Smith & Nephew REDAPT User manual

Surgical Technique

Smith & Nephew would like to acknowledge the contributions of the following
surgeons with whom we designed the REDAPT Revision Femoral System:
Mathias Bostrom, MD
New York, NY
Fares S. Haddad, BSc MCh, FRCS
London, NW United Kingdom
Stephen Incavo, MD
Houston, TX
John Masonis, MD
Charlotte, NC
Ari Pressman, MD
Pittsburgh, PA
Nota Bene The technique description herein is made available to the healthcare
professional to illustrate the suggested treatment for the uncomplicated procedure.
In the nal analysis, the preferred treatment is that which addresses the needs
of the patient.
REDAPT™ Revision Femoral System
Surgical Technique
This surgical technique is for informational and educational purposes only. It is
not intended to serve as medical advice. It is the responsibility of the treating
physicians to determine and utilize the appropriate products and techniques
according to their own clinical judgment for each of their patients. For more
information on the products shown in this surgical technique, including indications
for use, contraindications, effects, precautions and warnings, please consult the
Instructions for Use (IFU) for the product.

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The REDAPT™ Revision Femoral System by Smith & Nephew is uniquely designed to
address the challenges in today’s revision hip arthroplasty: xation in various bone
types, achievement of joint stability, predictable stem position and surgical efciency.
It all starts with ROCKTITE™ utes which are intended to provide rock-solid distal
xation in all bone types.
Surgeons have shown that REDAPT offers reproducible stem position which is
achieved by the combination of ROCKTITE xation and highly efcient, easy to use
instrumentation. When a surgeon requires the benets of a modular stem to best
meet individual patients’ needs, the REDAPT Modular Revision Femoral System
allows for a seamless intraoperative transition. This allows the surgeon to customize
the proximal/distal mismatch for the best stem t without compromising stem
strength. Further, the surgeon is able to achieve joint stability through independent
adjustment of neck angle, height, offset and version. For additional information on
the REDAPT Modular implants or technique, please see 7138-1674 REDAPT Revision
Surgical Technique.
Indications
Hip components are indicated for individuals undergoing primary and revision surgery
where other treatments or devices have failed in rehabilitating hips damaged as a
result of trauma or noninammatory degenerative joint disease (NIDJD) or any of its
composite diagnoses of osteoarthritis, avascular necrosis, traumatic arthritis, slipped
capital epiphysis, fused hip, fracture of the pelvis and diastrophic variant.
Hip components are also indicated for inammatory degenerative joint disease
including rheumatoid arthritis, arthritis secondary to a variety of diseases and
anomalies and congenital dysplasia; treatments of nonunion, femoral neck fracture
and trochanteric fractures of the proximal femur with head involvement that are
unmanageable using other techniques; endoprosthesis, femoral osteotomy or
Girdlestone resection; fracture-dislocation of the hip; and correction of deformity.
REDAPT Revision Femoral System components are intended for single use only and
are to be implanted without bone cement.
Implants
REDAPT is a tapered, forged titanium stem with proprietary ROCKTITE distal utes for
improved diaphyseal xation.
The 190mm Sleeveless stem (Figure 1) is available in sizes 12-21 (in 1mm increments)
and available in sizes 12-27 (in 1mm increments) in lengths of 240mm and 300mm.

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REDAPT™ Sleeveless Stem
12/14 Head taper
• Compatible with all Smith & Nephew heads
Neck
• Circulotrapezoidal shape for increased
range of motion
• 2 Offset options; Standard and High
Stem
• Forged Titanium tapered, uted design with
proprietary ROCKTITE™ utes
• Diameters: 12 – 27mm (1mm increments)
(190mm available 12 – 21mm)
• Lengths: 190mm, 240mm and 300mm
– Stem length is measured from +0 head
center at the at the top of the stem to distal
tip of the stem
Figure 1

