enztec star drill · overview 02 components & features 03 surgical protocol preparation for hip...

Enztec STAR Drill

Contents

OVERVIEW 02

COMPONENTS & FEATURES 03

SURGICAL PROTOCOL

Preparation for Hip Replacement 04

Short External Rotator Repair 05

Drill and Retrieve Sutures 06

Retrieve Remaining Sutures 07

Secure the Sutures 08

Complete Capsule Repair 09

NOTA BENE 10

01 Enztec STAR Drill - Surgical Protocol

Technique for Posterior Capsule and

Overview

The STAR Drill System is designed to facilitate transosseous capsule and external

rotator repair following total hip arthroplasty where a posterior or anterolateral approach

has been used.

The STAR Drill comprises a medical implant grade 316 stainless-steel drill bit with a

patented tip that allows drilling of bone and retrieving of sutures in a single step. The

cutting tip produces a hole 50% larger than the diameter of the drill shaft, allowing the

tip to retrieve up to two sutures at a time. The drill bit is used in conjunction with a

coupling created to allow powered operation and single-handed release. The STAR Drill

can be used at speeds of up to 1500rpm, and has been designed not to ‘walk’ on

initiation of drilling.

Contraindications

The following are relative contraindications for use of the STAR Drill:

- Active local or systemic infection (bio-resorbable sutures may be possible).

- Bone of poor quality unless a load distributing device is used for tying the sutures over.

- Protrusio hip reconstruction – as capsular length may be insufficient.



Components &Features

The STAR Drill System consists of two components:

the Coupling and the STAR Drill Assembly. The

Coupling is a reusable device, while the STAR Drill

Assembly is a single use device. Both devices are

provided non-sterile, and must be sterilised prior to

use.

COUPLING

STAR DRILL ASSEMBLY

Step One

Preparation for Hip Replacement

Place the patient in a lateral position and make a

posterolateral incision. Split the fascia lata and

gluteus maximus and use a blunt retractor to separate

the gluteus medius from the gluteus minimus.

Note: The piriformis, superior gemellus tendon, short

external rotators, and capsule are to be taken off at

their femoral insertion. Placing a temporary ‘stay’

suture through the capsule will aid in protecting the

sciatic nerve and avoiding capsular entrapment during

reduction. The inferior capsule should be incised

radially but not resected, allowing for better anterior

mobilisation of the proximal femur and increased

space for acetabular reaming. The anterior capsule

should be preserved, limiting external rotation and

anterior dislocation.

A standard hip replacement can now be performed.


Step Two

Technique for Posterior Capsule and

Short External Rotator Repair

Introduce a suture posteriorly through the piriformis

and then through the posterior superior aspect of the

capsule, leaving approximately 15cm of suture

remaining.

Note: Suggest using #2 abrasion resistant,

non-absorbable sutures.

Create a ‘snare’ stitch on the inside of the capsule

0.5-1cm from the cut edge. The suture should then be

fed back out of the capsule, picking up the superior

gemellus tendon. See Detail A.

Repeat the process moving down through the

capsule, picking up the short external rotators and

capsule. Suture loops of approximately 14cm should

be created on the posterior side of the capsule as

shown in Figure 1. Remove the needle once complete.


Detail A - Inner Capsule Suture

Fig 1 - Placing Capsular Repair Suture

Step Three

Drill and Retrieve Sutures

Rotate the hip approximately 15° internally, allowing

clear visualisation of the entry and exit points of the

drill. Use the STAR Drill to drill a hole proximally in the

greater trochanter 1.5cm anterior to the posterior

margin of the greater trochanter (avoid hitting the

prosthesis).

Once the drill tip exits the greater trochanter, release

the STAR Drill from the STAR Drill Coupling by pulling

the red casing of the STAR Drill coupling towards the

power drill. Orientate the STAR Drill so the hook is

facing anteriorly. The flat edge of the drill bit can be

used as a reference. I.e. both the flat edge and hook

should be facing towards the implant.

Slip the suture into the retrieval notch of the drill tip

using forceps and pull the STAR Drill back through the

trochanter, pulling the suture through the hole.


Fig 2 - Drilling with the STAR Drill

Step Four

Retrieve Remaining Sutures

Retrieve the remaining sutures per the

aforementioned technique, moving inferiorly along the

trochanter approximately 1cm each time.

Continue until four holes have been drilled, and two

loops and two ends of the suture have been retrieved

through the trochanter, as shown in Figure 3.


Fig 3 - Retrieving Sutures

Step Five

Secure the Sutures

Place the hip in 10° of internal rotation so the

posterior capsule is not overtightened. Cut the loops

in their mid-portions.

Starting proximally, identify the opposite ends of the

sutures by gently pulling, then pull back and securely

tie the capsule back to its insertion point on the

greater trochanter, as shown in Figure 4.


Fig 4 - Securing Sutures

Step Six

Complete Capsule Repair

This surgical technique provides a strong six-strand

repair of the short external rotator and capsule

complex using three knots. Hip stability can be

checked at this stage. Internal rotation will now be

restricted to the physiological rotation, making

posterior dislocation very unlikely with the repair

intact.


Fig 5 - Completed Capsule Repair

Nota Bene

Enztec Limited3/17 Print PlaceMiddletonChristchurch 8024New Zealand

A surgeon must always rely on his or her own professional clinical judgment when deciding

which products and/or techniques to use on individual patients. Enztec does not dispense

medical advice and recommends that surgeons be trained in orthopaedic surgeries before

performing surgeries.

Always refer to the package insert, product label and/or user instructions before using any

Enztec product. Products may not be available in all markets. Product availability is subject to the

regulatory and/or medical practices that govern individual markets. Please contact your Enztec

representative if you have any questions about the availability of Enztec products in your area.

Enztec own, use or have applied for the following trademarks or service marks: Enztec.

Patent: WO 2006009471 A1

© 2018 Enztec Limited All rights reserved.

Part Number: 11653-00, Rev: 2

ContactEnztec LimitedP.O Box 31029,Ilam,Christchurch, 8444,New ZealandPh: + 64 3 348 0203Fax: + 64 3 343 6182

enztec star drill · overview 02 components & features 03 surgical protocol preparation for hip...

Documents