Hip

Metaphyseal fixation of the SP-CL is assisted by the HX coating (CaP).⁸ At the same time, the polished distal stem region protects against thigh pain.^9,10 Medially the SP-CL rests along the length of the calcar (Shenton’s line) and is intended to promote a physiological distribution of forces.
 

The successful ribbed structure provides initial fixation in the compressed cancellous bone. This makes it possible to achieve a design elasticity in spite of the proven “fit and fill” principle in the proximal femur. Thus the ribs not only provide high primary stability,⁷ but in combination with the LINK Tilastan- S alloy, they also achieve double elasticity. This can lead to a reduction in “stress shielding”.¹

Anatomically shaped stems necessitate anatomically shaped instruments. The compressors in the SP-CL System follow exactly the anatomical design of the stems and prepare the bone bed for the SP-CL stem according to the natural contours of the intramedullary canal in the proximal femur.

While the flat, lateral implant profile is designed to protect the greater trochanter during implantation, cancellous bone compressors help to preserve valuable bone substance during resection.¹¹
 

The LINK SP-CL Hip Prosthesis System, with its anatomical, cementless design and its different versions, is aimed at the treatment of a wide range of patients. In order to meet the heavy demands put on the implants in a special way, the femoral components consistently follow the principle of the anatomical stem shape⁴, which has been in successful use for decades.

The anatomical S-shape helps to reduce stress peaks, which are a familiar problem with three-point fixation of straight stems. At the same time, it gives the implant greater rotational stability.^{1,5, 6}
 

LINK is one of the pioneers of anatomical and neck preserving prosthesis designs and has decades of experience in the development of these stem types.

The C.F.P.* stem which was introduced in 1998, has since then strongly marked the further development in the world of short stems. Today we are looking back at an impressive track record with survival rates of up to 98,3 % after 11 years.¹

In the C.F.P. II stem this legacy continues by taking clinically proven design features and combining them with today’s requirements of a modern short stem.

The specific implant and instrument design conserves bone and soft tissue and adapts to the natural anatomy of the femur.² Therefore the C.F.P. II equally lives up to its name and embodies our anatomical principles of bone preservation and “anatomy defines shape”.

The system is accompanied by a compact, ergonomic instrument set, which enables the surgeon to perform the arthroplasty smoothly and efficiently, regardless of the favored surgical approach.

* Collum Femoris Preserving

Anatomical Implant Design

The anatomical shape adapts to the natural femoral anatomy and effectively reduces stress risers.^{4, 5, 6}
 

Anatomical Compressor Design

Anatomically shaped stems require anatomically shaped instruments. The compressors of the C.F.P. II system strictly follow the anatomical stem design.

Physiological force transmission

Two different stem curvatures allow adaptation to the individual patient’s anatomy - for extended support of the implant on the Shenton’s line. The successful ribbed structure provides secure, rotationally stable fixation in the compressed cancellous bone.^{4, 5}
 

Femoral neck-preserving, bioharmonic hip prosthesis

The C.F.P. Hip Prosthesis Stem enables femoral neck-preserving, cementless implantation. It was developed specifically for young, active patients, whose long life expectancy means that they are more likely than older patients to experience aseptic loosening with a conventional hip prosthesis.

The design of the C.F.P. Hip Prosthesis Stem incorporates biomechanical loading and anchoring principles, conforming to the hip anatomy and physiology. This ensures stable, stress-resistant anchoring of the prosthesis.³

The bone-preserving resection, preserving the femoral neck, creates favorable conditions for later interventions.
 

Successful long-term outcomes

Many long-term outcomes with survival rates of up to 98.3 percent after 11 years emphasize the success and great reliability of the C.F.P. stem.³

Latest ODEP ratings can be found at www.odep.org.uk

For all different stem types of the LCU Hip System the same set of instruments is used, which allows for intraoperative flexibility.

Two offset types allow for adaption to the patient’s anatomy ²:

• Standard type with a CCD angle of 130º
• Lateralizing type with a CCD angle of 125º

The stability of the implant is additionally enhanced by the characteristic metaphyseal V-shape, while the rectangular cross-section neutralizes torsional forces.^{5, 6, 8}

• Meta-diaphyseal support and fixation provided by a large medial curvature with a 100 mm radius for anatomical adaptation. For the cementless version, this is the prerequisite for primary and secondary stability.

