Stryker Orthopaedics Hip Systems Labeling Update

ADM/MDM X3 Inserts, MDM Acetabular Inserts, MDM Acetabular Liners

The indications for use for total hip arthroplasty include:

1. Noninflammatory degenerative joint disease including osteoarthritis and avascular necrosis;

2. Rheumatoid arthritis;

3. Correction of functional deformity;

4. Revision procedures where other treatments or devices have failed; and,

5. Treatment of nonunion, femoral neck and trochanteric fractures of the proximal femur with head involvement that are unmanageable using other techniques.

6. Dislocation risks

MDM Liners are intended for cementless use only.

Universal Cement Restrictor, OmniFit Distal Cement Spacer

For cement spacers, mid-shaft restrictors and Cement Plugs:

» In cemented hip arthroplasty, when the cement spacer, restrictor and/or plug is thought to be advantageous.

Artisan Bone Plug

These bone plugs are intended to be placed in the femoral canal prior to the introduction of bone cement in a cemented hip procedure. The plug is placed distally to the femoral stem to help allow cement pressurization and to help prevent cement migration further down the femoral canal.

Trident® II Acetabular System (Trident II Cups (Clusterhole HA, PLS Clusterhold HA, Tritanium Clusterhole, Tritanium Multihole, Tritanium Solidback), 6.5mm Low Profile Hex Screw, Hex Dome Hole Plug)

» Painful, disabling joint disease of the hip resulting from: degenerative arthritis, rheumatoid arthritis, post-traumatic arthritis or late stage avascular necrosis.

* Revision of previous unsuccessful femoral head replacement, cup arthroplasty or other procedure.

* Clinical management problems where arthrodesis or alternative reconstructive techniques are less likely to achieve satisfactory results.

» Where bone stock is of poor quality or is inadequate for other reconstructive techniques as indicated by deficiencies of the acetabulum.

When used with MDM Liners

* Treatment of nonunion, femoral neck and trochanteric fractures of the proximal femur with head involvement that are unmanageable using other techniques.

* Dislocation risks

When used with Constrained Liner:

* The Trident Constrained Acetabular Insert is indicated for use in primary and revision patients at high risk of hip dislocation due to a history of prior dislocation, bone loss, joint or soft tissue laxity, neuromuscular disease, or intraoperative instability.

The Trident® II Acetabular Shells are indicated for cementless use only.

Restoration® Modular Hip System

The Restoration® Modular Hip System is indicated for use in:

* Noninflammatory degenerative joint disease, including osteoarthritis and avascular necrosis;

* Rheumatoid arthritis

* Correction of functional deformity;

* Revisions procedure where other treatments or devices have failed; and

* Nonunions, femoral neck fractures, and trochanteric fractures of the proximal femur with head involvement that are unmanageable using other techniques

Additional indications specific to the Restoration Modular Hip System

The Restoration® Modular Hip System is intended to be used for primary and revision total hip arthroplasty, as well as in the presence of severe proximal bone loss. These femoral stems are designed to be press fit into the proximal femur.

Accolade II Femoral Stems, Anato Femoral Stem, Secur-Fit Advanced

The indications for use for total hip arthroplasty with stems include:

» noninflammatory degenerative joint disease, including osteoarthritis and avascular necrosis;

» rheumatoid arthritis;

» correction of functional deformity;

* revision procedures where other treatments or devices have failed; and,

* nonunions, femoral neck fractures, and trochanteric fractures of the proximal femur with head involvement that are unmanageable using other techniques.

Additional indication specific to use of the Femoral Stem with compatible Howmedica Osteonics Constrained Liners:

» When the stem is to be used with compatible Howmedica Osteonics Constrained Liners, the device is intended for use in primary or revision patients at high risk of hip dislocation due to a history of prior dislocation, bone loss, soft tissue laxity, neuromuscular disease, or intra-operative instability.

The Stems are intended for cementless use only and are intended for total and hemiarthroplasty.

