Lima Modular Revision Hip System

Revision
stem
Your patient specific solution
SURGICAL
SURGICAL TECHNIQUE
TECHNIQUE
REVISION SURGICAL TECHNIQUE
Index
Indications and Contraindications Pag. >> 5

Stem Sizes Pag. >> 7
SURGICAL TECHNIQUE
Pre-Operative Planning Pag. >> 9

Femoral Canal Preparation Pag. >> 11
Femoral Reaming Pag. >> 12
Stem Insertion Pag. >> 14
Neck Site Preparation Pag. >> 16
Trial Reduction Pag. >> 17
Neck Insertion Pag. >> 19
Femoral Head Insertion Pag. >> 21
Components Removal Pag. >> 22
INSTRUMENT SET Pag. >> 24
PRODUCT CODES Pag. >> 27
Limacorporate spa, as manufacturer of prosthetic devices, does not practice medicine. This surgical technique
has been developed in consultation with an experienced surgeon team and provides the surgeon with general
guidance when implanting the REVISION femoral stem. Proper surgical procedures and techniques are necessarily
the responsibility of the medical professional. Each surgeon must evaluate the appropriateness of the surgical
technique used based on personal medical training, experience and clinical evaluation of each individual patient.
LEONARDO DA VINCI: Vitruvian Man. Study of the proportions of the human body (1490).
Indications and Contraindications
INDICATIONS RISK FACTORS
The Lima Corporate Revision hip stem is indicated The following risk factors may result in poor results with
for cementless revision hip arthroplasty of either an this prosthesis:
uncemented or cemented previous femoral hip implant.
• overweight;
• strenuous physical activities (active sports, heavy
Please follow the instructions for use enclosed in physical work);
the product packaging. • fretting of modular junctions;
• incorrect implant positioning (e.g. varus positioning);
• wrong size of components;
CONTRAINDICATIONS • medical disabilities which can lead to an unnatural
gait and loading of the hip joint;
Absolute contraindications include: • muscle deficiencies;
• local or systemic infection; • multiple joint disabilities;
• septicaemia; • refusal to modify postoperative physical activities;
• persistent acute or chronic osteomyelitis; • patient’s history of infections or falls;
• confirmed nerve or muscle lesion compromising hip • systemic diseases and metabolic disorders;
joint function. • local or disseminated neoplastic diseases;
• drug therapies that adversely affect bone quality,
Relative contraindications include: healing, or resistance to infection;
• vascular or nerve diseases affecting the concerned • drug use or alcoholism;
limb; • marked osteoporosis or osteomalacia;
• poor bone stock compromising the fixation and the • patient’s resistance to disease generally weakened
stability of the implant; (HIV, tumour, infections);
• metabolic disorders which may impair fixation and • severe deformity leading to impaired anchorage or
stability of the implant and bone formation; improper positioning of implants.
• any concomitant disease and dependence that might
affect the implanted prosthesis;
• metal hypersensitivity to implant materials.
REVISION Surgical Technique 5

Indications and Contraindications
PRE-OPERATIVE PLANNING
Lima Corporate products should be implanted only by Complications or failures of the total hip replacement are
surgeons familiar with the joint replacement procedures more likely to occur in heavy and highly active patients and
described in the specific surgical techniques. high offset combinations.
The surgeon should perform a careful evaluation of the
COMBINATIONS ALLOWED/NOT ALLOWED patient’s clinical condition and level of physical activity
before performing hip replacement. Patients who are
Allowed combination between Lima Corporate Femoral overweight (BMI >25 kg/m2) or have high activity levels may
heads and Revision femoral necks: not be candidates for a modular hip replacement. In case of
• only the sizes S, M and L can be coupled with bone loss or insufficient femoral bone stock, bone grafting
lateralized Revision necks (#Long) or other adjunctive reinforcement procedures is advisable
• only the sizes S, M, L and XL can be coupled with to provide proximal support to the stem. This is necessary
standard Revision necks (#Short). because, without proximal support, the stem is vulnerable
Use of femoral heads with greater neck lengths may result to fracture. If proximal support cannot be achieved, an
in failure of the hip stem (e.g. breakage due to fatigue). alternative surgical option should be considered.
Diameter 14 mm Revision stems cannot be combined with If proximal support is weak, the patient should be warned
Lateralized Revision necks . of an increased risk for potential fatigue fracture.
Pre-operative planning, through radiographic templates

