Insertion of the definitive insert
The hip is dislocated again; the trial head is removed followed by the trial broach. The inside of the cup is cleaned, and a check is made to ensure that there are no osteophytes protruding beyond the posterior or anterosuperior rim. The definitive insert (standard or hooded) is placed in the cup, and impacted using the insert impactor (Fig. 21).

Implanting the femoral component
The ABG™II HA stem must be inserted without gloves coming into contact with the hydroxyapatite. The distal part of the stem is introduced into the medullary canal. Before impaction, it is often useful to place part of the cancellous bone removed by the box chisel between the calcar and the medial border of the prosthesis in order to counteract varus positioning.

Using the femoral impactor, the prosthesis is introduced into the femur without force until the shoulder of the prosthesis comes to the level of the digital fossa (Fig. 22). After reduction, the correct length of the lower limb can be checked again by means of the trial heads.

Inserting the definitive head
It is essential to lavage and dry the tapered cone before implanting the definitive head. Whether it is made of cobalt chrome or zirconia, the head should never be struck but rather pushed onto the tapered cone. V40™ HEADS The ABG™II HA-coated prosthesis is compatible only with the Howmedica range of V40™ femoral heads. The V40™ heads have a 5° 40’ taper, 11.3mm/12.5mm diameter and are available in Vitallium® (Cobalt Chrome) and Alumina.

The +8mm neck length heads must only be used with stem sizes 2 to 8. They are not suitable for stem size 1.

Fig. 21 Implantation of the insert.

Fig. 22 Insertion of final femoral implant.