TRIDENT AND TRITANIUM® ACETABULAR COMPONENTS

» Painful, disabling joint disease of the hip resulting from: degenerative arthritis, rheumatoid arthritis, post-traumatic arthritis or late stage avascular necrosis.

* Revision of previous unsuccessful femoral head replacement, cup arthroplasty or other procedure.

* Clinical management problems where arthrodesis or alternative reconstructive techniques are less likely to achieve satisfactory results.

» Where bone stock is of poor quality or is inadequate for other reconstructive techniques as indicated by deficiencies of the acetabulum.

The HOWMEDICA OSTEONICS TRIDENT and TRITANIUM Acetabular Shells are intended for cementless use only.

Dome hole plug is indicated for cemented or cementless hip arthroplasty, when an acetabular shell plug is thought to be advantageous

Acetabular Dome Hole Plug

The Dome Hole Plug is an optional device which is available to seal the Howmedica Osteonics Acetabular Shell components during cemented or cementless applications of the acetabular cup. The Howmedica Osteonics Done Hole Plug is threaded into the dome hole of the shell.

Indications

* In cemented or cementless hip arthroplasty, when an acetabular shell plug is thought to be advantageous.

DALL-MILES® SYSTEMS

The DALL-MILES System is indicated for reattachment of the trochanter in any hip procedure using the trochanteric osteotomy (total or partial) approach.

The DALL-MILES Mini Cleat is indicated for vertical reattachment or reinforcement of the trochanter in any situation where the surgeon feels that the trochanter is at risk for detachment.

The Mini Cleat is intended for use with the DALL-MILES System for trochanteric reattachment only.

The DALL-MILES Cables and Cable Sleeves are indicated for trochanteric reattachment and trauma surgery of the hip; to stabilize bone graft material; and for supplementary cerclage fixation with plates and screws for fracture fixation.

The DALL-MILES Trochanteric Grips and Grip Plates are indicated for use in the fixation of the greater trochanter due to trochanteric fracture or osteotomy with intramedullary fixation as the primary device.

The DALL-MILES Trochanteric Grip Plate is additionally indicated for use in the fixation of the greater trochanter due to extended trochanteric osteotomies.

Exeter® V40™ Hip System (includes Orthinox V40 Femoral heads)

The Exeter® V40™ Femoral Hip System is indicated for:

» noninflammatory degenerative joint disease, including osteoarthritis and avascular necrosis;

» rheumatoid arthritis;

» correction of functional deformity;

* revision procedures where other treatments or devices have failed; and,

» treatment of nonunion, femoral neck and trochanteric fractures of the proximal femur with head involvement that are unmanageable using other techniques.

The Exeter® V40™ Femoral Stem Hip System is intended for use in total or hemi hip replacement. It is intended for cemented use only.

Exeter Centralizer, EXETER Intramedullary Plug

1. noninflammatory degenerative joint disease including osteoarthritis and avascular necrosis;

2. rheumatoid arthritis;

3. correction of functional deformity;

4. revision procedures where other treatments or devices have failed; and,

5. treatment of nonunion, femoral neck and trochanteric fractures of the proximal femur with head involvement that are unmanageable using other techniques.

The Exeter Centralizer is intended to be used to centralize the femoral stem within the intramedullary canal. The Exeter Centralizer is intended to be used with bone cement.

The Exeter Intramedullary Bone Plug is intended to be used to restrict the migration of bone cement down the femoral canal and permit cement pressurization during total hip arthroplasty. The Exeter Intramedullary Bone Plug is intended to be used with bone cement.

Exeter X3 RimFit Cups

The indications for use for total hip arthroplasty include:

1. Painful, disabling joint disease of the hip resulting from: degenerative arthritis, rheumatoid arthritis, post-traumatic arthritis or late stage avascular necrosis.

2. Revision of previous unsuccessful femoral head replacement, cup arthroplasty or other procedure.

3. Clinical management problems where arthrodesis or alternative reconstructive techniques are less likely to achieve satisfactory results.