The flat, tapered prosthesis neck allows a large range of motion between prosthesis stem and acetabular cup.²
The 12/14 mm taper is designed for the use of modular LINK prosthesis heads made of ceramic or metal with various lengths and diameters.

Furthermore, the highly polished neck region reduces abrasion in the event of unintentional contact with the acetabular cup.⁹

Cementless Version

• The stem is made from Tilastan-S (Ti6Al4V).

• The micro-roughness of the metal surface is created by corundum-blasting, which produces an even and uniform surface structure with pore sizes and roughness values for osseointegration.^{2, 3}

• The HX coating with a thickness of 20 +/- 10 µm is applied by LEP (LINK Electrochemical Process) to the entire length of the prosthesis, and promotes bone ongrowth.⁴

• The horizontal ribs in the proximal section of the stem serve to counteract subsidence of the stem and to promote primary stability. The distal region has vertical ribs to counteract the rotational forces.⁷

Cemented Version

• The stem is made from our EndoDur-S (CoCrMo alloy).

• It can be operated with the same broaches as the cementless version allowing for intraoperatively flexibility.

• The stem is highly polished to reduce the risk of cement abrasion.¹⁰

The 3C hip system employs a straight stem with tapered lateral shoulder, tapered lateral distal stem and proximal coating to encourage proximal bone ingrowth.

The profile is straight with a wide proximal M-L dimension to give the implant stability against rotational forces and protects against sinking.

Two stem types for cemented and cementless stems, as well as a short version of the cementless stems allow for optimal adaption to the patients anatomy and bone quality

• Standard stem type with a CCD angle of 131º
• Lateralizing stem type with a CCD angle of 127,5º
• No vertical drop difference

The short (B) version is a shortened standard (A) stem. The cemented version is one size down from the cementless stem. This features allow to implant a short, standard cementless or cemented stem with the same surgical technique, or for a intraoperative change between the 3C variants.

The following materials and coatings are used for 3C hip stems:

• The cemented stem is made from EndoDur-S (forged CoCrMo)
• The cementless stem is made from Tilastan-S (forged Ti6Al4V alloy)
• Micro-roughness of the stem’s surface ensures primary fixation and is available in PlasmaLink and osteoconductive double coating made from titanium plasma and calcium phosphate (TiCaP)¹

This produces a regular and uniform micro structure surface. The distal stem is smooth to discourage bone integration.

1. Flattened tapered neck increases the range of motion between stem and acetabular cup
    
2. The highly polished neck area reduces the abrasion of the polyethylene insert if contact should occur²
    
3. Tapered lateral shoulder of the stem allows the trochanter major to remain intact while still providing a wide proximal M-L dimension of the implant
   - Allows direct anterior approach
    
4. Large anatomical medial curvature provides metaphyseal support, fixation and load transfer. Additionally it ensures good anatomical fit, essential for primary and long term stability
    
5. Tapered distal end prevents bone contact
   - For the standard length this facilitates introduction of the stem into the medullary cavity

The cemented placement makes the hip prosthesis system particularly suitable for elderly patients for whom cementless placement is not a possibility. The direct stability of the stem and acetabular cup in the cement coating permits rapid postoperative mobilization of the patient. This, in turn, means shorter recovery times and shorter hospitalization for the patient.²
The 126° CCD angle was also chosen with elderly patients in mind. This reflects the physiological change of the angle with increasing age.²

In combination with the LINK IP Polyethylene Acetabular Cup, LINK Lubinus Polyethylene Acetabular Cup, or the LINK Vario Cup, this system offers outstanding cemented hip replacement.
 

The stem, which is made of a cobalt chrome alloy, has a simple but clinically proven design.¹ Wide, rounded surfaces on the medial and lateral side serve to protect the cement bed. The large prosthesis collar enables proximal, bioharmonic force transmission. The collar counteracts sintering of the stem.³
 

The Lubinus Classic Plus Total Hip System is in a class of its own. It combines the practical and economic advantages of a modern standard system with the high material and processing quality for which LINK has been known for over 50 years.
 

