designed the furlong® - jri orthopaedics · 2019-04-29 · 3 the femoral head size can then be...

The Furlong® Hemiarthroplasty System

Designed

specifically for

Hemiarthroplasty

System Benefits

Company Overview

Furlong® Cemented Hemiarthroplasty

Design Attributes

Clinical Evidence

Implant Range

Operative Technique

Instrumentation

Furlong® Hydroxyapatite Ceramic Coated Hemiarthroplasty

Design Attributes

Clinical Evidence

Implant Range

Operative Technique

Instrumentation

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Contents

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The Furlong® Arthroplasty System

• Cemented or H-A.C. Coated stem options and bi-polar or physiological head options

provide clinical flexibility to match surgeon preference

• The fully modular system allows the surgeon to select the implants which best meet the

patients clinical needs

• Versatility of the system allows for easy conversion to a total hip construct should this be

required intra or post operatively

• Easy to use effective instrumentation designed to enhance clinical outcome

• Clinically proven1,2,3

System Benefits

Company Overview

• JRI Limited, established in 1970 by Mr Ronald Furlong FRCS

• Developers of the world’s first H-A.C. coated hip replacement Prosthesis – first Furlong H-A.C. total hip replacement implanted 9 September 1985

• Market leading peer reviewed clinical results

• Dedicated orthopaedic research, development and manufacturing

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The Furlong® cemented hemiarthroplasty stem is a Müller type femoral stem that

has been devised to incorporate the design features and clinical success of the

Furlong cemented primary modular stem which has received an ODEP rating

of 10 C

Available in 5 stem sizes, designed to ensure optimal match to patient’s anatomy

Cost effective system compared to a total hip replacement

Collarless, double tapered, polished high nitrogen stainless steel stem,

designed to facilitate accurate placement of the prosthesis in the cement mantle.

72 Implants had been inserted into 71 different patients by 35 different

Surgeons of all grades. No dislocations in any of the 72 patients who had

bi-polar hips inserted during the study period1

Comparable with results of total hip replacement (THR) but without the risk

of dislocation1

Results are significantly better than would be expected with conventional

Hemiarthroplasty in this group of patients1

Eleven of the sixteen able to walk 1 mile before fracture were able to do so

at review. Mean follow up 32 months.1

Design Attributes

Clinical Evidence

4

A more flexible choice for you...

...a better outcome for Mary

Design Attributes

Clinical Evidence

5

Based on the proven 1979 design of the Furlong® Straight Stem. The high nitrogen stainless steel stem is double tapered, collarless and polished for longevity of cement fixation.

12-14 Taper allows for easy conversion to a total hip at a later date should this be required

The highly polished surface finish allows for controlled subsidence and self locking in the cement mantle.

Longer stem available to cater for most surgical requirements.

The 127º neck angle increases stability and reduces the risk of dislocation.

The JRI Bipolar head is pre assembled and available in 1mm increments. It has been designed specifically to minimize the risk of the prosthesis assuming a varus position.

The JRI Physiological Head is manufactured from proven High Nitrogen Stainless Steel. This increases biocompatibility and provides greater fatigue strength and corrosion resistance over conventional medical grade stainless steel.


127º

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DESCRIPTION PRODUCT NO.Femoral Stems (Standard Stem)

Extra Extra Small Stem 95.08.00Extra Small Stem 95.10.00Small Stem 95.12.00Medium Stem 95.15.00Large Stem 95.18.00

Femoral Stems (Long Stem)Small Stem 95.12.25Medium Stem 95.15.25Large Stem 95.18.25

Bipolar Heads40mm O/D 94.40.0141mm O/D 94.41.0142mm O/D 94.42.0143mm O/D 94.43.0144mm O/D 94.44.0145mm O/D 94.45.0146mm O/D 94.46.0147mm O/D 94.47.0148mm O/D 94.48.0149mm O/D 94.49.0150mm O/D 94.50.0151mm O/D 94.51.0152mm O/D 94.52.0153mm O/D 94.53.0154mm O/D 94.54.0156mm O/D 94.56.0158mm O/D 94.58.01

Physiological Heads

39mm O/D 93.39.01

40mm O/D 93.40.0141mm O/D 93.41.0142mm O/D 93.42.0143mm O/D 93.43.0144mm O/D 93.44.0145mm O/D 93.45.0146mm O/D 93.46.0147mm O/D 93.47.0148mm O/D 93.48.0149mm O/D 93.49.0150mm O/D 93.50.0151mm O/D 93.51.0152mm O/D 93.52.0153mm O/D 93.53.0154mm O/D 93.54.0156mm O/D 93.56.0158mm O/D 93.58.01

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Correct positioning of the patient, on the operating table, is very important and the hip joint is exposed using a preferred surgical approach for hemiarthroplasty.

