofthescrewinthebaseplatehole.

AssembletheModular2NmTorqueLimitingscrewdriverwiththeModularScrewdriver-T10tip.Usethisinstrumentto lockthescrewbytighteningthe innerscrewuntil theTorqueLimiterScrewdriverslips.Repeattheprocedureforeveryscrewused.

26.

Glenoidpolyaxialnon-lockingscrewscanbeusedasanalternative option for the Baseplate fixation.

Alltheprevioussurgicalstepsremainunchanged(upto§3.8).Oncethedesiredscrewlengthischosen,connectthescrewheadtotheScrewdriverT15forGlenoidNon-lockingScrewsasshownbelow.

27.

Insert theGlenoid PolyaxialNon-locking Screw into theboneandusetheScrewdrivertofullysitthescrewheadinthe dedicated seat of the Glenoid Baseplate.

28.

RepeattheprocedureforeveryscrewusedtilltheBaseplateis completely compressed on the prepared glenoid vault.


12

3.10 TRIAL GLENOSPHERE INSERTION

Insert the Trial Glenosphere into the Baseplate and orient it according to the anatomy of the glenoid using forceps.

SelectthelargestsizeoftheTrialGlenospherethatfitsthepatient’sanatomy.LocktheembeddedscrewoftheTrialGlenosphere to fix its position.

29.

4. HUMERAL METAPHYSIS PREPARATION

4.1 TRIAL HUMERAL DIAPHYSIS INSERTION

RemovetheHumeralCutProtectorbyunscrewingitfromthe broach using theHEX 3.5 screwdriver. Remove thebroachbyusingtheHumeralBroachHandle.TaketheTrialHumeralDiaphysisof the samesize as the last broachused to prepare the canal, connect it to its inserter byrotatingtheknobclockwiseandinsertitintothehumeralcanal until the marked line is flush with the humeralresection.

Screwtheretroversionrodintothedesiredversionholeandaligntherodwiththeforearmfixedat90degreestochecktheTrialHumeralDiaphysisinsertion(0°and20°optionsavailable).

30.

Unlockandextracttheinserter.

4.2 HUMERAL REAMING

Connect the Humeral Reaming Guide to the Trial Humeral Diaphysis.

Assemble the Reamer for Reverse Metaphysis to theReamer Handle. Slide it over the Reaming Guide and ream thehumerususingapowertooluntilthemechanicalstopis reached.

31.

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4.3 TRIAL HUMERAL REVERSE METAPHYSIS INSERTION

Connect the Trial Humeral Reverse Metaphysis to the Trial HumeralDiaphysisandfixitwiththeembeddedscrew.

32.

CAUTION The Trial Humeral Reverse Metaphysis is correctly oriented when the “Medial”mark is in thedirectionof thecalcarregion and the indexing pin is lateral.

4.4 TRIAL HUMERAL REVERSE LINER INSERTION

InserttheTrialHumeralReverseLinerofthesamesizeofthe selected Trial Glenosphere (cf. 3.9) into the TrialHumeral Reverse Metaphysis.

Alignthemarkingontheoutersurfaceofthetrialreverselinerwiththemediallineonthetrialreversemetaphysistoobtain an inclination of 155°. Insert the Trial HumeralReverseLinerintheoppositeorientation(180°rotated)toget an inclination of 145°.

33.

Reducethejointandtestthekinematics,especiallystabilityandmobility.

Makesurethatthereisnoearlyglenohumeralimpingement,“hinging-open”inadduction,extension,internalandexternalrotation.

Should the shoulder be unstable, height correctioncomponentscanbeselected.ThefollowingtableshowsthepossibleheightoptionsofboththeReverseMetaphysisand Reverse Liner:

AVAILABLE HEIGHT OPTIONS

REVERSE LINER

mm +0 +3 +6

REVERSE METAPHYSIS

+0 +0 +3 +6

+9 +9 +12 +15

Ifanyretroversioncorrectionisneeded,+20°Right/-20°Leftand +20°Left/-20°Right options can be used, for both+0mmand+9mmheightoptions.

4.5 RECORD VALUES AND REMOVE TRIALS

Record the height and inclination of the trial reverse liner. Record the height and retroversion of the Trial Reverse Metaphysis.

Snap the Trial Reverse Liner Extractor into the Trial Reverse Liner and pull the instrument to remove the trial.

34.

ConnecttheReverseStemInsertertotheassembledtrialreversestemaccordingtothefollowingprocedure.

Slide the Reverse Stem Inserter into the Trial Reverse Metaphysisaligningthe“1”lineoftheinstrumentwiththemedial line of the implant.


14

35.

Pushthehandledowntowardstheimplantand,holdingitdown,rotatetheinstrumentclockwisealigningthe“2”lineto the medial line of the implant. The instrument is correctly connectedwhenasnapisfelt.

