Trident II

Acetabular System
Design rationale
Trident II Acetabular System
Trident II
Clusterhole HA
Trident II Tritanium
Multihole
Trident II Tritanium
Clusterhole
Built on what works
The new Trident II Acetabular System builds
on the legacy that has defined Stryker’s Trident
brand for nearly two decades. Consistently
one of the most implanted brands in the
Australian1 and UK2 National Joint Registries,
Trident shells also demonstrate the lowest
revision rate at the longest follow-up among
uncemented shells in both registries.1,2 The
legacy of the Trident brand is reinforced by
clinically proven3-5 bearing options enabled
through the Innerchange Locking Mechanism,
such as Modular Dual Mobility (MDM) and X3
precisely engineered polyethylene.
Trident II is built on data from the largest
joint registries in the world,1,2 international
performance ratings12, and premier global
publications.
Trident II
PSL Clusterhole HA
Trident II Tritanium
Solidback
Creating what’s next
Additive Manufacturing is one of our critical
pillars of innovation, helping us design and bring
to market new implants. Trident II Tritanium
builds on the experience Stryker has gained from
the additive manufactured implants in our knee
and spine portfolios. Additive manufacturing
allows us to challenge conventional implant
design and production, unlocking implant
features to address clinical considerations such
as fixation and stability.
Streamlined trays complement new intuitive
instruments which are designed to facilitate
efficient and accurate bone preparation and
implantation. Additionally, Trident II Tritanium
is Mako enabled, combining the reliability
of additive manufactured implants with the
precision of robotic-arm assisted surgery.
 Stryker’s additive advantage
What is additive manufacturing?
Additive Manufacturing (AM) is a state of
the art manufacturing technique which uses
a computer model of an implant and grows
the part layer by layer in a three-dimensional
environment, fusing one layer of fine titanium
powder to the layer preceding it.
The specific type of AM which builds the
Trident II Tritanium Shell is Laser Rapid
Manufacturing which uses a focused laser
beam to melt layers of metal powder in a fusion
bed. This has been given many proprietary
pseudonyms by machine manufacturers,
such as SLM, DMLS and Cusing, and the first
machines began to appear in the late 1980s and
early 1990s. The development of metal based
powder bed fusion systems was driven by
European vendors.
Commercial launches
2014 2014 2015
Triathlon Triathlon Triathlon
Tritanium Baseplate Tritanium Patella Tritanium Cones
Stryker’s additive manufacturing journey
Stryker began investigating AM technology
in 2001 with academic research institutions.
Stryker’s research goal was to evaluate the
feasibility of the technology for controlling
porosity during manufacturing. During
the next eight years Stryker developed
an innovative approach to modeling and
manufacturing porous structures, and worked
with hardware and software companies to
develop production capable systems. In 2009 a
pilot plant was established in Stryker’s Cork,
Ireland facility to validate the production
capability of the process, which ultimately
led to Stryker’s first additive manufactured
product, the cementless Triathlon Tritanium
Baseplate.
2016 2017 2018
Tritanium Tritanium Trident II
PL Cage C Cage Tritanium Shell
Built on data

The Trident legacy

Trident II is created for case-to-case confidence
that comes from building on a system backed by
years of successful clinical data1-5 and reliable
features such as the notable Trident Innerchange
Locking Mechanism, Modular Dual Mobility
(MDM), and our X3 precisely engineered
polyethylene.

Trident’s Innerchange Locking Mechanism

remains in the new Trident II system. You’ll
appreciate the intraoperative flexibility to choose 1999 2018
from our clinically proven3-5 bearing options: Trident Trident II

Innerchange Locking Mechanism

MDM X3 Constrained
polyethylene liners

Lowest revision rates Most implanted Over 2 million

at the longest follow- acetabular shell in the shells implanted
up among uncemented Australian Registry for globally6
shells in both UK and 15 straight years10
Australian Registries1,2

X3 polyethylene
X3 precisely engineered polyethylene’s
patented manufacturing process of
sequential crosslinking uses three separate
gamma irradiation doses with an annealing
step after each.
Our patented process creates a polyethylene
that is strong7,9 and intrinsically resistant to
wear9 and oxidation.8
10-year wear rate of less than
10 microns per year11
 Built on data

Stability. We’ve got you covered.

