*smith&nephew; EP-FIT PLUS™

Surgical Technique
*smith&nephew
EP-FIT PLUS
Cementless Press-Fit
Cup System

EP-FIT PLUS
Table of Contents
Foreword ............................................................................... 3
Indications ............................................................................ 4
Contraindications .................................................................. 4
Case Study ............................................................................ 5
Preoperative Planning ........................................................... 5
Surgical Technique ................................................................ 6
Postoperative Treatment ......................................................18
Sterilization ..........................................................................18
References ...........................................................................19
Implants .............................................................................. 20
Instrumentation ................................................................... 26
Nota Bene
The technique description herein is made available to the healthcare professional
to illustrate the authors’ suggested treatment for the uncomplicated procedure.
In the final analysis, the preferred treatment is that which addresses the needs of
the patient.
1

Foreword
Shells conceived on the basis of the press-fit principle offer a number of advantages for total
hip replacement, including ease of manipulation and a minimum degree of bone resection.
In an acetabulum that is not deformed, the implantation of a hemispherical press-fit shell
without oversizing results in a large percentage of the mechanical load being borne by the
central region of the acetabulum. Moreover, the peripheral ring – especially its lower section –
will in part remain free of loading. For this reason hemispherical shells often have a limited
stability. Additional measures to improve stability, for instance the use of screws or mandrels
and/or the use of shells with oversizing (Lachiewicz et al., 1989), can introduce other problems.
In contrast, a hemispherical press-fit shell will bring greater stability in a patient with protrusio
acetabuli. Here, the mechanical loading is primarily on the peripheral zone (Adler et
al., 1992). It is therefore a logical step to optimize the intrinsic stability of the press-fit
shell by reproducing the protrusio situation.
We have therefore developed a shell that is not spherical throughout, with a patented triple
radius profile and which has proven itself over years of use of the EPF-PLUS‚ and PLUS-FIT
acetabular cups. EP-FIT PLUS is the latest generation of both these cup systems with direct
anchorage for hard articulating surfaces and with a greater surface roughness.
After implantation of the shell, the Triple Radius Profile results in a gap of approximately 2 mm
between the roof of the shell and the hemispherical reamed acetabulum. The actual dimensions
of the gap will vary, however, depending on the quality and elasticity of the bone. This
results in a close contact in the peripheral zone of the shell and a relatively low contact in
the pole region, yielding a favorable prestressing of the wall of the acetabulum. These stress
gradients, declining from the rim towards the dome of the acetabulum, result in a large percentage
of the mechanical loading being transferred to the wall of the acetabulum. This is in
contrast to oversized hemispherical cups, where only a narrow area along the acetabular rim
is subject to loading, and so may result in overloading of the bone in this area.
In summary, the EP-FIT PLUS system has the advantage of reducing the risk of fracture of
the acetabulum during implantation, whilst maintaining excellent primary stability through
connection to bone over a large area along the wall of the acetabulum.
3

Indications
• All forms of osteoarthritis.
• Progressive loss of function of the hip joint as a result of a degenerative posttraumatic
or inflammatory/rheumatic destruction of the joint.
• Femoral head necrosis.
• Proximal femoral fractures (especially femoral neck).
• Status following earlier operations such as osteosynthesis, intertrochanteric osteotomies,
arthrodesis or failed joint replacement.
Contraindications
• Acute or chronic infections, local or systemic.
• Severe damage to muscles, nerves or vessels that are a risk to the affected extremity.
• Severe bone defects or poor bone quality, endangering the stability of the implant.
• Associated disorders that could interfere with the functioning of the implant.
Remark
• Using hard-hard pairings, it is imperative to follow the specifications in the particular
chapters.
• The above-mentioned indications and contraindications apply for both
primary interventions and revisions.
• If a revision is performed then preferably an oversized implant should be chosen.
Multihole cups can be used for difficult cases.
4

Case Study
Preoperative
Postoperative
Female patient with dysplastic hip with OA. EP-FIT PLUS shell with SL-PLUS stem
in a female patient with dysplastic hip
with OA. Restoration of leg length.
Preoperative Planning
The surgeon uses the radiographic template (15% enlarged) to plan
• The intended size of the implant.
• The ideal position of the shell in relation to the acetabular teardrop figure.
Note
Exact determination of the size of a shell preoperatively using radiographic templates is only
possible to a certain degree.
In general, the removed femoral head gives a good indication of the size of the acetabular
cup. With a normal acetabulum, the definitive size of the shell is 4–6 mm larger than the
anteroposterior diameter of the removed femoral head.
The correct shell size is finally judged on the basis of the definitive reamer size/the correct
trial shell.
5

Surgical Technique
Note
Users of minimally invasive surgical techniques, please work through the following surgical
instructions additionally: posterolateral approach (Lit. No. 1426); anterolateral approach
(Lit. No. 1483); anterior approach (Lit. No. 1494).
Position of patient and approach
Surgery is performed with the patient in an
extended supine or lateral position.
Surgical approach – lateral or dorsolateral –
is determined on the basis of the patient
data established in advance and preference
of the surgeon.
Removal of the femoral head
An osteotomy of the femoral neck is performed
in accordance with the preoperative
planning for the corresponding stem system.
Preparation of the acetabulum
The joint capsule is opened and sufficiently
resected, fully if necessary.
The acetabulum is exposed to allow a good
view and sufficient room for reaming instruments.
6

