Ceramic Liners

These key surgical steps are highlights only and may not be used for training purposes. For the detailed procedure, please refer to the PINNACLE Surgical Technique Brochure (9068-80-050)

Alternative Bearing Liner Insertion

To ensure optimal component placement when using alternative bearing (AB) liners, trialling is critical. Dedicated trials for liners help ensure the correct restoration of biomechanics.

If correct joint biomechanics, free of mechanical impingement, cannot be obtained with the alternative bearing trials, perform a trial reduction using the PINNACLE polyethylene liner trials. Then use the PINNACLE polyethylene liner that results in joint stability.

Important: Before placing an alternative bearing into the PINNACLE cup, ensure all mating surfaces are clean and free of debris.

Handle the alternative bearing liner carefully to avoid damage that could compromise the mechanical integrity of the liner taper locking mechanism.

Alternative Bearing Gripper

Assemble the appropriate size gripper to the inserter shaft aligning the slot of the gripper with the pin of the shaft (Figure 38).

Thread the appropriate size tip to the shaft. Make sure that the gripper is positioned such that it is touching the tip once it has been fully threaded.

Use of the PINNACLE Alternative Bearing (AB) Gripper instrumentation is recommended for insertion of metal liners and is mandatory for ceramic liners.

Important: The surgical technique must be followed when inserting the ceramic liner into the acetabular cup to ensure correct alignment of the liner into the cup prior to impaction. Failure to do so could contribute to rim chipping during insertion or post-operative fracture.

Alternative Bearing Gripper – Insertion Technique

Press–fit the liner on the gripper component. Verify that the liner is fully seated to ensure proper alignment.

Cautiously advance the liner into the incision and align the face of the gripper to the face of the cup.

Proper alignment is achieved when the instrument will no longer rotate due to the locking features between the gripper, cup and liner.

Alternative Bearing Gripper – Insertion Technique

Press firmly on handle to introduce the liner into the cup.

Do not attempt to fully engage the taper locking mechanism by striking the end of the AB Gripper Inserter.

Carefully remove instrument by pulling back the plastic gripper flange whilst pushing down gently on the gripper handle.

Palpate the liner to confirm proper taper alignment and seating in the cup.

Alternative Bearing Gripper – Insertion Technique

Use an impactor with appropriate impactor tip for final seating of the liner. Final seating requires two to four moderate blows.

The nature of hard–on–hard bearings requires precise placement of femoral and acetabular components. It is important to optimise component placement to avoid mechanical impingement. To ensure optimal component placement when using alternative bearings, trialling is critical. Dedicated trials for alternative bearings help ensure the correct representation of biomechanics.

Note: if any other bearing surface has been impacted into the cup, a CERAMAX™ liner cannot be used. CERAMAX liners should only be used in new PINNACLE acetabular cups with an "as manufactured" taper.

Alternative Bearing Insert Extraction

If it is necessary to remove an AB liner from a PINNACLE cup, thread the extractor handle onto the appropriate size AB extractor. Each cup size has a specific extractor, e.g., 48 mm cup uses a 48 mm extractor.

Note: AB extractors are available for cups starting at 44 mm OD up to 66 mm OD. The AB extractor can be used with 28,32,36,40 and 44 mm ID.

Place the three tips of the AB extractor into any three scallops on the face of the PINNACLE shell.

Alternative Bearing – Extraction Technique

Push down the attached lever with thumb pressure to engage the suction cup against the inner face of the AB liner.

To remove the AB liner from the cup, impact the extraction handle lightly one to two times with a metal mallet. The resulting vibration will release the taper lock between the AB liner and the PINNACLE cup. The liner is then lifted out of the cup by the suction cup mechanism.