Dislocation following total hip arthroplasty Slim shell wall
continues to be one of the most common
reasons for a revision procedure.1 With this in The Trident II Tritanium shell features a slim
mind, enhancing hip stability was a critical shell wall, enabled by additive manufacturing.
objective for the Trident II system. This allows for large femoral head size options13
and optimal poly thickness to potentially aid in
greater range of motion,14 joint stability14 and
Get bigger, faster!13
lower risk of dislocation.15
Shell size (mm)

48 50 52
Maximum femoral head size (mm)

Stryker
Trident II 36 36 40
Zimmer Biomet
G7
32 36 36
Smith & Nephew
R3 32 32 36
Zimmer Biomet
Continuum
32 32 36
DePuy Synthes
Pinnacle
32 32 36

Dual mobility at its best

Add to the inherent stability of the Trident II System
with our Modular Dual Mobility (MDM) bearing option.
MDM is designed to help prevent dislocation16-20 and
assist your operative goals of stability16, longevity21,22
and advanced fixation for primary or revision total
hip arthroplasty cases.

MDM was the market’s first modular dual

mobility offering and has demonstrated
strong clinical results in primary and
revision arthroplasty17,20
Compared to conventional bearings, MDM
has shown “absolute dominance” with
respect to cost-effectiveness23
 Fixation expertise

Additive manufactured Tritanium

The Trident II Tritanium Acetabular shell joins our knee and spine products as the latest Stryker
implant to incorporate our additive manufactured Tritanium. Tritanium features a controlled
network of pores, designed to mimic the complex characteristics of cancellous bone, and to
promote long-term biologic fixation.24

When it comes to fixation, have confidence in additive manufactured Tritanium.

Cancellous Bone Tritanium

Trident II Tritanium
Average pore size25 Average porosity25
434 microns 60%

Surface** porosity25 Coefficient of friction26,27

76% 1.2
**Surface defined as a depth of up to 200 microns

PureFix HA
Stryker’s proprietary hydroxylapatite (HA) coating has been a consistent feature of our hip portfolio
since it was first implanted in 1987. Trident II HA shells continue this legacy, incorporating
approximately 50μm thick coating of PureFix HA over a roughened plasma spray titanium surface.

Choose between a hemispherical or peripheral self-locking (PSL) geometry to select the fixation
that best suits your patient. The Trident II PSL Clusterhole HA shell features circumferential
normalizations designed to maximize fixation in the peripheral lunate region of the acetabulum.

Trident II Trident II
PSL Clusterhole HA Clusterhole HA
 Fixation expertise

Adjunct screw fixation

We know that having ample screw fixation is imperative for addressing patient-specific, and
case-specific needs. Trident II is designed to enhance adjunct screw fixation, focusing on screw
hole placement, maximizing screw angulation, and introducing a new low-profile screw.

SOMA-verifiedv screw hole pattern

SOMA is the unique Stryker Modeling and Analytics
system for the design of orthopaedic devices. At the
heart of SOMA is a large database of high resolution
CT scanned bones from which size, shape, density,
and inner and outer cortical boundaries can be
drawn. The database is comprised of bones from a
diverse population of people that includes a range of
age, gender, and ethnicity.

Screw hole patterns for Trident II shells have been

SOMA-verified to help achieve multiple screws in
the safe zone of the acetabulum.28 The Trident II
Tritanium Multihole shells feature up to 13 screw
Shown: 66mm Trident II Tritanium Multihole
holes in the larger sizes. shell with SOMA-verified screw hole pattern

Solid core screw hole

The Trident II Tritanium screw holes feature
a solid core profile that is enabled by additive
manufacturing. In combination with the 6.5mm
37° Low Profile Hex Screws, these solid cores permit
the screw head to sit deep within the screw hole to
minimize interference with liner seating.

This recessed screw position delivers flexibility

to place screws, with Trident II Tritanium shells
offering an average screw angulation of 37°.29

v Based on 520+ CT scans

New technology, new tools

Streamlined tray layouts

The streamlined rigid-container compatibleF Trident II instrument trays help reduce cost and
complexity. Whether you choose to use the Mako System or manual instrumentation, Trident II
instrument trays have been smartly kitted to free up space on your back table.

Two instrument trays, Core Reamers and General, are configured to address 99% of the
patient sizes for implant bone preparation.6

Instrument features
Hands-free38 packaging Ball Joint Drill Shaft
Eliminate unnecessary contact to the Designed for soft tissue clearance and
porous surface of the implant prior variable drill angulation while eliminating
to impaction. the open coil design found in other common
drill shafts.

Keyed Shell
Impactor
Designed to allow for
simple shell attachment
and quick adjustments
to shell placement.
U-joint driver
Retaining hex tip interface for
efficient positioning of the screw
within the screw hole.
 New technology, new tools

Mako enabled
Combine the reliability of additive manufactured implants with the precision of Mako robotic-
arm assisted surgery. Mako uses CT-based 3D modeling of the patient’s bony anatomy to provide
you with a personalized surgical plan. Mako Total Hip enables surgeons to more accurately plan
and place components30, potentially reducing variability within the THA procedure and allowing
for enhanced functional and clinical outcomes.30-37

Only Trident II Tritanium shells are compatible with Mako.