Assembly of the reamer
The reamer is placed on the drive shaft using
pressure and turned clockwise until the locking
mechanism snaps in.
Reaming of the acetabulum
The acetabulum is reamed using a spherical
original Smith & Nephew Orthopaedics AG
reamer with increasing diameter until the
cartilage layer is fully removed and the subchondral
bone bleeds uniformly.
Note
It is recommended to begin with a reamer size equal to or 2 mm smaller than the head size
and that reaming is continued down to the base of the fovea acetabuli (teardrop figure).
As much hard sclerotic bone as possible should be removed from the pole region, but
retained in the peripheral zone. It may be advisable to choose a reamer that is in relation
to the cup size 1 mm larger to avoid fissures and ensure optimal seating.
Excessive reaming of the periphery should at all times be avoided as this would result in
a level of bone loss, especially at the anterior and posterior columns of the acetabulum, that
is too high.
The bone slurry that remains in the last reamer can be used to fill in the gap between the
acetabulum and the implant later on.
Reamers with 1 mm increments are available (see page 37).
7

Determination of the implant size using
the trial shell
Screw the trial shell onto the shell inserter
(130707).
2
1
An alignment guide (130728) may be used
for orientation purposes relative to the cup
position. The assembled alignment guide is
mounted on the shell inserter with the trial
shell.
10°–20°
The aim is an anteversion of 10° and an inclination
of 45°. Align the shell inserter in such
a way that rod (1) is perpendicular to the coronal
plane and rod (2) is perpendicular to
the sagittal plane of the patient. If the patient
is lying in the supine position (see illustration,
here: using the example of a right hip), the
long edge of the table can serve as an orientation
guide.
The trial shell is placed in the reamed acetabulum by exerting pressure on the shell inserter
(but without using an impacting tool).
Verification of correct seating in the acetabulum. After removal of the shell inserter the cup
position and depth can be checked. The trial shell is then removed with the shell inserter
screwed back in.
Note
In contrast to the original implants the trial shells are not oversized. If the desired degree
of stability is not attained, then the depth of the bone bed has to be increased (see “Reaming
of the acetabulum”) or the next largest size of trial shell chosen.
8

Implantation of the titanium shell with
trial shell inserter
Bone slurry from the last reaming procedure
can be uniformly distributed in the acetabulum
to compensate for possible gaps.
Mount the shell, of predetermined size, on
the shell inserter (130707).
If necessary, mount the alignment guide
(130728) on the shell inserter.
10°–20°
Position the cup shell in the acetabulum and
align the shell inserter as described in
“Determination of the implant size using the
trial shell”.
The inclination should ideally be 40–50º and
anteversion 10–20º to achieve optimum results.
Final acetabular component orientation
must also consider the position of the femoral
implant, the stability and degree of bone coverage
as well as correct softtissue tensioning,
to achieve the optimal result for each patient.
Any inclination of the shell greater than 50º
must be avoided because of possible impingement
and/or a tendency towards dislocation.
It may be advantageous to use a reliable
navigation system to position the cup as this
would considerably improve the accuracy of
positioning.
If no screws are used, the cup should be
orient ed with screw holes inferiorly. The implant
is inserted into the acetabulum by
impaction with the shell inserter and the
impaction/extraction hammer (130705).
Note
The information on the use of ceramic, metal
and PE inserts must be followed without fail
(see pages 12 to 18).
9

Implantation of the titanium shell using
the shell inserter (US version)
The shell inserter (130987) can be used
instead of the trial shell inserter.
Verification of position in the acetabulum
The distance (1–2 mm) between the implant
and the acetabulum is measured using
the depth gauge for shell (130731) through
the apex hole.
Note
Additional fixation of the EP-FIT PLUS press-fit
shell by screws is not routinely necessary,
but may be required routinely in certain circumstances.
Fixation of the shell with screws
The procedure is the same as for “Implantation
of the titanium shell using the shell inserter”
above, but the screw holes should be aligned
in a superolateral position upon insertion of
the shell.
Drill the intended holes using the drill guide
(130847) and flexible drill shaft (130490).
Insert the screws into the pelvis with the screwdriver
(130710). An anterior or central position
of the screws must at all times be avoided as
this could result in damage to the large pelvic
vessels and nerves.
Note
Only Smith&Nephew Orthopaedics cancellous
bone screws (25281–25286) with a low
head profile are to be used.
10

