Aequalis FX ®

Shoulder System

Operative technique
Aequalis FX Shoulder System | Operative technique

This publication sets forth detailed recommended procedures for using Stryker
devices and instruments. It offers guidance that you should heed, but, as with any
such technical guide, each surgeon must consider the particular needs of each patient
and make appropriate adjustments when and as required.

Important

• The patient should be advised • Please remember that the

that the device cannot and does compatibility of different product
not replicate a normal healthy systems has not been tested unless
bone, that the device can break specified otherwise in the product
or become damaged as a result of labeling.
strenuous activity or trauma and
that the device has a finite expected • Consult Instructions for Use
service life. ([Link] for a
complete list of potential adverse
• Removal or revision of the device effects and adverse events,
may be required sometime in the contraindications, warnings and
future. precautions.

• Cleaning and sterilization • The surgeon must advise patients

information is provided in the of surgical risks, and make them
applicable instructions for use. aware of adverse effects and
alternative treatments.
• Non-sterile devices, including
implants and instruments, must • An implant whose packaging is open
be cleaned and sterilized prior to or damaged or whose expiration
use, in accordance with validated date has passed must not be used.
methods. Every precaution must be taken to
ensure sterility when opening the
• Devices that are able to packaging of the implant and during
be disassembled should be implantation.
disassembled prior to point-of-use
processing. Additionally, devices
with movable components that do
not facilitate disassembly should
be manually articulated during
the point-of-use processing step in
order to evacuate additional soils.

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 Operative technique | Aequalis FX Shoulder System

Aequalis FX
Shoulder System
Table of contents

Operative technique............................................................................................................. 4
• Preoperative planning.................................................................................................................... 4
• Patient positioning.......................................................................................................................... 5
• Deltopectoral approach and exposure........................................................................................... 6
• Identification of the lesser and greater tuberosities and anterosuperior arthrotomy................ 6
• Tenotomy and excision of the long head of the biceps.................................................................. 6
• Extraction of humeral head fragment and selecting proper prosthetic head replacement........ 7
• Placing four horizontal stay sutures in the rotator cuff............................................................... 7
• Humeral reaming............................................................................................................................ 7
• Choice of the trial prosthesis and attachment to the fracture jig................................................ 8
• Setting height and retroversion..................................................................................................... 9
• Implantation and reduction of the trial prosthesis.....................................................................10
• Identification of the epicondyles and stabilization of the trial prosthesis.................................10
• Reduction of the greater tuberosity around the trial prosthesis and testing of the height......11
• Removal of the trial prosthesis.....................................................................................................11
• Drilling of the diaphysis and placement of the 2 vertical sutures..............................................11
• Assembling the implant.................................................................................................................12
• Cementing the implant..................................................................................................................13
• Removal of excess cement and placement of the cancellous bone graft....................................13
• Removal of two cancellous bone grafts with the bone graft cutter...........................................14
• Positioning the bone graft into the fenestration of the prosthesis.............................................15
• Placement of four horizontal sutures around the prosthetic neck..............................................15
• Positioning the bone graft on the flat lateral aspect of the stem................................................15
• Placing two horizontal cerclage sutures around the greater tuberosity....................................16
• Placing two horizontal cerclage sutures around both tuberosities............................................16
• Adding vertical tension band sutures on both tuberosities........................................................17
• Closing and tenodesis of the long head of the biceps...................................................................17
• Evaluation of the prosthetic stability and mobility.....................................................................18
• Final closing and immobilization of the arm in abduction and neutral rotation......................18
Postoperative rehabilitation............................................................................................ 19
Aequalis Fracture Shoulder Prosthesis Extra-Long Stems......................................... 20
Assembly instructions........................................................................................................ 23
Instruments.......................................................................................................................... 25
Implants................................................................................................................................ 26

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Aequalis FX Shoulder System | Operative technique

1. Operative technique
1. Preoperative planning
• Obtain stabilization of the prosthesis while using the fracture jig.
• The prosthetic retroversion is fixed at 20 degrees from the
trans-epicondylar axis (average value).
• The prosthetic height can be chosen:
- Intraoperatively, using the bony aspect and soft tissue without
any preoperative planning (approximate height).
- Preoperatively, using a scaled x-ray of the healthy contralateral
humerus (precise height).
A ruler with two marker points, with a distance of 100mm, will allow for
radiographic magnification conversion.

