Zimmer Continuum Acetabular System Surgical Technique,
1ZimmerContinuumAcetabularSystem Surgical TechniqueUS Continuum ST VitE 2c 2-16-15.indd 14/10/15 12:38 PM
2Zimmer Continuum Acetabular System Surgical TechniqueDevice Description The Continuum Shell is hemispherical in shape with an exterior ofTrabecular Metal Material that is bonded to a Tivanium alloysubstrate. The Shell has a snap fit locking groove for acceptanceof the Vivacit-E Vitamin E Highly Crosslinked PolyethyleneNeutral or Elevated Liners and the Longevity Highly CrosslinkedPolyethylene Neutral, Elevated, Offset, Oblique, or ConstrainedLiners. Twelve scallops, equally spaced in 30 increments,included on the Shell face mate with twelve anti-rotation tabs onthe Vivacit-E Vitamin E and Longevity Liners.Indications/Intended UseVivacit-E Vitamin E Highly Crosslinked Polyethylene and LongevityHighly Crosslinked Polyethylene Neutral and Elevated Liners The system is indicated for primary or revision surgery inskeletally mature individuals for rehabilitating hips damaged asa result of noninflammatory degenerative joint disease (NIDJD)or its composite diagnoses of osteoarthritis, avascular necrosis,protrusio acetabuli, traumatic arthritis, slipped capital epiphysis,fused hip, fracture of the pelvis, and diastrophic variant. The system is intended for use either with or without bonecement in total hip arthroplasty.Additional Liner OptionsFor instructions on implanting the Longevity Offset, Oblique, andConstrained Liners, please refer to the corresponding surgicaltechnique. Longevity Offset and Oblique Liners Surgical Technique:97-6305-102-00 Longevity Constrained Liner Surgical Technique:97-6305-109-00US Continuum ST VitE 2c 2-16-15.indd 24/10/15 12:38 PM
Zimmer Continuum Acetabular System Surgical TechniqueAcetabular Reamer54mm Reamer has a 54mm O.D.3Shell Provisional54mm Provisional has a 54mm O.D.Acetabular Shell54mm Continuum Shell has a 54mmO.D.Introduction The labeled outside diameter (O.D.) of the acetabular shellrepresents the true hemispherical diameter of the Implant. Anappropriate undersized reamer must be used to prepare theacetabulum if a press fit condition is desired. The amount of press fit used should be determined at the timeof surgery and be based on bone quality. Shell Implants are labeled with the exterior size and acorresponding two letter code (e.g. 56 KK). The matching LinerImplants are identified with the matching letter code and headdiameter (e.g. 28 KK, 32 KK, 36 KK, 40 KK).Templating The primary goal of templating is to estimate the size andposition of the acetabular Implant. 45 degrees of abduction and 20 degrees of forward flexion isrecommended in most cases. Use of the alignment guides withvarious patient positions is outlined in later sections of thetechnique. To increase the accuracy of templating, digital imaging or x-rayswith magnification markers should be used. The magnificationof the x-rays and the templates should be compared whensizing the Implant.Templating should start with the A/P radiograph. (Fig. 1) The component should NOT be more medial than the cortyloidnotch and should NOT be against the radiographic tear drop. To avoid vertical shell placement a line drawn along the shelltemplate opening should intersect the obturator foramen. It may be helpful to cross-check the acetabular componentsize on the lateral radiograph, which can provide a view of thehemispherical subchondral bone. The largest component that meets these requirements shouldbe selected. However, the final decision on component sizeshould be made during surgery, when all aspects of theacetabulum can be fully visualized.US Continuum ST VitE 2c 2-16-15.indd 3Fig. 1AP Templating View.4/10/15 12:38 PM