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Offset options
Each neck is made with a 12/14 taper for use with compatible cobalt chrome, ceramic
and OXINIUM™ heads. The circulotrapezoidal neck is designed for increased range of
motion. The following table and illustrations show the total offset and height for each
REDAPT™ stem.
Offset option (standard is +0 head center)
Size (mm)
SO Neck HO Neck
Height (mm) Offset (mm) Height (mm) Offset (mm)
12-15 33 37 33 45
16-27 35 42 35 50
Offset
Height
Figure 2
Sizing options
Sizes 12 – 27mm
Standard and high offset
300mm
Sizes 12 – 27mm
Standard and high offset
240mm
Sizes 12 – 21mm
Standard and high offset
190mm

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Instruments
REDAPT™ instruments are designed to maximize surgical efciency and improve
accuracy and reproducibility of implant position during the procedure. This is
accomplished by reaming and trialing “over the top” of the distal reamers. Distal and
proximal reamers are color-coded to provide easy identication of implant sizes and
reduce unnecessary instruments.
Distal reamers are intended to allow the surgeon to prepare and size the canal for
optimal t of the tapered, uted, distally xed stem. When used in conjunction with
trial bodies and necks, the distal reamers function as intramedullary trials which
should provide the surgeon with an accurate assessment of implant positioning
while reducing the number of instruments and trial components. Distal reamers are
available in diameters of 10mm to 21mm in 1.0mm increments in lengths of 190mm
and diameters of 10mm to 27mm in lengths of 240mm and 300mm.
The proximal reamers are uniquely designed to be used over the distal reamers. By
reaming “over the top”, the surgeon is preparing for the proximal aspect of the stem
based on the location of the distal reamer. During canal preparation, “over the top”
reaming allows the surgeon to maintain the relative position of the proximal and distal
reamed cavities to accept the implant of choice. Proximal reamers are available in
sizes which correspond to the Sleeveless stem size.
Distal reamer/
implant size
Color of reamer
and implant
packaging
Proximal Reamers by number*
Starter 1 2 3 4 5
12 Purple PF
13 Purple PF
14 Black PF
15 Black PF
16 Blue PF
17 Blue PF
18 Red PF
19 Red PF
20 Copper PF
21 Copper PF
22 Gray PF
23 Gray PF
24 Brown PF
25 Brown PF
26 White PF
27 White PF
Proximal reamer color code chart
* PF = Sleeveless Stem

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Preoperative planning and templating
Templating
Preoperative templating accomplishes several goals. The primary goal is to determine
the intended diameter and length of the revision stem and the remaining femoral
bone to support the conical, uted stem. While all revision situations are unique, in
general, 5-7cm of conical reaming of distal cortical bone is desired.
Preoperative planning for a revision total hip arthroplasty requires at a minimum a
standard set of radiographs, which includes an antero-posterior (A-P) radiograph of
the pelvis and a lateral radiograph of the affected hip. Depending on the length of
the existing femoral component several additional radiographs may be necessary.
Specically, the A-P and lateral radiographs should include the entire femoral
component. On occasion a full-length A-P radiograph of the entire femur may be
necessary. As part of the preoperative work-up, the surgeon may consider other
imaging modalities such as bone scans and computerized tomography (CT). However,
these are not typically necessary for preoperative templating.
Determine the appropriate classication for the femoral revision, for example the
Paprosky Revision Classication.1This will aid in determining the appropriate type,
size and position of the revision stem you will need.
An important goal of templating is achieving the optimal leg length and offset. As
with primary THA preop planning, establishing proper leg length requires assessment
of a number of clinical and radiographic parameters. Establishing the proper reference
lines requires using a horizontal line between the inferior portion of the teardrop as
well as a horizontal line between the inferior margin of the obtruator foramen and
ischial tuberosity. Due to the often distorted anatomy in revision cases, utilizing all
three reference lines may be necessary.
Similarly, due to bony defects on the femoral side, a combination of anatomic
landmarks such as the superior margin of the greater trochanter and inferior margin
of the lesser trochanter must be utilized. These obviously need to be compared to
similar points in the contralateral side using the A-P radiograph. Any pelvic obliquities
and/or spinal deformity must also be taken into account based on radiographic
and clinical assessments. The consideration of all relevant factors is necessary to
successfully restore the patient’s proper leg length.
Surgeon tip The use of simple wooden blocks during the preoperative physical
examination of the patient is very useful, as is a discussion of the patient’s perceived
length elicited during their preop interview.