in different formats (the templates and x-rays must have
the same magnification), provides useful, but indicative
information regarding the type and size of components to
be used and the correct combination of devices required
based on the anatomy and specific conditions of each
patient. Inadequate pre-operative planning can lead to
improper selection of the implants and/or incorrect implant
positioning.
The surgeon should carefully plan surgery considering the

following:
1. Smaller sized femoral implants (e.g. 14 and 16 mm
stems): the smaller sized femoral implants are designed
for patients with a small intramedullary canal and/
or diaphyseal region of the femur. The reduced size
(diameter) of these stems results in a corresponding
reduction in the fatigue strength of the implant;
2. High Offset combinations (use of lateralized modular
necks): the lateralized necks are designed to restore
the functional offset of the hip joint, however greater
neck lengths are accompanied by a higher risk of
failure (e.g. breakage due to fatigue).
6 Surgical Technique REVISION

Stem Sizes
STEM SIZES
The REVISION system is comprised of 12 sizes distal

components: 6 diameters from 14mm to 24mm, with
sizes varying by 2mm and two lengths for each diameter,
140mm and 200mm.
The proximal components are available in two different

configurations, standard (CCD 135°) and lateralized necks
(CCD 131°) and in 7 sizes from 50mm to 110mm of height
(measured from the base of the trunk at medium level from
the rotation centre), with sizes varying by 10mm.
By coupling the two modules, it is possible to obtain 14

implant lengths for each diameter, from a minimum of
190 mm (stem 140 mm + neck 50 mm) to a maximum of
310 mm.
The instrument set guides the operator in the choice,

simulation and correction of the overall dimensions.
Using the 26 modules it is possible to obtain 168 different
implants, thus having a wide range of solutions for the
anatomical adaptation of the prosthesis to the hosting
femur and an adequate recovery of articular motions.
 REVISION STEMS
DIAMETER LENGTH
14 mm* 140 mm
14 mm* 200mm
16 mm 140 mm
16 mm 200 mm
18 mm 140 mm
18 mm 200 mm
Length
20 mm 140 mm
20 mm 200 mm
22 mm 140 mm
22 mm 200 mm
24 mm 140 mm
24 mm 200 mm
* Stems 14 not suitable for lateralized necks (test according to ISO 7206-4)

Stem Sizes
 REVISION NECKS
STANDARD – 135°:
offset table with head M (+0 mm)
NECK HEIGHT -4° NEUTRAL STD +4°

Offset
 50 32,1 35,6 39,1
60 31,4 35,6 39,8
70 30,7 35,6 40,5
80 30,0 35,6 41,1
Height
90 29,3 35,6 41,8
100 28,6 35,6 42,5
110 27,9 35,6 43,2

Upon Request
CCD 135°
LATERALIZED - 131°:
offset table with head M (+0 mm)
Offset
NECK HEIGHT -4° NEUTRAL STD +4°

50 36,6 40,1 43,6
60 35,9 40,1 44,3
70 35,2 40,1 45,0
80 34,5 40,1 45,7
Height
90 33,8 40,1 46,4
100 33,2 40,1 47,1
110 32,5 40,1 47,8

Upon Request CCD 131°

Pre-Operative Planning
PRE-OPERATIVE PLANNING
Pre-operative planning is of fundamental importance for

establishing the ideal length of the implant and the correct
diameter of the final stem.
STEM DIAMETER
Position the pre-surgical templates over the X-rays of the

implant to be replaced, so that the fins circling the stem
penetrate the endosteal cortical to a depth of about 1 mm.
Note. The final and correct stem size must be determined

during surgery.
Where it is possible to match the size planned, the height
of the positioning has to consider the soft tissue tension
during trial reduction, and the quality of the bone.
STEM LENGTH
In order to accurately assess how deeply the stem

descends into the femur, it is advisable for the pre-surgical
planning to be performed on an X-ray of the femur also
in the lateral position, so as to carefully position the distal
end of the stem, and thus respect the shape of the
medullary cavity along the curvature of the femur.
The distal end of the implant must fit the femur to a depth
of at least 70-100 mm.
Thus for a winglet Wagner fixation the system approach
reminds that the stem should be always the even size
larger then the last even reamer diameter used.
In any case the odd diameter reamers are suggested
to a minimal diaphyseal canal caliper adaptation when
necessary.