4Zimmer Continuum Acetabular System Surgical TechniqueSurgical ApproachThe Continuum Shell may be implanted using a variety of standardsurgical approaches.Note: While the surgeon’s approach may vary, theapproach must provide adequate exposure to visualize theentire acetabular rim.Fig. 2aAcetabular PreparationFig. 2bExcise the acetabular labrum and remove any large peripheralosteophytes. Excise the ligamentum teres to expose the true floorof the acetabulum.Note: It is important to visualize the entire bony rim ofthe acetabulum to reduce the likelihood of soft tissueentrapment which may prevent the shell from seatingduring insertion.Fig. 2cShell and Provisional Shell Inserter OptionsNote: The 38mm IT Provisional Sizer is used to assess thesize of the reamed cavity. There is no corresponding 38mmImplant.Acetabular Reaming From templating and preoperative planning, determine thedesired head position. Start with a smaller reamer and proceed to the next largestreamer in 1-2mm increments. Reaming depth is based on bonequality but usually is completed after bleeding cancellous boneis exposed.Note: Take extra care to avoid eccentric reaming byholding the reamer steady. Apply constant pressure in therecommended final Implant orientation of 45 degrees ofabduction and 20 degrees of forward flexion.Caution: Throughout the entire procedure, take care in handlingsharp Implants or Instruments.Fig. 3The Shell Inserter with Adaptor mating with the Provisional Shell.Shell Provisional Insertion and Alignment Proper care must be taken to assess bone quality and todetermine the appropriate Implant size and type. You may use either the Straight Shell Inserter (Fig. 2a), HybridOffset Shell Inserter (Fig 2b) or the Trilogy Cup Positioner (Fig. 2c)with the appropriate metal cap to Insert the Provisional Shell.If using the Straight Shell Inserter or Hybrid Offset Shell Inserter: Place the Shell Inserter Adapter, with or without RotationalControl, onto the tip of either the Straight Shell Inserter orHybrid Offset Shell Inserter. (Fig. 3) Insert a Ball Head Hex Driver through the window and into thelocking Screw at the tip of the Inserter. (Fig. 4) While holding the Shell Provisional in place, securely thread theLocking Screw into the Polar Hole of the Shell Provisional. Attach the Alignment Frame or Gunsight Alignment Guide to theInserter and tighten the Thumb Screw.US Continuum ST VitE 2c 2-16-15.indd 4Fig. 4Attaching the Shell Provisional to the Inserter Handle using theHex-Head Driver.4/10/15 12:38 PM
Zimmer Continuum Acetabular System Surgical Technique5Note: The Alignment Support Frame on the ShellInserter will not be vertical to the floor and should notbe used as a positioning guide. (Fig. 5) The arms on theGuide are used to correctly position the Provisional Shelland/or Implant. See the diagrams for use instructions onthe lateral and supine approaches (Pages 16-19). With the Shell Provisional in the appropriate alignment, use amallet to impact the handle of the Inserter. To prevent threaddamage, verify that the Locking Screw is fully tightened to theShell Provisional as repetitive impacts could cause the screw toloosen. The Shell Provisional has fenestrations to assess proper shellseating inside the acetabulum. When the Shell Provisional is fully seated, turn the Drivercounterclockwise to loosen the attachment Screw on the Inserter. Remove the Inserter.If using the Trilogy Cup Positioner (Fig. 6): Select the appropriate Positioner cap based on Shell size.· Shells 40-46mm use the Micro Cap (Fig. 7)· Shells 48-80mm use the existing Trilogy Cap (Fig. 8)Fig. 5Do not use the support frame to align the Provisional Shell orShell Implant. Thread the Shell Provisional onto the Positioner until secure. Rotate the Alignment Connector to achieve desired Shell screwhole orientation.Alignment ConnectorLocking Nut Fix the Alignment Connector into place by tightening the LockingNut. Using the small slaphammer on their shafts, impact one ofthe following Alignment guides in the alignment connector toengage onto the taper:· Lateral A-Frame Alignment Guide· Supine A-Frame Alignment Guide· Lateral Gunsight Alignment Guide· Supine Gunsight Alignment GuideFig. 6Trilogy Cup PositionerIf using Lateral or Supine Gunsight Alignment Guide, insertAlignment Rod into appropriate hole (Left or Right).See the diagrams for use instructions on the lateral and supineapproaches (Pages 16-19). With the Shell Provisional in the appropriate alignment, use amallet to impact the handle of the Positioner. When the Shell Provisional is fully seated unscrew thePositioner from the Shell Provisional.US Continuum ST VitE 2c 2-16-15.indd 5Fig. 7Fig. 8Trilogy Micro CapTrilogy Cap4/10/15 12:38 PM