Optionally: trial reduction using trial
insert (standard 130826–130839/hooded
130850–130857)
Inner section
The trial stem is inserted in the femur after
the femur has been prepared (see cor respond
ing surgical procedure).
Outer section
Disassemble the inserter (130818).
Screw the corresponding size of trial insert
(standard and hooded) into the inner section
of the seating instrument.
Insert the trial insert into the implanted shell.
Unscrew the inner part of the inserter. Check
the seating of the insert in the shell, reduce
and manipulate.
Check the correct positioning of the PE insert
within the shell.
Screw the internal part of the seating instrument
back into the trial insert, then loosen
and remove it through a gentle tilting action.
Thoroughly rinse the implanted shell and carefully remove the bone debris.
11

Placement of the standard polyethylene
insert using the inserter/impactor
To position the polyethylene insert, it is
recommended to use the inserter/impactor
(130818).
The inserter/impactor must be reassembled
to do so.
Screw the adapter for the PE insert and the
impactor head onto the inserter/impactor.
Retract the internal section of the inserter/
impactor and mount the PE insert on the
three nipples.
Important
The Rexpol inserts, diameter 36 mm, Art.
No. 11000310–311, are not compatible with
the positioning and striking device and require
the Octoplus, Art. No. 1150126, positioning
device or can be inserted manually.
Insert the PE in the shell by impacting the
inner section of the inserter/impactor.
Optionally
Check the fit of the PE insert in the shell using
a raspatory.
Note
The PE insert must not be reused.
Rim osteophytes must be carefully removed
to prevent anterior or lateral impingement,
tendencies to dislocation or restriction of
movement.
12

Insertion of the hooded polyethylene insert using the inserter/impactor
It is recommended to insert the hooded polyethylene insert using the inserter/impactor
(130818).
The procedure for the hooded polyethylene insert and the inserting device is analogous to
the description under “Placement of the standard polyethylene insert using the inserter/
impactor”.
Note
The position of the shoulder of the hooded PE inserts can be changed in 30º increments.
Use of the BIOLOX ® forte/delta ceramic insert
Indications and contraindications
The same indications and contraindications apply to the use of the BIOLOX ® forte/delta cup
inserts as for total hip arthroplasty with other articulating surfaces.
The following additional contraindications apply to ceramic inserts:
• The inclination should not be substantially above or below the range 40–50º.
• The anteversion must not be above or below the range 10–20º.
• If the angle of inclination is below 30º or above 50º BIOLOX ® forte/delta inserts must not be
used. Smith&Nephew Orthopaedics standard and hooded PE inserts are available
for such cases.
• Ceramic cup inserts should similarly not be used for cups in a retroversion mode.
• Risk of impingement should at all times be avoided.
Implantation
A trial insert should be used before a ceramic insert is implanted. Trial heads of the
intended diameter must then be used to ensure an adequate range of motion (ROM) in all
directions and to check the stability of the joint. The artificial joint must not dislocate in
the course of movement or subluxate through impingement of the implant components or
soft tissue.
The alignment guide (130728) should always be used with BIOLOX ® forte/delta ceramic inserts
in order to obtain the necessary level of accuracy.
It is advisable to use computer-assisted navigation systems intraoperatively for documentation
and verification of the implant position and to get exact information on the ROM.
13

Placement of the ceramic insert
The procedure for the trial insert is the same
as described under “Optionally: trial reduction
using trial insert”.
Before insertion it must be ensured that the
inner surface of the metal shell is dry and
free of any debris.
Remove the BIOLOX ® forte ceramic insert
with the premounted CeraLock ® insertion aid
from its packaging. Remove the transparent
Plexiglas triggering protection and dispose
of it.
Place the CeraLock ® insertion aid on the front
face of the metal shell so that all 3 arms lie
on the edge and the BIOLOX ® forte ceramic
insert cannot tilt.
Exert force on the CeraLock ® plateau and
press the BIOLOX ® forte ceramic insert home
into the shell.
The instrument will have now released the
BIOLOX ® forte insert. Remove the CeraLock ®
insertion aid and dispose of it. It is intended
for single usage only and must not be resterilized.
The correct position of the insert in the metal
shell must be checked. Using the tip of the
fingers, touch the 2 front faces of the insert
and metal shell. If the position of the insert
over its entire circumference is level to the
metal edge, then it is correctly positioned in
the shell.
14

Note
To ensure that the BIOLOX ® forte ceramic insert is inserted correctly, it is supplied with a
premounted CeraLock ® insertion aid.
If the patients anatomy does not allow or limit the use of the CeraLock ® to a certain degree,
the ceramic insert can be carefully placed in the cup by hand or with help of the Impactor
for Insert Octoplus (1150126) and pressed home.
Prevention of fracture of a ceramic component
If a ceramic component damage is discovered intraoperatively or a damage is suspected for
good reasons, a ceramic insert must not be used. If already implanted, it must be removed.
A new ceramic inlay must only be used if the internal cone of the shell is free of damage.
Revision involving a broken ceramic insert
In case of acetabular cup revision in which a broken conically fixed ceramic insert is
removed a ceramic insert must not be used again. The cone of the cup may have been
damaged during the reoperation and would then no longer satisfy the requirements
placed on plug connections for conically fixed ceramic inserts. The risk of a fracture is
above average.
A polyethylene insert should be used as an alternative.
Revision of a broken ceramic femoral head
On a femoral prosthesis left in situ after revision of a ceramic femoral head, Smith&Nephew
Orthopaedics recommends the use of a BIOLOX ® OPTION (material: BIOLOX ® delta) femoral
head with metal sleeve (material: TiAl6V4) to be inserted. The BIOLOX ® OPTION system can
be used with any acetabular insert of the BIOLOX ® family as well as with Smith&Nephew
Orthopaedics Polyethylen/Rexpol inserts.
If both components (ball head and insert) are made of ceramic, in case of revision following
a fracture of one of the two components both the insert and the ball head have to be
replaced.
15