The LINK MP Reconstruction System gives the surgeon the intraoperative flexibility and certainty¹ that is essential for a successful revision procedure with pronounced bone loss. The system’s unique design has produced outstanding outcomes for decades.^{2, 3, 4}
 

With just three instrument trays, the MP System enables a simple and fast surgery and a smooth process in five steps. The modular system gives the surgeon a high degree of flexibility in terms of adapting leg length, offset, and anteversion, independently of the distal cementless or cemented anchoring of the stem. This permits a quick and uncomplicated intraoperative response to the individual anatomy and defect.⁵

The stems in all six lengths have a 3° angulation, which facilitates following the anatomical curvature of the femur. The 2° tapered stem with peripheral longitudinal ribs gives outstanding stability in the femur, even with large proximal defects.²
 

The cemented stems can also provide secure fixation when the bone quality is poor.
The PowerLock toothed connection allows the stem length to be adjusted intraoperatively by means of spacers in 10 mm increments up to 30 mm for revision arthroplasties. The absence of a taper connection means that the stem length and also the anteversion and offset can be adjusted retrospectively without endangering the distal fixation of the stem.

 

Neck segments with varying offsets, CCD angles, and volumes, with and without suture holes, allow reconstruction of the proximal femur to be adapted according to the particular defect and anatomy.
 

Going back to the proven design features of the MP Reconstruction System, the MP Monoblock is designed to meet the needs of modern revision surgery and is completing the MP Family with a new versatility. The MP 2° taper angle and the proven, broad spline geometry give the stem a superior axial stability and lower the risk of subsidence.¹ The rough, grit blasted surface of the stem made from biocompatible Tilastan-S shall support the osseointegration and bone remodelling to provide long-term stability.² Low risk of subsidence combined with a high offset version shall minimize the risk of luxation, while the short taper and flattened neck provide a great range of motion.^{1, 2, 3}

The surgical technique and instrumentation provides wide intraoperative versatility. The result is a system that allows the surgeon unlimited flexibility within the MP family.⁴

The instruments are designed to create a precise, reproducible relationship between the reamer, trial and implant positioning to help predict the ideal centre of rotation and support long-term stability of the hip joint.⁴

Many years of experience with successful implant systems and a range of fixation concepts, together with state-of-the-art material and coating technologies, have gone into the development of this new acetabular cup system. The result is the versatile cementless MobileLink Acetabular Cup System.
The MobileLink Acetabular Cup System comes in two different versions: A cluster-hole press-fit cup and a multi-hole press-fit cup. Both versions of the shells are available in a PlasmaLink, a TiCaP double coating or a TrabecuLink surface.

The TiCap double coating combines a porous surface for primary fixation with our osteoconductive² HX calcium phosphate coating. This combination is designed to give optimal primary stability and osseointegration.

The 3-dimensional TrabecuLink structure, with its pore size, porosity and structure depth, also provides an excellent basis for promoting osteoconduction and microvascularization, taking into account the requirements for the structure-covering protein layer (fibronectin - vitronectin - fibrinogen).^4,5

The MobileLink Acetabular Cup System can be used with ceramic or UHMWPE inserts. UHMWPE inserts are available in X-LINKed and E-DUR (X-LINKed, Vit-E PE) versions. All UHMWPE inserts are available in a standard version and also with protection against luxation. The MobileLink Acetabular Cup System can be combined with modular offset and/or inclining casing/insert adapters (Face Changer). The adapters allow restoration of the anatomy in revision cases. In addition, the adapters permit the use of ceramic inserts in revision arthroplasties.