The femoral neck is cut 1-2cm above the lesser trochanter. (This cut can be determined by where the fracture has occurred). A trial stem can be used, if required, to help identify where the neck cut should be and a line made using a diathermy probe or skin marker.

The saw cut should be perpendicular to the neck and the position of the tibia should be vertical while the cut is made.

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3

The femoral head size can then be estimated using the femoral head template guide.

The femoral head is removed using the corkscrew. A light tap may help engagement and purchase into the femoral head.

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Sizing is confirmed using the trial heads and introducer. The Labrum is best left intact but, if necessary, can be sectioned at this point to allow the correct size head to be selected.

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Operative Technique

The trial stem can be removed with the use of the trial stem extractor. Care must be taken to tap out of the femur in a neutral position to prevent possible damage to the femur.

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At this point, if required, the appropriate trial stem can be carefully inserted using the stem impactor.

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The smallest (4-8mm tapered) intramedullary reamer, which has a sharp tip, is mounted on the T-Handle, and used to expose the femoral canal. Care should be taken with this first reamer and if bone quality is poor then the 8mm intramedullary reamer should be used first, as it has a more rounded tip. Further straight reamers are used increasing in 1mm size increments until an acceptable reaming has been achieved.

The smallest rasp (extra, extra small) is used to prepare the proximal femur. The large tommy bar should be used to control version. If the fit of this first rasp is unsatisfactory then repeat the procedure increasing rasp size accordingly. Care should be taken to lateralise the rasps as they are inserted.

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9

The proximal femur is opened using the box chisel which is positioned laterally and posteriorly so that entry is in line with the femoral intramedullary canal.

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The chosen trial head is screwed onto the trial prosthesis and a reduction attempted. If the reduction is not possible or is regarded as too tight, remove the trial prosthesis. The neck should be resected further to permit deeper seating of the stem. Seat the rasp again and repeat the trialing process until the reduction is stable.

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Operative Technique Continued

The plug is then inserted into the femoral canal at a depth of 1–2cm beyond the distal tip of the prosthesis. To remove the introducer handle turn anti-clockwise to unscrew from the plug. Do not remove the introducer handle until the plug is seated correctly at the pre-measured depth.

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Making sure the tibia is vertical, the definitive femoral stem should be inserted in neutral alignment, to ensure a continuous circumferential cement mantle, using the stem impactor and inserted to the depth determined by the trial prosthesis.

The depth of the stem should be determined by the height of the centre of rotation of the femoral head on the contralateral side. If the same size rasp, trial and definitive stem are used then a cement mantle of approx. 1-2mm will be obtained. Should a thicker cement mantle be required, then a smaller size of prosthesis than the size of the last rasp used, should be selected.

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The implant head (either bi-polar or mono-polar, physiological) is fitted onto the stem and impacted using the femoral head impactor. A light tap is required to engage the taper.

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The preferred cementing technique is now used. Modern techniques recommend the use of a cement plug, lavage, drying of the femoral canal and retrograde filling with a cement gun.

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Before fitting the Bipolar or mono-polar, physiological femoral head ensure that the cement is fully cured and set.

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At this point a suitable size of cement restrictor or plug is chosen, depending on the size of the final intramedullary reamer used and screwed onto the introducer. The depth of insertion is determined by placing the cement plug introducer alongside the trial/prosthesis. The plug is aligned 1–2cm beyond the distal tip of the trial/prosthesis and a measurement taken from the markings on the introducer handle. The lateral shoulder of the trial/prosthesis is a good reference point. (Ref Chart A)

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Intramedullary Rasp

Reamer Size (mm) Implant Size Cement Plug (mm)

9

10Extra Extra Small or

Extra Small or

Small

10

11

1212.5

14 Medium or

Large

15

16 17.5 or 20

DESCRIPTION PRODUCT NO.

1 Cement Plug

Size AA 10.0mm Diameter 13.00.03

Size OA 12.5mm Diameter 13.00.04

Size OB 15.0mm Diameter 13.00.05

Size OC 17.5mm Diameter 13.00.06

Size OD 20.0mm Diameter 13.00.07

2 Cement Plug Introducer 13.00.01

Operative Technique Continued Operative Technique

Finally the joint is reduced, and the wound is closed.