Use of the PLUSMET metal insert
Indications and contraindications
Basically the same indications, contraindications and recommendations applying for THR
with other articulating surfaces, also apply for PLUSMET metal inserts.
The following additional contraindications have to be considered for metal inserts:
• Patients with chronic renal failure, renal insufficiency or on dialysis.
• Patients with known allergies of any kind or occupational exposure to cobalt,
Chrome or molybdenum.
• If angle of inclination is below 30º or above 50º, the PLUSMET metal insert
must not be used.
• If angle of anteversion underruns 10º or exeeds 20º, the PLUSMET metal insert must not
be used. Smith&Nephew Orthopaedics standard and hooded PE inserts are available
for such cases.
• If a stable reduction cannot be achieved.
• If cup is positioned in a retroversion mode.
Risk of impingement should at all times be avoided.
Implantation
A trial insert should be used before a metal insert is implanted. Trial heads of the intended
diameter must then be used to ensure an adequate range of motion (ROM) in all directions
of movement and to check the stability of the joint. The artificial joint must not dislocate in the
course of movement or subluxate through impingement of the implant components or soft
tissue. Pressure of the neck of the prosthesis at the edge of the metal insert may cause point
loads that increase the risk of abrasion.
The alignment guide (130728) should always be used with PLUSMET metal inserts in order to
obtain the necessary level of accuracy.
It is advisable to use computer-assisted navigation systems intraoperatively for documentation
and verification of the implant position, and to get exact information on the ROM.
16

Placement of the metal insert (ME)
Proceed with the trial insert as described in
“Optionally: trial reduction using trial insert”.
Before insertion it must be ensured that the
internal surface of the metal shell is dry and
free of any contamination.
Screw the adapter for ME-inserts (130989–
130993) and the impactor head onto the
inserter/impactor.
Attach the implant onto the adapter.
Place the 3 arms of the adapter on the front
face of the metal shell so that the PLUSMET
metal insert is not tilting.
Insert it into the shell by gently hitting the
inserter/impactor.
Note
To impact the metal/insert only the above
described adapter respectively inserter/
impactor must be used.
17

Revision of the metal/ceramic insert
Screw the extraction instrument for metal/
ceramic inserts onto the inserter/impactor
(130818).
Position the extraction instrument on the
edge of the metal/ceramic insert with care.
Fit the 3 tips into the lateral recess in the
shell – they are correctly positioned when
lateral torsion is not possible.
Release the metal/ceramic insert by impaction
of the inserter/impactor and remove it.
Postoperative Treatment
The treatment of the patient after surgery will depend on several factors (in particular the
surgical approach, the stem prosthesis used and any attendant diseases). If the patient has
a good bone quality and the primary implantation of both prosthesic components is stable,
then it is recommended that the patient use walking aids for 6–12 weeks after surgery.
However, the exact degree of walking assistance required will have to be decided by the
physician for each individual patient.
Sterilization
Implants
All the implants described in this Surgical Technique are sterile when they are delivered by
the manufacturer. Resterilization is not allowed.
Instruments
System components and instruments are not sterile when they are delivered. Before use they
must be cleaned by the usual methods in accordance with internal hospital regulations and
sterilized in an autoclave in accordance with the legal regulations and guidelines applicable
in the relevant country. (For detailed information please refer to leaflet Lit. No. 1363.)
The correct settings are given in the instructions for use issued by the autoclave manufacturer.
Instrument manufacturers and dealers accept no responsibility for sterilization of products
by the customer.
18

References
Zwartelé RE, Brand R, Doets HC
Increased risk of dislocation after primary total hip arthroplasty in inflammatory arthritis –
prospective observational study of 410 hips.
Acta Orthop Scand, 2004; 12
Adler E, Stuchin A, Kummer FJ
Stability of Press-Fit acetabular cup.
J Arthroplasty, 1992; 7:295–301
Doets HC, Olsthoorn PGM, Schmotzer H
Medium-term results with the Enhanced Press-Fit Cup in osteoarthrosis, rheumatoid arthritis
and revision arthroplasty, 2003.
Engh CA, Griffin WL, Marx CL
Cementless acetabular components.
J Bone Joint Surg (Br) 1990; 72B:53–59
Lachiewicz PF, Suh PB, Gilbert JA
In vitro initial fixation of porous-coated acetabular total hip components. A biomechanical
comparative study.
J Arthroplasty, 1989; 4:201–205
Lintner F, Zweymüller K, Brand G
Tissue reactions to titanium endoprostheses.
J Arthroplasty, 1986; Vol. 1, No. 3:183–95
McKenzie JR, Callaghan JJ, Pedersen P, Brown TD
Areas of contact and extent of gaps with implantation of oversized acetabular components
in Total Hip Arthroplasty.
Clin Orthop, 1984; 208:127–136
Snorrason F, Kärrholm PJ
Migration of fully threaded acetabular components.
A roentgen stereo-photogrammetic analysis.
J Bone Joint Surg, 1990; 72B:647–652
19

