Operative Technique
12. Spherical Reaming Femoral Head
Once the acetabular component has been
successfully seated within the acetabulum, it is
possible to complete the femoral head reaming. If the
acetabular component implanted is the same as that
selected during the pre-operative planning stage, the
femoral head should first be cylindrically reamed to
the correct size and then spherically reamed with the
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corresponding spherical reamer to match the femoral
resurfacing component. If the acetabular implanted
is larger than that originally selected during the pre-
operative planning stage, the femoral head should
be cylindrically and spherically reamed to match the
corresponding femoral resurfacing component.
Figure 28
Spherical reaming utilises the same guide rod as the
cylindrical reamer and it is important to ensure the
same length of guide rod is now used. It is important
to remember that a STD guide rod will permit the
removal of 6.5mm of bone from the top of the femoral
head. This 6.5mm equates to the thickness of material
of the ReCap
®
femoral resurfacing component. The
top of the prosthetic head is, therefore, at the same
position as the anatomic head. A –3mm guide rod will
permit the removal of only 3.5mm, (6.5mm – 3mm)
therefore increasing the neck length by 3mm and a
+3mm guide rod will permit the removal of 9.5mm
(6.5mm + 3mm) and will therefore shorten the neck
length by 3mm. (Figure 28)
Once the appropriately sized spherical reamer has
been selected, it is placed over the guide rod and
advanced. The spherical reamer will stop cutting when
it reaches the guide rod stop. Each spherical reamer
contains a window that permits visual confirmation
that the reamer has reached the guide rod stop.
Figure 29
(Figure 29)
When the spherical reamer stops cutting, a 6.5mm
bone spigot will be present beneath the guide rod
stop. This bone spigot will need to be removed with
a rongeur prior to attaching the trial head. Care
should be taken to thoroughly lavage the femoral
head and ensure all bone debris is removed from the
surrounding tissue.
It is important to note that the rim of the spherical reamer correlates exactly with the rim of femoral resurfacing component. It is,
therefore, recommended to use the rim of the spherical reamer as a visual gauge to highlight the final position of the resurfacing
femoral component in relation to the head neck junction.
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