Recommendation: Place the ruler with the marker point and the arm
parallel to the x-ray cassette to minimize errors of measurement. A small
cushion is placed under the elbow.

Example:
Calculation of humeral length taking into account the radiological
magnification: the real length between the two markers is 100mm; the
measured length between the two markers (A-B) is 105mm; the measured
length of the healthy humerus (C-D) is 330mm.
Therefore, using a rule of three:
105mm 100mm
330mm L’
L = 330 x 100/105 = 314 mm
The real length of the healthy humerus is therefore 314mm, a
measurement that should be entered on the fracture jig height ruler (see
page 7).

Ruler

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 Operative technique | Aequalis FX Shoulder System

1. Operative technique (continued)

2. Patient positioning
General anesthesia, beach chair position, shoulder free from the table.
The shoulder and entire upper extremity are prepped and draped. The
arm support for the fracture jig is secured to the arm using a sterile
elastic bandage. The elbow must be carefully positioned to fit correctly
in the arm support.

The arm support is fixed, leaving the elbow uncovered at the level of the
angle of the support. The entire shoulder must be free from the table to
allow the jig to be correctly positioned.

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Aequalis FX Shoulder System | Operative technique

1. Operative technique (continued) Lesser

Supraspinatus tuberosity

3. Deltopectoral approach and exposure

Greater
An incision is made from the tip of the coracoid process along the tuberosity
deltopectoral groove, slightly lateral to avoid postoperative scars in the
Humeral
axillary fold. The deltopectoral groove is opened to the insertion of the head
pectoralis major, and the deltoid and cephalic vein are retracted laterally. Humeral
shaft
The coracoid process is identified to allow for the insertion of a Hohmann
retractor above it. The clavicular, acromial and humeral insertions of
the deltoid are always preserved. The clavipectoral fascia is incised at
the lateral border of the conjoined tendon of the coracobrachialis and Biceps Subscapularis
the short head of the biceps. Usually, the coracoacromial ligament is
preserved.

Coraco-acromial
ligament
Open rotator
interval

4. Identification of the lesser and greater tuberosities and

anterosuperior arthrotomy
The glenohumeral joint is exposed by extending the fracture line between
the tuberosities, incising the rotator interval over the long head of the
biceps tendon.

Coraco-acromial
ligament

Long head
5. Tenotomy and excision of the long head of the biceps of the biceps
Humeral
head

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 Operative technique | Aequalis FX Shoulder System

1. Operative technique (continued)

Coraco-acromial
ligament

Humeral
6. Extraction of humeral head fragment and selecting proper head
prosthetic head replacement

The diameter of the humeral head is determined by measuring the

humeral head diameter with a caliper, or by using the trial head support
tray as a template. Hint: If the humeral head is between sizes, select the
smaller size. The most common mistake is to use a too large size.

Subscapularis

7. Placing four horizontal stay sutures in the rotator cuff Greater

tuberosity
Two non-absorbable sutures are placed in the infraspinatus tendon and
Lesser tuberosity
two more are placed in the teres minor tendon.

Humeral shaft

8. Humeral reaming
With the arm in adduction, external rotation and extension, the humerus
is progressively reamed using cylindrical reamers of increasing diameter
(6.5mm, 9mm, and 12mm).
The final reamer used will determine the diameter of the humeral stem.
At this stage, in case of revision, it is also important to remove as much
residual cement as possible in order to avoid compromising the healing of
the tuberosities.
Cylindrical reamers
of increasing sizes
are advanced as far
as the last ridge.

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Aequalis FX Shoulder System | Operative technique

1. Operative technique (continued)

9. Choice of trial prosthesis and attachment to the fracture jig

To accurately re-establish the humeral head, we recommend the use of a
prosthetic humeral head of the same size as the removed head.
The humeral head should be positioned either on the R for a right arm or
on the L for left arm.

The trial stem is secured to the prosthesis holder (right or left depending
on the side) using the two holes located on the low profile lateral part of
the implant. The prosthesis holder is then fixed to the fracture jig.