Insert compatibility

Trident II poly thickness (mm)

Shell size (mm) 42 44 46 48, 50 52, 54 56, 58 60, 62 64, 66 68, 70 72
Alpha code A B C D E F G H I J

44mm – – – – – 3.8 5.4 7.1 8.6 10.6

40mm – – – – 3.8 5.8 7.4 9.1 10.6 12.6

36mm – – – 3.9 5.9 7.9 9.4 11.2 12.7 14.7

Head
size
32mm – 3.9 4.9 5.9 7.9 9.9 11.4 13.2 14.7 16.7

28mm 4.9 5.9 6.9 7.9 9.9 11.9 13.4 15.2 16.7 18.7

22mm 7.8 8.8 9.8 10.8 12.8 14.8 16.3 18.1 19.6 21.6

MDM compatibility
Shell size (mm) 46 48, 50 52, 54 56, 58 60, 62 64, 66 68, 70 72
Alpha code C D E F G H I J

MDM CoCr liner 36C 38D 42E 46F 48G 52H 54I 58J

Poly Insert OD (mm) 36 38 42 46 48 52 54 58

Poly Insert ID (mm) 22.2 22.2 28 28 28 28 28 28

Nominal poly thickness (mm) 6.7 7.7 6.8 8.8 8.8 11.8 12.8 14.8
 Ordering information

Trident II Tritanium Clusterhole Trident II Tritanium Solidback

Cat. # Size (mm) # holes Cat. # Size (mm)
702-04-42A 42 3 700-04-42A 42
702-04-44B 44 3 700-04-44B 44
702-04-46C 46 3 700-04-46C 46
702-04-48D 48 3 700-04-48D 48
702-04-50D 50 3 700-04-50D 50
702-04-52E 52 5 700-04-52E 52
702-04-54E 54 5 700-04-54E 54
702-04-56F 56 5 700-04-56F 56
702-04-58F 58 5 700-04-58F 58
702-04-60G 60 5 700-04-60G 60
702-04-62G 62 5 700-04-62G 62
702-04-64H 64 5 700-04-64H 64
702-04-66H 66 5 700-04-66H 66

Trident II Tritanium Multihole

Cat. # Size (mm) # holes Cat. # Size (mm) # holes
709-04-42A 42 8 709-04-58F 58 13
709-04-44B 44 8 709-04-60G 60 13
709-04-46C 46 8 709-04-62G 62 13
709-04-48D 48 9 709-04-64H 64 13
709-04-50D 50 9 709-04-66H 66 13
709-04-52E 52 11 709-04-68I 68 13
709-04-54E 54 11 709-04-70I 70 13
709-04-56F 56 13 709-04-72J 72 13
Ordering information

Trident II Clusterhole HA Trident II PSL Clusterhole HA

Cat. # Size (mm) # holes Cat. # Size (mm) # holes
702-11-42A 42 3 742-11-42A 42 3
702-11-44B 44 3 742-11-44B 44 3
702-11-46C 46 3 742-11-46C 46 3
702-11-48D 48 3 742-11-48D 48 3
702-11-50D 50 3 742-11-50D 50 3
702-11-52E 52 5 742-11-52E 52 5
702-11-54E 54 5 742-11-54E 54 5
702-11-56F 56 5 742-11-56F 56 5
702-11-58F 58 5 742-11-58F 58 5
702-11-60G 60 5 742-11-60G 60 5
702-11-62G 62 5 742-11-62G 62 5
702-11-64H 64 5 742-11-64H 64 5
702-11-66H 66 5 742-11-66H 66 5

6.5mm Low Profile Hex Screws Hex Dome Hole Plug

Cat. # Size (mm) Cat. # Size (mm)
7030-6515 15 7060-0000 Hex Dome Hole Plug
7030-6520 20
7030-6525 25
7030-6530 30
7030-6535 35
7030-6540 40
7030-6545 45
7030-6550 50
7030-6555 55
7030-6560 60
Notes
Notes
References
1. Australian Orthopedic Association National Joint Replacement Registry, 2017 Annual Report. 24. Stryker R&D Technical Memo: Comparison of Tritanium Porous Surface to Cancellous Bone.
A0027625
16-year revision rate obtained from table HT12 in AOANJRR 2017 Annual Report
25. Stryker R&D Technical Report: Characterizing the Physical Properties of the Trident II
Femoral Acetabular N N 3 5 10 15 16
1 year Tritanium Acetabular Shell. May 22, 2017. A0021722
component component revised total years years years years years