36.

Removethetrialstemfromthebone.

Removetheinstrumentbypushingthecentralknobwhilstpullingthecapbackandrotatingitcounterclockwise(fromposition2toposition1).

RecordthesizeandtheorientationoftheTrialglenosphere. Remove the Trial glenosphere from the Baseplate.

5. GLENOSPHERE IMPLANT

5.1 GLENOSPHERE INSERTION AND IMPACTION

Connect the Glenosphere Guide to the retentive tip of the HEX3.5screwdriver. Tighten the Glenosphere Guide onto the Baseplate.

37.

Screw the glenosphere positioner to the selectedglenosphere.

38.

Pushtheeccentricitypointertowardstheglenospheretofree it.

39.

Alignitwiththeglenosphereeccentricityreferencingtothelinemarkedonitsbacksurface.Thenpullitbackwardstofix it.

40.

Position the glenosphere on the baseplate letting thepreviously inserted Glenosphere Guide align the twocomponents. Gently impact the Glenosphere.

15

41.

Ifneeded,theglenosphereeccentricitycanbecorrectedwiththeglenosphereorienter.

42.

Once a correct alignment of the eccentricity is achieved, gently impact the glenosphere.

43.

Assembletheglenosphereimpactortiptothemultipurposehandle and use it for the final impaction of the glenosphere.

44.

5.2 GLENOSPHERE FIXATION

WARNING RemovetheGlenosphereGuidefromthebaseplate.

ConnecttheGlenospherescrewtotheretentivetipofthetorque limiting screwdriver T15 3 N.m. Slide it into the Glenosphereandtightenituntilthescrewdriverslips.

45.


16

6. HUMERAL IMPLANT

6.1 REVERSE STEM BACK TABLE ASSEMBLY

Assemble the Backtable stem adapter of the selectedHumeralDiaphysissizewiththeBacktableAssemblyBlock,then insert the Humeral Diaphysis into the hole. Position the Reverse Metaphysis of the selected height and retroversion on the Humeral Diaphysis.

CAUTION TheReverseMetaphysis is correctly orientedwhen the155°markisinthedirectionofthecalcarregionandtheindexing pin is lateral and correctly inserted in the lateral groove of the Humeral Diaphysis.

InserttheReverseMetaphysisScrewandtightenitwiththeTorquelimitingscrewdriverT206N.muntilthescrewdriverslips.

46.

WARNING

47.

Carefully check the correct assembly of the ReverseMetaphysisontotheHumeralDiaphysis:nospaceshallbepresentbetweenthetwoassembledcomponents.

6.2 REVERSE STEM INSERTION AND IMPACTION

Connect the Reverse Stem Inserter to the assembledreversestemaccordingtothefollowingprocedure.

Slide the Reverse Stem Inserter into the Reverse Metaphysis aligningthe“1”lineoftheinstrumentwiththemediallineof the implant.

48.

Pushthehandledowntowardstheimplantand,holdingitdown,rotatetheinstrumentclockwisealigningthe“2”lineto the medial line of the implant. The instrument is correctly connectedwhenasnapisfelt.

49.

In case it is difficult to remove the stem from its slot, insert the Backtable Assembly Block in the Backtable StemRemoval Device and screw both components. Thiswillpushthestemupandreleaseitfromtheblock.

17

50.

Where a cemented humeral diaphysis is used, insert the appropriately sized cement restrictor into the humeralcanal approximately 1 cm below the distal tip of thehumeral stem. Brush, irrigate and dry the humeral canal beforebonecementispressurised.Mixthebonecementaccording to the manufacturer’s instructions. Extrude the bonecement into thehumeral canal, distal toproximal,usingaretrogradetechnique.Whenthebonecementhasreached a dough-like consistency, insert the cementedhumeraldiaphysisintothehumerusbygentlytappingtheinstrument handle. Upon completion, remove theinstrumenthandleandanyremainingexcessbonecement.Cementedhumeraldiaphysiscanbeimplantedlinetoline(cementedhumeraldiaphysisofthesamesizeasthefinalbroachsize),onesizedown(cementedhumeraldiaphysisonesizesmaller thanthefinalbroachsize,providing I.2mm diametrical cement mantle) or two sizes down(cementedhumeraldiaphysistwosizessmallerthanthefinal broach size, providing 2.4mmdiametrical cementmantle)accordingtothesurgeon’spreference.

For a cementless humeral diaphysis implantation, gently tap on the instrument handle to fix the position of the selected cementless humeral diaphysis into the humerus.

Screwtheretroversionrodintothedesiredversionholeandaligntherodwiththeforearmfixedat90degreestocontrolthesteminsertionalignment(0°and20°optionsavailable).

51.