Implants
Shells
Shell Ti-plasma,
without screw holes
Art. No. Art. No.
PO S&N Size
15300 75003886 40
15301 75003887 42
15302 75003888 44
15303 75003889 46
15304 75003890 48
15305 75003891 50
15306 75003892 52
15307 75003893 54
15308 75003894 56
15309 75003895 58
15310 75003896 60
15311 75003897 62
Shell Ti-plasma with
hydroxyapatite coating,
without screw holes
Art. No. Art. No.
PO S&N Size
15340 75003913 40
15341 75003914 42
15342 75003915 44
15343 75003916 46
15344 75003917 48
15345 75003918 50
15346 75003919 52
15347 75003920 54
15348 75003921 56
15349 75003922 58
15350 75003923 60
15351 75003924 62
Shell Ti-plasma,
with screw holes
Art. No. Art. No. No. of
PO S&N Size holes
15320 75003898 40 2
15321 75003899 42 2
15322 75003900 44 2
15323 75003901 46 2
15324 75003902 48 2
15325 75003903 50 2
15326 75003904 52 2
15327 75003905 54 2
15328 75003906 56 3
15329 75003907 58 3
15330 75003908 60 3
15531 75003909 62 3
15532 75003910 64 3
15333 75003911 66 3
15334 75003912 68 3
Shell Ti-plasma with
hydroxyapatite coating,
with screw holes
Art. No. Art. No. No. of
PO S&N Size holes
15360 75003925 40 2
15361 75003926 42 2
15362 75003927 44 2
15363 75003928 46 2
15364 75003929 48 2
15365 75003930 50 2
15366 75003931 52 2
15367 75003932 54 2
15368 75003933 56 3
15369 75003934 58 3
15370 75003935 60 3
15571 75003936 62 3
15572 75003937 64 3
15373 75003938 66 3
15374 75003939 68 3
20

Shell Ti-plasma, multihole
Art.No. Art. No. Size No. of
PO S&N holes
15410 75003944 56 6
15411 75003945 58 6
15412 75003946 60 6
15413 75003947 62 6
15414 75003948 64 6
15415 75003949 66 6
15416 75003950 68 6
21

Inserts
Note
All cup inserts must only be used in combination with the acetabular cup systems approved
by Smith&Nephew Orthopaedics AG.
PE inserts, standard (1)
Art. No. Art. No.
S&N PO Ø Size
75003956 15462 22 mm 40–44
75003957 15463 22 mm 46
75003958 15464 22 mm 48
75003959 15465 22 mm 50
75003960 15470 28 mm 46
75003961 15471 28 mm 48
75003962 15472 28 mm 50–52
75003963 15473 28 mm 54–56
75003964 15474 28 mm 58–68
75003967 15481 32 mm 50–52
75003968 15482 32 mm 54–56
75003969 15483 32 mm 58–68
PE inserts, hooded, 15° (2)
Art. No. Art. No.
S&N PO Ø Size
75003970 15486 28 mm 46
75003971 15487 28 mm 48
75003972 15488 28 mm 50–52
75003973 15489 28 mm 54–56
75003976 15490 28 mm 58–68
75003977 15491 32 mm 50–52
75003978 15492 32 mm 54–56
75003979 15493 32 mm 58–68
(1)
(2)
REXPOL, standard (3)
Art. No. Art. No.
S&N PO Ø Size
75004001 15570 28 mm 46
75004002 15571 28 mm 48
75004003 15572 28 mm 50–52
75004004 15573 28 mm 54–56
75004005 15574 28 mm 58–68
75004006 15582 32 mm 50–52
75004007 15583 32 mm 54–56
75004008 15584 32 mm 58–68
75000131 11000310 36 mm 54–56
75000132 11000311 36 mm 58–68
REXPOL, hooded 15° (4)
Art. No. Art. No.
S&N PO Ø Size
75003983 15500 28 mm 46
75003984 15501 28 mm 48
75003985 15502 28 mm 50–52
75003986 15503 28 mm 54–56
75003987 15504 28 mm 58–68
75003989 15512 32 mm 50–52
75003990 15513 32 mm 54–56
75003991 15514 32 mm 58–68
(3)
(4)
22