Secur-Fit Trident 1.2 1.9 2.3 3.4 4.6 4.6 26. Stryker R&D Technical Report: Evaluation of the Coefficient of Friction of the Trident II
181 5778
Plus (Shell) (1.0, 1.5) (1.6, 2.3) (2.0, 2.8) (2.9, 4.0) (3.8, 5.6) (3.8, 5.6) Tritanium Surface. Sep 01, 2016. A0015751

27. Stryker R&D Technical Memo: Trident II Tritanium Acetabular Shell Coefficient of Friction
2. UK National Joint Registry, 2017 Report. Equivalence Rationale. Oct 24, 2017. A0026809
13-year revision rate obtained from table 3.8 in UK National Joint Registry 2017
28. SOMA Screw Engagement. Stryker R&D Test Report - A0026638. October, 2017. SOMA
Median Cumulative percentge probability of revision (95% CI) at: verification at 45° inclination/20° anteversion.
Stem/cup (IQR) %
n
brand age at males 3 5 7 10 13 29. Stryker R&D Technical Report: Trident II Screw Angulation Memo. December 7, 2017.
primary 1 year years years years years years
A0026941
Exeter V40 / 0.55 1.03 1.41 1.86 2.61 2.89
Trident
60,984 69 (61-76) 39%
(0.50-0.62) (0.94-1.12) (1.29-1.52) (1.71-2.02) (2.36-2.89) (2.56-3.26)
30. Nawabi D, et al. Haptically Guided Robotic Technology in Total Hip Arthroplasty: A
Cadaveric Investigation. J Engineering in Medicine. 2012 Oct; 0(0) 1–8.

3. D’Antonio J, et al. Second-Generation Annealed Highlight Crosslinked Polyethylene has Low
Wear at Mean Seven Year Follow-up. Surgical Technology International. 2014 Nov;25:219-26.
4. Jauregui J, et al. Dual Mobility Cups: an Effective Prosthesis in Revision Total Hip
Arthroplasties for Preventing Dislocations. Hip Int. 2016 Jan-Feb;26(1):57-61.
5. Su E, et al. The Role of Constrained Liners in Total Hip Arthroplasty. Clin Orthop.
2004;420:122–129.
6. Sales data on file.
7. Fatigue Comparison of Various UHMWPE for Hip Applications. Stryker Internal Report
#RD-12-049. May, 2012.
8. Yau S, et al. Sequential Irradiation and Annealing of Highly Crosslinked Polyethylenes
Resists oxidation without sacrificing Physical/Mechanical Properties. 51st Annual Meeting
of the Orthopedic Research Society. Poster No. 1670.
9. Longaray et al. (2013). Fatigue and Wear Characterization of Various Contemporary Hip
Bearing Materials. ORS Annual Meeting: Poster #1779.
10. Australian Orthopaedic Association National Joint Registry. Annual Reports 2002-2017.
31. Bragdon C, et al. A Multicenter Evaluation of Acetabular Cup Positioning in Robotic-
Assisted Total Hip Arthroplasty. 43rd Annual Course: Advances in Arthroplasty, October
22-25, 2013, Boston, MA.
32. Domb BG, et al. Comparison of Robotic-assisted and Conventional Acetabular Cup
Placement in THA: A Matched-Pair Controlled Study., Clin Orthop Relat Res. 2014
Jan;472(1):329-36.
33. Redmond J, et al. Does Robotic-Assisted Computer Navigation Affect Acetabular Cup
Positioning in Total Hip Arthroplasty in the Obese Patient? A Comparison Study. J
Arthroplasty. 2015 Dec;30(12):2204-7
34. Redmond J, et al. The Learning Curve Associated with Robotic-Assisted Total Hip
Arthroplasty. J Arthroplasty. 2015 Jan;30(1):50-4.
35. Elson L, et al. Precision of Acetabular Cup Placement in Robotic Integrated Total Hip
Arthroplasty. Hip Int. 2015 Sept;25 (6): 531-536
36. Jerabek SA, et al. Accuracy of Cup Positioning, COR Restoration and Achieving Desired Hip
Length and Offset with Robotic Total Hip Arthroplasty. 14th Annual CAOS Meeting, June
18-21, 2014, Milan, Italy.