Pre-operative Planning
NECK HEIGHT AND OFFSET
Once the template of the stem is properly positioned,

using a frontal X-ray select the appropriate neck size by
lining up the tip of the greater trochanter with the center
of the femur head.
When choosing the neck, bear in mind that it may be

necessary to modify the lever arm offset and the length
of the limb.
It goes without saying that decisions made in the

planning stage are always subject to modification
during surgery.
If using the trans-femoral approach, it is advisable to

accurately measure the length of the stem to be removed
(as a rule, the X-ray images are magnified by 13-15%, so
after measuring the length of the stem, divide the value by
Figure 1 1.13-1.15).
This measurement will be useful for establishing how
long to make the diaphysectomy, if required (Fig. 1).
Instead of conventional templates, a digital version

compatible with most surgical planning software is also
available.

Femoral Canal Preparation
FEMORAL CANAL PREPARATION
After removing the old stem, if diaphysectomy of

the femur has been performed, a precautionary
reinforcement cerclage around the femoral diaphysis
can be put to avoid accidental bone splitting.
The Limacorporate cerclage system is available upon

request and consist of the following components:
• cerclage band (cod. 8610.28.100) made of pure

Titanum, grade 4
• band tightner (cod. 9086.10.100)
• positioner (cod. 9086.10.200)
• cutter/bender (cod. 9086.10.300)
Upon request Fig.2.
Figure 2

Femoral Reaming
FEMORAL REAMING
Assemble the smallest reamer, size 12, to the manual

snap wrench (code 9095.10.110) and start reaming to bore
through bone plugs, smooth out any unevenness and
avoid wrong directions (Fig. 3).
Switch to progressively larger diameter reamers until

actually scraping the bony walls.
If possible, a radiographic monitoring is suggested.
In case of trans-femoral approach, the reamers must bore

a deep enough hole to give the stem a distal fi t of at least
7-10 cm beyond the window. Therefore, the distal end of
the reamers should correspond to the anatomical curve of
the femoral procurvation.
Check for etch/witness marks alignment corresponding to

the apex of the greater trochanter.
Figure 3
Note. If the greater trochanter is damaged please select a

different reference point in the anatomy.
As far as the stem diameter is concerned, routinely the

choice would get for an even size larger than the last even
reamer diameter used, for instance, 16 mm reamer and
18 mm stem.
When the bone trophism can obstruct the wing penetration

it is nonetheless recommended the use of odd diameter
reamers to refi ne canal preparation. Thus considering the
example of size 18 mm of the stem the odd reamer 17 mm
can be used to adjust the femoral canal caliper.

Femoral Reaming
To select the correct stem and neck size, refer to the gauge
on the reamer axis at the level of the greater trochanter
(Fig. 4), where two numbers are marked.
The first refer to the length of the stem, the second to the
height of the neck.
For example, if the gauges read “200+ 80”, the stem to be

Figure 4 used in this case is the 200 mm size, with an 80 mm trial
neck.
The reamer axis also provides a useful indication of how to

make the best use of the implant’s 4° angle.
If using the trans-femoral approach, the reamer axis

generally appears anterior to the ideal neck axis (Fig. 5), so
that the stem, (usually long) will be fitted with the tapered
portion tilted posteriorly, thus restoring the normal neck
axis.
If, conversely, the trans-femoral approach is not employed,

the reamer axis generally appears posterior to the ideal
neck axis, therefore in this case the stem (usually short) will
be fitted with the tapered portion tilted anteriorly (Fig. 6).
Figure 5 It is of course also possible for the stem to be placed with

the neck in a varus or valgus position.
The surgeon must make this decision as circumstances

dictate, by comparing the reamer axis with the meta-
epiphyseal profi le of the femur.
Figure 6