Features and Advantages of Dual Mobility:

• Dual mobility leads to reduced risk of dislocation and increased range of motion (RoM) ⁶
• Polished inner surface for minimized wear and a prolonged implant life ^7,8
• Self-centering Liner promotes even wear patterns and enhances dislocation resistance ⁹

The 3-dimensional TrabecuLink structure, with its pore geometry (porosity: 70%, pore size: 610-820 μm, structure depth: up to 1 mm) ensures excellent cell ongrowth. ^4,5,10

Pore filling
The sequence of images shows a pore of the TrabecuLink structure being filled with tissue under in-vitro cell culture conditions. The fibronectin laid down by human fibroblasts and continually reorganized over a period of eight days is visible as green fibers. Fibronectin is a component of the extracellular matrix that is formed at an early stage of the healing process. It forms a basis for the embedding of collagen, which is essential for mineralization of the tissue and ingrowth of bone into the structure. Apart from the accumulation of fibronectin, which increases over time, a clear contraction of the matrix towards the center of the pore can be observed. This contraction mechanism, which is attributable to the cellular forces acting in the tissue, accelerates the rate at which the pore is filled with tissue, compared to a layer-by-layer tissue growth (Reference: Joly P et al., PLOS One 2013; journals.plos.org/plosone/article. Julius Wolff Institute, Charité - Universitätsmedizin Berlin

Versatility

• The Augment size range allows good fit for different anatomies and defects⁵
   
• Variable bone screw angulation/options
   
• The Augment design allows flexibility to put bone screws through shell and Augment – big recesses allow for great variability in positing the Augment⁵
   
• Low Augment profile  
   
• Augments can be used upside down as buttresses⁵

Effective fixation

• Sufficient grip of Augments. Augments have a great primary stability⁵
   
• Pore geometry of the TrabecuLink structure for effective cell ongrowth^3,4,7
   
• Great connection between shell and Augment by application of cement mantle (according to surgical technique) ^5,6

Reproducible surgical technique

• The Augment forceps helps to place the Augment⁵
   
• Temporary fixation of trial Augment and final Augment by drill pins through pin holes - pins which hold trial Augments in place help to position final implant⁵
   
• Small inventory    

Pore filling

The sequence of images shows a pore of the TrabecuLink structure being filled with tissue under in-vitro cell culture conditions. The fibronectin laid down by human fibroblasts and continually reorganized over a period of eight days is visible as green fibers. Fibronectin is a component of the extracellular matrix that is formed at an early stage of the healing process. It forms a basis for the embedding of collagen, which is essential for mineralization of the tissue and ingrowth of bone into the structure. Apart from the accumulation of fibronectin, which increases over time, a clear contraction of the matrix towards the center of the pore can be observed. This contraction mechanism, which is attributable to the cellular forces acting in the tissue, accelerates the rate at which the pore is filled with tissue, compared to a layer-by-layer tissue growth (Reference: Joly P et al., PLOS One 2013; https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0073545). Julius Wolff Institute, Charité - Universitätsmedizin Berlin

The concept of double mobility was developed by Prof. Gilles Bousquet in 1975, with the aim of treating recurrent hip luxations.¹³ The system consists of a metal casing with a highly polished internal surface and a movable polyethylene inlay, inside which a press-fitted prosthesis head moves. This provides a greater range of motion with less abrasion^{14, 15, 16} and reduced risk of luxation.^{15, 17, 18} It was on the basis of this principle that the BiMobile Acetabular Cup System came about.

The development of the bimobile acetabular cup system drew on many years of experience with successful implant systems and fixation concepts plus state-of-the-art material and coating technologies. The result is the versatile LINK BiMobile Acetabular Cup System.

The cementless LINK BiMobile Acetabular Cup is available with a TiCaP double coating. The TiCaP double coating combines the properties of a highly porous layer of pure titanium for primary fixation and an osteoconductive³ calcium phosphate coating, which together provide optimal primary and secondary implant stability.^{4, 5} A supportive macrostructure on the cup equator increases the primary stability.⁹

The cemented BiMobile Acetabular Cup has a finely matt-finished SatinLink surface, which is also a feature of the SP II stems. Latitudinal and longitudinal groove-like structures reinforce the fixation and allow air to escape when the implant is pressed into the cement bed.

The inlays are available in UHMWPE and E-Dur (X-LINKed Vit-E PE) and can be combined with Link prosthesis heads made of CoCrMo or ceramic with a 22 or 28 mm diameter.

