Surgical Technique

CPCS™ Collarless Polished Cemented Stem

Surgical technique completed

in conjunction with

James B. Benjamin, MD
Clinical Associate Professor of Surgery
Department of Orthopaedic Surgery
University of Arizona College of Medicine
Tucson, Arizona, USA

Knute Buehler, MD
Chief of Arthritis and Joint Replacement Surgery
Orthopaedic and Neurosurgery Center of the Cascades
St. Charles Medical Center
Bend, Oregon, USA

Kevin L. Garvin, MD
Professor of Orthopaedic Surgery
University of Nebraska Medical Center
Omaha, Nebraska, USA

James C. Kudrna, MD, PhD

Illinois Bone and Joint Institute LTD
Chicago, Illinois, USA

Stephen McMahon, MB MS, FRACS, FA (Orth.)

Consultant Orthopaedic Surgeon
Monash Medical Centre
Melbourne, Australia

Lars Weidenhielm, MD, PhD

Associate Professor and Senior Consultant
Department of Orthopaedics
Karolinska Hospital
Stockholm, Sweden

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.

2
Stem Specifications

Specifications Neck Height mm

Neck Distal Cross Stem A-P M-L When Femoral Head Component Selected Is:
Size Angle Section Length Width Width Size –3 +0 +4 +8 +12 +16
0, 0H 131°/125° 4.5mm 120mm 11mm 26mm
0 23 25 27 30 33 35
1, 1H 131°/125° 4.5mm 135mm 12mm 26mm
0H 23 25 27 30 32 34
2, 2H 131°/125° 4.5mm 135mm 13mm 28mm
1 24 26 28 31 34 36
3, 3H 131°/125° 4.5mm 135mm 15mm 30mm
1H 24 26 28 31 33 35
4, 4H 131°/125° 4.5mm 135mm 16mm 32mm
5, 5H 131°/125° 4.5mm 135mm 17mm 34mm 2 26 28 30 33 36 38
2H 26 28 30 33 35 37
3 28 30 32 35 37 40
3H 28 30 32 35 37 39
4 30 32 34 37 39 42
4H 30 32 34 36 39 41
5 32 34 36 39 41 44
5H 32 34 36 39 41 43

Neck Offset mm Neck Length mm

When Femoral Head Component Selected Is: When Femoral Head Component Selected Is:
Size –3 +0 +4 +8 +12 +16 Size –3 +0 +4 +8 +12 +16
0 31 33 36 39 42 45 0 25 28 32 36 40 44
0H 35 37 40 44 47 50 0H 29 32 36 40 44 48
1 32 35 38 41 44 47 1 27 30 34 38 42 46
1H 39 41 44 48 51 54 1H 32 35 39 43 47 51
2 34 36 39 42 45 48 2 29 32 36 40 44 48
2H 42 44 47 51 54 57 2H 35 38 41 45 49 53
3 35 38 41 44 47 50 3 31 34 38 42 46 50
3H 46 48 51 55 58 61 3H 39 42 46 50 54 58
4 37 39 42 45 48 51 4 33 36 40 44 48 52
4H 46 49 52 56 59 62 4H 41 44 48 52 56 60
5 38 41 44 47 50 53 5 35 38 42 46 50 54
5H 49 51 54 58 61 64 5H 43 46 50 54 58 62

For use with Smith & Nephew 12/14 femoral heads only.

3
Preparation of the Acetabulum

HIGH OFFSET

STANDARD OFFSET A-P WIDTH

+16 *
+12 * M-L WIDTH
+ 8
+ 4
NE
CK
+ 0
L
NECK
–3 EN
GT
HEIGHT
H
0
10
20
NECK ANGLE
131º/125º 30
Standard Offset High Offset

Minimum Minimum
CEMENT CEMENT
STEM Cement Cement
MANTLE MANTLE
LENGTH Mantle Mantle
2.0 mm
2.0mm 1.5 mm
1.5mm
Not Actual Size

-3 and +16 CoCr femoral

heads available in 28mm and
32mm only.

