Surgical Technique

REFLECTION™THREE HOLE

REFLECTION NO HOLE

*smith&nephew

Acetabular Components

Acetabular Components

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Reflecting the commitment to low wear

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Technique described byRobert L. Barrack, MDSt. Louis, Missouri

Nota Bene: This technique description herein is made available to the healthcare professional to illustrate the author’ssuggested treatment for the uncomplicated procedure. In the final analysis, the preferred treatment is that whichaddresses the needs of the patient.

Designed with fixation and surgical efficiency in mind, the REFLECTION? Acetabular Cupsystem minimizes wear and maximizes the integrity of the modular connection.REFLECTION Acetabular Components offer a variety of choices, allowing the surgeonversatility for indication and preference.

The MICROSTABLE™ Liner Locking Mechanism and the polished inner surface reflect thecontinued leadership of Smith & Nephew in advanced technology.

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REFLECTION? Acetabular ComponentsDesign features

Liner/shell stabilityAs shown in many independent studies, theMICROSTABLE? Liner Locking Mechanism has thelowest level of liner/shell motion of the shellstested.1-4 Internal Smith & Nephew testing furtherdemonstrates the superiority of the lockingmechanism over competitive designs andSmith & Nephew commitment to minimizewear due to micromotion.5

PolishingMotion between the liner and shell has beenproven to cause wear on the back side of theliner. The rougher the counterface, the morethe wear. These facts support the need for arefined finish on the inside of the shell. Thepolished inner surface of REFLECTION AcetabularComponents is a feature that has very lowroughness that is within the standard requiredof femoral heads.6

Range of motionSmith & Nephew understands the issue ofimpingement, and that range of motion (ROM)is not just dependent on neck design. As a result,REFLECTION liners are designed to allow maximumROM when combined with Smith & Nephewstems and have been shown to improve ROMover competitive offerings.7 The overhang, whilegiving 20\ of additional support, maintains a lowprofile to minimize impingement.

Porous coatingAll REFLECTION shells feature RoughCoat porouscoating. RoughCoat provides a scratch-fit andenhances initial friction and stability. The 2-3bead layering has a 20-40% average porosityand 170 microns average pore size. This poresize has been shown to promote bone in-growth.8

The sintered beads provide a three-dimensionalinterlock with bone that plasma spray cannotoffer.9

Hole coverHaving an apex hole in the shell allows easyassessment of cup seating.10 The watertight apexhole cover has a unique design that seals the shell,which prevents debris transfer as well as minimizespolyethylene creep.11

Poly thicknessWith a 5mm thick liner for the 46mm OD cup and7mm for the 50mm cup (for a 28mm femoralhead), REFLECTION Acetabular Components meetthe challenge of poly thickness.12,13 Unlike manyacetabular cup designs, the REFLECTION polythickness is not compromised by the lockingmechanism. If additional thickness is desired,the lateralized liners can be used, allowing4mm more thickness at the apex andapproximately 2mm additional thicknessin the load-bearing area.

Liner style

22mm 26mm 28mm 32mm 36mm

Neutral 143° 140° 142° 145° 148°

20\ overhang 122° 119° 122° 126° 128°

35\ overhang N/A N/A 107° 111° 113°

Anteverted 130° 133° 135° 138° 139°

Constrained 73° 79° 87° 96° N/A

Range of motion

Acetabular cup size

Femoral head size 42mm 44mm 46-48mm 50-52mm 54-56mm 58-60mm 62-64mm 66-68mm 70-76mm

22mm 6 7 8 10 12 13 15 17 19

26mm NA 5 6 8 10 11 13 15 17

28mm NA NA 5 7 9 10 12 14 16

32mm NA NA NA 5 7 8 10 12 14

36mm NA NA NA NA 5 6 8 10 12

Polyethylene thickness

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REFLECTION? THREE HOLE and REFLECTION NO HOLEAcetabular Components – design features

