aesculap orthopaedics plasmacup® · plasmacup® design 7 plasmacup ... press fit of the...
TRANSCRIPT
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Content
Plasmacup® system 4
Plasmacup® implants 5
Plasmapore® surface 6
Plasmacup® design 7
Plasmacup® surgical technique 8
Plasmacup® cup position 9
Plasmacup® implantation 10
OrthoPilot® THA navigation 11
Plasmacup® ordering information
Instruments 12
Implants 15
Liners 15
4
Plasmacup® system
The Plasmacup® system, which has proven
effective itself in clinical practice since
1992, is based on three essential elements:
Microporous Plasmapore® titanium
coating for excellent primary and
secondary stability
Press fit of the polyethylene liner
nearly eliminates micromotion and
backside wear
The world’s leading navigation
technology in hip arthroplastyPlasmacup® design
Plasmapore® coating OrthoPilot® navigation
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Plasmacup® implants
Plasmacup® SC µ-CaP
The Plasmacup® SC standard
implant features three holes for
optional fixation with 6.5 mm
screws. The Plasmacup® SC µ-CaPhas an additional resorbable
calcium phosphate layer.
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Plasmapore® surface
Plasmapore® Primary stability Plasmapore® µ-CaP
Plasmapore® coated implants have beenused by Aesculap since 1986. In a vacuumcoating process, pure titanium powder isapplied to the surface of cementless implants to form a 0.35 mm thick layerwith up to 40% microporosity.
The pore size of the Plasmapore® coating ranges between 50 and 200 µm to allow direct bone apposition.
The rough surface of the Plasmapore®
structure supports a more stable primaryfixation of the implants than other implantsurface types. Stability measurementsdemonstrate the superior primary stabilityachieved with Plasmapore® compared withother implant surfaces.
The newly developed Plasmapore® µ-CaPcoating uses calcium phosphate as anadditional layer.
A 20 µm layer of high-purity dicalciumphosphate dihydrate (DCPD) is
electro-chemically applied to thePlasmapore® coating. The thin µ-CaPcoating dissolves within eight to twelveweeks without the involvement ofmacrophages.
The Plasmacup® SC implants are availablewith Plasmapore® or Plasmapore® µ-CaPsurfaces.
Cup A Cup B Cup C Plasmacup® Cup E
Ischium Pubis Ilium
0
50
100
150
200
250
300
350
400
µm
Primary stability ofvarious press-fit cups in biomechanical experiments (Pitto 1997)
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Design Inner surfaceStability
way, both polyethylene and ceramic liners*are safely fixed. The drill holes are locatedin the cranial region of the cup, outside theconical attachment surface. The roughtitanium inner surface reduces relativemovements to only a few micro ns, whichprevents the formation of abrasionparticles on the back side of the liner.
The conical fixation surface of thePlasmacup® polyethylene liners also formsa seal against the migration of polyethyleneparticles from the articulating joint, andthus reduces the risk of an osteolysis adjacent to the screw holes.
The polyethylene liners are strongest whenthe load is directed cranially. In the primaryload area, Plasmacup® polyethyleneimplants are at least 6 mm thick. The fixation is highly stable against tilting androtation forces in-vivo.
The polyethylene used conforms toestablished standards and long-termclinical experience. The implants aremanufactured from high density PE plates,using CNC technology. The material issterilized by radiation in a nitrogenatmosphere, and packaged to preventoxidation.
In-vivo wear of the Plasmacup® polyethyleneliners with a ceramic 28 mm head is0.1 mm per year, which is below thethreshold that would cause osteolysis.Higher wear can occur with metal heads,by third-body wear, through incorrect cuppositioning, or as a result of implantloosening.
*Ceramic cup liners are not available in the U.S.
The Plasmacup® is characterized by goodpress-fit stability and safe attachment of modular polyethylene or ceramic liners.*
The external shape of Plasmacup® is hemispherical with a slightly flattenedapex. With standard liners, the center ofrotation is located at the exact center ofthe sphere. Plasmacup® is suitable for eitherpoly ethylene (PE) or ceramic cup liners.*
The Plasmacup® liners are attached by apress-fit cone with a large surface areaand, in case of the PE liners, through fullcontact with the base of the cup. In this
Plasmacup® design
Hip range of motion withdifferent head diametersand prosthesis cone sizes.
28 mm 32 mm 36 mm
130
140
150
cone 12/14
cone 8/10
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Acetabular reamers Trial cups Plasmacup® implant
The Plasmacup® implantation instrumentshave undergone continuous developmentduring more than 10 years of clinicalapplication. The optional use of theOrthoPilot® hip navigation system sets thetrend for a safe and reproducible operatingtechnique (see p. 12).
