Design Rationale and Surgical Technique

Maximizing performance from every angle

Saving time in the operating room is one of the most valuable solutions
Smith & Nephew can provide surgeons. The TANDEM INTL Bipolar/Unipolar Hip
System dramatically increases efficiency with an easy-to-assemble bipolar design,
one-tray instrumentation and a variety of operative options.
The TANDEM INTL Bipolar/Unipolar Hip System is the most comprehensive and
effective partial hip system seen on the market in years, addressing performance
from a multitude of angles. By integrating superior features into the new product
design, the TANDEM INTL Bipolar minimizes wear, eliminates poly degradation
caused by gamma irradiation and maximizes range of motion.

Nota Bene: The technique description herein is made available to the healthcare professional to illustrate the authors’ suggested
treatment for the uncomplicated procedure. In the final analysis, the preferred treatment is that which addresses the needs of the patient.
Introduction
David J. Jacofsky, M.D.
Mayo Clinic, Rochester, MN
Steven H. Stern, M.D.
Clinical Associate Professor of Orthopedic Surgery, Northwestern University, Northwestern Memorial Hospital

Hemiarthroplasty of the hip involves replacement of the diseased,

affected, or broken femoral head and/or neck with a prosthetic
component. Hemiarthroplasty does not involve resurfacing of the
acetabulum, and therefore a bipolar or unipolar prosthetic head
articulates against the host acetabular articular cartilage. Avoiding
the need, when appropriate, to resurface the acetabulum helps to
minimize surgical trauma, operative time and dislocation risk, while
preserving acetabular bone stock.
Intracapsular hip fractures may be amenable to internal fixation in
appropriately chosen patients. However, many fractures of the
femoral head and femoral neck are unsuitable for internal fixation
due to the patient’s bone quality, fracture displacement, fracture
chronicity, or pre-existing patient medical comorbidities. In these
situations, pain relief, mobility, and patient outcome may be best
served with prosthetic replacement. In addition, certain hip
pathology outside traumatic indications may benefit from
hemiarthroplasty of the hip.
 TANDEM INTL Bipolar Hip System

Design Features

Superior Wear Performance

The TANDEM INTL Bipolar minimizes rotational and axial movement
at the liner-shell interface by incorporating a preassembled
polyethylene component into the shell.
In addition, the TANDEM INTL Bipolar meets the minimum
requirement for polyethylene thickness as stated by Bartel,1
incorporating a minimum of 5mm of polyethylene in a majority of
sizes. Poly thickness, combined with the preassembled poly
component, provides unmatched superior wear performance.

Unique Sterilization
To reduce the potential for degradation of the polyethylene liner,
the TANDEM INTL Bipolar is EtO sterilized. This patent-pending
feature eliminates the susceptibility of the liner to oxidation caused
by gamma sterilization.

Maximum ROM
Smith & Nephew understands that range of motion (ROM) is not
dependent upon neck design alone. The wide liner chamfer of the
TANDEM INTL Bipolar, which is similar to the chamfer of REFLECTION™
liners, allows maximum ROM when combined with Smith & Nephew
stems. Internal testing has shown that the TANDEM INTL Bipolar
design improves ROM over competitive offerings.2

ROM ID (mm) OD (mm) Neck Offset

TANDEM INTL 82˚ 28 51 +0
TANDEM INTL 88˚ 28 59 -3
Competitor A 70˚ 28 60 -3*
Competitor B 68˚ 28 58 -3.5
Competitor C 66˚ 28 51 +0
* Smith & Nephew femoral head used.

1
Bartel, DL; Burstein, AH; Toda, MD; Edwards, DL: The effect of conformity and plastic thickness on contact
stresses in metal-backed plastic implants. J Biomech Eng. 1985 Aug; 107(3):193-9.
2
Smith & Nephew internal testing.
Easy Implant Assembly
To improve efficiency in the operating room, the TANDEM INTL
Bipolar was designed for easy implant assembly, requiring no tools
to assemble the bipolar component. The simple and quick
assembly requires less than five pounds of finger pressure.

