After checking that they correspond to the side being operated, the broaches are fixed to the broach handle. They are introduced beginning with the smallest size up to the size chosen during pre-op planning. Apply a lateral force to the broach during impaction to avoid a varus position.

The broach / trial prosthesis will determine the size of the permanent implant if two conditions are fulfilled:

• The broach must be pushed down to the correct level: the shoulder of the broach must be at the level of the trochanteric fossa.
• The broach must be perfectly stable in the coronal plane (varus-valgus) and particularly in rotation.
  

It is often useful to check the correct positioning of the broach by measuring the distance between the medial edge of the broach and the medial surface of the cortex of the calcar femorale. The ABG™II Modular instrument tray includes 4 golden rasps (size 1 & 2 left & right).
 
If, despite correct reaming, a broach/trial prosthesis smaller than the size anticipated in planning is perfectly stable in rotation (perhaps due to an anteroposterior narrowing of the neck), the use of a larger size must not be attempted because of the risk of a metaphyseal fissure or fracture.
 
Conversely, if the broach / trial prosthesis is unstable, the following solutions may be considered:

• Use of a larger broach (note: reaming may be required).
• Stabilise the planned implant with a cortico-cancellous bone graft taken from the remains of the resected bone (Please note however that stability of the implant should rarely be entrusted to bone graft).
• Cement an ABG™II femoral stem in Vitallium® with cement (if available in your area).
  

 
Reduction
 
Trial from the broach:

1. The metal trial neck from the broach featuring the femoral necks angle and neck length chosen during preop-templating combined with a standard (or Neutral) anteversion will be used 1st.
2. Then check the femoral necks angle and neck length that has been selected by checking leg length, and soft tissue tension. Various head lengths enable some fine tuning.
3. Once the most suitable femoral necks angle and neck/head length have been determined, the choice of the neck will be finally determined by adjusting the anteversion to get:

• a good internal / external rotational mobility in extension
• a good stability of the hip in flexion / internal rotation / adduction and in extension / external rotation.