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Furlong® Cemented Instrumentation

Chart A

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7 Intramedullary Reamers

4-8mm 14.48.61

8mm 14.61.08

9mm 14.61.09

10mm 14.61.10

11mm 14.61.11

12mm 14.61.12

13mm 14.61.13

14mm 14.61.14

16mm 14.61.16

8 Small Tommy Bar 10.08.28

9 Large Tommy Bar 10.25.28

10 Hudson Adaptor 10.00.26

11 Jacobs Adaptor 10.00.27

12 T Handle 10.00.50

13 Femoral Head Gauge 64.00.18

10

811

9

12

137


1 Trial Head Introducer 10.00.44

2 Head Impactor 10.00.47

3 Trial Stem Extractor 10.00.08

4 Box Chisel 50.99.45

5 Stem Impactor 50.99.34

6 Femoral Head Extractor 10.00.21


1

3

52

4

6

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DESCRIPTION PRODUCT NO. DESCRIPTION PRODUCT NO.16 Bipolar Trial Heads (Black) 17 Physiological Trial Heads (White)

39mm 64.39.10

40mm 64.40.94 40mm 64.40.10

41mm 64.41.94 41mm 64.41.10

42mm 64.42.94 42mm 64.42.10

43mm 64.43.94 43mm 64.43.10

44mm 64.44.94 44mm 64.44.10

45mm 64.45.94 45mm 64.45.10

46mm 64.46.94 46mm 64.46.10

47mm 64.47.94 47mm 64.47.10

48mm 64.48.94 48mm 64.48.10

49mm 64.49.94 49mm 64.49.10

50mm 64.50.94 50mm 64.50.10

51mm 64.51.94 51mm 64.51.10

52mm 64.52.94 52mm 64.52.10

53mm 64.53.94 53mm 64.53.10

54mm 64.54.94 54mm 64.54.10

56mm 64.56.94 56mm 64.56.10

58mm 64.58.94 58mm 64.58.10


16 17

14 Trial Stems (Threaded Spigot)

Extra Extra Small 96.08.08

Extra Small 96.08.10

Small 96.08.12

Medium 96.08.15

Large 96.08.18

Small Trial Long Stem 96.25.12Available as a revision option

Medium Trial Long Stem 96.25.15

Large Trial Long Stem 96.25.18

15 Rasps

Extra Extra Small 50.00.14

Extra Small 50.00.15

Small 50.00.16

Medium 50.00.17

Large 50.00.18

1514

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Furlong® H-A.C. Hemiarthroplasty

Supravit® H-A.C. coating and stem geometry are identical to the Furlong® H-A.C. hip replacement, which has an ODEP rating of 10 A

Very impressive clinical results have shown that Supravit makes the Furlong® H-A.C. Total Hip Replacement, possibly the most successful uncemented hip stem4-12

Can be used on patients with osteoporotic bone13

Cost effective compared to Total Hip Replacement

We conclude that Hemiarthroplasty with the Hydroxyapatite coated Bipolar Furlong®

prosthesis for displaced intracapsular fracture of the neck of the femur gives good mid term

results in elderly patients for return to mobility, use of mobility aids and freedom from pain2

Modularity of the head allows later conversion to total hip arthroplasty without revision

of the stem2

Use of the Hydroxyapatite–coated stem eliminates the need for cement and its attendant

risks to the cardio respiratory system in the elderly and often frail population2

The results of our study indicate that hip Hemiarthroplasty using the Furlong® H-A.C. coated

implant is associated with good functional recovery in terms of mobility and reliance on

walking aids2

The mean Clinical Rating Score was 70 ( Harris Hip Score 80.6 ). 86% had no pain and 90%

were satisfied. This prosthesis functions well in the active elderly patient with a displaced

intracapsular proximal femoral fracture3

Design Attributes

Clinical Evidence

14


A more flexible choice for you...

...a better outcome for Barbara

Design Attributes

Clinical Evidence

15

Fully coated with Supravit® hydroxy-apatite ensuring even distribution of forces transmitted through the prosthesis to the host bone.

Proven stem design of the Furlong® H-A.C. Total Hip Replacement

12-14 Taper allows for an easy conversion to a total hip replacement at a later date, should this be required

The 127º neck angle increases stability and reduces the risk of dislocation.

Proximal stem geometry aids primary fixation of the implant

The collar of the implant helps neutral alignment of the prosthesis.


The JRI Bipolar head is pre assembled and available in 1mm increments. It has been designed specifically to minimize the risk of the prosthesis assuming a varus position.

The JRI Physiological Head is manufactured from proven High Nitrogen Stainless Steel. This increases biocompatibility and provides greater fatigue strength and corrosion resistance over conventional medical grade stainless steel.