6Zimmer Continuum Acetabular System Surgical TechniqueProvisional Liner InsertionImplant InsertionInserting the Provisional LinerIf using the Straight Shell Inserter or Hybrid Offset Inserter: There are two different Provisional Liners. One with a LockingScrew that is independent of the Provisional Liner (Fig. 9) andone with a Locking Screw permanently affixed within the Provisional Liner. (Fig. 10) There are two Adapters for the Inserter Handles. The Adapterwith Rotational Control locks to prevent the Implant fromrotating freely on the Inserter handle. If this Adapter is usedwith a Cluster Hole Shell, the dark etch on the Adapter shouldbe in line with the alignment frame on the Inserter to allow forCluster Hole placement in the posterior superior and posteriorinferior quadrants.Note: The Permanently Affixed Locking Screw should notbe removed.Note: The Shell Inserter Adapter without Rotational Controlwill allow the Implant to rotate freely on the Inserter. Usethis Adapter when it is necessary to position the ScrewHoles in a specific location within the acetabulum. Select the Provisional Liner size that matches the selectedProvisional Shell. The selected Shell Provisional will be identified through a sizeand a two letter code (e.g. 50 HH). There are different innerdiameter Implant sizes available for each Shell size. The Provisional Liner will be identified by letter code matching the Shelldiameter and desired inner diameter (e.g. 32 HH). Both types of Provisional Liners are inserted the same way;however, the Provisional Liner with Independent Locking Screwmust first be assembled by using a Hex-head Driver to insertthe Provisional Locking Screw through the Polar Hole of the Provisional Liner. The Provisional Locking Screw will have a silverring. Insert the Provisional Liner by hand into the Provisional Shell. If applicable, ensure that the anti-rotation tabs of the Provisional Liner are engaged in the Shell Provisional scallops.Warning: Do not impact the Provisional Liner as damage may occur. The Shell Inserter Adapter with Rotational Control has two pinsthat will fit into slots at the tip of the Inserter. These pins are notfound on the Shell Inserter Adapter without Rotational Control. To insert the Implant, follow the same procedure describedpreviously for inserting provisional Shells using the StraightShell Inserter or Hybrid Offset Shell Inserter.If using the Trilogy Cup Positioner: The Trilogy Cup Positioner does not have rotational control.Control of Implant orientation is at the discretion of the surgeonand can be adjusted by rotating the position of the AlignmentConnector relative to the shaft of the Trilogy Cup Positioner. To insert the Implant, follow the same procedure describedpreviously for inserting provisional Shells using the Trilogy CupPositioner. Thread the Locking Screw into the Polar Hole of the ShellProvisional.Trial Range of Motion Insert a head/neck Provisional onto the Implanted Stem or RaspCone Provisional and perform a trial reduction. Check for stability and range of motion. Remove the Provisional components.Note: Refer to Zimmer’s product compatibility website,www.productcompatibility.zimmer.com, to determinecompatibility among all selected components.US Continuum ST VitE 2c 2-16-15.indd 6Fig. 9Fig. 10Provisional Liner withIndependent Locking ScrewProvisional Liner withPermanently Affixed LockingScrew4/10/15 12:38 PM
