Global APG Instrumentation Surgical Technique

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SURGICAL TECHNIQUE

GLOBAL® APG+

INSTRUMENTATION

Surgical Technique GLOBAL® APG+ DePuy Synthes Joint Reconstruction 3

CONTENTS

GLOBAL APG+ SYSTEM KEY SURGICAL STEPS 4-5

SURGICAL TECHNIQUE

KEY INFORMATION

Pre-Operative Planning 6

Glenoid Exposure 7-8

Sizing – Sizer Pin Guides

No Version Correction 9

Version Correction 9

Pin Placement - Sizer Pin Guides 10

Pin Placement and Sizing – Fixed Pin Guide 11

Reaming - Normal Exposure 12

Reaming - Challenging Exposure 13-14

Drilling Central Peg Hole and Guide Pin Extraction 15

Drilling Peripheral Peg Holes 16

Trialing 17

Applying Bone Paste 18

Cement Application 19-20

Seating the Implant and Wound Closure 21

Instrument Case Layout 22

Ordering Information and Instument Usage Diagram 23

Essential Product Information 24

GLOBAL® APG+ SYSTEM KEY SURGICAL STEPS

1. Release Capsule

3. Drilling Central

Peg Hole

2. Expose Glenoid

GLENOID EXPOSURE

GLENOID PREPARATION AND IMPLANTATION

1. Pin Placement, Sizing and

Retroversion Correction

2. Reaming

Normal Exposure

Sizer Pin Guides (No Version)

Fixed Pin Guide (Version or No Version)

Sizer Pin Guides (Version)

Challenging Exposure

4 DePuy Synthes Joint Reconstruction GLOBAL® APG+ Surgical Technique

4. Drilling Peripheral

Peg Holes

5. Trialing 6. Applying Bone Paste 7. Seating the Implant

Surgical Technique GLOBAL® APG+ DePuy Synthes Joint Reconstruction 5

PRE-OPERATIVE PLANNING

Pre-Operative Templating

Initial assessments of the glenoid bone should be carried

out using radiographic imaging to determine if the pa-

tient is suitable for treatment (Figure 1). Additional infor-

mation obtained from CT imaging can help determine

appropriate treatment as well. At this stage, measure-

ments can be identified for the angle of the plane of the

scapula, the plane of the glenoid fossa, glenoid version,

as well as size of the glenoid vault. One major pre-oper-

ative goal is to determine how much (if any) retroversion

correction is necessary (refer to Table 1 on page 13).

Corresponding information from the humeral compo-

nent of the joint is also assessed at this time.

Figure 2

Figure 3

Figure 1

6 DePuy Synthes Joint Reconstruction GLOBAL® APG+ Surgical Technique

Surgical Approach

The patient rests in the beach chair position for the sur-

gical procedure (Figures 2 and 3). The GLOBAL® Anchor

Peg Glenoid Implant should be implanted using the

delto-pectoral approach, humeral head resection, and

canal preparation as described in the GLOBAL®

ADVANTAGE® or GLOBAL® AP® System surgical tech-

niques. This allows for a good view of the inferior part

of the glenoid, and is also advantageous for revision sur-

gery where the difficult task of removal of the humeral

stem can be accomplished. Using this approach, a full

360 degree exposure of the bony glenoid should be

achieved. Sufficient posterior displacement of the proxi-

mal humerus is required to provide necessary exposure

for implanting the GLOBAL Anchor Peg Glenoid Implant.

This degree of posterior humeral displacement fre-

quently requires a posterior capsule release from the

posterior glenoid rim in addition to an anterior and infe-

rior capsular excision. To maintain this exposure a Mod-

ifed Sonnabend humeral head retractor, or a Lamina

Spreader retractor is used to lever against the humeral

broach or osteotomy cover, which is left in place to pro-

tect the proximal humerus.

Note: Failure to resect the entire humeral head at

its anatomic neck may limit glenoid exposure.