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 Operative technique | Aequalis FX Shoulder System

1. Operative technique (continued)

10. Setting height and retroversion

•  The height has been determined by the preoperative planning
(page 4).
•  The retroversion is set at 20°, which is an average value based on
anatomic studies from Gilles Walch, MD, and Pascal Boileau, MD.*

The Aequalis Fracture Jig is composed of:

• a ruler, to determine the humeral height
• a protractor, to determine the humeral retroversion.
The humeral height is determined in relation to the metaphyso-diaphyseal
axis (A-B), the top of the greater tuberosity (C) and the medial epicondyle
(D), while the humeral retroversion is determined in relation to the axis
of the epicondyles (D-E).
The proximal metaphyso-diaphyseal axis (A-B) represents the axis of the
future prosthetic stem. It must not be confused with the diaphyseal axis,
at the risk of causing a valgus position of the prosthesis and giving a false
measurement of length.

*Walch, Gilles and Boileau, Pascal. Shoulder Arthroplasty. Spring 1999.

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Aequalis FX Shoulder System | Operative technique

1. Operative technique (continued)

11. Implantation and reduction of the trial prosthesis

Positioning of the remaining components of the fracture jig assembly
(protractor, ruler, prosthesis holder and trial prosthesis) must be done
with the arm in extension.

Arm in
extension

Once the trial prosthesis has been inserted into the humerus,
the arm is placed in flexion to reduce the glenohumeral joint.

Arm in flexion

12. Identification of the epicondyles and stabilization of

the trial prosthesis
Accurate recreation of height and retroversion begins with the placement
of the epicondylar pads on the medial and lateral epicondyles.
The surgeon positions each epicondylar pad on the prominences of the
lateral and medial epicondyles.
At the same time, the assistant connects the protractor to the arm
support, securing the two angle joints by using knob n° 4.
The fracture jig is then secured, allowing the selection of height and
retroversion and a trial reduction.

Knob n° 4

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 Operative technique | Aequalis FX Shoulder System

1. Operative technique (continued)

13. Reduction of the greater tuberosity around the trial

prosthesis and testing of the height
The initial reduction of the prosthesis and the greater tuberosity enables
both the height and the retroversion to be tested. The greater tuberosity
is placed on the diaphysis and the prosthesis, effectively testing the
height of the prosthesis. There are three landmarks of interest:
1. The height of the acromiohumeral space, which is usually
10mm.
2. The top of the greater tuberosity, which should be located
5mm below the upper limit of the prosthetic head.
3. There must be no diastasis or overlap between the greater
tuberosity and the humeral diaphysis. The lesser tuberosity is
then reduced to verify the adjustment with the greater tuberosity
and the diaphysis. Once all of the adjustments have been
performed, the trial prosthesis is withdrawn.

14. Removal of the trial prosthesis

The shoulder is placed in extension to dislocate the trial prosthesis.
The prosthetic holder and the trial prosthesis are removed, leaving the
remaining component of the fracture jig in place.

15. Drilling of the diaphysis and placement of the

2 vertical sutures
Two holes are drilled laterally to the bicipital groove. Two
non-absorbable sutures are passed through the holes.

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Aequalis FX Shoulder System | Operative technique

1. Operative technique (continued)

16. Assembling the implant

Assembling
The assembly of the implant is done by impaction of the prosthetic head
onto the stem.
The assembly is secured by a taper lock system.
The prosthetic head is positioned on the stem, aligning the preselected
offset number with the superior aspect of the stem.

Impaction
The prosthesis is positioned on the impaction support. The locking screw
of the impaction support is tightened with a 4.5mm screwdriver to secure
the prosthesis during impaction. A mallet is used to firmly engage the
head onto the stem taper.

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 Operative technique | Aequalis FX Shoulder System

1. Operative technique (continued)

17. Cementing the implant

After placement of a cement restrictor, the canal is dried and cement is
injected using a large syringe.

The implant is attached to the prosthesis holder in the same manner as

the trial stem.
The prosthesis is introduced into the medullary canal as the prosthesis
holder is introduced into the ruler. Knob n° 3 is then tightened, to secure
the implant holder to the jig assembly.