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Standardized A-P radiographs is also critical in assessing proper
femoral offset. If there is a native hip on the contralateral side,
the proper offset can be determined by the horizontal distance
between the center of rotation of the head and anatomic axis of
the femur. If there is a well functioning total hip prosthesis on the
contralateral side, a similar assessment can be made using
the REDAPT™ templates.
Difculties sometimes arise when the contralateral hip is
deformed or has a malfunctioning THA. Additional problems
may be encountered if the ipsilateral acetabulum has failed or
has a protrusio deformity. In these cases, it is up to the surgeon
to determine intraoperatively what the proper offset should be
so as to achieve a hip that is stable without impingement in all
physiological positions.
Once the bone stock has been assessed and proper leg length
and offset have been determined, the surgeon should template
the femur to determine the appropriate stem size. If there is any
compromise in the diaphyseal femoral bone, it is recommended
that the implant bypass the decient bone by approximately
5-7cm and that it engages in good diaphsyeal bone.
REDAPT templates are available in digital and acetate formats
(Figure 3). Consult your Smith & Nephew representative for
assistance in obtaining templates.
Surgeon tip After the preliminary femoral stem size is determined,
physically draw these on the A-P radiograph in proper position.
Drawing is valuable when selecting the proper implant in
conjunction with the intraoperative ndings so as to establish the
proper implant position.
Figure 3

8
Abbreviated Surgical Technique
Trial ImplantDistal ream Proximal reamStarter ream

9
The following technique should be used when
implanting REDAPT Sleeveless monolithic
implants. Before surgery, review instrument
sets to ensure all instruments are present and
working properly.
Removal of a well xed femoral stem
The removal of a well xed femoral stem can at
times be accomplished using thin osteotomes
starting at the proximal portion of the implant.
If the ingrowth region of the implant is not
abutting cortical bone, this is more likely to be
successful. Often, however, the ingrowth region
of the stem is more distal and abuts the cortical
bone and advancing an osteotome may fracture
the femur. A proximal opening osteotomy,
typically an extended trochanteric osteotomy
(ETO), greatly facilitates stem removal. Once
the stem is exposed over the lateral surface,
a saw or burring device can be used to disrupt
the anterior and posterior surfaces. The medial
surface can then be disrupted using a Gigli
saw. This maneuver may be tedious and require
multiple saws. Once this is accomplished, the
ETO is replaced to its original position and held
in place with cerclage wires or cables.
Templating is useful in determining the length
of the ETO, identifying angular deformities which
may require corrective osteotomy, or planning
removal of other retained hardware.
Surgeon tip Before performing an ETO,
reaming, trialing and inserting a new stem,
place a cable or cerclage wire slightly distal
to the osteotomy or the existing stem before
reaming, trialing and inserting the stem to
minimize risk of propagating a crack or fracture.
Surgical Technique