GLENOID EXPOSURE

Before beginning glenoid exposure for preparation of

the glenoid, it is very useful to inspect the posterior as-

pect of the capsule and glenohumeral space. Place the

arm in a position so that the humeral osteotomy is paral-

lel to the glenoid fossa. This is generally with the fore-

arm perpendicular to the floor and the humerus in slight

abduction. Using an osteotomy cover to protect the re-

sected humeral surface, position a lamina spreader re-

tractor and laterally displace the proximal humerus to

create a space between the osteotomy surface and the

glenoid. Open the blades of the lamina spreader and

have an assistant hold the retractor to prevent rotation.

Use a Double Prong Gelpi (2245-10-001) to retract the

superficial soft tissues while placing a Reverse Hohm-

ann Retractor (2245-10-040) between the remaining

inferior capsule and neurovascular structures (axillary

nerve and posterior humeral circumflex vessels) to

achieve a clear view of the interval between the hu-

merus and glenoid to the back surface of the capsule.

The posterior capsule is then released from the posterior

glenoid rim (Figure 4). In cases with a very tight posterior

capsule (prior surgery or post traumatic arthritis), it can

be excised with this exposure. In addition, the posterior

labrum can be easily visualized for excision along with

removal of the remaining part of the long head of the

biceps. Most importantly, this step will allow for com-

plete removal of the anterior inferior capsule with excel-

lent visualization and protection of the axillary nerve. At

this step, any osteophytes are removed, and the tissue is

then placed back into physiologic tension thereby facili-

tating increased access and safety.

Figure 4

Surgical Technique GLOBAL® APG+ DePuy Synthes Joint Reconstruction 7

GLENOID EXPOSURE

Final exposure of the glenoid requires the use of a select

set of deep retractors. A Small Anterior Glenoid Neck

Retractor (2810-17-000) is placed over the anterior gle-

noid rim and is used to retract the subscapularis and the

anterior soft tissues. The arm is then gradually posi-

tioned in extension, external rotation, and abduction. A

Proximal Humerus Spreader (2245-10-100) is posi-

tioned with the medial foot plate at the base of the cor-

acoid and the lateral plate on the resected surface of the

humerus to provide improved glenoid exposure (Fig-

ure 5). With ideal exposure the resected surface of the

humerus is parallel to the posterior wall of the glenoid

as well as posterior to the posterior glenoid rim thereby

allowing full 360 degree exposure of the glenoid fossa.

If needed, a Reverse Hohmann Retractor, is placed on

the superior glenoid within the supraspinatus fossa to

retract the superior part of the deltoid.

Full 360 degree exposure of the glenoid fossa is difficult

in patients who have revision surgery, soft tissue scarring

from a prior surgery, or malunions resulting from post

traumatic cases. Patients who are very muscular or

obese can also present exposure problems. In these

cases, less than ideal exposure needs to be managed

with respect to the instrumentation, alternative methods

of retraction, and arm positioning to facilitate adequate

exposure of the glenoid.

Note: Extensive capsular excision and release,

along with proper resection of the humeral head,

will correct most loss of motion commonly due to

osteoarthritis, post capsulorrhaphy arthropathy,

and post traumatic arthritis (including mal-

unions). Soft tissue release often includes release

of the long head of the biceps. These releases are

essential for optimal glenoid exposure. Additional

details surrounding glenoid exposure can be

found in the GLOBAL® ENABLE™ System surgical

technique.

Figure 5

8 DePuy Synthes Joint Reconstruction GLOBAL® APG+ Surgical Technique

The 2.5mm Breakaway Guide Pin is set in an orientation

that may allow for an appropriate amount of retrover-

sion correction (if necessary), and is placed using one of

two pin placement devices – Sizer Pin Guides (+0, +3, or

+5mm), or a Fixed Pin Guide. The 2.5mm Breakaway

Guide Pin is scored in three locations (3, 4, and 5 inches

from the tip) allowing smooth and controlled breakage.

This feature allows the pin to be customized to a length

appropriate to the patient and surgeon preference.

No Version Correction

Identify which Sizer Pin Guide (40+0, 44+0, 48+0,

52+0, or 56+0mm) covers as much of the glenoid sur-

face as possible without overhanging the periphery of

the bone surface.