127º

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H-A.C. Femoral Stems

9mm 97.09.00

10mm 97.10.00

11mm 97.11.00

12mm 97.12.00

13mm 97.13.00

14mm 97.14.00

16mm 97.16.00

Bipolar Heads

40mm O/D 94.40.01

41mm O/D 94.41.01

42mm O/D 94.42.01

43mm O/D 94.43.01

44mm O/D 94.44.01

45mm O/D 94.45.01

46mm O/D 94.46.01

47mm O/D 94.47.01

48mm O/D 94.48.01

49mm O/D 94.49.01

50mm O/D 94.50.01

51mm O/D 94.51.01

52mm O/D 94.52.01

53mm O/D 94.53.01

54mm O/D 94.54.01

56mm O/D 94.56.01

58mm O/D 94.58.01

Physiological Heads

39mm O/D 93.39.01

40mm O/D 93.40.01

41mm O/D 93.41.01

42mm O/D 93.42.01

43mm O/D 93.43.01

44mm O/D 93.44.01

45mm O/D 93.45.01

46mm O/D 93.46.01

47mm O/D 93.47.01

48mm O/D 93.48.01

49mm O/D 93.49.01

50mm O/D 93.50.01

51mm O/D 93.51.01

52mm O/D 93.52.01

53mm O/D 93.53.01

54mm O/D 93.54.01

56mm O/D 93.56.01

58mm O/D 93.58.01

17


Correct positioning of the patient, on the operating table, is very important and the hip joint is exposed using a preferred surgical approach for hemiarthroplasty.

The femoral neck is resected. (This cut can be determined by where the fracture has occurred). A trial stem, rasp or template can be used, if required, to help identify where the neck cut should be and a line made using a diathermy probe or skin marker.

1 2

The size of the femoral head can then be estimated using the femoral head template guide.

The femoral head is removed using the corkscrew. A light tap may help engagement and purchase into the femoral head.

3 4

The actual implant head to be used (either bi-polar or mono-polar, physiological) is determined using the trial heads and introducer. The Labrum is best left intact but, if necessary, can be sectioned at this point to allow the correct size head to be selected.

The proximal femur is opened using the box chisel which is positioned laterally and posteriorly so that entry is in line with the femoral intramedullary canal.

5 6

18

Operative Technique

With the correct rasp in place remove the rasp handle and if required, trim the neck using the calcar cutter fitted onto the T-handle.

With the rasp still in place, the fin cutter is gently tapped home into the groove in the rasp with the teeth facing the greater trochanter.

11 12

If the fit of this first rasp is unstable then the next size of intramedullary reamer is used followed by the corresponding size of rasp. This ream / rasp technique is continued until the fit of the rasp is stable.

The smallest rasp (Size 9) is used first to prepare the proximal femur. The small tommy bar is used to control version.

9 10

The smallest (4-8mm tapered) intramedullary reamer, which has a sharp tip, is mounted on the T-Handle, and used to open up the femoral canal. Care should be taken with this first reamer and if the bone quality is poor then the 8mm intramedullary reamer should be used first in its place, as it has a more rounded tip.

Next the 9mm intramedullary reamer is used.

7 8

19


At this point, if required, the appropriate trial stem prosthesis can be carefully inserted using the stem impactor.

The chosen trial head is screwed onto the trial prosthesis and a reduction attempted. If the reduction is not possible or is regarded as too tight, the trial prosthesis is removed and the neck resected further to permit deeper seating of the stem. The rasp is seated again and the trialing process repeated until the reduction is satisfactory.

13 14

The definitive femoral stem should be inserted using the stem impactor and tapped home to the depth determined by the trial prosthesis.

The trial stem can be removed with the use of the trial stem extractor. Care must be taken to tap the trial out of the femur in a neutral position to prevent possible damage to the femur.

15 16

Seating of the collar on the calcar is preferred but not essential.

The implant head (either bi-polar or mono-polar, physiological) is fitted onto the stem and impacted using the nylon femoral head impactor. A light tap is required to engage the taper.

17 18

20

Operative Technique Continued

Finally the joint is reduced and the wound is closed.