PegsTo promote stability, REFLECTION THREE HOLEAcetabular Components offer the option of pegfixation. The modularity of REFLECTION THREE HOLEpegs makes the preparation easier, as well aseases the process of insertion after the cup hasbeen fully seated. The diverging nature providesmore fixation than the traditional parallel pegs. Inaddition, screws only work in compression, losingeffectiveness with even the slightest migration ofthe shell. Not only are pegs rigidly locked to theshell, so that migration has no effect, but there isalso less potential for fretting.8

Peg/screw hole placementIn primary cementless total hip arthroplasty,acetabular screws should be placed superiorlyinto the thickest bone for maximum fixation andsafety. This thick bone, described by Wasielewski,et al, covers a fairly small region of the acetabulum.14

By placing these three holes in a symmetricalpattern, the cup can easily be oriented properly toplace screws in this region for the left or rightacetabulum.

ScrewsREFLECTION spherical head screws come in avariety of lengths. All the screws are 6.5mmcancellous screws with a 4.0mm minor diameter.The root diameter provides a stronger screw – 56%stronger than a 3.2mm root diameter screw.

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Short technique

1. Preoperative planning 2. Acetabular exposure

3. Acetabular reaming 4. Acetabular trialing

5. Acetabular shell insertion 6. Acetabular screw insertion

8. Acetabular liner insertion7. Acetabular peg insertion

REFLECTION? THREE HOLE and REFLECTION NO HOLE

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REFLECTION? THREE HOLE and REFLECTION NO HOLEAcetabular Components

Preoperative X-Rays should include an AP of thepelvis centered over the hips and a lateral of theaffected hip.

Templating can be done on the affected side, butit is important that the contralateral hip also betemplated to verify the size.

To ensure a congruent fit, the acetabularcomponent should sit against the subchondralbone and the medial aspect of the acetabulum,as indicated by the teardrop.

The center of rotation also should be marked forsubsequent reference.

REFLECTION Porous-Coated

Instrument tip:The templates have holes that allow youto mark the center of the standard liner orthe +4mm lateralized liner.

Shown with standard and +4mmlateralized liner head centers.

120% magnification

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Complete exposure of the acetabulum is required,regardless of the type of approach.

First, resect the acetabular labrum and place a bluntretractor anteriorly.

After identifying the transverse acetabular ligament,divide it inferiorly and place a blunt retractor aroundthe inferior margin of the acetabulum.

Depending on the exposure, a third retractorcan be placed posteriorly following the excision ofthe labrum.

Remove all soft tissue and osteophytes in order todefine the medial wall.

The acetabulum must be medialized to restore thenormal center of hip rotation.

Surgical tips:To minimize the need of assistance,each of the acetabular retractors canbe tied directly to a Charnley retractor.

Dividing the transverse acetabularligament will allow reaming to begininferiorly, preventing the tendency ofthe reamer to migrate superiorly.

A medial osteophyte is often presentin the fovea, which is usually visibleon the preoperative radiographs.

Acetabular exposure

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REFLECTION? THREE HOLE and REFLECTION NO HOLEAcetabular Components – acetabular reaming

Select an acetabular reamer that is considerablysmaller than the templated size of the cup.Generally, a 46mm reamer is suitable.

Position the initial reamer in a vertical direction (1)to ensure the reamer is taken down to themedial wall.

Direct the second reamer and all subsequentreamers in approximately 45\ of abduction and 20\of anteversion for final position of the acetabularcomponent (2).

Preserve subchondral bone to provide goodsupport for the prosthesis.

Frequently palpate the posterior and anterior wallsof the acetabulum during the reaming process asthese walls will determine the largest acetabularsize that can be accommodated.

To press-fit the THREE HOLE and NO HOLE cups,the acetabulum should be under-reamed by1 - 2mm depending on bone quality andacetabular size. The cups are available in evensizes so the last reamer used should either bean odd size for 1mm under-reaming or an evensize for 2mm under-reaming.

Surgical tips:Each successive reamer must be fullyseated within the acetabulum. Failure todo so will result in lateralization of thetrial and exposure of the porous coating.If lateralization occurs, go back to asmaller reamer and begin again,checking each size to ensure that thereamers are fully seated.

Increasing the reamer size by 2mmis recommended, although insmaller patients 1mm incrementsmay be preferred.