Version Correction

Identify which Sizer Pin Guide (40+3, 40+5, 44+3,

44+5, 48+3, 48+5, 52+3, 52+5, 56+3, or 56+5mm)

covers as much of the glenoid surface as possible with-

out overhanging the periphery of the bone surface, and

has the appropriate step height (+3 or +5mm) (Figure 6)

that will provide the amount of version correction re-

quired (5 or 10 degrees) based on preoperative planning

or intra-operative assessment (See Table 1 and Figure 7).

Note: An implant that is too large will lack glenoid

bone support and interfere with normal rotator

cuff function.

Step Height (mm) Version Correction

+0 None

+3 5o

+5 10o

SIZING – SIZER PIN GUIDES

Figure 6

Figure 7

Surgical Technique GLOBAL® APG+ DePuy Synthes Joint Reconstruction 9

Use the selected Sizer Pin Guide for the glenoid surface

that allows placement of the 2.5mm Breakaway Guide

Pin (Figure 8) in the center of the glenoid fossa. The

viewing holes in the Sizer Pin Guide allow for visualiza-

tion of position and fit. If there is intraoperative difficulty

in glenoid sizing, reference the planned size for the hu-

meral head to determine which side of the joint needs

to be adjusted.

Attach the cannulated Curved Handle to the hexagonal

boss on the correct Sizer Pin Guide and center on the

glenoid fossa. This connection keeps the Sizer Pin Guide

from rotating when held in place.

Insert a 2.5mm Breakaway Guide Pin through the

Curved Handle/Sizer Pin Guide assembly and drill

securely into the glenoid fossa using a power drill

(Figure 9). Remove the Curved Handle/Sizer Pin Guide

assembly over the 2.5mm Breakaway Guide Pin. The

2.5mm Breakaway Guide Pin length may be adjusted at

this point by placing the guide pin through the hole in

the top of the Curved Handle just below the chosen

score line and snapping the guide pin using the Curved

Handle as a lever. The guide pin is now ready for the

other cannulated instrumentation.

Note: The grooves on the 2.5mm Breakaway Guide

Pin are exclusively used for the breakaway feature

and are not intended to indicate the depth to which

the pin should be inserted.

The pin is designed to break at the grooves. Be

aware that it may break unintentionally if sub-

jected to too much bending force.

After use of the guide pin is complete, confirm that

all sections (totaling the full length of the original,

unbroken pin) have been removed.

PIN PLACEMENT – SIZER PIN GUIDES

Figure 9

Figure 8

10 DePuy Synthes Joint Reconstruction GLOBAL® APG+ Surgical Technique

Insert the tip of the Straight Handle Hex Driver

through the top of the Fixed Pin Guide and engage it

in the bottom portion. Tighten the Internal Rod of the

Straight Handle Hex Driver through the external handle,

which expands the hexagonal tip securing the driver to

the Fixed Pin Guide.

Place the guide along the anterior wall of the glenoid

until its tip reaches the lateral aspect of the subscapu-

laris fossa. Identify the hole in the upper portion of the

Fixed Pin Guide that corresponds to the center of the

glenoid fossa. Care needs to be taken that the inclina-

tion angle of the Fixed Guide Pin is set appropriately.

Insert a 2.5mm Breakaway Guide Pin through the

chosen hole of the Fixed Pin Guide directly and drill se-

curely into the glenoid fossa using a power drill (Fig-

ure 10). Loosen the Internal Rod (Figure 11) of the

Straight Handle Hex Driver to disengage from the Fixed

Pin Guide. Remove the Fixed Pin Guide from the glenoid.

The lower portion of the guide is designed to pivot away

from the anterior glenoid for easy removal over the

2.5mm Breakaway Guide Pin. The 2.5mm Breakaway

Guide Pin length may be adjusted at this point by plac-

ing the guide pin through the hole in the top of the

Curved Handle just below the chosen score line and

snapping the guide pin using the Curved Handle as a le-

ver. The guide pin is now ready for the other cannulated

instrumentation.

Identify which Sizer Pin Guide (40, 44, 48, 52 or, 56 --

+0, +3, +5) covers as much of the glenoid surface as

possible without overhanging the periphery of the bone

surface (See Table 1 and Figure 7 on page 13).