Stem Insertion
STEM INSERTION
Take out from the sterile package the Stem whose diameter
is one size larger than the last reamer diameter used (for
instance, 16 mm reamer, 18 mm stem).
Dynamic Impactor Two different impactors may be used to tap the stem
cod. 9038.10.100
in the diaphyseal shaft: a Dynamic Impactor (code
9038.10.100) and a Manual Impactor used with a hammer
(code 9038.10.110) (Fig. 7).
Manual Impactor Screw the manual impactor onto the stem.

cod. 9038.10.110
Figure 7 Four grooves at the base of cone are reference of the

possible stem position in according to the femoral
procurving and antecurving or varus and valgus of neck,
as already described.
Push the stem into the canal. Definitely strike down gently
tapping the stem until distal fixation is obtained (Fig. 8).
M L A P
Figure 8

Stem Insertion
The impactors feature a gauge to determine how deep

down the stem has to be driven (Fig. 9).
The gauge indicates the neck sizes.
Taking the tip of the greater trochanter as a reference, drive

the stem down until it reaches the neck height selected
during the reaming stage (80 mm in our instance).
If difficult is too much to get the stem in, stop short of the
preset depth (provided that a minimum neck height was not
chosen, i.e. 50 mm). Nevertheless odd diameter reamers
refines canal preparation to adjust for a stem descending
(thus considering the example of size 18 mm of the stem, if
it were necessary, the odd reamer 17 mm can be used to
adjust the femoral canal caliper).
Figure 9
Conversely, if the stem reaches down the pre-established
level but does not give you a feeling of good fi t, push it
further down until proper upper level is reached (provided
that a maximum height neck was not chosen, i. e. 110 mm).
If the reamer diameter chosen was not correct – or in rare

cases of poor bone trophism – you may even find it all too
easy to get the stem down.
If this is the case, we suggest using a larger diameter stem

and special care when inserting it.

Neck Site Preparation
NECK SITE PREPARATION
To prepare the femoral neck seating, use the Neck Reamer

(code 9038.10.120) for proximal reaming.
Screw the Neck Reamer Guide (code 9038.10.115) tight

into the stem Morse-type taper using the Allen Wrench
(code 9095.10.117) fitted in the Manual Snap Wrench (code
9095.10.110) (Fig. 10).
Figure 10
Fix the manual snap wrench onto the neck
reamer and insert the reamer in the guide
(Figs. 11 and 12).
Rotate the reamer into the femur meta-epiphyseal cavity

until end of stroke.
Neck Reamer Manual Snap Wrench
cod. 9038.10.120 cod. 9095.10.110
Note. The inspection hole on the reamer allows by a metallic
wire or a needle to check reaming is completed (Fig.13).
Figure 11
Then remove reamer and guide.
Figure 12
Figure 13

Trial Reduction
TRIAL REDUCTION
After accurately washing the stem taper to remove any

bone debris left over from the previous stage, fit the Trial
Neck on it (code 9038.10.160...) choosing the size that was
read previously on the Stem Impactor gauge (Fig. 14).
Rotate the reamer into the femur meta-epiphyseal cavity
until end of stroke.
Carefully select the neck anteversion; then tighten the neck

Figure 14
locking screw using the Allen wrench (Fig. 15).
This stage does not usually require using the Neck Stopper
(code 9038.10.240), although you may decide to use it
anyway for more safety reasons.
Insert the Trial Head and check out the implant reduction
(Fig. 16).
If the implant length does not fit with any trial head, replace
the trial neck and pick up a new one of a different height.
Figure 15 Since the neck height increments are of one centimetre

each, one can easily figure out the correct implant size.
If the height were still to be excessive when using a minimum

size Trial Neck (50 mm), drive the stem a bit further down.
If the stem would not discende enough, remove it and
provide for a canal caliper refining by the larger odd reamer,
than re-insert the stem and check for the height level.
Figure 16