In order to have a good press-fit fixation ofthe Plasmacup® implant, there must be agood bony structure and proper surgicaltechnique. Acetabular exposure removal ofthe articular cartilage and osteophytes arerequired for the proper preparation of theacetabulum.
This is done using spherical reamers, whichare driven by a low-speed motor handpiece.During the reaming procedure, allcartilaginous material must be ablateddown to the subchondral bone untilbleeding occurs.
For non-dysplastic cases, care must be taken that the center of rotation of the joint is not medialized unnecessarily. Thesocket edges should be prepared for a sufficiently large bony fixation surface.
In cases of dysplastic changes, a cupposition in the region of the primary socket
is recommended, provided the shorteningof the leg can be compensated. The caudal edge of the socket should be at the level ofthe tear drop figure. A cranial bone graft isperformed, if necessary, before the socketbase is deepened to provide sufficient cranial roofing.
The size of the Plasmacup® implantscorresponds to the size of the lastacetabular reamer used and include theproper press-fit conditions.
The final selection of the implant is onlydetermined after a trial cup has beenseated firmly. A stable fit of this trial cup is achieved when the pelvis of the patient canbe moved by gently moving the trial cup byabout 10°. The trial implant can be easilylevered out from the in-vivo trial positionby moving beyond this angle.
Plasmacup® surgical technique
Reaming of the acetabulum
Plasmacup® trial cup
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After completing the Plasmacup® surgerysteps of acetabular exposure, reaming,assessment of the cup bed with the trialimplant and implantation of the cup, thetrial liner is inserted. The final selection ofthe modular liner is determined only afterthe stem is implanted and the final trialreduced.
Aiming device lateral decubitus position
Plasmacup® cup position
The safe and stable assembly of thePlasmacup® implant on the impactor shaftmust be checked by a surgical assistantand the surgeon prior to implantation. Aslotted hammer on the impactor shaft issuitable for shifting and correcting theposition of the Plasmacup® implant.
Aiming device supine position
Plasmacup® with trial liner
Aiming devices are available for Plasmacup®
to measure inclination and anteversion forboth standard and navigated surgeries.These devices, which have been designedfor supine or lateral decubitus positions,can be mounted on the cup impactor shaft.
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Generally, in good bone, Plasmacup® can beimplanted without additional screws. As a stability check, the cup impactor is movedthrough ± 20° until the patient’s pelvismoves. Under these conditions, Plasmacup®
SC can also be rotated 180° prior toimplantation, placing the screw holes inthe non-load bearing caudal region sincethey are not needed cranially. If there isany doubt concerning the intraoperativeprimary stability, fixation screws must beused or the implant must be replaced.
For cases where additional stability withfixation screws is necessary, Plasmacup® SCfeatures three holes in the cranial region.To protect the medial blood vessels, themiddle and lateral screw positions can beused and the medial hole is usually leftopen.
Prior to inserting the self- tapping 6.5 mmscrews, the drill holes are prepared with aflexible 3.2 mm drill (or with a 4 mm drillfor severely sclerotic bone). The requiredscrew length is measured and the screwsare implanted using a screw holdingforceps and a cardan-jointed screwdriver.
Plasmacup® implantation
Plasmacup®
fixation screws
The pivot angle of the 6.5 mm Plasmacup® screws
is 20°. Before implanting the modular liner, the
surgeon must make certain that none of the
screw head protrudes into the liner anchoring
zone.
Instruments for screw implantation
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OrthoPilot® THA navigation
OrthoPilot® navigation of acetabular reaming
OrthoPilot® hip navigation of leg length and offset
OrthoPilot® THA navigation combines the data on theposition of Plasmacup® with the position of the stem.Stem rotation is displayed in relative to the cup position. The surgeon obtains information regarding theleg length, the offset, and the range of motion of the hipjoint.
Aesculap is the world leader in orthopaedic navigation,and Plasmacup® components can be used with OrthoPilot®
navigation technology. OrthoPilot® cup navigation workswithout CT or fluoroscopy, following the principles ofkinematic referencing.In navigated Plasmacup® surgeries, the system measuresthe inclination and anteversion angles relative to theanterior pelvic plane. During the acetabular reamingstage, the joint center, the reaming depth, and theorientation of the reamer are measured and displayed.Plasmacup® navigation with OrthoPilot® is suitable for different patient positions and surgical approaches. Italso supports less invasive surgical procedures and surgeries on dysplastic cases. Navigation of the cup is anintegral part of OrthoPilot® THA navigation.