Note: The Fixed Pin Guide is designed to place the

guide pin straight down the axis of the glenoid re-

gardless of version. Inclination must be indepen-

dently determined and set by the surgeon.

PIN PLACEMENT AND SIZING – FIXED PIN GUIDE

Figure 10

Figure 11

Surgical Technique GLOBAL® APG+ DePuy Synthes Joint Reconstruction 11

Attach the appropriately sized Access Reamer (40, 44,

48, 52, or 56mm) to the Quick Connect Driver Shaft, and

advance over the 2.5mm Breakaway Guide Pin (Figures

12 and 13). Remove unwanted cartilage and bone from

the surface of the center portion of the glenoid fossa

making sure to remove only as much bone as necessary

(Figure 14). Remove the Access Reamer and Quick Con-

nect Driver Shaft over the 2.5mm Breakaway Guide Pin.

Detach the Access Reamer from the Quick Connect Driver

Shaft to ready the driver for the drilling step.

Note: It is important to prepare the surface com-

pletely before moving on to the next step. Care

needs to be taken that there is congruent contact

between the bone and the back side of the implant.

The appropriately sized Sizer Pin Guide (+0) may

be used to check contact.

Caution: Over-reaming decreases the surface area

of the glenoid, decreases the depth of the glenoid

vault, and removes the subchondral bone. All of

these conditions can lead to suboptimal seating

and support of the implant.

REAMING – NORMAL EXPOSURE

Figure 13 Figure 14

Figure 12

12 DePuy Synthes Joint Reconstruction GLOBAL® APG+ Surgical Technique

REAMING – CHALLENGING EXPOSURE

Attach the appropriately sized Low Profile Central

Reamer (40/44mm or 48/52/56mm) to the Quick

Connect Driver Shaft, and advance over the 2.5mm

Breakaway Guide Pin. The size and shape of the Low

Profile Central Reamer is designed to prepare the ante-

rior/posterior portion of the glenoid fossa only, and a

second step is needed to remove unwanted cartilage

and bone from the superior/inferior portions. Remove

unwanted cartilage and bone from the surface of the

center portion of the glenoid fossa making sure to re-

move only as much bone as necessary (Figure 15). Re-

move the Low Profile Central Reamer and Quick Con-

nect Driver Shaft over the 2.5mm Breakaway Guide

Pin. Detach the Low Profile Central Reamer from the

Quick Connect Driver Shaft to ready the driver for the

drilling step.

Figure 15

Surgical Technique GLOBAL® APG+ DePuy Synthes Joint Reconstruction 13

Select the appropriately sized Low Profile Peripheral

Reamer (40, 44, 48, 52, or 56mm), and attach to the

Ratchet T-Handle from either the GLOBAL ADVANTAGE or

GLOBAL AP Instrument Set. Finish creating a uniform, con-

cave surface across the entire glenoid fossa by manually op-

erating the Low Profile Peripheral Reamer (Figure 16) until

its depth-stop bottoms out on the center portion of the gle-

noid.

Note: It is important to prepare the surface completely

before moving on to the next step. Care needs to be

taken that there is congruent contact between the

bone and the back side of the implant. The appropri-

ately sized Sizer Pin Guide (+0) may be used to check

contact.

Tip: Remove all retractors and use reamer shaft to re-

tract soft tissue for extra room during challenging ex-

posure cases.

Caution: Over-reaming decreases the surface area of

the glenoid, decreases the depth of the glenoid vault,

and removes the subchondral bone. All of these condi-

tions can lead to suboptimal seating and support of

the implant.

Caution: The Low Profile Peripheral Reamer is NOT

intended for use with power. If hard bone impedes

bone removal, a Hand Burr may be used to conserva-

tively remove problem areas. Care should be taken to

avoid removal of too much subchondral bone as this

may compromise implant stability.

Figure 16

REAMING – CHALLENGING EXPOSURE

14 DePuy Synthes Joint Reconstruction GLOBAL® APG+ Surgical Technique

DRILLING CENTRAL PEG HOLE AND

GUIDE PIN EXTRACTION

Drilling Central Peg Hole

Attach the appropriately sized cannulated Quick Con-

nect Central Drill Bit (40/44mm or 48/52/56mm) to

the Quick Connect Driver Shaft, and introduce over

the 2.5mm Breakaway Guide Pin.