Bone graft
18. Removal of excess cement and placement of the cancellous
bone graft
Excess cement is removed from the metaphyseal region and replaced
with cancellous bone, taken from the humeral head to promote healing
between the tuberosities and the diaphysis.
At this stage, if the humeral head doesn’t provide enough bone graft (or in Cement
case of revision), it is possible to use other graft sources.
Once the cement is set, the prosthesis holder and the rest of the Aequalis
Fracture Jig are removed.

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Aequalis FX Shoulder System | Operative technique

1. Operative technique (continued)

19. Removal of two cancellous bone grafts with the bone graft cutter
Bone grafting is highly recommended to improve tuberosity healing. Two bone grafts are removed from the resected humeral head
using the bone graft cutter.
The bone graft cutter allows two bone grafts shaped according to the fenestration of the prosthesis to be removed from the
resected humeral head.
The graft pusher is unscrewed and the bone graft source is placed in the base of the bone graft cutter.
The bone graft cutter handles are firmly tightened to cut the bone graft.
In the case of exceptionally hard bone, a mallet can be used to impact the clamp.
The positioning of the two bone grafts is described in sections 20 and 22.

The graft pusher is then

screwed down to eject the
resected bone graft.

As the bone graft is

partially ejected from
the cutter, use a rongeur
to remove cartilage
partially from the graft.

One graft is positioned on the One graft is introduced into the

lateral prosthetic surface. open prosthetic neck.

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 Operative technique | Aequalis FX Shoulder System

1. Operative technique (continued)

20. Positioning the bone graft into the fenestration of

the prosthesis

21. Placement of four horizontal sutures around the

prosthetic neck
Reconstruction begins with the greater tuberosity and employs two of
the four horizontal sutures placed earlier. Passing these sutures through
the prosthetic fin does not provide enough stability for the fixation of the
tuberosities.
Therefore, it is recommended that the sutures are passed medially around
the prosthetic neck.

22. Positioning of the bone graft on the flat lateral base

of the neck

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Aequalis FX Shoulder System | Operative technique

1. Operative technique (continued)

23. Placing two horizontal cerclage sutures around the

greater tuberosity
Fixation of the greater tuberosity begins with two horizontal cerclage
sutures to anatomically position the tuberosity.
The arm is placed in neutral position. A clamp is used to pull the greater
tuberosity anteriorly, reducing the greater tuberosity to the prosthesis.
The two horizontal cerclage sutures (one superior, one inferior) are then
tied to secure the greater tuberosity to the prosthesis.

24. Placing two horizontal cerclage sutures around

both tuberosities
The next step is the reconstruction of the lesser tuberosity, which also
uses two of the four horizontal sutures. The two remaining horizontal
sutures, which have initially been passed around the greater tuberosity,
and the prosthetic neck are then passed through the subscapularis tendon
from inside to outside. This maneuver pulls the lesser tuberosity into
position under the prosthetic head.

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 Operative technique | Aequalis FX Shoulder System

1. Operative technique (continued)

25. Adding vertical tension band sutures on both tuberosities

The final tightening is performed in the vertical plane using the two
nonabsorbable sutures from the diaphysis in a tension-band technique.
One suture is passed anteriorly through the subscapularis and the
supraspinatus tendons, while the other suture is passed posteriorly
through the infraspinatus and supraspinatus tendons. This provides the
all-important fixation of the tuberosity fragments to the humeral shaft.

26. Closing and tenodesis of the long head of the biceps

Biceps tenodesis
After resecting the intra-articular portion of the long head of the biceps,
a nonabsorbable suture is passed through its free end using a modified
Kessler stitch. The tendon is relocated in the bicipital groove with one
end of the suture passed through the supraspinatus tendon. The suture
is then tied.

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Aequalis FX Shoulder System | Operative technique

1. Operative technique (continued)

27. Evaluation of the prosthetic stability and mobility

With the arm in neutral position, it is recommended to have
a posterior translation of approximately 25% to 50% with an
automatic rebound.

A minimum external rotation of 40° is recommended.

The greater tuberosity should not move as the arm is
internally rotated.

40°

28. Final closing and immobilization of the arm in abduction

and neutral rotation.