In addition to the material properties, the external shape of the acetabular cups helps to prevent loosening. Radial notches on the surface create a high degree of cement contact and allow air to escape when the implant is pressed into the cement bed.⁴ Approximately 0.5 mm of play between prosthesis head and acetabular cup allows for “lubrication” by body fluids.⁹ Furthermore, spacers on the rear surface of the acetabular cup permit a uniform cement coating. This surface design increases the stability of the cup in the acetabulum, thereby largely eliminating the risk of loosening.⁵ This design is used successfully in the Lubinus^® Acetabular Cup and in the FAL and IP Polyethylene Acetabular Cups.
 

LINK^® has decades of experience in the use of UHMWPE, and this was particularly valuable in the design of the cemented acetabular cups. The high quality of the polyethylene demonstrably minimizes abrasion suffered by the components, and thereby reduces the risk of osteolysis. Consequently, the incidence of component loosening is very low. In addition to the Standard UHMWPE, we also supply the system in acetabular cups made of X-Linked UHMWPE. This highly crosslinked polyethylene makes it possible to achieve even lower abrasion levels.^{2, 3, 7, 8}
 

The LINK^® Lubinus^® Polyethylene Acetabular Cup is a cemented acetabular cup made of UHMWPE. The direct stability of the cup in the cement coating permits rapid postoperative mobilization of the patient. This, in turn, means shorter recovery times and shorter hospitalization for the patient.¹
 

LINK has decades of experience in the use of UHMWPE, and this was particularly valuable in the design of the cemented acetabular cups. The high quality of the polyethylene demonstrably minimizes abrasion suffered by the components, and thereby reduces the risk of osteolysis. Consequently, the incidence of component loosening is very low. In addition to the Standard UHMWPE, we also supply the system in acetabular cups made of X-LINKed UHMWPE, This highly crosslinked polyethylene make it possible to achieve even lower abrasion levels.^{2, 3, 7, 8}

In addition to the material properties, the external shape of the acetabular cups helps to prevent loosening. Radial notches in the surface create a high degree of cement contact and allow air to escape when the implant is pressed into the cement bed.⁴ Furthermore, spacers on the rear surface of the acetabular cup permit a uniform cement coating. This surface design increases the stability of the cup in the acetabulum, thereby largely eliminating the risk of loosening This cup design is used successfully in the FAL and IP Polyethylene Acetabular Cups and also in the Lubinus Acetabular Cup.

The LINK FALPolyethylene Acetabular Cup is a cemented acetabular cup made of UHMWPE. The direct stability of the cup in the cement coating permits rapid postoperative mobilization of the patient. This, in turn, means shorter recovery times and shorter hospitalization for the patient.¹

LINK has decades of experience in the use of UHMWPE, and this was particularly valuable in the design of the cemented acetabular cups. The high quality of the polyethylene demonstrably minimizes abrasion suffered by the components, and thereby reduces the risk of osteolysis. Consequently, the incidence of component loosening is very low. In addition to the Standard UHMWPE, we also supply the system in acetabular cups made of X-LINKed UHMWPE. This highly crosslinked polyethylene makes it possible to achieve even lower abrasion levels.^{2, 7, 8}

In addition to the material properties, the external shape of the acetabular cups help to prevent loosening. Radial notches in the surface create a high degree of cement contact and allow air to escape when the implant is pressed into the cement bed.⁴ Approximately 0.5 mm of play between prosthesis head and acetabular cup allows for “lubrication” by body fluids.¹⁰ Furthermore, spacers on the rear surface of the acetabular cup permit a uniform cement coating. This surface design increases the stability of the cup in the acetabulum, thereby largely eliminating the risk of loosening.⁵ This design is used successfully in the FC, FAL, and IP Polyethylene Acetabular Cups and also in the Lubinus Acetabular Cup.

The LINK Endo-Model Polyethylene Acetabular Cup is a cemented acetabular cup made of UHMWPE. The direct stability of the cup in the cement coating permits rapid postoperative mobilization of the patient. This, in turn, means shorter recovery times and shorter hospitalization for the patient.¹

LINK has decades of experience in the use of UHMWPE, and this was particularly valuable in the design of the cemented acetabular cups. The high quality of the polyethylene demonstrably minimizes abrasion suffered by the components, and thereby reduces the risk of osteolysis. Consequently, the incidence of component loosening is very low. In addition to the Standard UHMWPE, we also supply the system in acetabular cups made of X-Linked UHMWPE, This highly crosslinked polyethylene makes it possible to achieve even lower abrasion levels.^{2, 7, 8}

In addition to the material properties, the external shape of the acetabular cups helps to prevent loosening. Radial notches in the surface create a high degree of cement contact and allow air to escape when the implant is pressed into the cement bed.⁴ Furthermore, spacers on the rear surface of the acetabular cup permit a uniform cement coating. This surface design increases the stability of the cup in the acetabulum and largely eliminates the risk of loosening. This cup design is used successfully in the FAL and IP Polyethylene Acetabular Cups and also in the Lubinus Acetabular Cup.