Note
EP-FIT PLUS metal inserts must only be used with PLUSMET metal ball heads
for metal/metal pairings. Ball heads from other manufacturers must not be used.
Metal inserts, standard
Art. No. Art. No.
S&N PO Ø Size
75003856 15100 28 mm 46
75003857 15101 28 mm 48
75003858 15102 28 mm 50–52
75003859 15103 28 mm 54–56
75003860 15104 28 mm 58–68
Ceramic inserts, BIOLOX ® forte
Art. No. Art. No.
S&N PO Ø Size
75003865 15140 28 mm 46
75003866 15141 28 mm 48
75003867 15142 28 mm 50–52
75003868 15143 28 mm 54–56
75003869 15144 28 mm 58–68
75003870 15149 32 mm 46
75003872 15150 32 mm 48
75003873 15151 32 mm 50–52
75003874 15152 32 mm 54–56
75003875 15153 32 mm 58–68
75007454 66021 44/36 mm 50–52
75007455 66022 48/36 mm 54–56
75007456 66023 52/36 mm 58–68
Ceramic inserts, BIOLOX ® delta
Art. No. Art. No.
S&N PO Ø Size
75001964 11000191 39/32 mm 46
75001965 11000192 41/32 mm 48
75001966 11000193 44/32 mm 50–52
75001967 11000194 48/32 mm 54–56
75001968 11000195 52/32 mm 58–68
75007457 66024 44/36 mm 50–52
75007458 66025 48/36 mm 54–56
75007459 66026 52/36 mm 58–68
Note
Only a combination of BIOLOX ® forte/delta ball heads with cup inserts of BIOLOX ® forte/delta
is permitted. Any of the BIOLOX ® forte/delta family of ball heads may be used with any of
the ceramic inserts from the BIOLOX ® family, provided that the correct head/calotte diameter
is used. Other components that have not been approved by Smith&Nephew Orthopaedics
must not be used. Pairings with 32 mm ball heads or bigger generally improve the range of
motion and thus reduce the risk of impingement and subluxation.
23

Ball heads
Ceramic ball heads, BIOLOX ® forte
Art. No. Art. No.
S&N PO Ø Cone Neck length
75004169 16151 28 mm 12/14 S
75004170 16152 28 mm 12/14 M
75004171 16153 28 mm 12/14 L
75004172 16161 32 mm 12/14 S
75004173 16162 32 mm 12/14 M
75004174 16163 32 mm 12/14 L
75007441 66011 36 mm 12/14 S
75007442 66012 36 mm 12/14 M
75007446 66013 36 mm 12/14 L
Ceramic ball heads, BIOLOX ® delta
Art. No. Art. No.
S&N PO Ø Cone Neck length
75007451 66018 28 mm 12/14 S
75007452 66019 28 mm 12/14 M
75007453 66020 28 mm 12/14 L
75007460 66027 32 mm 12/14 S
75007461 66028 32 mm 12/14 M
75007462 66029 32 mm 12/14 L
75007463 66030 32 mm 12/14 XL
75007448 66015 36 mm 12/14 S
75007449 66016 36 mm 12/14 M
75007450 66017 36 mm 12/14 L
75007447 66014 36 mm 12/14 XL
Metal ball heads, PLUSMET
Art. No. Art. No.
S&N PO Ø Cone Neck length
75004181 16181 28 mm 12/14 S
75004182 16182 28 mm 12/14 M
75004183 16183 28 mm 12/14 L
75004184 16184 28 mm 12/14 XL
75004185 16185 28 mm 12/14 XXL
75011852 16186 28 mm 14/16 S
75011853 16187 28 mm 14/16 M
75011854 16188 28 mm 14/16 L
75011855 16189 28 mm 14/16 XL
75011856 16190 28 mm 14/16 XXL
24

Ceramic ball heads, BIOLOX ® OPTION (for revisions)
Art. No. Art. No.
S&N PO Ø Cone Neck length
75007727 CE3849717693581 28 mm 12/14 S
75007728 CE3849717693582 28 mm 12/14 M
75016564 CE3849717693583 28 mm 12/14 L
75007729 CE3849717693584 28 mm 12/14 XL
75007731 CE3849717694581 32 mm 12/14 S
75007732 CE3849717694582 32 mm 12/14 M
75016565 CE3849717694583 32 mm 12/14 L
75007733 CE3849717694584 32 mm 12/14 XL
75007735 CE3849717696581 36 mm 12/14 S
75007736 CE3849717696582 36 mm 12/14 M
75007738 CE3849717696585 36 mm 12/14 L
75007737 CE3849717696584 36 mm 12/14 XL
Note
Before the BIOLOX ® forte/delta/OPTION, PLUSMET ball head
is placed on the stem it must be ensured that the cone is free
of contaminating particles such as bone fragments, metal or
cement, and that it is not damaged.
Cancellous bone screws (sterile)
Art. No. Art. No.
S&N PO Description Ø Length
75005904 25281 Cancellous bone screw 6,5 mm 20 mm
75005905 25282 Cancellous bone screw 6,5 mm 25 mm
75005906 25283 Cancellous bone screw 6,5 mm 30 mm
75005910 25287 Cancellous bone screw 6,5 mm 35 mm
75005907 25284 Cancellous bone screw 6,5 mm 40 mm
75005911 25288 Cancellous bone screw 6,5 mm 45 mm
75005908 25285 Cancellous bone screw 6,5 mm 50 mm
75005912 25289 Cancellous bone screw 6,5 mm 55 mm
75005909 25286 Cancellous bone screw 6,5 mm 60 mm
CeraLock ® , BIOLOX ® forte, BIOLOX ® OPTION and BIOLOX ® delta are registered
trademarks of CeramTec AG, Germany.
25

