Mayo Set-up

This is an ANTERIOR HIP Set-up, I would add different retractors for a lateral hip)

– 10 blades on reg & long #3 knife handles
Cvd Mayo to open myofascia
Tonsil to clamp & aid in cauterization of any bleeding vessels
Kocher (Oschner) to grasp tissue (capsule, labrum, etc) to be dissected out
Cobb Elevator to clean tissue (periosteum) off bone to aid in visualization of hip anatomy
Rongeur (Leksell) to grasp tissue & bite bone during dissection
Mallet to impact broaches & implants
Scofield Retr for retraction
Rake Retr for retraction
Cobra Retr for retaction placed against the greater & lesser trochanters to aid in visualization of the femoral neck & head
Trochanteric Retr to aid in the visualization down the femoral shaft while reaming and or broaching the femur

 

 

Acetabular Reamers (top tray of reflection pan)

After the femoral head is removed & the acetabulum is cleaned up of soft tissue, the acetabulum will be reamed to create good bleeding bone for the ACETABULAR SHELL to be placed

– I usually start with a 44 reamer

– Then ask the Dr. if they want to go by 1 or jump for the next reamer size (usually will jump to 46, then 48, & the ream one size up at a time)

– For this system we ream 1 under or line to line (same size of the implant)

– Save the reamings (Dr. may want / need to use bone as bone graft) (I don’t save the 1st reaming too much junk in it)

– Always tell the Dr. what size reamer you are handing them

 

Acetabular Shell, Liner, & Screw Instruments
(Bottom tray of the Reflection Pan)

-Acetabular Shell Impactor . At the tip of this instrument there is a plastic collet screwed on this is to reduce the threads to the same thickness of the implant (so when the implant is screwed on the impactor everything will be flush,if extra threads are showing they could be impacted through the acetabulum and into the abdominal cavity)

– 3 metal balls (heads). These balls are different diameters 28mm, 32mm, 36mm. After the Metal Acetabular Shell is impacted one of these heads are screwed onto the Acetabular Impactor. This will be used to impact the Plastic Liner into the Metal Acetabular Shell. Depending on what size metal shell you use will determine what size metal ball you will use.

– Screw Instruments. If for some reason the Dr. feels they want better fixation of the Metal Acetabular Shell BEFORE the Plastic liner is impacted the Dr. may put screws in. You will need a flexible drill bit (not shown), drill guide, depth gauge, screwdriver, & screw head holding device.

 

Synergy Reamer Pan

– Box Osteotome (back right of the pan) to create a hole in the femur to access the femoral canal

– Canal Finder (not put together <sorry>) initial reaming of the femoral canal

– Femoral Reamers used to ream up sequentially until there is cortical bone chatter

– Whatever size you ream to; load a femoral broach (rasp) 3 sizes smaller

Synergy Broach Pan

– Femoral Broaches w/ Angled (Anterior) Broach Handle. Start with a broach (rasp) about 3 sizes smaller than previously reamed. Broach sequentially up to the last size reamed. These broaches are also the Femoral Trials

– Femoral Neck Trials. Choose a neck trial that corresponds with the size broach that is being used. There will be 2 necks that correspond with each broach size. HO (High Offset) & STD (Standard). Hand the Dr. the Standard Neck Trial unless asked for the High Offset. (High Offset necks lateralize & lengthen the hip)

– Femoral Head Trials (colored balls). The heads are 3 different diameters 28mm, 32mm, 36mm. You will choose the diameter head that was the same size as the metal ball to impact the Plastic Acetabular Liner. The colors of the heads correspond with how low or high they sit on the Femoral Trial & Implant. The different lengths are important so that the Dr. can give the pt. a. proper fit & leg lengths are the same. Also proper length is important b/c if the head length is to short the pt. will chronically dislocate.

Green = -3
Yellow = +0
Red = +4
White = +8
Blue = +12

– Femoral Impactor to impact the Femoral Stem Implant

– Femoral Head Impactor to impact Femoral Head Implant

– Calcar Reamers (back left of pan) it there is bone preventing the trial neck to seat properly the Calcar reamer is used to plane the bone.

 

Hip Instruments

From Left to Right
– Narrow Femoral Neck Elevator used to elevate the femoral neck to aid in accessing the femoral canal for reaming & broaching

– Wide Femoral Neck Elevator same as Narrow

– Corkscrew in an Anterior Hip the hip is not dislocated when the femoral head is sawed off. After the femoral cut the first few threads of the corkscrew is malleted into the head the screwed in and the head is levered out of the acetabulum (sometimes in conjunction with a Cobb & a little femoral distraction)

– Femoral Head Impactor to impact Femoral Head Implant

– Bone Hook x 2 (2 different sizes) used during femoral broaching & dislocating after trialing

– McElroy Curettes x 3 (3 different sizes) to scrape the tissue out of the acetabulum before Acetabular Reaming

 

 

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