Zimmer Continuum Acetabular System Surgical Technique7 With the Implant in the appropriate position and alignment,use a mallet to impact the handle of the Inserter. When the Implant is fully seated, turn the Drivercounterclockwise to loosen the Attachment Screw on theInserter. Remove the Inserter.PosteriorSuperiorNote: The impact required to seat the Implant is dictatedby the bone quality.Note: Do not lever on the Shell or the Shell Inserter toreposition the Implant, as damage may occur to thethreads or inner diameter of the Shell.Note: The potential for neurologic and vascular injurycan be minimized if the posterior quadrants are usedfor transacetabular screw placement.* The Shell shouldbe positioned to allow screw placement in the posteriorsuperior and/or posterior inferior quadrants of theacetabulum. (Fig. 11) The Continuum Screw Holes arelocated closer to the Polar region as compared to theTrabecular Metal Modular eriorFig. 11Correct location for Screw placement in shaded regions.* Wasielewski RC, Cooperstein LA, Kruger MP, Rubash HE. Acetabular anatomy and thetransacetabular fixation of screws in total hip arthroplasty. J Bone Joint Surg. 1990:72A(4);501-508.US Continuum ST VitE 2c 2-16-15.indd 74/10/15 12:38 PM
8Zimmer Continuum Acetabular System Surgical TechniqueScrew InsertionIf Screw placement is desired: Carefully following these steps for Screw insertion can helpto minimize Screw push-through or torque-out after initialimplantation. Drill a pilot hole, using either a Modular or One-Piece Flex Drill. If using the Modular Flex Drill attach the selected bit using theHex Wrench. (Fig. 12) Check the bit to ensure that it is not dull. Position the Adjustable Drill Guide and Flex Drill into theselected Screw Hole. (Fig. 13) The screw angle may vary by as much as 33 degrees (inclusive).The effective lengths of the three drill bits available are 15mm,30mm and 45mm. Upon seating of the drill bit completely into the drill guide, thedrilled holes will correspond to the effective length of the drillbit.Fig. 12Attaching the bit to the Flex Drill with the Hex Wrench. For sclerotic bone, an option may be to tap the Screw hole.· Attach the Modular Tap Shaft into the Modular Handle bypulling back on the snap-lock collet and aligning the hole inthe shaft with the etched line on the collet.· Attach the appropriate Tap to the Modular Tap Shaft.· Bicortical tapping the entire depth should be done with careby turning the Tap Handle clockwise.Set Screw Removal To loosen the set screw, turn it counterclockwise until the threadfully disengages from the flexible shaft. The set screw will becaptured in the flexible drill shaft between the threads and thescrew stop. (Fig. 14) Alternatively, the set screw can be removed by turning itclockwise to fully disengage the set screw and placing it into theset screw holder in the instrument tray.Fig. 13Inserting the Adjustable Drill Guide and Modular Flex Shaft intothe Shell. After either loosening or removing the set screw, remove thedrill bit.Fig. 14Loosening the Flex Drill set screw.US Continuum ST VitE 2c 2-16-15.indd 84/10/15 12:38 PM
Zimmer Continuum Acetabular System Surgical Technique9After drilling the pilot or tapping the Screw hole: Use the Depth Gauge to measure the depth of the Screw hole.(Fig. 15) Select the appropriate length Trilogy Screw. Use a Screwdriver to insert it into the selected Screw hole.Screws cannot be inserted into the Polar Hole at the dome ofthe Shell. (Fig. 16)Note: Countersink screw heads below the interior surfaceof the Shell to prevent the liner from contacting the screwhead. Ensure that the screw heads are properly seated.Screw heads that protrude in to the inner Shell can preventadequate seating of the liner. Use a 3.2mm diameter drillprior to insertion of the 4.5 or 6.5mm diameter screws.Avoid penetration beyond the inner cortex of the pelviswhen drilling holes and inserting screws. (Fig. 17) Place additional Screws as necessary. Carefully evaluate the bone quality, and avoidover-tightening the Screws.Fig. 15Using the Depth Gauge to measure the screw hole depth. To remove a Screw, engage the Screw with a Hex Head Driverand turn it counterclockwise.Warning: Avoid Screw placement through the Shell intothe anterior inferior and anterior superior quadrants of theacetabulum to prevent injury to the neurovascular structures.Fig. 16Using a screwdriver to insert the screws.Fig. 17Checking to ensure that the screws are properly seated.US Continuum ST VitE 2c 2-16-15.indd 94/10/15 12:38 PM