Mark the medial wall with anelectrocautery prior to using the lastreamer. If the last reamer does notremove the mark, repeat reaming,dropping back a size if necessary.

Instrument tip:The REFLECTION reamer has an openback, which helps visualize reaming andallows easy access to bone chips. Thisstyle of reamer is hemispherical andwhen fully seated it should be coveredby the rim of the acetabulum.

Gently rock reamer handle back andforth approximately 5\ for last size usedONLY to ensure rim is accurate for thedesired press fit.

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After the preparation of the acetabulum, the trialshell should be inserted to verify size and positionof the cup.

If trial reduction using a trial insert is desired atthis time, then the preparation of the femur shouldoccur up until the trial reduction stage. The hipshould be reduced and leg length, offset, andcomponent position should be assessed.

The surgeon should note the appropriateorientation of the acetabular trial to positionthe cup correctly.

Surgical tips:The bone at the edge of the trial shellcan be marked with an electrocautery tohelp in final component positioning.

In a relatively normal acetabulum, thefinal component can be positioned andhead coverage adjusted if necessaryusing overhang liners.

Instrument tip:The trial shells are the exact sizespecified and slightly less thanhemispherical. They can be used toassess the accuracy of reaming or canbe press-fit into the acetabulum if usinga larger size than the final reamer.

Acetabular trialing

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Select the appropriate acetabular implant, attachthe shell to the cup positioner/impactor and insertit into the acetabulum.

Rotate the X-bar shaft so that it is in line with theliner removal slot. This positions the THREE HOLEholes in the superior direction.

Position the X-bar so that the vertical bar isperpendicular to the long axis of the body and theappropriate crossbar aligns with the long axis ofthe body.

Firmly tap the inserter with a mallet until the cup isfully seated.

Gently toggle the impactor handle to assess thestability and contact of the shell.

Unscrew the impactor handle and look through theimpactor hole to judge the distance between themedial wall and the shell.

If the cup is firmly seated, there should be no gapbetween the shell and the medial wall and noapparent movement in the component.

Surgical tip:The change in pitch that occurs as theshell is seated against the medial wall isoften audible. A depth gauge can beinserted through the screw holes andapex hole to determine the adequacy ofshell seating.

Instrument tips:The positioner, like the reamer handle,has an easy-to-remove spring to simplifycleaning; however, the spring and nutcannot detach from theshaft, which prevents items frombeing misplaced.

The positioner references 45\ ofabduction and 20\ of anteversion.

REFLECTION? THREE HOLE and REFLECTION NO HOLEAcetabular Components – acetabular shell insertion

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Screw fixation is simple, fast, and the mostcommon method of assuring additional fixation.REFLECTION™ screws work in compression, whichallows the shell to fully seat in the acetabular cavity.

For screw fixation, each screw hole must bepredrilled. First, seat the screw drill guide fully intothe correct hole in the acetabular shell.The drill guide will position the screw properly,avoiding impingement of the screw head againstthe shell. After drilling the hole, use the depthgauge to verify appropriate screw length(s).

Use the screw forceps to hold the screw. Attachthe ball-joint or flexible screwdriver shaft to theend of the screw. Then introduce the screw intothe hole and screw it into place using theratcheting screwdriver handle. Make sure thescrew is fully seated within the screw hole so thatit will not impinge on the acetabular shell/liner.

Surgical tip:Screws have been shown to be areliable method of assuring fixation;however, it is important to avoidneurovascular complications byproper screw placement, avoidingthe anterior/superior oranterior/inferior quadrants.

Acetabular screw insertion

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REFLECTION? THREE HOLE and REFLECTION NO HOLEAcetabular Components – acetabular peg insertion

Pegs can be used to provide satisfactoryadjunctive fixation in the stabilization of theacetabular prosthesis.

The modularity of second generation pegs hasallowed for easier fixation. These modular pegsincrease acetabular shell stability by locking to it,thereby resisting any rotational movement.

When using pegs, the selected holes must bepredrilled using a peg drill and peg drill guide.Place the guide in the correct hole of theacetabular shell and then drill the peg hole. Donot place a peg in the center hole of the shell.Make sure the drilled holes are lavaged andthoroughly cleaned of all bone debris. This willenable the peg to lock into the shell.