More Options
The TANDEM INTL Bipolar implants are designed to work with either
22 or 28mm femoral heads, depending on the outer diameter shell
size. The 22mm femoral heads are offered in four neck lengths,
ranging from +0 to +12mm. Available in six neck lengths, the 28mm
ranges from -3 to +16mm.
The TANDEM INTL Bipolar is available in a variety of sizes,
increasing operative options. The implants are offered in 38-42mm
outer diameter sizes which use a 22mm inner head. The 28mm
inner heads are coupled with the 43-55, 57, and 59mm sizes.

Unsurpassed Mechanical Strength

The strength characteristics of the TANDEM INTL Bipolar are Bipolar Implants
superior to that of competitive designs. Internal testing shows that 500

the TANDEM INTL Bipolar has average maximum pullout strength of 400
400 lbf. with a 28mm femoral head, which exceeds or meets the
strength of tested competitive designs.2 300

200
Pullout Load (lbf)

Positive Eccentricity
100
The positive eccentricity in the TANDEM INTL Bipolar design aligns
the femoral head with the joint reaction force of the body. The 0
Competitor A TANDEM
amount of eccentricity is varied based on inner and outer diameter
dimensions of the bipolar component.

Biocompatible Material
The TANDEM INTL Bipolar is cast and machined out of standard
cobalt-chrome material, a wear resistant and biocompatible
material that has been used for years in medical device implants.
TANDEM Unipolar Hip System

Design Features

Flexibility
The TANDEM Unipolar provides a complete,
yet streamlined, option for surgeons whose
preference in partial hip replacement is a
unipolar endoprosthesis.
The TANDEM Unipolar can be used with a variety
of Smith & Nephew stems, providing independent
sizing of the acetabulum and femur. If needed,
this allows re-establishment of proper soft tissue
tensioning and revision without stem removal.

Wear Resistant and Biocompatible

The TANDEM Unipolar head, made of solid cobalt
chrome, a wear resistant and biocompatible
material, is available in a range of OD sizes from
40-55, 57, 59, and 61mm.

Versatile
To achieve proper joint restoration, the taper
sleeves are provided in five neck lengths ranging
from -3 to +12mm.
TANDEM Instrumentation

One-Tray Instrumentation
The simple, one-tray instrumentation design
incorporates two trialing techniques into one
system. Maximizing efficiency in the operating
room, this design facilitates fast and easy trialing
for either procedure.

TANDEM Trial Shells

Designed for dimensional stability, TANDEM
Trial Shells perform accurately after repeated
sterilization. In addition, the interchangeability
of the femoral head trials (included in the femoral
instrument set) and unipolar conversion sleeves
with the trial shells increases the versatility of the
instruments. The trial shells are also threaded for
surgeons who prefer to perform a “suction” test.

TANDEM Unipolar Conversion Sleeves

TANDEM Unipolar Conversion Sleeves allow easy
conversion of the trial shells into a unipolar trial
quickly and efficiently. The sleeves snap directly into
the trial shell and can be easily removed using the
tip of the trial handle.

TANDEM Quick-Connect Trial Handle

The TANDEM Quick-Connect Trial Handle (pictured) is
designed to allow the trial shells to snap off quickly
for a more efficient procedure and provides more
visibility inside the wound.
A straight threaded trial handle is also available
for surgeons who prefer additional security in
their trialing technique.

Ring Spreader
The Ring Spreader is used to disassemble the
bipolar when there is a need to change femoral
head neck lengths or for the removal of the
bipolar component.

Unipolar Taper Sleeve Removal Tool

The Unipolar Taper Sleeve Removal Tool threads
into the top portion of the taper sleeve and is used
to release the taper sleeve from the stem neck.
 TANDEM INTL Bipolar Hip System

Surgical Technique

Acetabular Measurement
To estimate acetabular size, use preoperative
templates or measure the excised femoral head
with ID/OD gauges or calipers.
To determine implant size, acetabular measurement
can be performed with TANDEM Trial Shells and
the quick-connect trial handle. A straight threaded
trial handle is also available.