10
Neck resection technique when using the
stem in a challenging primary application
The femoral neck resection may need to
be modied in some challenging primary
applications such as angular and rotational
deformity. The conical, uted design is
particularly well-suited for these cases due to
the stability that is possible with this design.
The shoulder of the implant is intended to match
the center of the femoral head for average
anatomy, and this should correspond to the tip of
the greater trochanter. Templating will determine
the proper level of the prosthesis with respect
to the greater trochanter. Individual adjustments
should be made as necessary.
Causes of proximal femoral deformity or
dysplasia may require trochanteric osteotomy or
femoral osteotomy. The nal level of the shoulder
of the prosthesis may have to be adjusted in
these cases. Placement of the box osteotome
and insertion of the canal nder may have to be
modied in these cases.
Femoral preparation
The starter reamer can be used to open the
proximal aspect of the femur to remove bone
from the greater trochanteric or medial calcar
regions. The presence of this bone will be largely
dependent on the stem previously implanted
and the stem removal process. Use the starter
reamer to remove lateral bone as shown in
(Figure 4). Removing lateral bone is important for
maintaining neutral stem placement.
Caution Align etched depth mark on starter
reamer to greater trochanter to ensure proper
proximal t of, while taking care not to fracture
potentially compromised bone.
Figure 4
Surgical Technique continued

11
Figure 5
Figure 6
Black line on quick connect
indicates alignment of
greater trochanter or other
predetermined landmark
Distal reaming
Select the appropriate reamer for the length of
stem chosen: 190mm reamers should be used for
190mm stems, 240mm reamers should be used
for 240mm stems and 300mm reamers should
be used for 300mm stems.
Attach the quick connect to the appropriate
distal reamer (Figure 5).
Set power in forward position and ream the
distal femoral canal until desired distal t is
achieved. Begin reaming with a distal reamer
that is at least 2mm smaller than the templated
size or a reamer that has little or no resistance.
To minimize potential risk of reaming through
the anterior cortex, direct the reamer from
anterior to posterior. Care should be taken to
avoid bone or surrounding soft tissue when
introducing reamers.
Note Do not strike the quick connect or
distal reamers.
Surgeon tip Ream until you hear cortical chatter,
the reamer contains cortical bone debris and
the reamer does not advance under rm axial
pressure. The reaming technique may be more
aggressive than with a cylindrical porous stem.
Caution Take care when handling reamers as
they are sharp and may damage surgical gloves
and soft tissue.
Progressively ream in 1mm increments. Note the
color code marked on the shaft of select distal
reamers. This color will identify available implant
sizes and appropriate instrumentation
for subsequent steps.
The size of a REDAPT™ stem is 0.25mm greater
than the equivalently sized reamer, providing
a press t of 0.25mm.
The depth of the reamer is determined by
aligning the mark on the quick connect, which
represents the +0 head center, with the greater
trochanter (Figure 6). If the greater trochanter
is not available then an alternative anatomical
reference must be made. A ruler can be used to
measure from the distal end of the osteotomy to
the previous location of the greater trochanter.
(Ruler not included in instrument set.) Ream
consistently to the determined land mark.

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Figure 7 Figure 8
Color coding corresponds
to the reamer and stem size
* PF =Sleeveless Stem
Proximal reamer color code chart
Distal
reamer/
implant
size
Color of
reamer/
implant
Proximal Reamers by number*
Starter 1 2 3 4 5
12 Purple PF
13 Purple PF
14 Black PF
15 Black PF
16 Blue PF
17 Blue PF
18 Red PF
19 Red PF
20 Copper PF
21 Copper PF
22 Gray PF
23 Gray PF
24 Brown PF
25 Brown PF
26 White PF
27 White PF
Upon achieving desired distal t, disengage the
quick connect and power, apply a T-handle and
ensure the reamer does not rotate or translate
axially. Leave nal distal reamer in the canal and
note the size.
Proximal reaming
Select a proximal reamer that offers little or no
resistance when placed over the shaft of the
nal distal reamer. Commence proximal reaming.
The proximal reamer will rotate, however the
distal reamer will act as a guide and should
not advance. If the distal reamer advances
during proximal reaming, re-ream distally with
successively larger distal reamers until desired
distal t is achieved. The distal reamer provides
a positive depth stop for the proximal reamer,
the surgeon may hear a click or observe that
the etched depth mark is aligned to the greater
trochanter or other predetermined reference
location indicating the proximal reamer has
bottomed out (Figure 7). During progressive
reaming, pulse lavage may be used to remove
bone debris from the canal so it will not impede
the proximal reamer from bottoming out on the
distal reamer.
Proximal and distal reamers with the same color
code represent compatible and available implant
options. For example, if the nal distal reamer
is 17 (blue), the corresponding 17 PF proximal
reamer is identied by a blue band located near
the chuck end and in the size markings on the
shaft of the proximal reamer (Figure 8).
Progressively ream until the PF proximal reamer
which corresponds to the distal reamer size is
reached. Ream consistently to the determined
landmark. Remove the proximal reamer, leaving
the distal reamer in position.
Surgical Technique continued