Insert all pegs into the shell by hand. Impacteach peg using the angled peg impactor withthree moderate blows of the mallet. Inspect thesurface for peg seating.

To remove a peg, thread a disposable pegremoval pin into the peg by hand or with aflexible or ball joint screwdriver until it stops.Place the peg removal instrument over the headof the removal pin. Close the handles of the pegremoval tool to remove the peg. Use a new pegremoval pin for each peg.

Surgical tips:Although rigid stability can be achievedwith peg fixation, it is vital to preventany neurovascular complications byavoiding the anterior quadrants whenfixation pegs are utilized.

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Acetabular liner insertion

Trial reduction should be performed with the finalshell and broach in place to appropriately assesshead length, stem offset, and liner style andposition stem type (standard or high offset), necklength, and liner type (neutral, +4mm, overhang).Every attempt should be made to avoid the useof “skirted”modular heads.

Before inserting the acetabular polyethylene liner,lavage any unused holes and insert the holecovers. Using the angled hole cover inserter,place screw hole covers over any remaining screwholes and then impact with the peg impactor.Cover the apex hole with the watertight threadedhole cover. Using the straight screwdriver, screwin the hole cover until it stops and is flush withthe inner diameter of the shell.

For the liner insertion, place the appropriate linerimpactor head on the end of the cup positionerand ensure that the splines on the liner arealigned with the splines on the shell.

Firmly impact the inserter with the mallet until theliner is fully seated.

Inspect the liner/shell interface for proper seating.

Surgical tips:If there is continual difficulty insertingthe liner, recheck the lock mechanismto assure that no soft tissue isobstructing it. Then chill the liner incold saline for 2 or 3 minutes and fullyseat the liner into the shell.

Use an instrument such as ahemostat to assure proper locking ofthe polyethylene insert. A properlylocked liner will not toggle; however,due to the unique, non-damaging lockmechanism, the liner can be pulledout. If the liner is not locked in place,even low loads will toggle it.

Instrument tips:The liner requires an impaction forcebetween 120 and 200 poundsincreasing with the diameter of the shell.

The liner can be removed andrepositioned 3 times withoutcompromising the locking mechanismof the liner. To remove, insert theremoval tool fully into the removal slotand pry the liner loose.

The threaded trial liners are designedto screw into the shell, which providesmore stability in trialing.

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REFLECTION? Acetabular ComponentsCatalog

REFLECTION XLPE Acetabular Liners REFLECTION XLPE Lateralized (+4mm) Liners20° Liner

0° Liner 20° Liner 35° Liner 0° Liner Anteverted 20° LinerCat. No. Cat. No. Cat. No. Cat. No. Cat. No. Cat. No.

7133-3351 7133-3301 7133-3451 7133-34017133-3352 7133-3302 7133-3452 7133-34027133-3353 7133-3303 7133-3453 7133-34037133-3354 7133-3304 7133-3454 7133-34047133-3355 7133-3305 7133-3455 7133-34057133-3356 7133-3306 7133-3456 7133-34067133-3357 7133-3307 7133-3457 7133-34077133-3358 7133-3308 7133-3458 7133-34087133-3359 7133-3309 7133-3459 7133-3409

7133-3362 7133-3312 7133-3462 7133-34127133-3363 7133-3313 7133-3463 7133-34137133-3364 7133-3314 7133-3464 7133-34147133-3365 7133-3315 7133-3465 7133-34157133-3366 7133-3316 7133-3466 7133-34167133-3367 7133-3317 7133-3467 7133-34177133-3368 7133-3318 7133-3468 7133-34187133-3369 7133-3319 7133-3469 7133-3419

7133-3373 7133-3323 7133-9946 7133-3473 7133-3423 7133-98467133-3374 7133-3324 7133-9950 7133-3474 7133-3424 7133-98507133-3375 7133-3325 7133-3475 7133-3425 7133-98547133-3376 7133-3326 7133-3476 7133-34267133-3377 7133-3327 7133-3477 7133-34277133-3378 7133-3328 7133-3478 7133-34287133-3379 7133-3329 7133-3479 7133-3429