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 Operative technique | Aequalis FX Shoulder System

2. Postoperative rehabilitation
Postoperative rehabilitation is as equally important after shoulder arthroplasty for a fracture case as it is following shoulder
arthroplasty for chronic etiologies, contributing at least 50% to the final outcome. Rehabilitation after prosthetic replacement
of a 4-part proximal humerus fracture is perhaps the most challenging aspect of shoulder rehabilitation.
In order to avoid complications such as hemarthrosis, hematoma, and prosthetic instability, it is recommended to delay the
postoperative rehabilitation until the tuberosities have healed, 45 to 60 days postoperatively.
Because of frequent tuberosity fixation failure previously observed, the aggressiveness of postoperative rehabilitation has been
reduced to avoid these potentially catastrophic complications. Early passive motion is not recommended because it is easier to
treat a stiff shoulder than a tuberosity migration or nonunion.
The patient’s arm is immobilized in 45° abduction and neutral rotation for a period of 4 to 6 weeks. During the first 3
postoperative weeks, active mobility of the hand, fingers and elbow is allowed without any movement of the shoulder joint.
In the fourth postoperative week, after ensuring the tuberosities have remained in place radiographically, passive abduction of
the arm is permitted starting from a resting position of 45 degrees abduction. No rotation is allowed at this time as this could
cause suture failure before the tuberosities have healed.
At 6 weeks postoperative, passive rehabilitation is initiated emphasizing elevation and rotation. The patient sees a physiotherapist
3 times per week, but the patient, with the assistance of family, carries out therapy exercises at home on days they do not see the
therapist. Rehabilitation in a warm water pool is particularly helpful when feasible from the 21st postoperative day.
Once the tuberosities clearly show radiographic healing (2 to 3 months postoperative), active mobility is permitted in elevation
and internal rotation. These exercises can be performed by the patient at home many times during the day. Strengthening and
resistance exercises are avoided as these can be responsible for pain and have shown no proven benefit.
Experience with this rehabilitation protocol has demonstrated tuberosity migration and nonunion to occur infrequently. Patients
must be informed of the risk of postoperative stiffness during the first 6 to 9 postoperative months. This stiffness invariably
diminishes, provided the anatomy has been properly re-established. Final mobility is usually obtained by 12 months postoperatively.
In summary, rehabilitation following humeral head replacement for fracture focuses on obtaining union of the tuberosities.
The postoperative radiographs show anatomical reconstruction using the Aequalis fracture solution.
Pascal Boileau, MD, and Gilles Walch, MD

The postoperative x-rays shows a perfect anatomical reconstruction using the

Aequalis fracture solution

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Aequalis FX Shoulder System | Operative technique

3. Aequalis Fracture Shoulder Prosthesis

Extra-Long Stems
The operative technique for the Aequalis Fracture X-Long Stem slightly 3cm above the
scribed line
differs from the standard Aequalis Fracture Stem procedure.
Some steps of the standard surgical protocol have been modified. To
ensure correct implantation of this x-long stem, please follow the Scribed line
for “long”
directions below regarding paragraphs 8, 9, 16, 17, 18 and 19 of the
standard Aequalis Fracture Stem surgical procedure.

8. Humeral reaming (page 7)

With the arm placed in abduction, external rotation, and extension, the
humerus is progressively reamed, using cylindrical reamers of increasing
diameter (6.5mm, 9mm, and 12mm).
The reamer should be inserted carefully, until the scribed line for “long”
on the smooth section of the reamer is buried approximately 3cm into the The final reamer
used will determine
bone. the diameter of the
humeral stem
At this stage, it is also important to remove as much of the
residual cement as possible because it might compromise healing
tuberosities.
The remainder is exactly the same as the standard Aequalis Fracture
operative technique.

9. Choice of trial prosthesis (page 8)

Trial humeral stems (shorter than the final stem) are included in
the instrument set (YKAD50) for the Aequalis Fracture X-Long Stems.

For head/trial stem assembly, and attachment of the trial prosthesis

to the fracture jig prosthesis holder, use the standard technique.

16. Assembling the implant (page 12)

The assembly of the definitive implant is made on a specific impaction
support for the long Aequalis Fracture Stems available in the YKAD50
instrument set. For correct assembly of the implant, the support should
be moved to the edge of the table so that the stem can hang off the table.

The remainder is exactly the same as the standard

Aequalis Fracture operative technique.