Advance the bit until it bottoms out on the reamed sur-

face of the glenoid (Figure 17). The morselized bone

captured during drilling the central hole should be saved

for use as bone paste between the flutes of the GLOBAL

Anchor Peg Glenoid. Remove the Quick Connect Central

Drill Bit and Quick Connect Driver Shaft over the 2.5mm

Breakaway Guide Pin.

Note: Use Quick Connect Central Drill Bit

40/44mm for implanting a 40mm or a 44mm An-

chor Peg Glenoid. Use Quick Connect Central Drill

Bit 48/52/56mm for implanting a 48mm, 52mm, or

56mm GLOBAL Anchor Peg Glenoid.

Figure 17

Figure 18

Guide Pin Extraction

Grasp and remove the 2.5mm Breakaway Guide Pin

using the Pin Extractor (Figure 18).

Note: After use of the guide pin is complete, con-

firm that all sections (totaling the full length of the

original, unbroken pin) have been removed.

Surgical Technique GLOBAL® APG+ DePuy Synthes Joint Reconstruction 15

Insert the tip of the Straight Handle Hex Driver into

one of the hexagonal holes on the Peripheral Drill

Guide. Tighten the Internal Rod of the Straight Handle

Hex Driver expanding the hexagonal tip and securing the

driver to the Peripheral Drill Guide. Insert the Peripheral

Drill Guide into the central hole. It should fully contact

the prepared bone surface on the glenoid fossa.

Connect the Quick Connect Peripheral Drill Bit to the

Quick Connect Driver Shaft to prepare for drilling of

the peripheral holes. The peripheral holes should not

penetrate the base of the scapula (Figure 19).

Place an Anti-Rotation Peg into the newly drilled pe-

ripheral hole using the Anti-Rotation Peg Inserter/Re-

mover (Figure 20). The peg will help prevent the Periph-

eral Drill Guide from shifting or rotating during the

drilling of subsequent holes. This will ultimately enable

the resulting peripheral hole pattern to precisely accom-

modate the peripheral pegs of the implant. Prepare the

anterior and posterior holes using the same Quick Con-

nect Peripheral Drill Bit.

Remove the Anti-Rotation Peg using the Anti-Rotation

Peg Inserter/Remover.

Option: An alternative to holding the Peripheral

Drill Guide in place is to use a 2.5mm x 70mm Fix-

ation Pin. Insert a 2.5mm x 70mm Fixation Pin

through one of two angled holes in the Peripheral

Drill Guide directly and securely into the glenoid

fossa (Figure 21). This alleviates the need to hold

the Peripheral Drill Guide in place by hand, and

allows for better visibility and maneuverability in

the joint space.

Note: Check each peripheral hole to determine

whether it penetrates the cortical wall of the gle-

noid vault. Penetrating holes are cemented but ex-

tra care is exercised to avoid pressurizing the ce-

ment.

Note: The recommended order of peripheral peg

hole preparation is: 1) anterior-inferior 2) anterior

- posterior 3) superior (Figure 21).

DRILLING PERIPHERAL PEG HOLES

Figure 19

Figure 20

Figure 21

1 2

3

16 DePuy Synthes Joint Reconstruction GLOBAL® APG+ Surgical Technique

Insert the appropriate implant Trial (40, 44, 48, 52, or

56mm) (Figure 22) into the prepared glenoid using the

Glenoid Grasper (Figure 23). Assess the fit to deter-

mine that the Trial sits flush with the prepared surface of

the glenoid. There should be full and concentric contact

between the back side of the Trial and the prepared sur-

face of the bone. If there is not full and concentric con-

tact between Trial and prepared bone surface, some or

all of the prior bone preparation steps may need to be

repeated. If the fit is adequate, remove the Trial, and fi-

nalize the bone preparation with pulsatile lavage or

other means of thorough irrigation to remove any blood

clots from the four drilled holes.

Note: Check the quality of the glenoid bone prepa-

ration by determining if the component is directly

supported by precisely contoured bone, which

should prevent the component from rocking, even

when an eccentric load is applied to the rim of the

implant.