7133-3384 7133-3334 7133-3484 7133-34347133-3385 7133-3335 7133-9354 7133-3485 7133-3435 7133-92547133-3386 7133-3336 7133-9358 7133-3486 7133-3436 7133-92587133-3387 7133-3337 7133-9362 7133-3487 7133-3437 7133-92627133-3388 7133-3338 7133-3488 7133-3438 7133-92667133-3389 7133-3339 7133-3489 7133-3439 7133-9270

7133-3395 7133-3345 7133-3495 7133-34457133-3396 7133-3346 7133-9658 7133-3496 7133-34467133-3397 7133-3347 7133-9662 7133-3497 7133-34477133-3398 7133-3348 7133-9666 7133-3498 7133-34487133-3399 7133-3349 7133-9670 7133-3499 7133-3449

I.D. O.D. Liner(mm) (mm) Size

22 42 B22 44 C22 46-48 D22 50-52 E22 54-56 F22 58-60 G22 62-64 H22 66-68 J22 70-76 K

26 44 C26 46-48 D26 50-52 E26 54-56 F26 58-60 G26 62-64 H26 66-68 J26 70-76 K

28 46-48 D28 50-52 E28 54-56 F28 58-60 G28 62-64 H28 66-68 J28 70-76 K

32 50-52 E32 54-56 F32 58-60 G32 62-64 H32 66-68 J32 70-76 K

36 54-56 F36 58-60 G36 62-64 H36 66-68 J36 70-76 K

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REFLECTION Liner Impactor Head

SizeCat. No. (mm)

7136-2222 227136-2226 267136-2228 287136-2232 327136-3622 36

REFLECTION™ Acetabular Liners (Conventional Poly)

0° Liner 20° Liner I.D. O.D. LinerCat. No. Cat. No. (mm) (mm) Size

7174-2042 7174-2242 22 42 B7174-2044 7174-2244 22 44 C7174-2046 7174-2246 22 46-48 D7174-2050 7174-2250 22 50-52 E7174-2054 7174-2254 22 54-56 F7174-2058 7174-2258 22 58-60 G

7174-0644 7174-2644 26 44 C7174-0646 7174-2646 26 46-48 D7174-0650 7174-2650 26 50-52 E7174-0654 7174-2654 26 54-56 F7174-0658 7174-2658 26 58-60 G

7174-0846 7174-2846 28 46-48 D7174-0850 7174-2850 28 50-52 E7174-0854 7174-2854 28 54-56 F7174-0858 7174-2858 28 58-60 G7174-0862 7174-2862 28 62-64 H7174-0866 7174-2866 28 66-68 J7174-0870 7174-2870 28 70-76 K

7174-0250 7174-3250 32 50-52 E7174-0254 7174-3254 32 54-56 F7174-0258 7174-3258 32 58-60 G7174-0262 7174-3262 32 62-64 H7174-0266 7174-3266 32 66-68 J7174-0270 7174-3270 32 70-76 K

REFLECTION Trial Shells

O.D.Cat. No. (mm)

Standard Size Trial Shells7136-2345 457136-2346 467136-2347 477136-2348 487136-2349 497136-2350 507136-2351 517136-2352 527136-2353 537136-2354 547136-2355 557136-2356 567136-2357 577136-2358 587136-2359 597136-2360 607136-2361 617136-2362 627136-2363 637136-2364 64

O.D.Cat. No. (mm)

Small Size Trial Shells7136-2340 407136-2341 417136-2342 427136-2343 437136-2344 44

Large Size Trial Shells7136-2365 657136-2366 667136-2367 677136-2368 687136-2369 697136-2370 707136-2371 717136-2372 727136-2373 737136-2374 747136-2375 757136-2376 767136-2377 777136-2378 787136-2379 797136-2380 80

Positioner/ImpactorReplacement TipCat. No. 7136-2109

REFLECTION Trial Shell HandleCat. No. 7136-2297

REFLECTION Liner Removal ToolCat. No. 7136-2296

REFLECTION Positioner/ImpactorCat. No. 7136-2299

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REFLECTION? Acetabular ComponentsCatalog