Bipolar trial options Broach and Implant Trialing

Follow the surgical technique for the Smith &
Nephew femoral component to be used. Neck
length trialing can be performed using TANDEM
Trial Shells and 28mm trial femoral heads
(included in the femoral instrument set).
Trialing can be performed off either the broach
(using the appropriate trial neck) or the implant.
Based on preoperative templating, select a trial
head neck length and perform a trial reduction.
Continue adjusting the trial femoral head neck
length until proper leg length and joint stability
Broach Implant are achieved.

Trial Removal
To remove the femoral trial head from the trial shell,
insert the tip of either trial handle into the outer
portion of the threaded hole of the trial shell.
Femoral Head Selection TANDEM INTL Bipolar Selection
For instrument simplicity, all bipolar trialing utilizes
28mm trial femoral heads. OD ID Trial ID Implant
A 22mm femoral head must be used with a
38-42mm OD. A 28mm femoral head requires
38, 39mm n/a 22mm
43mm and larger ODs. 40-42mm 28mm 22mm
43-55mm 28mm 28mm
57, 59mm 28mm 28mm

Bipolar Assembly
The bipolar component (shell and liner) is
packaged in one box. Place the appropriate
diameter femoral head, corresponding to the
outer diameter and appropriate neck length,
into the preassembled metal-polyethylene
bipolar shell.

Place the polyethylene top-locking ring over the

femoral head.

Making sure the poly ring is not tilted, ease “Click”

the poly locking ring into the shell. Using finger
pressure, gently press down on the poly lock
ring until an audible click is heard.

The poly locking ring should be flush with the

metal shell.
TANDEM INTL Bipolar Hip System

Surgical Technique

Implant Assembly
Clean and dry the stem taper. Place the fully
assembled bipolar onto the stem taper and tap
with the femoral head impactor until secure.

Bipolar Disassembly: Back Table

Holding the assembled bipolar over a clean,
secure surface, place the tip of the ring spreader
into the disassembly slot of the bipolar
component. By squeezing the handles of the
ring spreader, the inner snap ring will expand,
allowing the top poly ring to disengage. If
necessary, gently shake the component until
the poly ring is disengaged and the femoral
head is released.

Bipolar Disassembly: In Vivo

Place the tip of the ring spreader into the
disassembly slot of the bipolar component.
Squeezing the handles of the ring spreader,
slightly push in to release the retaining ring.
While holding the retaining ring open, gently lift
the bipolar metal shell until the top poly ring is
disengaged.
TANDEM Unipolar Hip System

Surgical Technique

Acetabular Measurement
To estimate acetabular size, use preoperative
templates or measure the excised femoral head
with ID/OD gauge or calipers.
To determine implant size, acetabular
measurement can be performed with TANDEM Trial
Shells and the quick-connect trial handle.
A straight threaded trial handle is also available.

Broach and Implant Trialing Unipolar trial options Unipolar neck offset options
-3, +0, +4, +8, +12mm
Follow the surgical technique for the
Smith & Nephew femoral component to be used.
Neck length trialing can be performed using
TANDEM Trial Shells and TANDEM Unipolar
Conversion Sleeves.
Trialing can be performed off either the broach
(using the appropriate trial neck) or the implant.
Based on preoperative templating, select the
appropriate unipolar conversion sleeve and
perform a trial reduction. Continue adjusting the
unipolar conversion neck length until proper leg
length and joint stability are achieved. Broach Implant

Trial Removal
To remove the TANDEM Unipolar Conversion
Sleeve from the trial shell, insert the tip of either
trial handle into the outer portion of the threaded
hole of the trial shell.
TANDEM Unipolar Hip System

Surgical Technique

Implant Assembly
Clean and dry the stem taper. Firmly place the
taper sleeve on the femoral taper.

Clean and dry the taper sleeve and place the

appropriate size unipolar head onto the sleeve.
Impact with the femoral head impactor and mallet.