19

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7 Intramedullary Reamers

4-8mm 14.48.61

9mm 14.61.09

10mm 14.61.10

11mm 14.61.11

12mm 14.61.12

13mm 14.61.13

14mm 14.61.14

16mm 14.61.16



10 Fin Cutter 90.99.02

11 Calcar Cutter 90.00.23

12 T Handle 10.00.50

13 Femoral Head Gauge 64.00.18

Furlong® H-A.C. Instrumentation

10

8

9

137


1 Trial Head Introducer 10.00.44

2 Head Impactor 10.00.47

3 Trial Stem Extractor 10.00.08

4 Box Chisel 50.99.45

5 Stem Impactor 50.99.34

6 Femoral Head Extractor 10.00.21

1

3

52

4

6

1112

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Furlong® H-A.C. Instrumentation

DESCRIPTION PRODUCT NO. DESCRIPTION PRODUCT NO.17 Bipolar Trial Heads (Black) 18 Physiological Trial Heads (White)

39mm 64.39.10

40mm 64.40.94 40mm 64.40.10

41mm 64.41.94 41mm 64.41.10

42mm 64.42.94 42mm 64.42.10

43mm 64.43.94 43mm 64.43.10

44mm 64.44.94 44mm 64.44.10

45mm 64.45.94 45mm 64.45.10

46mm 64.46.94 46mm 64.46.10

47mm 64.47.94 47mm 64.47.10

48mm 64.48.94 48mm 64.48.10

49mm 64.49.94 49mm 64.49.10

50mm 64.50.94 50mm 64.50.10

51mm 64.51.94 51mm 64.51.10

52mm 64.52.94 52mm 64.52.10

53mm 64.53.94 53mm 64.53.10

54mm 64.54.94 54mm 64.54.10

56mm 64.56.94 56mm 64.56.10

58mm 64.58.94 58mm 64.58.10

17 18

14 Trial Stems

9mm 98.08.09

10mm 98.08.10

11mm 98.08.11

12mm 98.08.12

13mm 98.08.13

14mm 98.08.14

16mm 98.08.16

15 Rasp Handle 200.02.99

16 Rasps

9mm 91.11.09

10mm 91.11.10

11mm 91.11.11

12mm 91.11.12

13mm 91.11.13

14mm 91.11.14

16mm 91.11.16

15

1614

Joint Replacement Instrumentation Limited

18 Churchill Way, 35A Business Park, Chapeltown, Sheffield S35 2PY

T: 0114 345 0000 F: 0114 345 0004 W: www.jri-ltd.co.uk

1. S Dixon et al. Cemented Bipolar Hemiarthoplasty for Displaced Intracapsular Fracture in the Mobile Active Elderly

Patient. Int. J Care Injured 2004; 35:152-156. 2. P Chandran et al. Mid Term Results of Furlong LOL Uncemented

Hip Hemiarthroplasty for Fractures of the Femoral Neck. Acta Orthop. Belg., 2006; 72:426-433. 3. R Rees et al.

The JRI Bipolar Hemiarthroplasty for the Active Patient With a Displaced Intracapsulat Proximal Femoral Fracture.

BOA 2001. 4. Survivorship of 38 cases in under 50 year olds. N.N. Shah et al J Bone Joint Surg [Br] 2009; 91-B:865-9

5. Survivorship of 331 consecutive cases. J.A.N Shepperd et al J Bone Joint Surg [Br] 2008; 90-B:27-30

6. Survivorship of 134 consecutive cases. A.A. Shetty et al J Bone Joint Surg [Br] 2005; 87-B:1050-4 7. Survivorship in

2212 cases. J.M. Buchanan, Sunderland Royal Hospital Data presented at BOA, Manchester, 26 - 28 September 2007. 8.

Sources: Fisher J, University of Leeds (UK); Pandorf T, CeramTecAG (Germany), 2006 9. Buchanan J.M. A nineteen-year

review of hydroxyapatite ceramic coated hip implants: a clinical and histological evaluation. BOA, 2007; Manchester

26-28th September 2007. 10. Raman R, David D, Eswaramoorthy V, Tiru M, Angus P; Long term results of 586 cementless

primary total hip arthroplasties using H-A.C. coated endoprosthesis: BOA ; Manchester 26-28th September 2007. 11. Escriba

I, Sancho R, Crusi X, Valera M; Hemispherical hydroxyapatite-coated cups for acetabular revision in severe bone defects: 3 to

7 year results. EFORT, Helsinki, Finland, June 4 -10th 2003. 12. Data on file. 13. Data on file – published at EFORT AOS 2008.

Wholly owned by the Furlong Research Charitable Foundation who

independently fund orthopaedic research

References:

JRI Services/Education

• Research Funding

• Nurse Training

• Factory Tours

• Furlong Hip Course

• In service support

• Consignment stock checks:

• Implants

• Instruments

• PACS Digital X-Ray templates

CCG VS01/07/2010 0473

designed the furlong® - jri orthopaedics · 2019-04-29 · 3 the femoral head size can then be...

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