4. Where bone stock is of poor quality or inadequate for other reconstructive techniques, such as cementless fixation, as indicated by deficiencies of the acetabulum.

The EXETER X3 RimFit Cup is intended for cemented use only.

Restoration GAP II Acetabular Shell

Painful, disabling joint disease of the hip resulting from: degenerative arthritis, rheumatoid arthritis, post- traumatic arthritis or late stage avascular necrosis.

Revision of previous unsuccessful femoral head replacement, cup arthroplasty or other procedure.

Clinical management problems where arthrodesis or alternative reconstructive techniques are less likely to achieve satisfactory results.

Where bone stock is of poor quality or inadequate for other reconstructive techniques as indicated by deficiencies of the acetabulum.

Segmental and/or cavitary acetabular defects which make it difficult to restore normal hip biomechanics or to reconstitute the normal structural continuity and integrity of the acetabulum, using standard total hip replacement acetabular components and procedures.

Gap Screws, Torx Screws, and Osteolock Bone Screws

HOWMEDICA OSTEONICS Torx Cancellous Bone Screws are intended for supplemental fixation of associated HOWMEDICA OSTEONICS cementless Acetabular Shells.

* HOWMEDICA OSTEONICS RESTORATION GAP Plate Screws are intended for fixation of the dome and iliac plates of the associated HOWMEDICA OSTEONICS RESTORATION GAP Acetabular Shell, TRIDENT TRITANIUM Hemispherical Multihole Acetabular Shells, restoration Acetabular Augments, and Restoration Anatomic shells.

Insignia Hip Stem

Hip Arthroplasty Indications:

» Painful, disabling joint disease of the hip resulting from: noninflammatory degenerative joint disease (including osteoarthritis or avascular necrosis), rheumatoid arthritis or post-traumatic arthritis.

* Revision of previous unsuccessful femoral head replacement, hip arthroplasty or other procedure.

» Correction of functional deformity

* Treatment of nonunion, femoral neck and trochanteric fractures of the proximal femur with head involvement that are unmanageable using other techniques.

Additional indication specific to use of Insignia Hip Stems with compatible Howmedica Osteonics Constrained Liners:

» When the stem is to be used with compatible Howmedica Osteonics Constrained Liners, the device is intended for use in primary or revision patients at high risk of hip dislocation due to a history of prior dislocation, bone loss, soft tissue laxity, neuromuscular disease, or intra-operative instability.

Additional indication specific to use of Insignia Hip Stems with compatible ADM and MDM Acetabular Components:

» When the stem is to be used with compatible Howmedica Osteonics ADM and MDM Acetabular Components, the device is indicated for Dislocation risks

Insignia Femoral Stems are intended for cementless use only and are intended for total and hemiarthroplasty procedures.

Omnifit HFX Femoral Stems

For use as a Bipolar Hip Replacement:

* Femoral head/neck fractures or non-unions.

* Aseptic necrosis of the femoral head.

* Osteo-, rheumatoid, and post-traumatic arthritis of the hip with minimal acetabular involvement or distortion.

Other Considerations:

» Pathological conditions or age considerations which indicate a more conservative acetabular procedure and an avoidance of the use of bone cement in the acetabulum.

» Salvage of failed total hip arthroplasty.

* Femoral neck fractures.

For use as a Total Hip Replacement:

» Painful, disabling joint disease of the hip resulting from: degenerative arthritis, rheumatoid arthritis, post-traumatic arthritis or late stage avascular necrosis.

* Revision of previous unsuccessful femoral head replacement, cup arthroplasty or other procedure.

* Clinical management problems where arthrodesis or alternative reconstructive techniques are less likely to achieve satisfactory results.

* Clinical circumstances which require an altered femoral resection level due to a proximal fracture, bone loss or calcar lysis.

Omnifit EON Cemented Femoral Stems

For use as a Bipolar Hip Replacement:

* Femoral head/neck fractures or non-unions.

* Aseptic necrosis of the femoral head.

* Osteo-, rheumatoid, and post-traumatic arthritis of the hip with minimal acetabular involvement or distortion.