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 Operative technique | Aequalis FX Shoulder System

3. Aequalis Fracture Shoulder Prosthesis

Extra-Long Stems (continued)

17. Cementing the implant (page 13)

After placement of a cement restrictor, 10mm under the extremity
of the prosthesis, the canal is dried, and cement is injected using a
large syringe.

The remainder is exactly the same as the standard Aequalis

Fracture operative technique.

18. Removal of excess cement and placing the cancellous bone

graft (page 13)
Remove any excess cement from the humeral upper shaft and insert bone
grafts to promote healing of the tuberosities to the shaft. Bone graft can
be taken from the humeral head (if still available), or from other bone
graft sources in case of revision.

The remainder is exactly the same as the standard Aequalis

Fracture operative technique.

19. Removal of two cancellous bone grafts with the bone graft
cutter (page 14)
Bone grafting is highly recommended to improve tuberosity healing.
The bone graft cutter allows two bone grafts shaped according to the
fenestration of the prosthesis to be removed from the resected humeral
head, when possible, or from the bone graft source. The graft pusher is
unscrewed and the humeral head or the other bone graft source is placed
in the base of the bone graft cutter. The bone graft cutter handles are
firmly tightened to cut the bone graft. In case of exceptionally hard
bone, a mallet can be used to impact the clamp. The positioning of the
two bone grafts is described in paragraphs 20 and 22 of the standard
operative technique.

The remainder is exactly the same as the standard Aequalis

Fracture operative technique.

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Aequalis FX Shoulder System | Operative technique

3. Aequalis Fracture Shoulder Prosthesis

Extra-Long Stems (continued)

Postoperative rehabilitation (page 19)

The postoperative rehabilitation protocol is identical to the one described
in the standard Aequalis Fracture operative technique. However, it
is recommended to wait for the radiographic bone healing of all the
bony fragments prior to the start of the passive motion rehabilitation
procedure.

Except for the above specifications, all other steps of the

operative technique and the use of the instrumentation are
unchanged, and strictly identical to the Aequalis Fracture
literature enclosed with this document.

Instruments
In addition to the basic Aequalis Fracture Instrument Set, a specific tray
for extra-long stem (YKAD50) should be used.

Basic instrumentation
YKAD08-09 + YKAD01 + YKAD33 or YKAD30 + YKAD01

Ref. YKAD50

Long trial stems

Size ref. Ref.

6.5mm / L 170mm MWA320

9mm / L 180mm MWA321

12mm / L 180mm MWA322

Impaction support
Ref. MWA325

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 Operative technique | Aequalis FX Shoulder System

4. Assembly instructions: left arm

For assembly on an instrument table.

The yellow items are on the outside of the operative arm.

1 Preparation 4 Attachment of ruler

of arm support
What you need
What you need
• Graduated ruler
• Arm support
• Blue handle n° 2
What you do
• Pivot the angle What you do
joint horizontally. • The definitive height is that
of the healthy humerus. To
slide the ruler to the desired
measurement, loosen the
blue knob n° 2 and then
tighten.

2 Attachment of epicondylar pads 5 Attachment of handle n° 4

What you need What you need
• Rectangular yellow feeler (lateral epicondyle) • Yellow male part
• Round blue feeler (medial epicondyle) • Yellow female part
• Protractor • Yellow ring n° 4
• Yellow handle n° 4
What you do
• Leave the unit untightened
Clic
to allow assembly 6.

3 Attachment of slide 6 Attachment of swivel joint to

small angle joint
What you need
What you need Large arm
• Protractor
• Small angle joint
• Blue handle n° 1
• Articulated swivel joint
• Slide
What you do What you do

• Place slide on 20° (side marker • Attach angle joint to protractor.

“retroversion left arm”). • Loosen knob n° 4 and small Small arm

• To alter the retroversion thumbwheel to allow free

loosen blue knob n° 1, slide assembly.
and then tighten. Parts used later: 1 right prosthesis holder - knob n° 3.

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Aequalis FX Shoulder System | Operative technique

4. Assembly instructions: right arm

For assembly on an instrument table.

The yellow items are on the outside of the operative arm.

1 Preparation 4 Attachment of ruler

of arm support What you need
What you need • Graduated ruler
• Arm support
• Blue handle n° 2
What you do What you do
• Pivot the angle • The definitive height
joint horizontally. is that of the healthy
humerus. To slide the
ruler to the desired
measurement, loosen the
blue knob n° 2 and then
tighten.

