Trabecular Metal™ Acetabular Revision System

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The Zimmer Biomet Trabecular Metal™ Acetabular Revision System (TMARS) combines  Trabecular Metal Technology1–3 with the ability to tailor individualised solutions for each patient. From simple to complex revision arthroplasty, this combination sets new standards for acetabular reconstruction.

The TMARS system consists of the following acetabular and auxiliary implant designs:

  • Trabecular Metal Revision Shells and Liners
  • Trabecular Metal Cup-Cage Constructs
  • Trabecular Metal Buttress and Shim Augments
  • Trabecular Metal Augments and Restrictors

Trabecular Metal Revision Shell and Liners

The Trabecular Metal shell is designed for use in revision and primary cases, and it is placed in best position for maximum host bone contact, while 0 degree neutral and 10 degree oblique liners allow for preferred version. Created by cementing the liner, the 1 piece construct of the Trabecular Metal Revision Shell eliminates concerns about backside wear. The low modulus of elasticity of the Trabecular Metal material can produce more normal physiological loading and reduce stress shielding.4 The features of the shell include:

  • Elliptical geometry to maximise bone contact for initial stability5
  • Dome screw holes to allow for additional fixation
  • Longevity® Highly Crosslinked Polyethylene liners in various configurations are available to best meet patient needs

Trabecular Metal Cup Cage

Used in conjunction with the Trabecular Metal Revision Shell  to provide adequate stability by spanning acetabular defects and pelvic discontinuities to provide mechanical stability of the Cup-Cage construct until biological ingrowth occurs. Cementing the Longevity Highly Crosslinked Polyethylene liners, Cages, and Trabecular Metal Revision Shells together creates a single construct, without concerns of micromotion.6

The Trabecular Metal Cup Cage is:

  • Made from commercially pure titanium construction for optimised mechanical strength
  • Available in left and right configurations
  • Long-flange and short-flange
  • Designed for inferior flange to be spiked into ischium
  • Shaped to fit individual patient anatomy

Trabecular Metal Buttress and Shims

  • The Trabecular Buttress and Shim Augments work with the revision shell to address extensive superior segmental defects (Paprosky Type IIIA)
  • Serves as an alternative to allograft, without potential for bone resorption or disease transmission
  • Creates a monolithic construct without concerns for micromotion by using cemented interfaces6
  • Conserves host bone while implant size, position, and orientation are determined by the defect
  • Allows head centre to be restored for optimisation of patient kinetics

Trabecular Metal Augments and Restrictors

The Trabecular Metal Acetabular Augments and Restrictors fill bone deficiencies as an alternative to preparing and using structural grafts.7  

  • Interfaces are cemented against the Trabecular Metal Revision Shell, creating a monolithic construct without concerns of micromotion
  • Partical hemisphere augment shape is available in 4 thicknesses and 6 sizes to allow for fit in various defects 
  • Restrictor is concave and available in 3 diameters to allow for coverage of a medial wall defect and containment of morsellised bone graft 

Technology

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References

  1. Lakstein, D. et al. Trabecular Metal Cups 9for Acetabular Defects with 50% or Less Host Bone Contact. Clinical Orthopedics and Related Research. 467(9):2318-24, 2009.
  2. Nakashima. et al. Clinical and Radiographic Evaluation of Total Hip Arthroplasties using Porous Tantalum Modular Acetabular Components: 5-year Follow-up of Clinical Trial. Modern Rheumatology. 23(1):112-8, 2013.
  3. Simon, J. and  and Bellmans, J. Clinical and Radiological Evaluation of Modular Trabecular Metal Acetabular Cups Short-term Results in 64 Hips. Acta Orthopaedica (Belg). 75:623-30, 2009.
  4. Pedersen DR, Brown TD, Poggie RA. Finite element analysis of periarticular stress of cemented, metal-backed, and porous tantalum backed acetabular components. 45th Annual Orthopaedic Research Society Meeting, Anaheim, CA. 1999.
  5. Sculco, T. The Acetabular Component: An Elliptical Monoblock Alternative. Journal of Arthroplasty.  17(4): 118-20, 2002.
  6. Taylor, E and Browne, J. Reconstruction Options for Acetabular Revision. Would Journal of Orhtopedics. (3)7:95-100, 2012.
  7. Nehme, A. et al.  Modular Porous Metal Augments for Treatment of Severe Acetabular Bone Loss During Revision Hip Arthroplasty. Clinical Orthopaedics and Related Research. 429:201-8, 2004.

 

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