10Zimmer Continuum Acetabular System Surgical TechniqueOptional Screw Hole PlugsScrew Hole Plug Place a Screw Hole Plug on the appropriate Hex Head Driver toensure it is perpendicular to the Screw Hole Plug. Align the Plug and Screw Hole until the Plug clearly drops intothe Hole.Note: The Screw Hole Plugs are slightly oval in shape andengage by providing an interference fit. To lock the Plug, turn it in either direction. The Plug will lock inplace with a partial turn. To remove the Hole Plug, turn in the opposite direction to releasethe interference fit. (Fig. 18)Note: The Screw Hole Plugs cannot be used with 40mm and42mm Shells as the screw holes in these Shells were notdesigned to accept a Screw Hole Plug.Provisional Liner PositioningFig. 18 Clean and dry the shell with a sterile cloth, wipe or sponge toremove third-body debris.Screw Hole Plug insertion. Clear all soft tissue from around the perimeter of the Shell andassess visualization. Insert the Provisional Liner by hand into the Shell. If applicable, ensure that the anti-rotation tabs of the ProvisionalLiner are engaged in the Shell scallops.Warning: Do not impact the Provisional Liner as damage may occur. Thread the Locking Screw into the Polar Hole of the Shell.Optional Dome Hole Plugs Insert a Plug into the Polar Hole and thread it into place. When correctly inserted the Plug will be slightly inset relativeto the interior surface of the Shell, but it will be slightly proudwithin the recessed square at the pole. (Fig. 19) Take care not to overtighten the Dome Hole Plug.Fig. 19Correct seating of the Polar Hole Plug.US Continuum ST VitE 2c 2-16-15.indd 104/10/15 12:38 PM
Zimmer Continuum Acetabular System Surgical Technique11Vivacit-E Vitamin E Polyethylene LinerLongevity Polyethylene Liner The Vivacit-E Vitamin E Liners and the Longevity Liners haveidentical geometries. Prior to inserting the Vivacit-E Liner or the Longevity Liner,ensure that the Shell interior is clean and dry. Place the final polyethylene Liner into the implanted Shell byhand, or use the Liner Insertion Instrument. If inserting by hand, spin the Liner until scallops engage.Note: Before impaction, the polyethylene Liner will not beflush with the rim of the Shell.Fig. 20Dome Impactor.Note: Smaller inner diameter polyethylene liners (i.e.22mm) may not freely disengage from the Liner InsertionInstrument. Select the proper size Dome Impactor and attach it to theUniversal Handle. (Fig. 20)· Align the pins on the Universal Handle with the keyhole sloton the underside of the Impactor.· Push the Impactor onto the handle and twist in eitherdirection to lock it in place. Verify that the Liner is in the desired position prior to impactingthe Liner. Place the Impactor on the Liner and strike the Liner until it isfully seated.Fig. 21Verify that the Neutral Poly Liner is properly seated into the Shell.Note: Once the liner is seated within the Shell, it cannotbe removed without causing damage to the liner, thusnecessitating removal and disposal.Verifying Liner SeatingNeutral Liner Verify that the neutral polyethylene Liner isproperly seated by running finger around the face of the Shell toensure the Liner is flush. (Fig. 21)Elevated Liner Verify the elevated polyethylene Liner is seatedby running a finger around the exposed portion of the Shell faceto ensure the Liner is flush relative to the face of the Shell.(Fig. 22) If additional Liner seating verification is desired gentlymove the elevated portion of the Liner to ensure that it is lockedinto place. (Fig. 23)Fig. 22Verify that the Elevated Poly Liner is seated flush into the Shell.Final ReductionPerform a final reduction and assess range of motion, hip stability,and limb length.Fig. 23Verify that the elevated portion of the Poly Liner is properly seatedinto the Shell.US Continuum ST VitE 2c 2-16-15.indd 114/10/15 12:38 PM