13
Trial neck
Trial body
assembly
Distal reamer
Figure 9
PF Sleeveless Stem
Color A dimension
12/13 PF 17.5
14/15 PF 17.5
16/17 PF 19.5
18/19 PF 21.5
20/21 PF 23.5
22/23 PF 25.5
24/25 PF 25.5
26 PF 26.5
27 PF 27.5
The following information illustrates the approximate proximal size of each Sleeveless stem.
Trialing
Assemble trial components over the proximal
end of the distal reamer starting with the trial
body assembly and nally with neck trials
(Figure 9). At this point, establish correct femoral
anteversion. Check the trial body assembly for
soft tissue and/or bone debris that may impede
the components from seating properly.

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Screw pops up
when seated on
proximal spacer
Figure 10 Figure 12Figure 11
Trial body assemblies have been designed
so that when the teeth on the underside
of the trial body mate with the teeth on the
proximal spacer when initially placed. When the
components are properly mated the screw on
the top of the trial body pops up. See Figure 10.
Secure the trial components together by
tightening the screw of the trial body with the
trial assembly instrument. Advance the trial
body screw until it is ush with the top of the
trial body. Figure 11 and 12.
Once the trial body assembly is tightly secured,
place the desired trial neck (Standard or High
offset) on the trial body. Attach the selected trial
head to the trial neck. Perform trial reduction
and range of motion (ROM) exercise to conrm
proper seating of implant, assess joint tension
and there is no impingement to the hip. Adjust
trial components and position of trial neck to
achieve desired neck offset and neck version.
(see gure 13) For version adjustment, loosen
trial body screw and rotate trial body to desired
position. Use a cautery pen to mark desired
position of the implant. Retighten screw and
perform trial reduction again to conrm position.
Press button
to release
Figure 13
Surgical Technique continued

15
Figure 15 Figure 16
Position of reamer
removal cap
Figure 14
Trial/Reamer removal
Attach trial handle to trial removal hook (Figure 14).
To remove the assembled trial components insert
the trial removal hook through the cross hole of
the trial body assembly (Figure 15). Using gentle
force, extract the trial components superiorly,
to avoid damage to surrounding tissue. If the
removal cross hole is not accessible, the trial
body assembly may be removed and the reamer
extracted using the reamer removal cap.
Important Reamers and trials are not
implantable devices and must be removed
prior to implant insertion.
If trialing was not performed, then the distal
reamer component can be removed using the
reamer removal cap. Screw the reamer removal
cap completely onto the threads of the distal
reamer, then place the trial removal hook
assembled onto the trial handle through the
cross hole in the reamer removal tool and use
gentle force to extract superiorly (Figure 16).
If resistance occurs when removing the reamer,
unscrew the distal reamer removal cap and
assemble the quick connect. Use the T-handle
to reverse the reamer out of the canal.
Note Do not use other devices or instruments to
remove reamer as these may damage the threads.