Trial Reduction
If the standard neck offset does not fit for a proper articular
ratio, replace it choosing the lateralizing one.
Note. (Test according to ISO 7206-4): The lateralized

modular necks can’t be coupled with 14 mm diameter
stems.
All the modular necks can be coupled only with modular
Figure 17 femoral heads of length not over “L”.
Note. The 50 mm trial neck screw is screwed on the 12/14

taper of the trial neck.
Once the right size of the head and neck has been selected,
remove the trial neck unscrewing the locking screw.
If it were too hard to get the trial neck out, use the Trial Neck
Extractor (code 9038.10.250) wich is screwed (Fig. 17) on
the stem impactor where the neck stopper may be fitted
(Fig. 18).
Figure 18

Neck Insertion
NECK INSERTION
IMPORTANT. Carefully clean and dry the taper junction of

the distal stem ensuring it is free of debris.
Take the final Neck out of the sterile package of the size
selected in the previous stage. (Caution! The neck package
also contains the locking screw).
Figure 19 Screw the Neck Impactor-Extractor (code 9038.10.230) in

the neck threading after removing the long coaxial screw
(wich is only meant for neck removal) (Fig. 19).
IMPORTANT. The 50 mm definitive necks (standard and

lateralized) don’t have the treading hole to screw the neck
impactor/extractor.
After accurately washing and drying the stem taper,

insert the neck on the stem Morse-type taper with the
anteversion selected previously.
Figure 20
Gently tap the impactor along its axis using a hammer
(possibly a plastic one) in order to fit the two cones
(Fig. 20).
Finally, unscrew the impactor off the neck.

Neck Insertion
To grant an accurate Morse taper coupling, reducing

possible occurrence of fretting phenomena and minimizing
the risk of improper safety screw tightening, a Torque
Wrench must be used.
Connect the Torque Wrench T-handle (code 9095.11.753)
to the Allen Wrech (code 9095.10.134) via the Zimmer
connection (Fig.21).
Figure 21
Lock the safety screw turning the T-handle of the

Torque Wrench clockwise, while maintaining the desired
anteversion with the aid of the neck stopper, until the
T-handle clicks (Fig.22).
This ensures that the appropriate torque has been applied

and the safety screw has been fully seated.
Repeat the torque application until a second click can be
heard.
Note. Before using the Torque Wrench make sure that

the calibration date has not expired. The calibration date
expiration is marked on the Torque Wrench T-handle.
The combined actions of the torque wrench and of the

neck stopper keep any torque load from being transmitted
to the femur.
Figure 22
If a bone splint was overturned for trans-femoral approach,

position it back into its original site in order to close the
femoral window and reinforce it with metal cerclage,
tacking care of avoiding the direct contact between the
wire and the prosthesis.

Femoral Head Insertion
FEMORAL HEAD INSERTION
Clean and dry the taper thoroughly, ensuring it is free of

debris. Place the appropriate femoral head onto the taper;
engage it by pushing and twisting (Fig.23).
Then strike the definitive head with the apposite impactor

(Fig.24).
Note. The head impactor has an internal double concavity,

allowing its use with all head diameters (28, 32, 36 and
Figure 23
40 mm).
Clean the bearing surfaces and reduce the hip (Fig.25).
Figure 24
Figure 25

Components Removal
COMPONENTS REMOVAL
If necessary the various prosthetic components can be

removed. The femoral head can be removed by simply
tapping the base of the head axially using an impactor.
IMPORTANT. If only the head needs removing and

replacing with a new ceramic head, always use ceramic
revision heads (on request only) which have a Titanium
safety sleeve.
DISENGAGING THE TAPER JUNCTION
1. Unscrew the safety screw.

2. Disassemble the neck extractor’s two components.
3. Thread and tighten the outer sleeve into the REVISION
neck .
4. With the aid of the T- wrench, screw the pushing rod
(of the neck extractor) into the outer sleeve, holding in
place the latter.
5. Remove the T-wrench.
6. Hammer onto the pushing rod, while keeping steady
the outer sleeve.
7. Reassemble the T-wrench onto the pushing rod and
tighten the rod again.
8. If the neck is still engaged, continue the iterative
process, from step 4, until the taper junction
disengages.
Note. Hammering on the pushing rod, producing vibrations,

eases the removal process.