I.D. O.D. Liner(mm) (mm) Size

22 42 B22 44 C22 46-48 D22 50-52 E22 54-56 F22 58-60 G22 62-64 H22 66-68 J22 70-76 K

26 44 C26 46-48 D26 50-52 E26 54-56 F26 58-60 G26 62-64 H26 66-68 J26 70-76 K

28 46-48 D28 50-52 E28 54-56 F28 58-60 G28 62-64 H28 66-68 J28 70-76 K

32 50-52 E32 54-56 F32 58-60 G32 62-64 H32 66-68 J32 70-76 K

36 54-56 F36 58-60 G36 62-64 H36 66-68 J36 70-76 K

REFLECTION Screw�in Trial Liners REFLECTION Lateralized (+4mm) Screw�in Trial Liners20° Liner

0° Liner 20° Liner 35° Liner 0° Liner Anteverted 20° LinerCat. No. Cat. No. Cat. No. Cat. No. Cat. No. Cat. No.

7136-2243 7136-2242 7136-2235 7136-22387136-2245 7136-2244 7136-2236 7136-22397136-2247 7136-2246 7136-2249 7136-22487136-2251 7136-2250 7136-2253 7136-22527136-2255 7136-2254 7136-2257 7136-22567136-2259 7136-2258 7136-2261 7136-22607136-2263 7136-2262 7136-2265 7136-22647136-2267 7136-2266 7136-2269 7136-22687136-2271 7136-2270 7136-2273 7136-2272

7136-2645 7136-2644 7136-2636 7136-26357136-2647 7136-2646 7136-2649 7136-26487136-2651 7136-2650 7136-2653 7136-26527136-2655 7136-2654 7136-2657 7136-26567136-2659 7136-2658 7136-2661 7136-26607136-2663 7136-2662 7136-2665 7136-26647136-2667 7136-2666 7136-2669 7136-26687136-2671 7136-2670 7136-2673 7136-2672

7136-2847 7136-2846 7136-9946 7136-2849 7136-2848 7136-98467136-2851 7136-2850 7136-9950 7136-2853 7136-2852 7136-98507136-2855 7136-2854 7136-2857 7136-2856 7136-98547136-2859 7136-2858 7136-2861 7136-28607136-2863 7136-2862 7136-2865 7136-28647136-2867 7136-2866 7136-2869 7136-28687136-2871 7136-2870 7136-2873 7136-2872

7136-3251 7136-3250 7136-3253 7136-32527136-3255 7136-3254 7136-9354 7136-3257 7136-3256 7136-92547136-3259 7136-3258 7136-9358 7136-3261 7136-3260 7136-92587136-3263 7136-3262 7136-9362 7136-3265 7136-3264 7136-92627136-3267 7136-3266 7136-3269 7136-3268 7136-92667136-3271 7136-3270 7136-3273 7136-3272 7136-9270

7136-3655 7136-3654 7136-3657 7136-36567136-3659 7136-3658 7136-9658 7136-3661 7136-36607136-3663 7136-3662 7136-9662 7136-3665 7136-36647136-3667 7136-3666 7136-9666 7136-3669 7136-36687136-3671 7136-3670 7136-9670 7136-3673 7136-3672

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REFLECTION Large Reamer/Trial TrayCat. No. 7136�2284

REFLECTION Small Reamer/Trial TrayCat. No. 7136�2286

REFLECTION Trial Shell TrayCat. No. 7136�2282

REFLECTION Jumbo Reamer/Trial TrayCat. No. 7136�2285

REFLECTION Additional Trial Liner TrayCat. No. 7136�2283

REFLECTION Main Instrument Tray(Shown with instruments)Cat. No. 7136�2280

REFLECTION Primary Reamer Tray(Shown with instruments)Cat. No. 7136�2281

Watertight Hole CoverCat. No. 7133�0001

REFLECTION Reamer HandleCat. No. 7136�2279

REFLECTION Ratchet HandleCat. No. 7136�2294

REFLECTION X�BarCat. No. MT�2201

Power AdaptersCat. No. 7136�2781Cat. No. 7136�2782Cat. No. 7136�2783

REFLECTION? ReamerDomes

SizeCat. No. (mm)