Other Considerations:

» Pathological conditions or age considerations which indicate a more conservative acetabular procedure and an avoidance of the use of bone cement in the acetabulum.

» Salvage of failed total hip arthroplasty.

For use as a Total Hip Replacement:

» Painful, disabling joint disease of the hip resulting from: degenerative arthritis, rheumatoid arthritis, post-traumatic arthritis or late stage avascular necrosis.

* Revision of previous unsuccessful femoral head replacement, cup arthroplasty or other procedure.

* Clinical management problems where arthrodesis or alternative reconstructive techniques are less likely to achieve satisfactory results.

Indications for use as a Total Hip Replacement include:

* noninflammatory degenerative joint disease, including osteoarthritis and avascular necrosis;

» rheumatoid arthritis;

» correction of functional deformity;

* revision procedures where other treatments or devices have failed; and,

» treatment of nonunion, femoral neck and trochanteric fractures of the proximal femur with head involvement that are unmanageable using other techniques.

Restoration Anatomic Shell

» Painful, disabling joint disease of the hip resulting from: degenerative arthritis, rheumatoid arthritis, posttraumatic arthritis or late stage avascular necrosis.

* Revision of previous unsuccessful femoral head replacement, cup arthroplasty or other procedure.

* Clinical management problems where arthrodesis or alternative reconstructive techniques are less likely to achieve satisfactory results.

» Where bone stock is of poor quality or is inadequate for other reconstructive techniques as indicated by deficiencies of the acetabulum.

When used with MDM Liners

* Treatment of nonunion, femoral neck and trochanteric fractures of the proximal femur with head involvement that are unmanageable using other techniques.

* Dislocation risks

When used with Constrained Liner:

* The Trident Constrained Acetabular Insert is indicated for use in primary and revision patients at high risk of hip dislocation due to a history of prior dislocation, bone loss, joint or soft tissue laxity, neuromuscular disease, or intraoperative instability.

The Restoration® Anatomic Shell is indicated for cementless use only.

Trident Constrained Acetabular Insert/ Constrained Acetabular Insert

The Constrained Acetabular Insert is intended for use as a component of a total hip prosthesis in primary or revision patients at a high risk of hip dislocation due to a history of dislocation, bone loss, joint or soft tissue laxity, neuromuscular disease or intraoperative instability.

Trident X3, Trident Crossfire, and Trident X3/Crossfire Elevated Rim Acetabular Liners

» Painful, disabling joint disease of the hip resulting from: degenerative arthritis, rheumatoid arthritis, post-traumatic arthritis or late stage avascular necrosis.

* Revision of previous unsuccessful femoral head replacement, cup arthroplasty or other procedure.

* Clinical management problems where arthrodesis or alternative reconstructive techniques are less likely to achieve satisfactory results.

» Where bone stock is of poor quality or is inadequate for other reconstructive techniques as indicated by deficiencies of the acetabulum.

UHR Bipolar

* Femoral head/neck fractures or non-unions.

* Aseptic necrosis of the femoral head.

* Osteo-, rheumatoid, and post-traumatic arthritis of the hip with minimal acetabular involvement or distortion.

Other Considerations:

» Pathological conditions or age considerations which indicate a more conservative acetabular procedure and an avoidance of the use of bone cement in the acetabulum.

» Salvage of failed total hip arthroplasty.

Unitrax V40 Head, V40 Adapter Sleeve and C-Taper Adapter Sleeve

The HOWMEDICA OSTEONICS Unitrax Endoprosthesis, and the V40 Modular Adaptor sleeves are used as a hemiarthroplasty device for the following indications: femoral neck fractures, idiopathic avascular necrosis, and non-unions. The C-taper sleeves are intended for use as a Hemi-Hip Replacement with the following indications: femoral head/neck fractures or non-unions, aseptic necrosis of the femoral head/neck and osteo- and post traumatic arthritis. The patient’s acetabular bone stock must be adequate to support articulation with the head of the endoprosthesis.