* Denotes skirted head

NOTE: For illustration purposes
only. Surgical Templates are
available by contacting your
Smith & Nephew
Representative or Customer
DISTAL
Service. CROSS
SECTION

4
 Femoral Osteotomy

1. Femoral Osteotomy

The level of neck resection should be based on

preoperative templating. Place the template over
the X-ray of the hip. After determining the
appropriate size stem, determine the level of
femoral neck resection based on the lesser
trochanter as a landmark.
A graduation scale can be found on the medial
aspect of the stem on the template. This scale
corresponds to the marks on the osteotomy guide.
Make note of how many graduations above the
lesser trochanter the osteotomy will take place, as
determined by the middle depth mark on the Figure 1
medial aspect of the stem (also identified as the
zero mark on the graduation scale).
In the OR, place the osteotomy guide on the femur
by referencing the lesser trochanter at the same
graduation mark as noted during templating.
Osteotomize the neck (Figures 1 and 2).

2. Prepare Acetabulum

If acetabular reconstruction is required, prepare the

acetabulum using the technique for the intended
acetabular component.

Figure 2

5
 Femoral Canal Preparation

3. Femoral Canal Preparation

Open the medullary canal at the transected neck

using the box chisel. Stay posterior and lateral in
order to obtain a neutral stem position (Figure 3).
Identify and open the femoral canal using the blunt
medullary reamer (Figure 4).

Figure 3

Figure 5

Figure 4

The trochanteric reamer is

available to help ensure a
lateral start point and open
the metaphysis (Figure 5).

6
 Femoral Canal Preparation

4. Femoral Broaching

Assemble the broach to the broach handle by

placing the broach post in the clamp. Use the thumb
to lock the clamp onto the broach. A modular
anteversion handle can be assembled to the broach
handle to provide version control (Figure 6). Anteversion
Handle
Start the broaching procedure along the mid-axis of Figure 6 (optional)
the femur with the starter broach and progressively
broach to the appropriate femoral stem size. Seat the
final broach slightly below the level of the femoral
neck resection to facilitate calcar reaming if desired
(Figure 7).
The CPCS broach is designed to provide a minimum
Clamp
2.0mm cement mantle per side, medially and
laterally, and 1.5mm per side, anteriorly and
posteriorly. Additional cement mantle thickness is
achieved by pressurizing the cement into the
cancellous bone. The broach is 10mm longer than
the corresponding implant to accommodate the
distal centralizer.
Disassemble the broach from the broach handle by
placing two fingers (index and middle) in the
Figure 8
rectangular slot. Apply pressure to the release bar by
squeezing two fingers toward the thumb resting on
the medial side of the broach handle (Figure 8).

Figure 7

7
 Calcar Preparation & Trialing

5. Calcar Preparation (optional)

If the femoral neck resection is asymmetric, with

the broach fully seated, remove the broach
handle and ream the calcar.
Plane the calcar until it is level with the broach.

6. Trialing

Remove the calcar reamer and place the

matching standard or high offset trial neck (as
determined by templating) onto the broach post.
Select the trial femoral head of desired diameter
and length. Reduce the hip to assess stability
and to restore leg length. In some cases soft
tissue tension may be improved by using the
high offset trial neck instead of the standard
offset trial neck.
The CPCS hip system was designed to allow the
last broach seated in the femur to dictate the
size implant to be used.

Femoral Head And Neck Length Options

Trial
Color 22mm 26mm 28mm 32mm
Green — — –3 –3
Yellow +0 +0 +0 +0
Red +4 +4 +4 +4
White +8 +8 +8 +8
Blue +12* +12* +12* +12*
Black — — +16* +16*
*Denotes skirted heads.

8
 Sizing the Femoral Canal

7. Sizing the Femoral Canal

Attach the broach handle to the broach and remove

the broach from the femoral canal.
Using femoral canal sounds, determine the canal
diameter to select the appropriately sized distal
centralizer and cement restictor (Figure 9).
A distal centralizer, ensures neutral stem alignment,
and, if necessary, allows for slight subsidence of the
stem by preventing the stem from becoming end-
bearing in the cement. Neutral stem alignment
provides a minimum 2.0mm cement mantle per side,
medially and laterally, and 1.5mm cement mantle per
side, anteriorly and posteriorly. Additional cement
mantle thickness can be
achieved by cement pressurization and the ensuing
cement interdigitation.
Centralizers in 2mm increments are available in sizes
8-18mm. Any size centralizer fits on any size stem.