Standard Size Domes7136�2742 427136�2743 437136�2744 447136�2745 457136�2746 467136�2747 477136�2748 487136�2749 497136�2750 507136�2751 517136�2752 527136�2753 537136�2754 547136�2755 557136�2756 567136�2757 577136�2758 587136�2759 597136�2760 607136�2761 617136�2762 627136�2763 637136�2764 64

SizeCat. No. (mm)

Small Size Domes7136�2738 387136�2739 397136�2740 407136�2741 41

Large Size Domes7136�2765 657136�2766 667136�2767 677136�2768 687136�2769 697136�2770 707136�2771 717136�2772 727136�2773 737136�2774 747136�2775 757136�2776 76

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REFLECTION? THREE HOLE and REFLECTION NO HOLEAcetabular Components

Catalog

O.D. LinerCat. No. (mm) Size

Standard Size Shells7133�4146 46 D7133�4148 48 D7133�4150 50 E7133�4152 52 E7133�4154 54 F7133�4156 56 F7133�4158 58 G7133�4160 60 G7133�4162 62 H7133�4164 64 H

O.D. LinerCat. No. (mm) Size

Standard Size HA Shells7133�4246 46 D7133�4248 48 D7133�4250 50 E7133�4252 52 E7133�4254 54 F7133�4256 56 F7133�4258 58 G7133�4260 60 G7133�4262 62 H7133�4264 64 H

O.D. LinerCat. No. (mm) Size

Standard Size Shells7133�6446 46 D7133�6448 48 D7133�6450 50 E7133�6452 52 E7133�6454 54 F7133�6456 56 F7133�6458 58 G7133�6460 60 G7133�6462 62 H7133�6464 64 H

Small Size Shells7133�6440 40 A7133�6442 42 B7133�6444 44 C

O.D. LinerCat. No. (mm) Size

Large Size Shells7133�6466 66 J7133�6468 68 J

Standard Size HA Shells7133�6246 46 D7133�6248 48 D7133�6250 50 E7133�6252 52 E7133�6254 54 F7133�6256 56 F7133�6258 58 G7133�6260 60 G7133�6262 62 H7133�6264 64 H

REFLECTION THREE HOLE ShellsREFLECTION HA THREE HOLE Shells

REFLECTION NO HOLE ShellsREFLECTION HA NO HOLE Shells

REFLECTION Locking Head PegCat. No. 7133�2518

REFLECTION Screw Hole CoverCat. No. 7133�2500

Peg Removal PinCat. No. 7136�2129

REFLECTION Flexible Peg DrillCat. No. 7136�2918

REFLECTION Spherical Head ScrewsLength

Cat. No. (mm)

7133�2515 157133�2520 207133�2525 257133�2530 307133�2535 357133�2540 407133�2545 457133�2550 507133�2560 607133�2570 70

O.D. LinerCat. No. (mm) Size

Standard Size Shells7133�5150 50 E7133�5152 52 E7133�5154 54 F7133�5156 56 F7133�5158 58 G7133�5160 60 G7133�5162 62 H7133�5164 64 H7133�5166 66 J7133�5168 68 J

O.D. LinerCat. No. (mm) Size

Standard Size HA Shells7133�5250 50 E7133�5252 52 E7133�5254 54 F7133�5256 56 F7133�5258 58 G7133�5260 60 G7133�5262 62 H7133�5264 64 H7133�5266 66 J7133�5268 68 J