Caution: Component loosening or excessive wear

may occur if the glenoid component lacks sufficient

bone support.

TRIALING

Figure 23

Size 56

Size 52Size 48

Size 44Size 40

Figure 22

Surgical Technique GLOBAL® APG+ DePuy Synthes Joint Reconstruction 17

Use the Bone Graft Applicator to apply cancellous

bone paste between the flutes of the appropriately sized

GLOBAL Anchor Peg Glenoid Implant (40, 44, 48,

52, or 56mm) to help facilitate tissue integration. Place

the GLOBAL Anchor Peg Glenoid Implant on a table

with the articular surface down and the central peg

flutes up. Place the circular opening of the Bone Graft

Applicator over the flutes and open the handles to ex-

pose the central peg flutes. Place the bone paste col-

lected from drilling the central peg hole, or from drilling

the underneath side of the humeral head, into the Bone

Graft Applicator on both sides of the central peg flutes

(Figure 24). Close and hold the Bone Graft Applicator.

At the same time, hold the GLOBAL Anchor Peg Glenoid

Implant at its base, and twist the Bone Graft Applicator

several times back and forth (Figure 25). Pull the Bone

Graft Applicator straight off leaving bone interposed

evenly between the central peg flutes (Figure 26).

APPLYING BONE PASTE

Figure 25

Figure 24

Figure 26

18 DePuy Synthes Joint Reconstruction GLOBAL® APG+ Surgical Technique

Obtain hemostasis in each of the three peripheral holes.

Mix cement as indicated in SMARTMIX® Mini System

protocol (Figure 27). Replace mixing blade with plunger.

Orient the mixing cartridge horizontally with the syringe

port facing up. Remove any unwanted air from the car-

tridge by advancing the cement until it has reached the

port. Securely connect the syringe to the port. Fill the sy-

ringe with cement (Figure 28). When cement has

reached a doughy state and no longer sticks to surgical

gloves, it is ready for use.

CEMENT APPLICATION

Figure 28

Figure 27

Surgical Technique GLOBAL® APG+ DePuy Synthes Joint Reconstruction 19

Use the SMARTMIX Mini Cement Applicator to place

three measured half turns of SMARTSET® HV cement

into each peripheral hole (Figure 29). Only a small amount

of cement is necessary in each hole to provide the proper

1mm cement mantle around each GLOBAL Anchor Peg

Glenoid Implant peripheral peg (Figure 30). Make sure

no cement is in the central hole or on the backside of the

implant that could inhibit proper seating.

Note: Excessive cement extruding from the drilled

holes and lying between the prosthesis and gle-

noid fossa is undesirable. It may create an uneven

mantle for the glenoid prosthesis, and cement may

fragment with repetitive loading and become

loose in the joint causing damage to the polyethyl-

ene surface. Figure 29

Figure 30

CEMENT APPLICATION

20 DePuy Synthes Joint Reconstruction GLOBAL® APG+ Surgical Technique

Seating the Implant

Insert the final implant using the Glenoid Grasper

(Figure 31).

Use both the Universal Glenoid Handle and the poly-

ethylene Glenoid Impactor Tip to seat the implant until

there is complete contact between the back side of the

implant and the prepared glenoid surface (Figure 32).

The implant will be most stable when supported by pre-

cisely contoured bone. This support should prevent rock-

ing even with unbalanced loads applied to the rim of the

implant. Maintain direct pressure on the implant until

the cement has hardened.

Note: Confirm that the central hole is clear prior to

implant insertion.

SEATING THE IMPLANT AND WOUND CLOSURE

Figure 31

Figure 32

Wound Closure

Verify soft tissue tension and range of motion after com-

pleting the humeral procedure according to the GLOBAL

ADVANTAGE or GLOBAL AP System surgical technique.

Thoroughly irrigate the wound with antibiotic solution.

After repairing the biomechanical aspects of the joint,

take measures to manage short-term pain and limit for-

mations of post-operative hematoma. The wound is

closed according to surgeon preference.