Instrumentation
Case 1
1 A Basic Case: Instruments and trial shells
Art. No. Art. No.
S&N PO Description Size
75003499 130994 Basic Case I (without cover)
75003404 130999 Cover for EP-FIT PLUS case
75003344 130707 Shell Inserter, standard version
75003340 130705 Insertion/Extraction hammer
75003355 130728 Shell alignment guide, standard version
75003357 130731 Depth gauge for shell
75003359 130734 Trial shell 40
75003360 130735 Trial shell 42
75003344 130712 Trial shell 44
75003345 130713 Trial shell 46
75003346 130714 Trial shell 48
75003347 130715 Trial shell 50
75003348 130716 Trial shell 52
75003349 130717 Trial shell 54
75003350 130719 Trial shell 56
75003351 130720 Trial shell 58
75003352 130721 Trial shell 60
75003353 130723 Trial shell 62
75003354 130724 Trial shell 64
75003361 130736 Trial shell 66
75003362 130737 Trial shell 68
75003373 130820 Extraction instrument for metal/ceramic insert to 130818 46
75003363 130794 Extraction instrument for metal/ceramic insert to 130818 48
75003364 130795 Extraction instrument for metal/ceramic insert to 130818 50–52
75003365 130796 Extraction instrument for metal/ceramic insert to 130818 54–56
75003366 130797 Extraction instrument for metal/ceramic insert to 130818 58–68
26

27

1 B Tray: Reamer (2 mm increments) and inserter/impactor for PE inserts
Art. No. Art. No.
S&N PO Description Size
75003501 130996 Tray to Case 130994
75003405 130870 Drive shaft, with Synthes-coupling
75003406 130871 Reamer 40
75003408 130873 Reamer 42
75003410 130875 Reamer 44
75003412 130877 Reamer 46
75003414 130879 Reamer 48
75003416 130881 Reamer 50
75003418 130883 Reamer 52
75003420 130885 Reamer 54
75003422 130887 Reamer 56
75003424 130889 Reamer 58
75003426 130891 Reamer 60
75003428 130893 Reamer 62
75003430 130895 Reamer 64
75003432 130897 Reamer 66
75003434 130899 Reamer 68
75003374 130822 Impactor head 22
75003475 130823 Impactor head 28
75003476 130824 Impactor head 32
75003392 130848 Impactor head 36
75003372 130818 Inserter/Impactor
75003367 130802 Adapter for PE insert, standard, to 130818 40–44
75003368 130803 Adapter for PE insert, standard, to 130818 46–48
75003369 130804 Adapter for PE insert, standard, to 130818 50–68
75003370 130806 Adapter for PE insert, hooded, to 130818 46–48
75003371 130807 Adapter for PE insert, hooded, to 130818 50–68
28

29

Case 2
2 A Basic Case: Trial inserts
Art. No. Art. No.
S&N PO Description Ø Size
75003506 131001 Basic Case II (without cover)
75003504 130999 Cover for EP-FIT PLUS case
75003494 130989 Adapter for ME insert, standard, to 130818 46
75003495 130990 Adapter for ME insert, standard, to 130818 48
75003496 130991 Adapter for ME insert, standard, to 130818 50–52
75003497 130992 Adapter for ME insert, standard, to 130818 54–56
75003498 130993 Adapter for ME insert, standard, to 130818 58–68
75003377 130826 Trial insert, standard 22 mm 40–44
75003378 130827 Trial insert, standard 22 mm 46
75003379 130828 Trial insert, standard 22 mm 48
75003380 130829 Trial insert, standard 22 mm 50
75003381 130830 Trial insert, standard 28 mm 46
75003382 130831 Trial insert, standard 28 mm 48
75003383 130832 Trial insert, standard 28 mm 50–52
75003384 130833 Trial insert, standard 28 mm 54–56
75003385 130834 Trial insert, standard 28 mm 58–68
75003386 130835 Trial insert, standard 32 mm 46
75003387 130836 Trial insert, standard 32 mm 48
75003388 130837 Trial insert, standard 32 mm 50–52
75003389 130838 Trial insert, standard 32 mm 54–56
75003390 130839 Trial insert, standard 32 mm 58–68
75007443 660121 Trial insert, standard 36 mm 50–52
75007444 660122 Trial insert, standard 36 mm 54–56
75007445 660123 Trial insert, standard 36 mm 58–68
75003394 130850 Trial insert, hooded 28 mm 46
75003395 130851 Trial insert, hooded 28 mm 48
75003396 130852 Trial insert, hooded 28 mm 50–52
75003397 130853 Trial insert, hooded 28 mm 54–56
75003398 130854 Trial insert, hooded 28 mm 58–68
75003399 130855 Trial insert, hooded 32 mm 50–52
75003400 130856 Trial insert, hooded 32 mm 54–56
75003401 130857 Trial insert, hooded 32 mm 58–68
30