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Plasmacup® instruments
JF217R
ND170R
ND172
ND174
NF269R
NF271R
NF275R
NF278R
NF279R
NF280R
NF281R
NF282R
NF285R
NF287R
NF292R
Plasmacup® instruments ST0204 Plasmacup® instruments ST0204
Tray 1
1/1 Size Perf Basket Lid 489 X 257 mm
Cup Inserting and Pressing Instrument
Cup Pressing Head D32 mm
Cup Pressing Head D28 mm
Plasmacup S Screw Gauge
Plasmacup S Tray Implantation Instrument
Slotted Hammer Slot Width 12 mm
Plasmacup S Drill Guide F/Screw D3.2 mm
Plasmacup S Drill Guide F/Screw D4.0 mm
Plasmacup S Flexible Drill D3.2 mm UL32 mm
Plasmacup S Flexible Drill D3.2 mm UL44 mm
Plasmacup S Flexible Drill D4.0 mm UL32 mm
Plasmacup S Articul. Screw Driver SW3.5
Screw Holding Forcepts
Plasmacup Aiming Device F/Post. Access
JF213R
JF217R
JF932
FS944R
FS947R
NF371R
JK486
JN444
Tray 2
1/1 Size Perf Basket 485 X 253 X 76 mm
1/1 Size Perf Basket Lid 489 X 257 mm
Silicone Pad Blue 470 X 230 X 30 mm
Plasmacup Insertion Instru STR 305 mm
Plasmacup Insertion Instru CVD 305 mm
Ball Head Screw Driver SW8.0 L395 mm
Full-Size Lid w/ Retention Plate Blue
Full-Size Perf Bottom 187 mm
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Plasmacup® instruments ST0204 Plasmacup® instruments ST0204
Tray 3
1/1 Size Perf Basket Lid 489 X 257 mm
Plasmacup® Tray F/NG034
Plasmacup® SC/MSC Trial Cup Size 40 mm
Plasmacup® SC/MSC Trial Cup Size 42 mm
Plasmacup® SC/MSC Trial Cup Size 44 mm
Plasmacup® SC/MSC Trial Cup Size 46 mm
Plasmacup® SC/MSC Trial Cup Size 48 mm
Plasmacup® SC/MSC Trial Cup Size 50 mm
Plasmacup® SC/MSC Trial Cup Size 52 mm
Plasmacup® SC/MSC Trial Cup Size 54 mm
Plasmacup® SC/MSC Trial Cup Size 56 mm
Plasmacup® SC/MSC Trial Cup Size 58 mm
Plasmacup® SC/MSC Trial Cup Size 60 mm
Plasmacup®SC/MSC Trial Cup Size 62 mm
Plasmacup® SC/MSC Trial Cup Size 64 mm
Plasmacup® SC/MSC Trial Cup Size 66 mm
Plasmacup® SC/MSC Trial Cup Size 68 mm
JF217R
NG035R
NG940R
NG942R
NG944R
NG946R
NG948R
NG950R
NG952R
NG954R
NG956R
NG958R
NG960R
NG962R
NG964R
NG966R
NG968R
Tray 4
1/1 Size Perf Basket Lid 489 X 257 mm
SC/MSC Tray F/NG360
SC/MSC Trial Insert 28 mm 44/46 SYM.
SC/MSC Removal Forcepts F/PE-Inserts
SC/MSC Tight.FCPS F/ASYM.Trial Inserts
SC/MSC Trial Insert 32 mm 48/50 SYM.
SC/MSC Trial Insert 32 mm 52/54 SYM.
SC/MSC Trial Insert 32 mm 56/58 SYM.
SC/MSC Trial Insert 32 mm 60/62 SYM.
SC/MSC Trial Insert 32 mm 64-68 SYM.