11. Campbell D, et al. Wear of a Second-Generation XLPE Liner Remains Low at 10 Years: An
RSA Study. 5th Annual International RSA Conference, October 6-8, 2017, Adelaide, SA,
Australia.
12. Orthopaedic Data Evaluation Panel (ODEP) Product Page - Trident PE. http://www.odep.org.
uk/product.aspx?pid=204.
37. Thompson M. Efficient and Accurate Hip Length and Combined Offset with the MAKOplasty
THA Femoral Express Workflow. Mako Surgical Corp. March 2014.
38. Internal memo: Nurse Appreciation Day VOC. July 28, 2017. A0029201.
F Trays compatible with Aesculap Configuration JN442 (base), JK48x (lid).

13. Internal memo: Market Analysis of Poly Bearing Options - Trident II Versus Competitors.
October 18, 2017.

14. Burroughs B, et al. Range of Motion and Stability in Total Hip Arthroplasty with 28-, 32-,
38- and 44-mm Femoral Head Sizes In Vitro Study. The Journal of Arthorplasty, Vol. 20, No.
1, 2005 pp. 11-19.

15. Berry D.J., et al. Effect of Femoral Head Diameter and Operative Approach on Risk of
Dislocation After Primary Total Hip Arthroplasty. J of Bone and Joint Surgery Vol. 87-A, No.
11 (2005); pp. 2456-2463.

16. Heffernan C, et al. (2011). Development and Validation of a Novel Modular Dual Mobility
Hip Bearing. ORS Annual Meeting Poster #1165.

17. Epinette J, et al. Early experience with dual mobility acetabular systems featuring highly
crosslinked polyethylene liners for primary hip arthroplasty in patients under fifty-five
years of age: an international multi-centre preliminary study. International orthopaedics
(SICOT). Sept. 2016 DOI 10.1007/s00264-016-3367-0.

18. Jauregui J, et al. Dual mobility cups: an effective prosthesis in revision total hip
arthroplasties for preventing dislocations. Hip Int. 2016 Feb 8;26(1):57-61.

19. Mont MA, et al. The Use of Dual-Mobility Bearings in Difficult Hip Arthroplasty
Reconstructive Cases. Surg Technol Int. 2011 Dec.; 21:234-40.

20. Abdel M, et al. Dual-Mobility Constructs in Revision THA Reduced Dislocation, Re-Revision
& Reoperation Compared to Large Femoral Heads. Hip Society 2017 Otto Aufranc Award.

21. Herrera L, et al. (2010) Edge Loading Wear due to Inclination Angle for Three Contemporary
Hip Bearings. 56th Annual ORS Meeting. Poster #2259.

22. Stryker Orthopaedics Restoration ADMX3 28mm ID acetabular inserts made of X3 Gas
Plasma Sterilized UHMWPE, show a 97% reduction in volumetric wear rate versus 28 mm
ID Restoration ADM Duration Gamma Radiation Sterilized UHMWPE. Both ADM constructs
utilized a 54mm OD shell and the inserts were approximately 9.9 mm thick. Testing was
conducted under multi-axial hip joint simulation for 5 million cycles using a 28mm CoCr
modular femoral head articulating counterface and calf serum lubricant. Volumetric wear
rates were 109.7±6.0 mm3/106 cycles and -1.03 ± 3.8 mm3/106 cycles for Duration and X3
polyethylene insert test samples. Although in-vitro hip wear simulation methods have not
been shown to quantitatively predict clinical wear performance, the current model has been
able to reproduce correct wear resistance rankings for some materials with documented
clinical results.1-3
1) Wang, A, et. al., Tribology International, Vol. 31, No. 1-3: 17-33, 1998.
2) Essner, A. et. al., 44th Annual Meeting, ORS, New Orleans, Mar. 16-19, 1998: 774.
3) Essner, A. et. al., 47th Annual Meeting, ORS, San Francisco, Feb. 25-28,2001:1007.

23. Barlow B, et al. The Cost-Effectiveness of Dual Mobility Implants for Primary Total Hip
Arthroplasty: A Computer-Based Cost-Utility Model. J of Bone and Joint Surgery. 2017 May
3:99(9):768–777.
Orthopaedics
A surgeon must always rely on his or her own professional clinical 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. The information presented is intended to demonstrate the breadth of Stryker’s product offerings. A surgeon must
always refer to the package insert, product label and/or instructions for use before using any of Stryker’s products. 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 sales
representative if you have questions about the availability of products in your area.

Stryker Corporation or its divisions or other corporate affiliated entities own, use or have applied for the following trademarks or service
marks: ADM, Duration, Gamma, Mako, MAKOplasty, MDM, PureFix, Restoration, SOMA, Stryker, Stryker Orthopaedics, Triathlon, Trident,
Tritanium, X3. All other trademarks are trademarks of their respective owners or holders.

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