Figure 9

9
 Placing the BUCK™ Cement Restrictor

8. Placing the BUCK Cement Restrictor

The proximal flange of the cement restrictor

should always be larger than the distal canal
diameter. Accurate cement restrictor depth
placement is then determined by placing the
CPCS stem (with attached centralizer) next to the
inserter tool and adding 20mm to the length (see
chart below).
Thread the cement restrictor onto the inserter
using a clockwise motion. Insert the device to
the level of the medullary canal that has been
predetermined. Once this level is reached,
disengage the restrictor from the inserter using a
counterclockwise twisting motion. Remove the
inserter from the medullary canal. If it is
necessary to remove the restrictor prior to
cement insertion, it can be reattached to the
inserter rod and pulled out of the canal. The
surgeon may adjust the restrictor as many times
as required.

Size Depth
0 140mm
1 160mm
2 160mm
3 160mm
4 160mm
5 160mm

BUCK Plug Size Canal Size Catalog Number

18.5mm <15mm 129418
25mm 16-21mm 129419
30mm 22-26mm 7127-9420
35mm 27-31mm 7127-9421

10
 Preparing the Femoral Canal

9. Preparing The Femoral Canal

Irrigate the canal with saline solution and pulsatile

lavage to remove all debris. Continue preparing the
femur with the femoral canal brush to remove any
remaining weak cancellous bone, blood clots, and
marrow fats. Repeat lavaging as necessary to
remove all remaining debris.

10. Drying The Femoral Canal

Insert the canal suction absorber into the femoral

canal to dry the canal while mixing the cement.

11
 Reconstruction Ring Surgical Technique

11. Loading Cement

Load VERSABOND™ bone cement into the VORTEX™

vacuum mixer.

12. Mixing

Mix the cement according to manufacturer’s

instructions. Turn handle clockwise to achieve
optimal homogenous mixture.

13. Injecting Cement

Remove the femoral canal suction absorber and use

pulsatile lavage and dry. The cement should be
introduced promptly to minimize bleeding into the
canal. Insert the nozzle of the cement gun to the top
of the Buck cement restrictor and inject cement into
the canal in retrograde fashion. Continue injecting
cement until the canal is completely full and the distal
tip of the nozzle is clear of the canal.

12
 Pressurizing Cement

14. Pressurizing Cement

Break off the long nozzle and place the femoral

pressurizer over the short nozzle. Apply the
disposable femoral pressurizer into the mouth of the
canal. This will occlude the canal and compress the
cement. Maintain firm pressure until the cement is
in a doughy state and can withstand displacement
and will allow for proper cement interdigitation into
trabecular bone. Withdraw the femoral pressurizer
and remove any extruded cement around the
periphery of the canal.

13
 Stem Insertion

15. Stem Insertion

Using clean gloves, place the distal centralizer over

the distal tip of the stem by carefully pushing the
centralizer superiorly until snug.
Attach the CPCS stem driver handle to the
stem driver. The handle can be attached in
two positions, horizontal or vertical depending
on surgeon preference (Figure 10). A button must to Figure 10
be pushed at the end of the handle to either
engage or disengage the handle.
Insert the selected femoral stem into the canal by
fitting the tip of the locking stem driver into the
stem driving platform (Figure 11). The circular disc
on the stem driver must be pulled superiorly to
engage the tip of the stem driver to the stem
driving platform.
While pushing the stem into the canal, place
the thumb medial to the stem in order to pressurize
Figure 11
the cement and ensure correct alignment (Figure
12). Advance the stem approximately 1cm per
second to avoid air inclusions in the stem/cement
interface. The stem should be inserted to the
appropriate medial depth mark as determined
during trial reduction and templating.
Trim away excess cement with Concise cement
sculps. Carefully remove the stem driver by pulling
the circular disc on the stem driver superiorly.
Maintain steady pressure with the thumb on the
neck taper until the cement is polymerized.

Figure 12

14
 Final Trial Reduction

16. Final Trial Reduction

A final trial reduction may be performed at this time

using trial femoral heads.

17. Femoral Head Assembly

Clean and dry the neck taper with a clean cloth.

Place the prosthetic femoral head on the neck taper
and firmly impact with a head impactor and a mallet.

Indentions to indicate
Stainless Steel
NOTE: Care should be taken not to use Cobalt-
Chromium heads on stainless steel stems. To
distinguish the material, the stainless steel
femoral heads have an indention at their taper
opening, while the stainless steel stems have
an indention in the middle of the taper.