Surgical Technique GLOBAL® APG+ DePuy Synthes Joint Reconstruction 21

INSTRUMENT CASE LAYOUT

ORDERING INFORMATION

Part Number

2236-00-100

2236-00-110

2236-00-111

2236-00-112

2236-00-113

2236-00-120

2230-00-320

2230-00-321

2236-00-300

Description

CASE COMPLETE

CASE

PIN PLACEMENT TRAY

SURFACE PREP TRAY

PEG PREP AND TRIAL TRAY

SIZER PIN GUIDE +0 CADDY

SIZER PIN GUIDE +3 CADDY

SIZER PIN GUIDE +5 CADDY

LID

Tray 1 - Pin Placement

Tray 2 - Surface Prep

Tray 3 - Peg Prep and Trial

22 DePuy Synthes Joint Reconstruction GLOBAL® APG+ Surgical Technique

Description

GLOBAL ANCHOR PEG GLENOID TEMPLATE

SIZER PIN GUIDE 40+0

SIZER PIN GUIDE 44+0

SIZER PIN GUIDE 48+0

SIZER PIN GUIDE 52+0

SIZER PIN GUIDE 56+0

CURVED HANDLE

SIZER PIN GUIDE 40+3

SIZER PIN GUIDE 40+5

SIZER PIN GUIDE 44+3

SIZER PIN GUIDE 44+5

SIZER PIN GUIDE 48+3

SIZER PIN GUIDE 48+5

SIZER PIN GUIDE 52+3

SIZER PIN GUIDE 52+5

SIZER PIN GUIDE 56+3

SIZER PIN GUIDE 56+5

FIXED PIN GUIDE

STRAIGHT HANDLE HEX DRIVER (INTERNAL ROD)

STRAIGHT HANDLE HEX DRIVER (EXTERNAL HANDLE)

2.5mm BREAKAWAY GUIDE PIN

QUICK CONNECT DRIVER SHAFT

ACCESS REAMER 40

ACCESS REAMER 44

ACCESS REAMER 48

ACCESS REAMER 52

ACCESS REAMER 56

LOW PROFILE CENTRAL REAMER 40/44

LOW PROFILE CENTRAL REAMER 48/52/56

LOW PROFILE PERIPHERAL REAMER 40

LOW PROFILE PERIPHERAL REAMER 44

LOW PROFILE PERIPHERAL REAMER 48

LOW PROFILE PERIPHERAL REAMER 52

LOW PROFILE PERIPHERAL REAMER 56

RATCHET T-HANDLE

QUICK CONNECT CENTRAL DRILL BIT 40/44

QUICK CONNECT CENTRAL DRILL BIT 48/52/56

PIN EXTRACTOR

PERIPHERAL DRILL GUIDE

QUICK CONNECT PERIPHERAL DRILL BIT

ANTI-ROTATION PEG

ANTI-ROTATION PEG INSERTER/REMOVER

2.5mm X 70mm FIXATION PIN

TRIAL 40

TRIAL 44

TRIAL 48

TRIAL 52

TRIAL 56

GLENOID GRASPER

BONE GRAFT APPLICATOR

SMARTSET HV 20g

SMARTMIX MINI SYSTEM

UNIVERSAL GLENOID HANDLE

GLENOID IMPACTOR TIP

GLOBAL ANCHOR PEG GLENOID 40mm

GLOBAL ANCHOR PEG GLENOID 44mm

GLOBAL ANCHOR PEG GLENOID 48mm

GLOBAL ANCHOR PEG GLENOID 52mm

GLOBAL ANCHOR PEG GLENOID 56mm

GLOBAL ANCHOR PEG GLENOID DNI

Part Number

2236-80-098

2236-00-001

2236-00-002

2236-00-003

2236-00-004

2236-00-005

2230-00-023

2230-00-003

2230-00-004

2230-00-006

2230-00-007

2230-00-009

2230-00-010

2230-00-012

2230-00-013

2230-00-015

2230-00-016

2230-00-018

2230-00-024

2230-00-025

2230-00-019

2230-00-029

2236-00-008

2236-00-009

2236-00-010

2236-00-011

2236-00-012

2230-00-030

2230-00-031

2230-00-032

2230-00-033

2230-00-034

2230-00-035

2230-00-036

2128-61-070

2236-00-014

2236-00-015

2307-99-004

2236-00-016

2230-00-095

2230-00-099

2230-00-021

8555-06-000

2236-00-018

2236-00-019

2236-00-020

2236-00-021

2236-00-022

2236-00-017

2236-00-023

3092020

5401-39-000

2236-03-000

2236-21-000

1136-40-026

1136-41-026

1136-42-026

1136-43-026

1136-44-026

2128-99-060

ORDERING INFORMATION

INSTRUMENT USAGE DIAGRAM KEY

Sizing and Pin Placement (No Version)