Components Removal
REMOVING THE REVISION STEM
Thread the Dynamic Impactor (cod. 9038.10.100) onto the

REVISION stem and, with upward movements of the slap
hammer, extract the stem.
IMPORTANT. This method may be used in cases where

biological fixation is absent or weak; otherwise it is
necessary to separate the integrated surfaces of the bone
using suitable small scalpels or Kirschner wires. In some
cases a Wagner femoral osteotomy may be required.

Instrument Set
9038.15.000 Instrument Set n.1 for Revision Femoral Stem
Ref. CODE DESCRIPTION Qty.
A1 9038.10.010 Reamer Dia. 12mm 1

A1 9038.10.015 Reamer Dia. 13mm 1
A1 9038.10.020 Reamer Dia. 14mm 1
A1 9038.10.025 Reamer Dia. 15mm 1
A1 9038.10.030 Reamer Dia. 16mm 1
A1 9038.10.035 Reamer Dia. 17mm 1
A1 9038.10.040 Reamer Dia. 18mm 1
A1 9038.10.045 Reamer Dia. 19mm 1
A1 9038.10.050 Reamer Dia. 20mm 1
A1 9038.10.055 Reamer Dia. 21mm 1
A1 9038.10.060 Reamer Dia. 22mm 1
A1 9038.10.065 Reamer Dia. 23mm 1
9038.15.950 Sterilizable Box 1

Additional Instrument Set
9038.16.000 Instrument Set n.2 for Revision Femoral Stem
A2 9095.10.110 Manual Snap Wrench 1

B2 9038.10.150 Trial Neck H50 with Screw 1
C2 9038.10.310 Lateralized Trial Neck H50 with Screw 1
D2 9095.10.511 Trial Head Low Taper 12/14 Dia. 28mm S 1
D2 9095.10.512 Trial Head Low Taper 12/14 Dia. 28mm M 1
D2 9095.10.513 Trial Head Low Taper 12/14 Dia. 28mm L 1
E2 9095.10.521 Trial Head Low Taper 12/14 Dia. 32mm S 1
E2 9095.10.522 Trial Head Low Taper 12/14 Dia. 32mm M 1
E2 9095.10.523 Trial Head Low Taper 12/14 Dia. 32mm L 1
9038.17.000 Instrument Set n. 3 for Revision Femoral Stem
A3 9038.10.100 Dynamic Impactor 1

B3 9038.10.110 Manual Impactor 1
C3 9038.10.115 Neck Reamer Guide 1
D3 9038.10.120 Neck Reamer 1
E3 9038.10.230 Neck Impactor-Extractor 1
F3 9038.10.240 Neck Stopper 1
G3 9038.10.250 Trial Neck Extractor 1
H3 9095.10.117 Allen Wrench 1

Instrument Set
9095.11.753 Torque Wrench T-Handle
CODE DESCRIPTION
9095.11.753 Torque Wrench T-Handle
9095.10.134 Allen Wrench for Zimmer connection

CODE DESCRIPTION
9095.10.134 Allen Wrench for Zimmer connection

 CEMENTLESS FEMORAL STEMS (TI6AL4V)
CODE DIAMETER LENGTH
3810.15.010 14 mm* 140 mm
3810.15.020 14 mm* 200mm
3812.15.010 16 mm 140 mm
3812.15.020 16 mm 200 mm
3814.15.010 18 mm 140 mm
3814.15.020 18 mm 200 mm
3816.15.010 20 mm 140 mm
3816.15.020 20 mm 200 mm
3818.15.010 22 mm 140 mm
3818.15.020 22 mm 200 mm
3820.15.010 24 mm 140 mm
3820.15.020 24 mm 200 mm
* Stems 14 non suitable for lateralized necks (test according to ISO 7206-4)

Product Codes
 STANDARD NECKS WITH LOCKING SCREW (Ti6Al4V) -

TAPER 12/14
CODE HEIGHT
7515.15.005 50 mm 
7515.15.010 60 mm
7515.15.020 70 mm
7515.15.030 80 mm
7515.15.040 90 mm
7515.15.050 100 mm
7515.15.060 110 mm