15
Catalog Information - Femoral Stem & Head Components

CPCS™
Primary Standard Offset Stems
Forged Cobalt Chromium – ASTM F 799
Stem Implant Broach/Trial Trial Neck
Size Length Cat. No. Cat. No. Cat. No.
0 120mm 7131-2360 7136-3499 7136-2700
1 135mm 7131-2361 7136-3501 7136-2701
2 135mm 7131-2362 7136-3502 7136-2701
3 135mm 7131-2363 7136-3503 7136-2702
4 135mm 7131-2364 7136-3504 7136-2702
5 135mm 7131-2365 7136-3505 7136-2702

CPCS
Primary Standard Offset Stems
Stainless Steel – ASTM F 1586
Stem Implant Broach/Trial Trial Neck
Size Length Cat. No. Cat. No. Cat. No.
0 120mm 7131-2380 7136-3499 7136-2700
1 135mm 7131-2381 7136-3501 7136-2701
2 135mm 7131-2382 7136-3502 7136-2701
3 135mm 7131-2383 7136-3503 7136-2702
4 135mm 7131-2384 7136-3504 7136-2702
5 135mm 7131-2385 7136-3505 7136-2702

CPCS
Primary High Offset Stems
Forged Cobalt Chromium – ASTM F 799
Stem Implant Broach/Trial Trial Neck
Size Length Cat. No. Cat. No. Cat. No.
0 120mm 7131-2370 7136-3499 7136-2703
1H 135mm 7131-2371 7136-3501 7136-2704
2H 135mm 7131-2372 7136-3502 7136-2704
3H 135mm 7131-2373 7136-3503 7136-2705
4H 135mm 7131-2374 7136-3504 7136-2705
5H 135mm 7131-2375 7136-3505 7136-2705

CPCS
Primary High Offset Stems
Stainless Steel – ASTM F 1586
Stem Implant Broach/Trial Trial Neck
Size Length Cat. No. Cat. No. Cat. No.
0 120mm 7131-2390 7136-3499 7136-2703
1H 135mm 7131-2391 7136-3501 7136-2704
2H 135mm 7131-2392 7136-3502 7136-2704
3H 135mm 7131-2393 7136-3503 7136-2705
4H 135mm 7131-2394 7136-3504 7136-2705
5H 135mm 7131-2395 7136-3505 7136-2705

16
Catalog Information - Femoral Stem & Head Components

CoCr 12/14 SST 12/14

Femoral Heads Femoral Heads
Cobalt Chromium – ASTM F 799 Stainless Steel – ASTM F 1586
Neck Neck
Length 22mm 26mm Length 22mm 26mm
-3 — — -3 — —
+0 7130-2200 7130-2600 +0 7129-2200 7129-2600
+4 7130-2204 7130-2604 +4 7129-2204 7129-2604
+8 7130-2208 7130-2608 +8 7129-2208 7129-2608
+12 7130-2212 7130-2612 +12 7129-2212 7129-2612
+16 — — +16 — —

Neck Neck
Length 28mm 32mm Length 28mm 32mm
-3 7130-2803 7130-3203 -3 7129-2803 7129-3203
+0 7130-2800 7130-3200 +0 7129-2800 7129-3200
+4 7130-2804 7130-3204 +4 7129-2804 7129-3204
+8 7130-2808 7130-3208 +8 7129-2808 7129-3208
+12 7130-2812 7130-3212 +12 7129-2812 7129-3212
+16 7130-2816 7130-3216 +16 7129-2816 7129-3216

CPCS Distal Centralizers

Cat. No. OD
7131-2400 0mm
7131-2408 8mm
7131-2410 1mm
7131-2412 12mm
7131-2414 14mm
7131-2416 16mm
7131-2418 18mm

17
Catalog Information - Instrumentation

Trial 12/14 Taper Femoral Heads

Neck Color
Length Code 22mm *26mm *28mm 32mm
–3 Green — — 7135-2803 7135-3203
+0 Yellow 7135-2200 7135-2600 7135-2800 7135-3200
+4 Red 7135-2204 7135-2604 7135-2804 7135-3204
+8 White 7135-2208 7135-2608 7135-2808 7135-3208
+12 Blue 7135-2212 7135-2612 7135-2812 7135-3212
+16 Black — — 7135-2816 7135-3216
*Space allowed for 26 mm and 28 mm heads in instrument tray.