12Zimmer Continuum Acetabular System Surgical TechniqueLiner Removal Upon removal of any Liner, inspect the taper and polyethylenelocking mechanisms for damage. Special care should be taken not to lever against the Shellduring Liner removal.Metasul LinersFor using the Liner Insertion Instrument, follow these assemblyinstructions: Insert the suction tip onto the shaft of the Instrument up to theetch line. Ensure that the shaft is bottomed out in the suction tip. Saline or water can be used to lubricate the suction cup foreasier assembly. Attach the Liner Insertion Instrument to the Metasul Liner bypressing the Suction Cup in the Liner. (Fig. 24) Ensure the Linerand Liner Insertion Tool are clean and dry prior to attachment.Fig. 24Liner Insertion Instrument with Suction Cup attached to theMetasul Liner. Attach the Single Point Hard Bearing Remover to the UniversalHandle by aligning the pins on the Universal Handle with thekeyhole slot on the underside of the Single Point Hard BearingRemover. Place the tip of the Single Point Hard Bearing Remover on theface of the Implant Shell with the alignment tab between theoutside edge of the Shell and the bone, between scallops onthe thickest portion of the Shell. (Fig. 25) Place the tip of the Single Point Hard Bearing Remover entirelyflush onto the edge of the metal Shell. (Fig. 26) Firmly strike the Universal Handle once with a mallet to dislodgethe Liner from the Shell while pulling on the Liner InsertionInstrument. Once the acetabular Shell taper has been deformed throughassembly of a hard bearing insert (Metasul insert), the Shellshould not be used with another hard bearing insert.Fig. 25Proper placement of the Single Point Hard Bearing Removal Instrument.Note: The Single Point Hard Bearing Remover should notcontact the Liner during impaction.Note: Do not impact the Liner Insertion Instrument. This isindicated on the Instrument using the following symbol.Fig. 26Proper seating of the Single Point Hard Bearing Remover.US Continuum ST VitE 2c 2-16-15.indd 124/10/15 12:38 PM
Zimmer Continuum Acetabular System Surgical Technique13Polyethylene Liner Removal (Bone Screw Method) Locate a 3.2mm or 3.5mm drill bit included in the Screw Kit. Drill a pilot hole into the dome of the Liner between the poleand the taper region of the Shell. Locate a non-self tapping screw (e.g. periarticular screw 002347-024-30). (Fig. 27) A self tapping screw should NOT be used. (Fig. 28) Drive the screw into the pilot hole by hand until the Liner islifted out of the Shell. (Fig. 29) Special care should be taken not to damage the Shell taper orlocking mechanism during removal of the Liner.Fig. 27Fig. 28Non-self tapping screwSelf tapping screwIntraoperative Shell RemovalIf you are using the Straight Hybrid Inserter or Offset HybridInserter: Place an Adapter on the end of the inserter handle. Place the inserter with attached Adapter into the ShellPolar Hole. Turn the locking Screw clockwise to secure the locking Screw. Remove the inserter and Shell.If you are using the Trilogy Cup Positioner: Place the cap on the end of the Trilogy Cup Positioner. Thread the Inserter into the Shell Polar Hole until it is fullyengaged. Remove the Trilogy Cup Positioner and Shell.Fig. 29Screwing a non-self tapping screw into the dome of the Liner.US Continuum ST VitE 2c 2-16-15.indd 134/10/15 12:38 PM
14Zimmer Continuum Acetabular System Surgical TechniqueLateral Patient Positioning “A-Frame” Insert the Shell Provisional or Implant into the prepared acetabulum. To achieve 45 of abduction and 20 of forward flexion, ensure that the Alignment Frame is parallel to the floor and the anteriorrod of the Alignment Frame is in line with the longitudinal body axis. (Fig. 30) Patient positioning is the same for the Straight Inserter, Hybrid Offset Inserter and Trilogy Cup Positioner.A-Frame for Straight ShellInserter or Hybrid Offset ShellInserterFig. 30US Continuum ST VitE 2c 2-16-15.indd 144/10/15 12:38 PM