The LINK FC Polyethylene Acetabular Cup is a cemented acetabular cup made of UHMWPE. The direct stability of the cup in the cement coating permits rapid postoperative mobilization of the patient. This, in turn, means shorter recovery times and shorter hospitalization for the patient.¹

LINK has decades of experience in the use of UHMWPE, and this was particularly valuable in the design of the cemented acetabular cups. The high quality of the polyethylene demonstrably minimizes abrasion suffered by the components, and thereby reduces the risk of osteolysis. Consequently, the incidence of component loosening is very low. In addition to the Standard UHMWPE, we also supply the system in acetabular cups made of X-Linked UHMWPE, This highly crosslinked polyethylene make it possible to achieve even lower abrasion levels.^{2, 3, 6, 7}

In addition to the material properties, the external shape of the acetabular cups helps to prevent loosening. Radial notches in the surface create a high degree of cement contact and allow air to escape when the implant is pressed into the cement bed.⁴ Furthermore, spacers on the rear surface of the acetabular cup permit a uniform cement coating. This surface design increases the stability of the cup in the acetabulum, thereby largely eliminating the risk of loosening.⁸ This design is used successfully in both the IP and FAL Polyethylene Acetabular Cups and in the Lubinus Acetabular Cup.

The LINK IP Polyethylene Acetabular Cup is a cemented acetabular cup made of UHMWPE. The direct stability of the cup in the cement coating permits rapid postoperative mobilization of the patient. This, in turn, means shorter recovery times and shorter hospitalization for the patient.¹

ANATOMICAL APPROACH with Anatomical Stems made by LINK

Tissue preserving approach meets bone preserving stems
 

• Polished tip supports easy and safe insertion¹
   
• Integrated anteversion facilitates access to the femur
   
• Flattened lateral shoulder helps to preserve bone and soft tissue²

COLLABORATIVE Partnership

Fine-tuned to your needs
 

• Peer to peer training courses
   
• Clinical Visits
   
• Local trainers for ongoing support

EFFICIENT Training

Be great from the start
 

• Simple interpretation of the DAA
   
• Intuitive instrument workflow³
   
• No traction table

ECONOMICAL Approach

Little buy-in, large difference
 

• Streamlined instrument set
   
• No additional surgery equipment
   
• Only one assistant required

The UHMWPE inserts are available in standard and anti-luxation versions. Both versions offer five adjustable rotation positions, and this permits individual alignment to suit the specific hip situation.

For enhanced secondary stability, the LINK T.O.P. II Acetabular Cup System with osteoconductive HX calcium phosphate coating (CaP) is available.^{2, 3}

Years of experience with successful implant systems and fixation concepts plus state-of-the-art material and coating technologies were applied in the the design of the Link T.O.P. II Acetabular Cup System.

The medioventral recess serves to protect the femoral nerve and psoas tendon, while allowing a greater range of motion.¹
 

The CombiCup System is a versatile acetabular cup system, consisting of the CombiCup Press-Fit Acetabular Cup, CombiCup Screw-in Acetabular Cup and CombiCup Revision Acetabular Cup. The acetabular cups can be combined with inserts made of BIOLOX delta* ceramic and also PE and X-PE (crosslinked UHMWPE). In addition, the CombiCup Revision System comprises neutral, lateralizing and angled adapters (Face changer) for various anatomical situations.

Intelligently designed and sensibly graduated options permit reconstruction of virtually all anatomical situations. Furthermore, identical acetabular cup inserts, a shared basic instrument set plus specific additional instruments together guarantee intraoperative flexibility and lean inventory.