31

2 B Tray: Bone screws and accessories
Art. No. Art. No.
S&N PO Description Ø Length
75003500 130995 Tray to Case 131001
75003282 130490 Flexible drill shaft for quick coupling
75003391 130847 Drill guide for screws 3,2 mm
75003342 130708 Depth gauge for screws
75003358 130732 Screw-holding forceps
75003343 130710 Screwdriver, hexagon W 3,5 mm
75003283 130492 Twist drill 3,2 mm 56 mm
75003284 130493 Twist drill 3,2 mm 70 mm
75003285 130496 Cardan screwdriver, hexagon W 3,5 mm
75003507 131002 Container for cancellous bone screws to tray 130995
32

33

Case 3
3 A Basic Case: Instruments and trial shells (identical to 1A)
Art. No. Art. No.
S&N PO Description Size
75003505 131000 Basic Case III (without cover)
75003539 130999 Cover for EP-FIT PLUS case
75013965 130707 Shell inserter, standard version
75013965 130705 Insertion/Extraction hammer
75013967 130728 Shell alignment guide, standard version
75013968 130731 Depth gauge for shell
75013968 130734 Trial shell 40
75013968 130735 Trial shell 42
75013966 130712 Trial shell 44
75013966 130713 Trial shell 46
75013966 130714 Trial shell 48
75013966 130715 Trial shell 50
75013966 130716 Trial shell 52
75013966 130717 Trial shell 54
75013966 130719 Trial shell 56
75013967 130720 Trial shell 58
75013967 130721 Trial shell 60
75013967 130723 Trial shell 62
75013967 130724 Trial shell 64
75013968 130736 Trial shell 66
75013968 130737 Trial shell 68
75013975 130820 Extraction instrument for metal/ceramic insert, to 130818 46
75003537 130794 Extraction instrument for metal/ceramic insert, to 130818 48
75003537 130795 Extraction instrument for metal/ceramic insert, to 130818 50–52
75003537 130796 Extraction instrument for metal/ceramic insert, to 130818 54–56
75003537 130797 Extraction instrument for metal/ceramic insert, to 130818 58–68
34

35

3 B Tray: Reamer (1 mm increments) sizes 40–43 and 66–69
Art. No. Art. No.
S&N PO Description Size
75003503 130998 Tray to Case 131000
75003493 130987 Shell Inserter
75003481 130975 Adapter, to 130987 40–44
75003482 130976 Adapter, to 130987 46
75003483 130977 Adapter, to 130987 48
75003484 130978 Adapter, to 130987 50–52
75003485 130979 Adapter, to 130987 54–56
75003486 130980 Adapter, to 130987 58–68
75003432 130897 Reamer 66
75003433 130898 Reamer 67
75003434 130899 Reamer 68
75003435 130900 Reamer 69
75003406 130871 Reamer 40
75003407 130872 Reamer 41
75003408 130873 Reamer 42
75003409 130874 Reamer 43
75003374 130822 Impactor head 22
75003375 130823 Impactor head 28
75003376 130824 Impactor head 32
75003392 130848 Impactor head 36
75003367 130802 Adapter for PE insert, standard, to 130818 40–44
75003368 130803 Adapter for PE insert, standard, to 130818 46–48
75003369 130804 Adapter for PE insert, standard, to 130818 50–68
75003370 130806 Adapter for PE insert, hooded, to 130818 46–48
75003371 130807 Adapter for PE insert, hooded, to 130818 50–68
75003372 130818 Inserter/Impactor
75003402 130858 Shell alignment guide (US version)
36

37

3 C Tray: Reamer (1 mm increments) sizes 44–45
Art. No. Art. No.
S&N PO Description Size
75003502 130997 Tray to Case 131000
75003405 130870 Drive shaft
75003410 130875 Reamer 44
75003411 130876 Reamer 45
75003412 130877 Reamer 46
75003413 130878 Reamer 47
75003414 130879 Reamer 48
75003415 130880 Reamer 49
75003416 130881 Reamer 50
75003417 130882 Reamer 51
75003418 130883 Reamer 52
75003419 130884 Reamer 53
75003420 130885 Reamer 54
75003421 130886 Reamer 55
75003422 130887 Reamer 56
75003423 130888 Reamer 57
75003424 130889 Reamer 58
75003425 130890 Reamer 59
75003426 130891 Reamer 60
75003427 130892 Reamer 61
75003428 130893 Reamer 62
75003429 130894 Reamer 63
75003430 130895 Reamer 64
75003431 130896 Reamer 65
Note
Case 1 may be replaced by case 3 if a reamer with 1 mm increments is required.
38

39

40
Notes

Manufacturer
Smith & Nephew Orthopaedics AG For further information please contact
Erlenstrasse 4a
our local sales office.
6343 Rotkreuz www.smith-nephew.com
Switzerland
Trademark of Smith & Nephew Lit. No. 1258-e Ed. 11/07 EU 300 Ex. 04/08 300 Ex. 11/07 0123