Zimmer Continuum Acetabular System Surgical Technique15Lateral Patient Positioning “Gunsight” Insert the Shell Provisional or Implant into the prepared acetabulum. The “Gunsight” alignment extension needs to be parallel with the longitudinal body axis to achieve a 45 inclination (abduction)and 20 of forward flexion. (Fig. 31) Patient positioning is the same for the Straight Inserter, Hybrid Offset Inserter and Trilogy Cup Positioner.Gunsight for Straight ShellInserter or Hybrid Offset ShellInserterFig. 31US Continuum ST VitE 2c 2-16-15.indd 154/10/15 12:38 PM
16Zimmer Continuum Acetabular System Surgical TechniqueSupine Patient Positioning “A-Frame” Insert the Shell Provisional or Implant into the prepared acetabulum. To achieve 45 of abduction and 20 of forward flexion, ensure that the Alignment Frame is parallel to the floor and the lateral arm isparallel with the longitudinal body axis. (Fig. 32) Patient positioning is the same for the Straight Inserter, Hybrid Offset Inserter and Trilogy Cup Positioner.A-Frame for Straight ShellInserter or Hybrid Offset ShellInserterFig. 32US Continuum ST VitE 2c 2-16-15.indd 164/10/15 12:38 PM
Zimmer Continuum Acetabular System Surgical Technique17Supine Patient Positioning “Gunsight” Insert the Shell Provisional or Implant into the prepared acetabulum. The “Gunsight” alignment extension needs to be parallel with the longitudinal body axis to achieve a 45 inclination (abduction)and 20 of forward flexion. (Fig. 33) Patient positioning is the same for the Straight Inserter, Hybrid Offset Inserter and Trilogy Cup Positioner.Gunsight for Straight ShellInserter or Hybrid Offset ShellInserterFig. 33US Continuum ST VitE 2c 2-16-15.indd 174/10/15 12:38 PM
18Zimmer Continuum Acetabular System Surgical TechniqueShell and Articulation Liner Sizing ChartThe articulation diameter along with its corresponding head diameter is represented by the number in the shaded area of the chart below(e.g. 28mm is a 28mm head and liner combination).Shell Sizein mm4042444648505254565860626466687072747678* SSTTUUVVVV28mm Neutraland ElevatedVivacit-E32mm NeutralVitamin EHighlyCrosslinkedPolyethylene32mm Elevated36mm Neutral and Elevated40mm thylene28mm Neutral and Elevated32mm Neutral32mm Elevated36mm Neutral and Elevated40mm Neutral* 78mm and 80mm Continuum Shells have the same inner diameter and share the same liners.US Continuum ST VitE 2c 2-16-15.indd 184/10/15 12:38 PM
Zimmer Continuum Acetabular System Surgical Technique19ImplantsContinuum Shell, Uni HoleItem NumberDescription00-8757-040-00Continuum Shell, Uni, 40 CC00-8757-042-00Continuum Shell, Uni, 42 DD00-8757-044-00Continuum Shell, Uni, 44 EE00-8757-046-00Continuum Shell, Uni, 46 FF00-8757-048-00Continuum Shell, Uni, 48 GG00-8757-050-00Continuum Shell, Uni, 50 HH00-8757-052-00Continuum Shell, Uni, 52 II00-8757-054-00Continuum Shell, Uni, 54 JJ00-8757-056-00Continuum Shell, Uni, 56 KK00-8757-058-00Continuum Shell, Uni, 58 LL00-8757-060-00Continuum Shell, Uni, 60 MM00-8757-062-00Continuum Shell, Uni, 62 NN00-8757-064-00Continuum Shell, Uni, 64 OO00-8757-066-00Continuum Shell, Uni, 66 PP00-8757-068-00Continuum Shell, Uni, 68 QU00-8757-070-00Continuum Shell, Uni, 70 RR00-8757-072-00Continuum Shell, Uni, 72 SS00-8757-074-00Continuum Shell, Uni, 74 TT00-8757-076-00Continuum Shell, Uni, 76 UU00-8757-078-00Continuum Shell, Uni, 78 VV00-8757-080-00Continuum Shell, Uni, 80 VVContinuum Shell, Cluster Hole00-8757-044-01Continuum Shell, Cluster, 44 EE00-8757-046-01Continuum Shell, Cluster, 46 FF00-8757-048-01Continuum Shell, Cluster, 48 GG00-8757-050-01Continuum Shell, Cluster, 50 HH00-8757-052-01Continuum Shell, Cluster, 52 II00-8757-054-01Continuum Shell, Cluster, 54 JJ00-8757-056-01Continuum Shell, Cluster, 56 KK00-8757-058-01Continuum Shell, Cluster, 58 LL00-8757-060-01Continuum Shell, Cluster, 60 MM00-8757-062-01Continuum Shell, Cluster, 62 NN00-8757-064-01Continuum Shell, Cluster, 64 OO00-8757-066-01Continuum Shell, Cluster, 66 PP00-8757-068-01Continuum Shell, Cluster, 68 QU00-8757-070-01Continuum Shell, Cluster, 70 RR00-8757-072-01Continuum Shell, Cluster, 72 SS00-8757-074-01Continuum Shell, Cluster, 74 TT00-8757-076-01Continuum Shell, Cluster, 76 