Upon Request
 LATERALIZED NECKS WITH LOCKING SCREW (Ti6Al4V) -

TAPER 12/14
CODE HEIGHT
7515.15.105 50 mm 
7515.15.110 60 mm
7515.15.120 70 mm
7515.15.130 80 mm
7515.15.140 90 mm
7515.15.150 100 mm
7515.15.160 110 mm
For all the modular necks the femoral head must not exceed size L
(test according to ISO 7206-4)

Upon Request

Product Codes
CERCLAGE KIT
CODE DESCRIPTION
8610.28.100 Cerclage Band
Cerclage Band
9086.10.000 Instrument Set for Cerclage

A
A 9086.10.100 Band Tightner 1
B 9086.10.200 Positioner 1
B C 9086.10.300 Cutter / Bender 1

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Lima Modular Revision Hip System

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Revision

Indications and Contraindications Pag. >> 5

Pre-Operative Planning Pag. >> 9

INSTRUMENT SET Pag. >> 24

PRODUCT CODES Pag. >> 27

 INDICATIONS  RISK FACTORS

REVISION Surgical Technique 5

Pre-operative planning, through radiographic templates

The surgeon should carefully plan surgery considering the

6 Surgical Technique REVISION

The REVISION system is comprised of 12 sizes distal

The proximal components are available in two different

By coupling the two modules, it is possible to obtain 14

The instrument set guides the operator in the choice,

REVISION Surgical Technique 7

NECK HEIGHT -4° NEUTRAL STD +4°

8 Surgical Technique REVISION

Pre-operative planning is of fundamental importance for

Position the pre-surgical templates over the X-rays of the

Note. The final and correct stem size must be determined

In order to accurately assess how deeply the stem

REVISION Surgical Technique 9

NECK HEIGHT AND OFFSET

Once the template of the stem is properly positioned,

When choosing the neck, bear in mind that it may be

It goes without saying that decisions made in the

If using the trans-femoral approach, it is advisable to

Instead of conventional templates, a digital version

10 Surgical Technique REVISION

 FEMORAL CANAL PREPARATION

After removing the old stem, if diaphysectomy of

The Limacorporate cerclage system is available upon

• cerclage band (cod. 8610.28.100) made of pure

Upon request Fig.2.

REVISION Surgical Technique 11

Assemble the smallest reamer, size 12, to the manual

Switch to progressively larger diameter reamers until

In case of trans-femoral approach, the reamers must bore

Check for etch/witness marks alignment corresponding to

Note. If the greater trochanter is damaged please select a

As far as the stem diameter is concerned, routinely the

When the bone trophism can obstruct the wing penetration

12 Surgical Technique REVISION

For example, if the gauges read “200+ 80”, the stem to be

The reamer axis also provides a useful indication of how to

If using the trans-femoral approach, the reamer axis

If, conversely, the trans-femoral approach is not employed,

Figure 5 It is of course also possible for the stem to be placed with

The surgeon must make this decision as circumstances

REVISION Surgical Technique 13

Manual Impactor Screw the manual impactor onto the stem.

Figure 7 Four grooves at the base of cone are reference of the

14 Surgical Technique REVISION

The impactors feature a gauge to determine how deep

Taking the tip of the greater trochanter as a reference, drive

If the reamer diameter chosen was not correct – or in rare

If this is the case, we suggest using a larger diameter stem

REVISION Surgical Technique 15

 NECK SITE PREPARATION

To prepare the femoral neck seating, use the Neck Reamer

Screw the Neck Reamer Guide (code 9038.10.115) tight

Rotate the reamer into the femur meta-epiphyseal cavity

Then remove reamer and guide.

16 Surgical Technique REVISION

INDICATIONS RISK FACTORS

FEMORAL CANAL PREPARATION

NECK SITE PREPARATION

FEMORAL HEAD INSERTION

9038.15.000 Instrument Set n.1 for Revision Femoral Stem

9038.16.000 Instrument Set n.2 for Revision Femoral Stem

9038.17.000 Instrument Set n. 3 for Revision Femoral Stem

9095.11.753 Torque Wrench T-Handle

9095.10.134 Allen Wrench for Zimmer connection

9086.10.000 Instrument Set for Cerclage