BIOLOX Delta Ceramic Heads (V40, C-Taper and Universal and C-Taper to Universal Taper Adapter Sleeve)

The femoral heads are intended for mechanical fixation to their mating hip stems, and can be used in cemented or cementless hip arthroplasty procedures.

For Use as a Total Hip Replacement:

» Painful disabling joint disease of the hip resulting from: degenerative arthritis, rheumatoid arthritis, post-traumatic arthritis or late stage avascular necrosis.

* Revision of previous cup arthroplasty or other procedures

* Clinical management problems where arthrodesis or alternative reconstructive techniques are less likely to achieve satisfactory results.

» Where bone stock is of poor quality or is inadequate for other reconstructive techniques as indicated by deficiencies in the acetabulum.

For Use as a Bipolar Hip Replacement

* Femoral head/neck fractures or non-unions.

* Aseptic necrosis of the femoral head.

* Osteo-, rheumatoid, and post traumatic arthritis of the hip with minimal acetabular involvement or distortion.

» Pathological considerations or age considerations which indicate a more conservative acetabular procedure and an avoidance of the use of bone cement in the acetabulum.

» Salvage of failed total hip arthroplasty

Alumina C-Taper and V40 Ceramic Heads

For Use as a Total Hip Replacement:

» Painful disabling joint disease of the hip resulting from: degenerative arthritis, rheumatoid arthritis, post-traumatic arthritis or late stage avascular necrosis.

* Revision of previous cup arthroplasty or other procedures

* Clinical management problems where arthrodesis or alternative reconstructive techniques are less likely to achieve satisfactory results.

» Where bone stock is of poor quality or is inadequate for other reconstructive techniques as indicated by deficiencies in the acetabulum.

Additional indications for the Alumina C-Taper Ceramic Heads

For Use as a Bipolar Hip Replacement

* Femoral head/neck fractures or non-unions.

* Aseptic necrosis of the femoral head.

* Osteo-, rheumatoid, and post traumatic arthritis of the hip with minimal acetabular involvement or distortion.

» Pathological considerations or age considerations which indicate a more conservative acetabular procedure and an avoidance of the use of bone cement in the acetabulum.

» Salvage of failed total hip arthroplasty

Co Cr Femoral Heads (C-Taper and V40 Taper, LFIT and non-LFIT)

» Painful disabling joint disease of the hip resulting from: degenerative arthritis, rheumatoid arthritis, post-traumatic arthritis or late stage avascular necrosis.

* Revision of previous cup arthroplasty or other procedures

* Clinical management problems where arthrodesis or alternative reconstructive techniques are less likely to achieve satisfactory results.

» Where bone stock is of poor quality or is inadequate for other reconstructive techniques as indicated by deficiencies in the acetabulum.

Accolade C Femoral Stems, Accolade HFx Femoral Stems

Indications for use as a Total Hip Replacement include:

» noninflammatory degenerative joint disease, including osteoarthritis and avascular necrosis;

* rheumatoid arthritis;

» correction of functional deformity;

* revision procedures where other treatments or devices have failed; and,

» treatment of nonunion, femoral neck and trochanteric fractures of the proximal femur with head involvement that are unmanageable using other techniques.

Accolade TMZF and Accolade TMZF Plus Femoral Stems

The subject hip stem is a single-use device intended for use in total hip replacement. It is intended for the reconstruction of the head and neck of the femoral joint. This hip stem is intended for primary reconstruction of the proximal femur or revision total hip arthroplasty. This device is intended for use with any currently available Howmedica Osteonics acetabular component and V40™ femoral heads that can be mated with a TMZF 5° 40’ trunnion.

Indications:

» Cementless primary hip surgery in cases of non-inflammatory degenerative joint disease including osteoarthritis, avascular necrosis, rheumatoid arthritis, and correction of functional deformity.

* Treatment of nonunion, and femoral neck and trochanteric fractures of the proximal femur with head involvement that are unmanageable using other techniques.

» Revision procedures where other treatments or devices have failed.