REFLECTION SPM MULTI�HOLE ShellsREFLECTION HA SPM MULTI�HOLE Shells

18

REFLECTION Captured Flexible Screwdriver ShaftCat. No. 7136�2291

REFLECTION Straight Screwdriver ShaftCat. No. 7136�2293

REFLECTION Flexible Screwdriver ShaftCat. No. 7136�2290

REFLECTION Captured U�Joint Screwdriver ShaftCat. No. 7136�2292

REFLECTION Ball Joint ScrewdriverCat. No. 7136�2295

Peg Removal ToolCat. No. 73�2127

REFLECTION Peg Drill GuideCat. No. 7136�2917

REFLECTION Screw ForcepsCat. No. 7136�2298

REFLECTION Hole Cover InserterCat. No. 73�2133

REFLECTION Angled Peg ImpactorCat. No. 73�2117REFLECTION Depth Gauge

Cat. No. 7136�2012

Modular Drill BitLength

Cat. No. (mm)

7136�2515 157136�2520 207136�2525 257136�2530 307136�2535 357136�2540 407136�2545 457136�2550 507136�2560 607136�2570 70

REFLECTION Modular Drill ShaftCat. No. 7136�2519

REFLECTION MalletCat. No. 7136�2106

Flexible Screw DrillsLength

Cat. No. (mm)

7136�2915 157136�2925 257136�2935 357136�2950 50

REFLECTION™ Screw Drill GuideCat. No. 7136�2919

19

References

1Chen, PC; Mead, EH; Pinto, JG; Colwell, CW. Polyethylene wear debris in modular acetabularprostheses. Clin Orthop. 1995 Aug; (317):44-56.

2 Lieberman, JR; Kay, RM; Hamlet, WP; Park, SH; Kabo, JM. Wear of the polyethylene liner-metallic shellinterface in modular acetabular components. An in-vitro analysis. J Arthroplasty. 1996 Aug; 11(5):602-8.

3Williams, VG II; Whiteside, LA; White, SE; McCarthy, DS. Fixation of ultra-high-molecular-weightpolyethylene liners to metal-backed acetabular cups. J Arthroplasty. 1997 Jan; 12(1):25-31.

4 Fehring, TK; Smith, SE; Braun, ER; Mobley, C; Wang, PL; Griffin, WL. Motion at the modular acetabularshell and liner interface. A comparative study. Clin Orthop. 1999 Oct; (367):306-14.

5Smith & Nephew Internal Testing.6 ISO 7206-2.7 Barrack, RL; Thornberry, RL; Ries, MD; Lavernia, C; Tozakoglou, E. The Effect of Component Designon range of motion to impingement in total hip arthroplasty. AAOS Instr. Course Lecture. 2001;50:275-279.

8Kroeber, MW; Ries, MD; Ashford, F; Olmes, F; Lotz, J. Impact biomechanics and pelvic deformationduring insertion of press-fit acetabular cups. Scientific Exhibit. American Academy of OrthopaedicSurgeons, Anaheim, CA, February 4-8, 1999.

9 Simmons, CA; Valiquette, N; Pilliar, RM. Osseointegration of sintered porous-surfaced and plasmaspray-coated implants: An animal model study of early post-implantation healing response andmechanical stability. J Biomed Mater Res. 1999 Nov; 47(2):127-38.

10 Friedman, RJ; Black, J; Galante, JO; Jacobs, JJ; Skinner, HB. Current concepts in orthopaedicbiomaterials and implant fixation. Instr. Course Lect. 1994; 43:233-55. Review.

11 Huk, OL; Bansal, M; Betts, F; Rimnac, CM; Lieberman, JR; Huo, MH; Salvati, EA. Polyethyleneand metal debris generated by non-articulating surfaces of modular acetabular components.J Bone Joint Surg Br. 1994 Jul; 76(4):568-74.

12 Bartel, DL; Burstein, AH; Toda, MD; Edwards, DL. The effect of conformity and plastic thicknesson contact stresses in metal-backed plastic implants. J Biomech Eng. 1985 Aug; 107(3):193-9.

13 Bartel, DL; Bicknell, VL; Wright, TM. The effect of conformity, thickness and material on stressesin ultra-high-molecular-weight components for total joint replacement. J Bone Joint Surg Am.1986 Sep; 68(7):1041-51.

14Wasielewski, RC; Cooperstein, LA; Kruger, MP; Rubash, HE. Acetabular anatomy and the transacetabularfixation of screws in total hip arthroplasty. J Bone Joint Surg Am. 1990 Apr; 72(4):501-8.

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Notes

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