Key Surgical Steps
These key surgical steps are highlights only and may not be used for training purposes. For the detailed procedure, please refer to the CORAIL® Platform Brochure (DSEM/JRC/0616/0665(2)).
CAUTION: This section is for Cemented Stems only - HA Coated Implants must not be implanted with cement.
Note: The canal is prepared in exactly the same way as for the CORAIL Cementless. Please refer to the CORAIL Platform Brochure (DSEM/JRC/0616/0665(2)) pages 24-27.
X-ray templates are used to determine the femoral neck cutting plane, the degree of lateralisation and the positioning of the cup inside the native acetabular cavity.
Cement Restrictor - Trial
Select the size of trial cement restrictor identified during pre-operative templating to fit the distal canal. Attach it to the cement restrictor inserter and insert the trial cement restrictor to the planned depth. Check that it is firmly seated in the canal. Remove the trial cement restrictor.
The use of pulse lavage is recommended to clean the femoral canal of debris and to open the interstices of the bone.
By using the pulse lavage prior to setting the cement restrictor, the risks of fatty embolism will be reduced.1
- Breusch S, Reitgel T, Schnerder U, Volkmann M, Ewerbeck V, Lukoschek M. Cemented Hip Prosthesis Implantation - Decreasing the Rate of Fat Embolism with Pulsed Pressure Lavage. Orthopade. 2000;29:578-586.
Cement Restrictor - Implant
Insert the selected DePuy cement restrictor implant at the same level as the restrictor trial.
Tip: The size of the cement restrictor should be one size larger than the last trial restrictor inserted to the planned level. The planned level should be 1cm below the tip of the implant.
Final Bone Preparation
The bone can be dried by passing a swab down the femoral canal which helps to remove any remaining debris..
Cementing Technique - Insertion
High viscosity cement should be used. The cement is ready for insertion when is has taken on a dull, doughy appearance.
Start at the distal part of the femoral canal and inject the cement in a retrograde fashion, allowing the cement to push the nozzle gently back, until the canal is completely filled and the distal tip of the nozzle is clear of the canal.
Tip: Setting time may vary if the cement components or mixing equipment have not been fully equilibrated to 23°C before use.
Cementing Technique - Femoral Pressuriser
The cement must be pressurised to ensure good interdigitation of the cement into the trabecular bone. Continually inject cement during the period of pressurisation.
Tip: Use the femoral preparation kit curettes to remove excess bone cement.
Femoral Component Insertion
Important Note: The protective covers should be left on until the components are ready to be implanted. Before implanting a femoral head, the male taper on the femoral stem should be wiped clean of any blood, bone chips or other foreign materials.
Select a stem of the same size as the final broach inserted. Introduce the implant using the curved stem inserter in line with the long axis of the femur in one slow movement. Its entry point should be lateral, close to the greater trochanter.
During stem insertion maintain thumb pressure on the cement at the medial femoral neck. Insert the stem up to the resection level. If necessary, a few light taps on the stem inserter will bring the stem to the right level.
Tip: Remove excess cement with a curette. Maintain pressure until the cement is completely polymerised.
Femoral Head Impaction
A final trial reduction is carried out to confirm joint stability and range of motion.
Important Note: Clean and dry the stem taper carefully to remove any particulate debris.
Place the femoral head onto the taper and lightly tap it using the head impactor. Ensure bearing surfaces are clean and finally reduce the hip.
Note: A DePuy Synthes 12/14 ARTICUL/EZE™ Head must be used.