Sizing and Pin Placement (Version)

Fixed Pin Placement and Sizing

Reaming Normal Exposure

Guide Pin Extraction

Reaming Challenging Exposure

Drilling Central Peg Hole

Drilling Peripheral Peg Holes

Trialing

Seating the Implant

Surgical Technique GLOBAL® APG+ DePuy Synthes Joint Reconstruction 23

Important

This Essential Product Information sheet does not include all of the in-

formation necessary for selection and use of a device. Please see full

labeling for all necessary information.

Indications

Total shoulder or hemi-shoulder replacement is indicated for: 1) A se-

verely painful and/or disabled joint resulting from osteoarthritis, trau-

matic arthritis or rheumatoid arthritis; 2) Fracture-dislocations of the

proximal humerus where the articular surface is severely comminuted,

separated from its blood supply or where the surgeon’s experience in-

dicates that alternative methods of treatment are unsatisfactory; 3)

Other difficult clinical problems where shoulder arthrodesis or resec-

tion arthroplasty are not acceptable (e.g., revision of a failed primary

component).

Hemi-shoulder replacement is also indicated for: 1) Ununited humeral

head fractures; 2) Avascular necrosis of the humeral head; 3) Rotator

cuff tear arthropathy. GLOBAL® CAP® System is indicated for intact

or repairable rotator cuff. 4) Deformity and/or limited motion.

• GLOBAL® AP® CTA System heads are indicated for hemi-

shoulder replacement only and are to be used with GLOBAL

AP Humeral Stems only.

• GLOBAL® CAP® CTA System heads are indicated for hemi-

shoulder replacement only.

• GLOBAL CAP and GLOBAL CAP CTA Systems are intended for

cementless use only.

Porocoat® Porous-Coated Components

Porocoat porous-coated humeral stem prostheses are indicated for ce-

mented or cementless use with fixation provided by biological tissue

in-growth into the porous coating.

Cemented Components

Humeral stem and Glenoid components labeled “For Cemented Use

Only” are indicated only for use with bone cement.

Press-fit or Cemented Components

Humeral stem prostheses without porous coating and labeled “For

Press-fit or Cemented Use Only” are indicated for press-fit uncemented

use or for use with bone cement.

Contraindications

The following conditions are contraindications for total shoulder and

hemi-shoulder arthroplasty. 1) Active local or systemic infection; 2) In-

adequate bone stock in the proximal humerus or glenoid fossa for sup-

porting the components; 3) Poor bone quality, such as osteoporosis,

where there could be considerable migration of the prosthesis and/or a

chance of fracture of the humerus or glenoid.

The following condition is a contraindication for total shoulder arthro-

plasty. 1) Absent, irreparable or nonfunctional rotator cuff or other es-

sential muscles.

Warnings and Precautions

The use of a glenoid prosthesis in patients with cuff tear arthropathy

could increase the risk of glenoid component loosening due to non an-

atomic loading conditions. The following conditions tend to adversely

affect shoulder replacement implants: excessive patient weight, high

levels of patient activity, likelihood of falls, poor bone stock, metabolic

disorders, disabilities of other joints.

Adverse Events

The following are the most frequent adverse events after shoulder ar-

throplasty: change in position of the components, loosening of com-

ponents, dislocation, infection, hematoma, pneumonia, and cardiovas-

cular disorders.

DePuy Orthopaedics, Inc.

700 Orthopaedic Drive

Warsaw, IN 46582

T. +1 (800) 366-8143

www.depuysynthes.com

© DePuy Synthes Joint Reconstruction, a division of DOI 2014. All rights reserved.

0612-13-509 (Rev. 3) 1.5M 03/14