SC/MSC Trial Insert 32 mm 52/54 Post. Wall
SC/MSC Trial Insert 32 mm 56/58 Post. Wall
SC/MSC Trial Insert 32 mm 60/62 Post. Wall
SC/MSC Trial Insert 32 mm 64-68 Post. Wall
SC/MSC Trial Insert 28 mm 44/46 Post. Wall
SC/MSC Trial Insert 28 mm 48/50 Post. Wall
Full-size Lid w/Retention Plate Blue
Full-size Perf Bottom 187 mm
JF217R
NG035R
NG940R
NG942R
NG944R
NG946R
NG948R
NG950R
NG952R
NG954R
NG956R
NG958R
NG960R
NG962R
NG964R
NG966R
NG968R
JN444
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Plasmacup® instruments
Tray 5
1/1 Size Perf Basket Lid 489 X 257 mm
Tray F/Acetabular Reamers Set 24
Acetabular Reamer Head Standard D40 mm
Acetabular Reamer Head Standard D41 mm
Acetabular Reamer Head Standard D42 mm
Acetabular Reamer Head Standard D43 mm
Acetabular Reamer Head Standard D44 mm
Acetabular Reamer Head Standard D45 mm
Acetabular Reamer Head Standard D46 mm
Acetabular Reamer Head Standard D47 mm
Acetabular Reamer Head Standard D48 mm
Acetabular Reamer Head Standard D49 mm
Acetabular Reamer Head Standard D50 mm
Acetabular Reamer Head Standard D51 mm
Acetabular Reamer Head Standard D52 mm
Acetabular Reamer Head Standard D53 mm
Acetabular Reamer Head Standard D54 mm
Acetabular Reamer Head Standard D55 mm
Acetabular Reamer Head Standard D56 mm
Acetabular Reamer Head Standard D57 mm
Acetabular Reamer Head Standard D58 mm
Acetabular Reamer Head Standard D59 mm
JF217R
NF933R
NF940R
NF941R
NF942R
NF943R
NF944R
NF945R
NF946R
NF947R
NF948R
NF949R
NF950R
NF951R
NF952R
NF953R
NF954R
NF955R
NF956R
NF957R
NF958R
NF959R
Tray 6
OrthoPilot THA Mild Reamer Shank Zimmer
OrthoPilot THA Gloves Protection
OrthoPilot THA Reamer Shank MPR Zimmer
1/1 Size Perf Basket Lid 489 X 257 mm
Tray F/Acetabular Reamers Set 13
Acetabular Reamer Head Standard D60 mm
Acetabular Reamer Head Standard D61 mm
Acetabular Reamer Head Standard D62 mm
Acetabular Reamer Head Standard D63 mm
Acetabular Reamer Head Standard D64 mm
Acetabular Reamer Head Standard D65 mm
Acetabular Reamer Head Standard D66 mm
Acetabular Reamer Head Standard D67 mm
Acetabular Reamer Head Standard D68 mm
Full-size Lid w/Retention Plate Blue
Full-size Perf Bottom 187 mm
FS935R
FS939
FS959R
JF217R
NF932R
NF960R
NF961R
NF962R
NF963R
NF964R
NF965R
NF966R
NF967R
NF968R
JK486
JN444
Plasmacup® instruments ST0204 Plasmacup® instruments ST0204
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Plasmacup® implants
Implant materials:ISOTAN®
F Titanium forged alloy (Ti6Al4V / ISO 5832-3)
Plasmapore® Pure titanium surface (Ti ISO 5832-2)
Plasmapore® µ-CaP Pure titanium surface with 20 µm layer of
dicalcium phosphate dihydrate (CaHPO4x2H2O)
Biolox® forte Aluminum oxide ceramics (Al2O3 / ISO 6474)
Biolox® delta Al2O3 matrix ceramics
UHMWPE Ultra-high molecular weight polyethylene (ISO 5834-2)
ISOTAN ®F
Length
16 mm
NA766T
20 mm
NA770T
24 mm
NA774T
28 mm
NA778T
32 mm
NA782T
36 mm
NA786T
40 mm
NA790T
44 mm
NA794T 6.5 mm
Plasmacup® screws 6.5 mm
UHMWPE polyethylene
—
NH191
NH192
NH193
NH194
NH195
NH196
—
—
NH202
NH203
NH204
NH205
NH206
—
NH401
NH402
NH403
NH404
NH405
NH406
—
—
—
NH413
NH414
NH415
NH416
Posterior wall
40 mm42 mm
44 mm46 mm
48 mm50 mm
52 mm54 mm
56 mm58 mm
60 mm62 mm
64 mm66 mm68 mm
Symmetrical
Ø 28 mm Ø 32 mm Ø 28 mm Ø 32 mm
Plasmacup® SC µ-CaP
ISOTAN ®F
40 mm
42 mm
44 mm
46 mm
48 mm
50 mm
52 mm
54 mm
56 mm
58 mm
60 mm
62 mm
64 mm
66 mm
68 mm
--
--
NC444T
NC446T
NC448T
NC450T
NC452T
NC454T
NC456T
NC458T
NC460T
NC462T
NC464T
NC466T
NC468T
Plasmapore® µ-CaP
Aesculap Implant Systems, Inc.
3773 Corporate ParkwayCenter Valley, PA 18034Phone: 866-229-3002
www.aesculapimplantsystems.com©2008 AESCULAP. ALL RIGHTS RESERVED. PRINTED IN THE USA. DOC565 REV. A 2M 1 /08Aesculap is an equal opportunity employer
All rights reserved. Technical alterations are possible. This leaflet may be used for no other purposes than offering, buying and selling of our products. No part may be copied or reproduced in any form. In the case of misuse we retain the rights to recall our catalogs and price lists and to take legal actions.