UU00-8757-078-01Continuum Shell, Cluster, 78 VV00-8757-080-01Continuum Shell, Cluster, 80 VVContinuum Shell, Multi HoleItem NumberDescription00-8757-040-02Continuum Shell, Multi, 40 CC00-8757-042-02Continuum Shell, Multi, 42 DD00-8757-044-02Continuum Shell, Multi, 44 EE00-8757-046-02Continuum Shell, Multi, 46 FF00-8757-048-02Continuum Shell, Multi, 48 GG00-8757-050-02Continuum Shell, Multi, 50 HH00-8757-052-02Continuum Shell, Multi, 52 II00-8757-054-02Continuum Shell, Multi, 54 JJ00-8757-056-02Continuum Shell, Multi, 56 KK00-8757-058-02Continuum Shell, Multi, 58 LL00-8757-060-02Continuum Shell, Multi, 60 MM00-8757-062-02Continuum Shell, Multi, 62 NN00-8757-064-02Continuum Shell, Multi, 64 OO00-8757-066-02Continuum Shell, Multi, 66 PP00-8757-068-02Continuum Shell, Multi, 68 QU00-8757-070-02Continuum Shell, Multi, 70 RR00-8757-072-02Continuum Shell, Multi, 72 SS00-8757-074-02Continuum Shell, Multi, 74 TT00-8757-076-02Continuum Shell, Multi, 76 UU00-8757-078-02Continuum Shell, Multi, 78 VV00-8757-080-02Continuum Shell, Multi, 80 VVContinuum Hole Plugs00-8757-000-01Dome Hole Plug–Single Pack00-8757-000-02Screw Hole Plug–Three Pack00-8757-000-03Dome (1) & Screw (3) Hole Plug PackBone ScrewsSCREWS are available in 5mm LENGTH incrementsup to 40m
6 Zimmer Continuum Acetabular System Surgical Technique Provisional Liner Insertion Inserting the Provisional Liner There are two different Provisional Liners. One with a Locking Screw that is independent of the Provisional Liner (Fig. 9) and one with a Locking Screw permanentl
Stryker offers a wide variety of acetabular components that are compatible with Citation Femoral Stems. The surgeon should refer to a specific acetabular component's surgical tech-nique for a discussion of acetabular surgical procedures. Surgical Approach Each surgeon should use the surgical approach for total hip arthroplasty with which he .
The Zimmer PSI Knee System should not be used to perform surgical procedures other than those specified in this surgical technique. The Zimmer PSI Knee System should be used in conjunction with a femur first technique The Disposable Zimmer PSI Knee Instruments, including instrument guides and bone models are patient specific
the Pinnacle (DePuy), Harris–Galante (Zimmer) and Trident (Stryker) acetabular components. To the best of our knowledge, this is the first case report of PLD in an R3 (Smith & Nephew) acetabular component. This case report highlights the implant choice for treatment of the liner dissociation and the rol
pleted using the posterolateral hip approach. The pros-thesis was a cementless acetabular cup (Trilogy IT Acetabular System, Shell with Cluster Holes Porous, Zimmer, USA) and a cementless femoral stem (VerSys Hip System, Fiber Metal Taper, Zimmer, USA). A drain
the available Zimmer PSI Knee kits. The pre-operative guide and instructions for use of the Zimmer PSI Knee Planner application are provided in the Zimmer PSI Knee Planner Software User Guide 97-5970-035-00. Indication for use The Zimmer PSI Knee System is indicated as an orthopedic instrument system to assist in the positioning of knee
Zimmer Continuum Longevity (10 Mrad) DePuy Synthes Pinnacle AltrX (7.5 Mrad) 442 446 Statistically equivalent 204 53% Lower Force (in-lbf) Lever Out: Disassembly force required to dislodge a polyethylene liner from an acetabular shell All tests were performed
Zimmer’s growth in the near term. That is especially true in our two largest product categories, knees and hips. In knees, growth will come from the Gender Solutions brand and our Zimmer NexGen LPS-Flex Mobile Knee, designed to accommodate an increased range of motion. The Zimmer M/L
Scrum 1 Agile has become one of the big buzzwords in the software development industry. But what exactly is agile development? Put simply, agile development is a different way of executing software development teams and projects. To understand what is new, let us recap the traditional methods. In conventional software development, the product requirements are finalized before proceeding with .