CPCS™ Trial Necks

Primary Primary
Standard Offset High Offset
Size Cat. No. Size Cat. No.
0 7136-2700 0H 7136-2703
1,2 7136-2701 1H,2H 7136-2704
3,4,5 7136-2702 3H,4H,5H 7136-2705

Osteotomy Guide
Cat. No. Size
7136-4000 Sizes 0–5

Broach Handle
Cat. No. 7136-4007

Box Chisel
Cat. No. Size
7136-4002 Small

Anteversion Handle
Cat. No. 7136-4012

Trochanteric Reamer
Cat. No. 7136-4015

Femoral Head Impactor

Cat. No. 7136-4009

Blunt Medullary Reamer

Cat. No. 11-9657

18
Catalog Information - Instrumentation

Femoral Sounds
Cat. No. Size
7136-3508 8-9mm
7136-3510 10-11mm
7136-3512 12-13mm
7136-3514 14-15mm
7136-3516 16-17mm
7136-3518 18-19mm

Broaches/Trials
Cat. No. Size
7136-3499 Starter
7136-3500 Size 0
7136-3501 Size 1
7136-3502 Size 2
7136-3503 Size 3
7136-3504 Size 4
7136-3505 Size 5

CPCS™ Inserter Handle

Cat. No. 7136-2630

CPCS Femoral Stem Driver

Cat. No. 7136-2631

Calcar Reamers
Cat. No. Size
7136-4004 Small
7136-4005 Large

CPCS Primary Instrument Tray

Cat. No. 7136-3528

Small Exterior Carrying Case

Not Shown
Cat. No. 7112-9401

Lid for Exterior Carrying Case

Not Shown
Cat. No. 7112-9402

Femoral Sound Tray

Not Shown
Cat. No. 7136-3529

19
Catalog Information - Cement & Accessories

PREP-IM™ Kit
Cat. No. 12-1000
Kit contains the following:
Cat. No. Description
12-9418 BUCK™ Cement Restrictor, 18.5mm
12-9419 BUCK Cement Restrictor, 25mm
11-0003 Femoral Canal Brush, 19mm
11-1000 Concise Cement Sculps Kit
11-0037 Femoral Canal Suction Absorber, 19mm
— Disposable Cement Restrictor Tool
(Available in kit only)

Vent Opening Tool

Cat. No. 11-0028

BUCK Cement Restrictor

Cat. No. Size
12-9418 18.5mm
12-9419 25mm
7127-9420 30mm
7127-9421 35mm

Concise Cement Sculps Kit

Cat. No. 11-1000
(one of each)

Femoral Canal Suction Absorber

Cat. No. Size
11-0037 19mm
11-0038 25mm

20
Catalog Information - Cement & Accessories

Femoral Pressurizers
Cat. No. Size
7127-0026 Small
7127-0027 Medium
7127-0028 Large

BUCK Femoral Cement

Restrictor Inserter
Cat. No. 11-2428

Femoral Canal Brush

Cat. No. OD
11-0003 19mm
11-0033 12.5mm

MIXOR™ Vacuum Mixing

System with Syringe
Cat. No. 7127-0020

Femoral Cement Compressor

Cat. No. 11-1434

21
Catalog Information - Cement & Accessories

Disposable Femoral Cement

Compressor Cap
Cat. No. 11-1435

MIXOR™ Pump and Hose Kit

Cat. No. 7127-0040

MIXOR Hose Only

(not shown)
Cat. No. 7127-0041

MIXOR Pump Only

(not shown)
Cat. No. 7127-0042

Injector Gun
Cat. No. 7127-2000

VORTEX™ Vacuum Mixer

Cat. No. 7127-0070

VERSABOND™
Cat. No. 7127-1140

VERSABOND Sample
Cat. No. 7127-0094

22
Catalog Information - Cement & Accessories

Connector, Schraeder
Cat. No. 7127-0050

Connector, Drager
Cat. No. 7127-0051

Connector, DISS
Cat. No. 7127-0052

Handpiece with Zimmer Coupling

Cat. No. 7127-7000

Powerhose with Zimmer Coupling

Cat. No. 7127-7001

Hip and Knee without suction

Cat. No. 7127-7004

Hip and Knee without Suction

Cat. No. 7127-7005

23
Orthopaedic Reconstruction
Smith & Nephew, Inc. www.smith-nephew.com
1450 Brooks Road
Memphis, TN 38116
USA

Telephone: 1-901-396-2121
Information: 1-800-821-5700
Orders/Inquiries: 1-800-238-7538

™Trademark of Smith & Nephew. Certain marks Reg. US Pat & TM Off. 45720101-1 7138-0787 5/07