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Remove the trial cup and humeral implant using the
humeral implant driver. select the appropriate final
monobloc humeral implant corresponding to the trial
implant.
Inserting Cement Restrictor
Determine the trial size of the cement restrictor and
gauge the implantation depth (Figure 86). check that
the trial restrictor is firmly seated in the canal. Then
remove the trial restrictor.
use pulsatile lavage and a nylon brush to clear the
humeral canal of debris and to open the interstices
of the bone ready for the cement. place the definitive
cement restrictor at the appropriate depth and check
that it is firmly seated in the canal.
pass non-absorbable sutures through the proximal
humerus near the lesser tuberosity to enable secure
re-attachment of the subscapularis (if possible). Avoid
re-attachment if unable to externally rotate the humerus
to zero degrees.
irrigate the canal, during a second cleaning stage, using
pulsatile lavage removing loose bone remnants and
marrow. some surgeons may wish to insert a one-
inch gauze pre-soaked in an epinephrine (1:1,000,000
solution) or hydrogen peroxide solution to aid haemostasis
and the drying of the humeral canal (Figure 87).
Cement preparation
Antibiotic-impregnated cement is recommended,
particularly in revision cases, such as the smARTsET
®
ghv gentamicin bone cement from Depuy cmW. mix
cement using a classical technique or using the CEMVAC
®
syringe vacuum mixing system. Attach the syringe to the
cEmvAc cement injection gun and assess the viscosity.
The cement is ready for insertion when it has taken on
a dull, doughy appearance and does not adhere to the
surgeon’s glove.
once the cement has reached the correct viscosity, fill the
humeral canal in a retrograde manner using appropriate
nozzle attachments if required. Allow the cement to
push the nozzle gently back until the canal is completely
filled and the distal tip of the nozzle is clear of the canal.
Apply slight manual pressurisation, to hold back any back
bleeding pressure whilst the cement is penetrating the
cancellous bone, to form an even cement mantle.
For full description see the Depuy cmW cementing
technique catalogue.
DEFiNiTivE humERAL impLANTs iNsERTioN
cEmENTED moNoBLoc humERAL impLANTs
Figure 86
Figure 87