16
Figure 17
Surgical Technique continued
Implant assembly and insertion
Attach the implant driving platform of the stem
inserter to the proximal end of the stem implant
(Figure 17). To attach, stand the stem inserter
upright so that the threaded tip is pointed up.
Ensure that the lever handle is open on the stem
inserter and screw the implant onto the threaded
tip as far as possible. Flip the assembly over so
that the stem tip is now pointing down. Engage
the frame tines into the slots adjacent to the
threaded hole on the stem. Rotate the pommel
until the assembly is secure.
Caution Prior to use, inspect the inserter to
ensure that the threads are not damaged and
the tip is not bent. Do not over tighten the
pommel as this may cause it to lock up during
repeated impacting. Close the lever handle to
lock the pommel.
Note Take care to protect the taper during the
attachment of the stem inserter.
Orient the stem to achieve the desired version.
Insert the stem into the femoral canal using
hand pressure. Once the stem is in the desired
position, use a mallet to seat the stem. Once
the stem is implanted, raise the lever on the
inserter and unscrew the pommel to release
the instrument from the stem. Trialing may
be repeated with a trial head on the implant
if desired.
Ensure the stem taper is clean and dry before
placing the desired femoral head implant on
the trunnion. Impact head implant component
with the head impaction tool. Correct selection
of the head length, cup and stem positioning
are important. Muscle looseness and/or
mal-positioning of components may result in
loosening, subluxation, dislocation and/or
fracture of the component and/or bone. Perform
nal ROM with implants in position.

17
Proximal support
Once the nal components are implanted,
the osteotomy is reduced and secured with
cables. In order to reduce the osteotomized
bone fragment in its anatomic position, it may
be necessary to shape the endosteal surface
of the bone fragment with a curette or burr
to t against the lateral position of the
femoral component.
Caution The implant must contact bone, bone
ller, or secured allograft to provide adequate
secondary support.
Reattach the trochanteric segment using
ACCORD™ Cables (Figure 18) or other
appropriate proximal support.
Caution To gain adequate proximal support
and reduce the risk of implant failure, the use
of adjunctive devices such as cables, cerclage
wires, struts, etc. is recommended.
Figure 18

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Catalog information
REDAPT™ Sleeveless Revision Stems
190mm 240mm 300mm
Size STD Offset Hi Offset STD Offset Hi Offset STD Offset Hi Offset
12 7135-4461 7135-4478 7135-4701 7135-4718 7135-4736 7135-4754
13 7135-4462 7135-4479 7135-4702 7135-4719 7135-4737 7135-4755
14 7135-4463 7135-4481 7135-4703 7135-4721 7135-4738 7135-4756
15 7135-4464 7135-4482 7135-4704 7135-4722 7135-4739 7135-4757
16 7135-4465 7135-4483 7135-4705 7135-4723 7135-4741 7135-4758
17 7135-4466 7135-4484 7135-4706 7135-4724 7135-4742 7135-4759
18 7135-4467 7135-4485 7135-4707 7135-4725 7135-4743 7135-4761
19 7135-4468 7135-4486 7135-4708 7135-4726 7135-4744 7135-4762
20 7135-4469 7135-4487 7135-4709 7135-4727 7135-4745 7135-4763
21 7135-4471 7135-4488 7135-4711 7135-4728 7135-4746 7135-4764
22 - - 7135-4712 7135-4729 7135-4747 7135-4765
23 - - 7135-4713 7135-4731 7135-4748 7135-4766
24 - - 7135-4714 7135-4732 7135-4749 7135-4767
25 - - 7135-4715 7135-4733 7135-4751 7135-4768
26 - - 7135-4716 7135-4734 7135-4752 7135-4769
27 - - 7135-4717 7135-4735 7135-4753 7135-4771
240mm
REDAPT Sleeveless Implant Sets
Catalog Item Description
7135-0000 Sleeveless 190mm Implant Set (sz 12-21)
7135-1700 Sleeveless 240mm Implant Set (sz 12-21)
7135-2930 Sleeveless 300mm Implant Set (sz 12-21)
7135-1300 Sleeveless Large Size Implant Set (sz 21-27)