Removetheinstrumentbypushingthecentralknobwhilstpullingthecapbackandrotatingitcounterclockwise(fromposition2toposition1).

52.

6.3 REVERSE LINER IMPACTION

Connect the Reverse Liner Impactor Tip to the Impactor Handle.

53.

Position the Reverse Liner as defined in the trialling phase andimpactitwiththereverselinerimpactor.

54.


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7. IMPLANTS AND INSTRUMENTS NOMENCLATURE

IMPLANTS

REFERENCE DESCRIPTION PICTURE

04.01.0001 STD Humeral diaphysis - cementless - 6


04.01.0003 STDHumeraldiaphysis-cementless-8


04.01.0005 STDHumeraldiaphysis-cementless-10







04.01.0012 STD Humeral diaphysis - cemented - 6

04.01.0014 STDHumeraldiaphysis-cemented-8

04.01.0016 STDHumeraldiaphysis-cemented-10




IMPLANTS


04.01.0110 Humeralreversemetaphysis+0mm/0°

04.01.0111 Humeralreversemetaphysis+9mm/0°

04.01.0112 Humeralreversemetaphysis+0mm/+20°L*

04.01.0113 Humeralreversemetaphysis+9mm/+20°L*

04.01.0114 Humeralreversemetaphysis+0mm/+20°R*

04.01.0115 Humeralreversemetaphysis+9mm/+20°R*

*Ondemand

19

IMPLANTS


04.01.0116 HumeralreverseHCPElinerØ32/+0mm*



04.01.0119 HumeralreverseHCPElinerØ36/+0mm









(*) NOTE: UHMWPEimplantsshouldbestoredforatleastthreehoursat20ºC(+/-3ºC)beforetheoperation

*Ondemand

IMPLANTS


04.01.0190 ThreadedglenoidbaseplateØ24.5x25

04.01.0191 ThreadedglenoidbaseplateØ24.5x30

04.01.0192 ThreadedglenoidbaseplateØ27x30

04.01.0193 ThreadedglenoidbaseplateØ27x35


20

IMPLANTS


04.01.0157 Glenoidpolyaxiallockingscrew-L14










04.01.0194 Glenoidpolyaxialnon-lockingscrew–L14










IMPLANTS


04.01.0178 Glenosphere32xØ24.5*



04.01.0171 Glenosphere42xØ24.5

04.01.0172 Glenosphere36xØ27



*Ondemand

IMPLANTS


04.01.0176 Reversemetaphysisscrew

04.01.0177 Glenospherescrew

21

INSTRUMENTS


04.01S.310US Medacta Shoulder General

04.01S.311US Medacta Shoulder Humerus

04.01S.312 Medacta Shoulder Reverse

NOTE:AlltheaboveinstrumentssetsincludemotorizedinstrumentswithZimmer-Hallconnection,inalternative: 04.01S.310:motorizedinstrumentswithAOconnection 04.01S.311:motorizedinstrumentswithAOconnection

8. COMPATIBILITY TABLE BASEPLATES - GLENOSPHERES

Thetablebelowillustratesthepossiblecombinationsbetweenthethreadedglenoidbaseplatesandtheglenosphere,pleasefollowthistabletobuildyourimplantconstruct:

Ø32 Ø36 Ø39 Ø42

Baseplate 24.5

Baseplate 27 -


22

9. INSTRUMENTS COLOUR CODING INSTRUCTIONS

ColourCodingforInstruments*:

• HumeralInstruments:allthededicatedhumeralinstrumentshaveayellowtag

• Glenoid Instruments: all the dedicated glenoid instruments have a red tag

• GeneralInstruments:allthemultipurposeinstrumentshaveawhitetag

*=exceptfortorquelimitingscrewdrivers

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Partnumberssubjecttochange.

NOTE FOR STERILIZATIONTheinstrumentationisnotsterileupondelivery.Instrumentsmustbecleanedbeforeuseandsterilizedinanautoclaverespectingthe US regulations, directives where applicable, and following the manufactures instructions for use of the autoclave. Fordetailed instructionspleaserefer to thedocument “RecommendationsforcleaningdecontaminationandsterilisationofMedactaInternationalorthopaedicdevices”availableatwww.medacta.com.

Medacta Shoulder SystemSurgical Technique

ref:99.81T.12USrev.02

Lastupdate:November2018

Medacta International SAStradaRegina-6874CastelSanPietro-SwitzerlandPhone+41916966060-Fax+41916966066info@medacta.ch

Findyourlocaldealerat:medacta.com/locations

Alltrademarksandregisteredtrademarksarethepropertyoftheirrespectiveowners.ThisdocumentisintendedfortheUSmarket.

Documents

Surgical Technique - media.medacta.com · Rv Suld Athro Teaded B Surgical Technique 8 12. If the measured depth is significantly longer than 35mm, remove the k-wire and reposition