2 Attachment of epicondylar pads 5 Attachment of handle n° 4

What you need What you need
• Rectangular yellow feeler (lateral epicondyle) • Yellow male part
• Round blue feeler (medial epicondyle) • Yellow female part
• Protractor • Yellow ring n° 4
• Yellow handle n° 4
What you do
• Leave the unit untightened
to allow assembly 6.

3 Attachment of slide 6 Attachment of swivel joint to

small angle joint
What you need
Large arm
What you need
• Protractor
• Small angle joint
• Blue handle n° 1
• Articulated swivel joint
• Slide
What you do What you do

• Place slide on 20° (side marker • Attach angle joint to protractor.

Small
“retroversion right arm”). • Loosen knob n° 4 and small arm

• To alter the retroversion thumbwheel to allow free

loosen blue knob n° 1, slide assembly.
and then tighten. Parts used later: 1 right prosthesis holder - knob n° 3.

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 Operative technique | Aequalis FX Shoulder System

Instruments
Hexagonal
Cylindrical reamers
screwdriver 4.5 mm
6.5mm Ref. MWA607 Ref. MWB012

9mm Ref. MWA609

12mm Ref. MWA612
Trial stem
6.5mm Ref. MWA308
Hexagonal screwdriver
9mm Ref. MWA309
3.5 mm
Ref. MWA124 12mm Ref. MWA310

Trial head template

Ref. MWA162

Bone graft cutter

Ref. MWA301

Trial head
39mm x 14mm Ref. MWA239
41mm x 15mm Ref. MWA241
43mm x 16mm Ref. MWA243 Impaction support
46mm x 17mm Ref. MWA246 Ref. MWA302
48mm x 18mm Ref. MWA248
50mm x 16mm Ref. MWA250
50mm x 19mm Ref. MWA251

Fracture
jig
Cement restrictor
inserter
Ref. MBO101

Trial head clamp

Ref. MWA103

T handle
Ref. MWA106

Humeral prosthesis
impactor
Ref. MWA108

Mallet
Ref. MWA122

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Aequalis FX Shoulder System | Operative technique

Implants

Trial head Humeral stems HA coated

Size Ref. Size Ref.
37mm x 13.5mm DWB237 6.5mm / L 130mm DWB171
39mm x 14mm DWB239 9mm / L 130mm DWB172
41mm x 15mm DWB241 12mm / L 130mm DWB173
43mm x 16mm DWB243
46mm x 17mm DWB246
48mm x 18mm DWB248 Humeral long stems HA coated
50mm x 16mm DWB250 Size Ref.

50mm x 19mm DWB251 6.5mm / L 170mm DWB161*

52mm x 19mm DWB252 9mm / L 180mm DWB162*

52mm x 23mm DWB253 12mm / L 180mm DWB163*

Extended sizes head Humeral extra-long

Size Ref. stems HA coated
54mm x 23mm DWB254* Size Ref.
54mm x 27mm DWB255* 9mm / L 210mm DWB165*
*Available upon special request 12mm / L 210mm DWB166*

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 Operative technique | Aequalis FX Shoulder System

Notes

27
This document is intended solely for the use of healthcare professionals. A surgeon must always rely on his or her own professional clinical Manufacturer:
judgment when deciding whether to use a particular product when treating a particular patient. Stryker does not dispense medical advice
and recommends that surgeons be trained in the use of any particular product before using it in surgery. Tornier SAS
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The information presented is intended to demonstrate a Stryker product. A surgeon must always refer to the package insert, product 38330 Montbonnot Saint Martin
label and/or instructions for use, including the instructions for cleaning and sterilization (if applicable), before using any Stryker product. France
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Products may not be available in all markets because product availability is subject to the regulatory and/or medical practices in
individual markets. Please contact your Stryker representative if you have questions about the availability of Stryker products in your area. [Link]
The instructions for use, operative techniques, cleaning instructions, patient information leaflets and other associated labeling may be
requested online at [Link] or [Link]. If saving the instructions for use, operative techniques, cleaning instructions from the
above mentioned websites, please make sure you always have the most up to date version prior to use.

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Content ID: AP-015523A 29-Sep-2021

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