Implant Disassembly
After removing the unipolar head from the taper
sleeve, thread the Unipolar Taper Sleeve Removal
Tool into the top of the taper sleeve implant until
it contacts the femoral taper. Continue turning
until the sleeve separates from the stem.
Catalog

Implants

TANDEM INTL Bipolar Implant 12/14 Taper Femoral Heads

(Cobalt Chrome/UHMWPE) (Cobalt Chrome)
Cat. No. Outer Inner Cat. No. Outer Neck
Diameter Diameter Diameter Length
7132-4038 38mm 22mm 7130-2200 22mm +0mm
7132-4039 39mm 22mm 7130-2204 22mm +4mm
7132-4040 40mm 22mm 7130-2208 22mm +8mm
7132-4041 41mm 22mm 7130-2212 22mm +12mm
7132-4042 42mm 22mm 7130-2803 28mm -3mm
7132-4043 43mm 28mm 7130-2800 28mm +0mm
7132-4044 44mm 28mm 7130-2804 28mm +4mm
7132-4045 45mm 28mm 7130-2808 28mm +8mm
7132-4046 46mm 28mm 7130-2812 28mm +12mm
7132-4047 47mm 28mm 7130-2816 28mm +16mm
7132-4048 48mm 28mm
7132-4049 49mm 28mm
7132-4050 50mm 28mm
7132-4051 51mm 28mm
7132-4052 52mm 28mm
7132-4053 53mm 28mm
7132-4054 54mm 28mm
7132-4055 55mm 28mm
7132-4057 57mm 28mm
7132-4059 59mm 28mm

TANDEM Unipolar Implant TANDEM Unipolar 12/14

(Cobalt Chrome) Taper Sleeves
Cat. No. Outer Cat. No. Neck
Diameter Length
12-6640 40mm 7132-6603 -3mm
12-6641 41mm 7132-6600 +0mm
12-6642 42mm 7132-6604 +4mm
12-6643 43mm 7132-6608 +8mm
12-6644 44mm 7132-6612 +12mm
12-6645 45mm
12-6646 46mm
12-6647 47mm
12-6648 48mm
12-6649 49mm
12-6650 50mm
12-6651 51mm
12-6652 52mm
12-6653 53mm
12-6654 54mm
12-6655 55mm
12-6657 57mm
12-6659 59mm
12-6661 61mm
Catalog

Instruments

TANDEM Trial Shells Ring Spreader

Cat. No. Outer Cat. No. 7136-2802
Diameter
7136-3040 40mm
7136-3041 41mm
7136-3042 42mm
7136-3043 43mm
7136-3044 44mm TANDEM Quick-Connect
7136-3045 45mm
7136-3046 46mm Trial Handle
7136-3047 47mm
7136-3048 48mm Cat. No. 7136-2803
7136-3049 49mm
7136-3050 50mm
7136-3051 51mm
7136-3052 52mm
7136-3053 53mm TANDEM Straight Threaded
7136-3054 54mm Trial Handle (Not Shown)
7136-3055 55mm
7136-3057 57mm Cat. No. 7136-2804
7136-3059 59mm

Unipolar Taper Sleeve

Removal Tool
TANDEM Unipolar Conversion Sleeves Cat. No. 11-6608

Cat. No. Description

7136-7903 -3mm

7136-7900 +0mm

7136-7904 +4mm

7136-7908 +8mm

7136-7912 +12mm
TANDEM Instrument Tray
Cat. No. 7136-2805

TANDEM Instrument Set

Cat. No. 7131-1002

TANDEM CoCr Bipolar

Implant Set (Not Shown)
Cat. No. 7131-9933

TANDEM CoCr Unipolar

Implant Set (Not Shown)
Cat. No. 7131-9916
Orthopaedics
Smith & Nephew, Inc. www.smith-nephew.com
1450 Brooks Road
Memphis, TN 38116
USA

Telephone: 1-901-396-2121
Information: 1-800-821-5700
Orders/Inquiries: 1-800-238-7538

™Trademark of Smith & Nephew, Reg. U.S. Pat. & Tm. Off. 11/04 7138-0925