Use a straight reamer to open up the femoral canal. Be sure to open both the posterior and lateral walls sufficiently. Insufficient reaming will make it impossible to align the femoral stem properly in both planes.
Start with the smallest available rasp impactor and increase until the size determined at preoperative planning has been achieved. Be prepared to use a flexible reamer to enlarge the isthmus if necessary.
Determine the plug size by using the special instrument or a flexible reamer. Insert the appropriate distal femoral plug. Place the plug 10 mm distal to the intended level of the tip of the stem.
Remove soft tissue and loose cancellous bone with a femoral
Rotate the brush counter clockwise to remove debris from the femur.
Continue the cleaning sequence using the high-pressure pulse lavage system repeatedly in order to facilitate micro-interlock between bone and cement.
This will also prevent microembolization of the marrow contents and significantly minimize circulatory changes. Use a nozzle with side orifices, allowing the pulse lavage to act perpendicular to the bone surface.
Secure the haemostasis with a sponge impregnated with adrenaline or liquid hydrogen peroxide.