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Surgical procedure
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 1.
Determination of the neck section plane
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The
section height is done as planned and determined based on
the tracing. It should allow to drive in the stem
satisfactorily.
The
neck may be cut again if possible.
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an illustration to increase it then to close the
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2.
Metaphysiary preparation
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Assess the direction of the medullar canal with
a fine reamer type or a curette driven into the femur.
Open
the medullar canal with the box chisel to the size
determined during the surgical planning.
Insert the chisel at an angle from the neck
cutting surface, and lift the neck against the greater
trochanter, and drive the chisel following the anatomic
femoral axis.
The
spongy bone should be removed and kept for later needs. The
proper positioning of the prosthesis depends on this phase.
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an illustration to increase it then to close the
window
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3.
Shaft diameter sizing.
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After
the metaphysiary preparation phase, the 10 diameter feeler
is inserted using the quick lock handle. Feelers with sizes
increasing in mm increments are successively used until a
simple contact with the shaft cortical is achieved. This
helps determine the diameter of the prosthetic shaft part :
it should be just one size smaller than the last feeler
used.
Never
choose the same diameter than the last feeler, this would
result in thigh pain due to constraints transmitted by the
end of the prosthesis to the shaft bone.
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an illustration to increase it then to close the
window
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Warning :
This phase should not use a motor, as
it consists in palpating, not in drilling.
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4. Use
of greaters.
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The
concept of using ESOP HA rasps consists in always using the
same trial shaft since it was chosen based on the medullar
canal diameter, and then in screwing to the various broach
needed for preparing the ESOP HA prosthesis
base.
In
order to make handling easier, two sets of test shafts are
available in the ancillary equipment.
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an illustration to increase it then to close the
window
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5.
Installing the rasps or broachs
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When
introducing the broach, it is advisable to push it outward,
until it rests against the inside face of the greater
trochanter.
This
helps protect a spongy bone triangle, the "safety triangle"
opposite the Merckel spur area.
The
final broach is the first stable broach.
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an illustration to increase it then to close the
window
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6.
Stability tests....
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Test
the broach stability by slowly rotating the rasp-holder
around in the sagital plane. Slight instability in the
frontal plane would result in implant micromobility leading
to thigh pain during the first weeks.
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an illustration to increase it then to close the
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...
and length tests.
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In
order to carry out length tests, remove the rasp handle, and
place a test head on the rasp neck. Length tests are carried
out with short neck (-3.5 mm), medium neck (0 mm) and long
neck (+ 3.5 mm), or even in some cases, extra long neck ( +
7 mm ) test heads.
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7.
Fitting in the implant
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The
distal part is screwed to the metaphysiary section using the
screwing handle, until it is tightly screwed.
The
prosthesis is driven in using a hammer and impacter, until
it is blocked.
The
depth mark is the limit of the hydroxyapatite covered-area.
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an illustration to increase it then to close the
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Tests
can still be carried out using test heads on the implant.
Then
the final head is placed on the cone by giving a quarter
turn.
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window
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