PURIST Orthopedic Leg Positioner | STERIS
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PURIST Orthopedic Leg Positioner™

  • Designed for direct anterior hip replacement
  • Allows for measurable and reproducible positioning
  • Small footprint, free-standing, and mobile design
  • Compatible with your existing general surgical tables


Product Overview

The PURIST Orthopedic Leg Positioner is designed to boost efficiency and surgeon control throughout the direct anterior Total Hip Replacement (THR) procedure. It is a surgical leg holder that enables all essential leg movements for direct anterior THR in a condensed and efficient manner.

How PURIST Orthopedic Leg Positioner works

The PURIST Orthopedic Leg Positioner streamlines procedures, supports repeatability, and frees the hands of the surgical team. It is fixed on a mobile base with large casters, making mobility effortless and allowing it to pair with any general surgical table.

Why PURIST Orthopedic Leg Positioner?

It is built to perform independent Direct Anterior (THR) movements on a graduated scale and its enhanced design allows the surgeon to control traction and rotation intra-operatively with precision and without help from non-sterile personnel. Its quick setup, staff-friendly operation, and small footprint make the PURIST popular with busy operating room (OR) teams. Combine the PURIST with any standard OR table to build a superior leg positioning system.

A dedicated orthopedic table is typically expensive, bulky, and challenging to move about the OR and even into storage. The PURIST Orthopedic Leg Positioner offers meticulous surgical positioning capabilities such as independent traction, rotation, extension, and ab/adduction controls, with a smaller footprint, making storage simple.

It is fixed on a mobile base with large casters, making mobility effortless. Easy to store, generally low maintenance, and flexibility to pair with any general surgical table.

Clinical Advantages:

  • Built to perform independent DA THR movements on a graduated scale
  • Up to 180° rotation
  • 130mm available traction
  • Full extension
  • Up to 40° adduction or abduction
  • Enhanced design allows the surgeon to control traction and rotation and perform a range of motion stability testing
  • Fast Track Hybrid System™ provides simultaneous traction and rotation functionality
  • Patented design releases traction during leg extension and automatically restores traction at 0° extension

Operational Advantages:

  • Quick OR setup
  • Effortless and safe leg movements for orthopedic position
  • Ergonomic design
  • Built-in drape holder for well-defined, reproducible draping
  • Small footprint (2 x 3 ft.)
  • Staff-friendly operation simplifies back-to-back surgeries
  • Facilitates bilateral DA THR

*with Opposite Leg Holder
**with DAA Top 360

Surgical Features OR Table IconOR Table Only (Off-Table) PURIST iconPURIST Orthopedic Table IconFull Orthopedic Table
Measurable, Reproducible Positioning - + -
Mechanically Supported Femoral Exposure - + +
Hip Extension - + +
Limited Pelvic Tilt - +* +
Lower Extension Risk - + +
Cutouts under the hips for improved acetabular access - +** +
Logistical Features OR Table IconOR Table Only (Off-Table) PURIST iconPURIST Orthopedic Table IconFull Orthopedic Table
OR Flexibility - no dedicated OR needed + + -
Small Storage Footprint + + -
Low Maintenance Costs + + -

Source: https://www.iotiot.com/leg-positioning-systems-for-improved-surgical-control-femoral-exposure

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Surgical Functions

The PURIST Leg Positioning System has four measurable surgical functions: Traction, Rotation, Extension / Flexion, and Adduction / Abduction. Operators should stand directly behind the PURIST for the simplest operation of these functions.



Adduction / Abduction


The PURIST has controls for fine and gross traction. Fine traction is controlled with the traction hand wheel, and gross traction is controlled by pulling the red handle. Traction, measured in millimeters of length, can be applied from 0 mm to 130 mm. Most surgeons use less than 80mm of traction.

Gross Traction
Fine Traction


180° of internal or external rotation of the patient’s foot/leg is available. Rotation is controlled in increments of 10 degrees. High levels of external rotation will be used during a Direct Anterior THA case.



The PURIST is capable of 31.5 inches of leg extension. The PURIST traction boot slides along a straight pendulum attached to a gas piston. When a patient’s leg is attached, the pendulum will automatically swing out and follow the natural arc of the leg. The gas strut supports this compensating movement. The patient’s leg can be positioned at infinite positions along the pendulum using a hand wheel that executes the leg extension. The PURIST automatically removes traction during extension and restores traction at 0° extension as a safety feature.



40° of Ab- or Ad-duction is available (80° total). Ab/Adduction is controlled in increments of 10 degrees in either direction using an extendable lever handle. The added length of the extendable lever will give the operator more leverage. The amount of Ab/Adduction can be read on the back of the PURIST.

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Specifications PURIST
Weight Capacity 500 lbs. (227 kg)
Product Weight 88 lbs. (40 kg)
Traction 5.2" (13 cm)
Rotation 180° / 10° increments
Extension 31.5" (80 cm)
Flexion N/A
Adduction / Abduction 40° / 10° increments
Length 24" (61 cm)
Width 36" (91cm)
Height 48" (122cm)
Fracture / Trauma Not Capable
Anterior Hip Capable
Table Connected No
Accessories Required

Opposite Leg Holder (BF00406)

Perineal Post (BF00403)

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Shop Now

Product Number Description  
BF00402 PURIST Orthopedic Leg Positioner
BF00403 Perineal Operative Post
BF00406 Opposite Leg Holder, Red
BF00407 Opposite Leg Holder, Denyer+, Red
BF00412 PURIST / OLH Traction Boot, Red, Small
BF00411 PURIST / OLH Traction Boot, Red, Medium
BF00421 Perineal Post Pad for Perineal Operative Post / DAA Top 360
BF00422 Femoral Support Pad for Perineal Operative Post
BF00423 Tabletop Pad for DAA Top 360
BF00424 Femoral Support Pad for DAA Top 360
BF00431 Single-Use Anterior Hip Drape
BF00433 Single-Use Fluid Collection Pouch
BF00432 Single-Use Instrument Pouch
BF00434 Single-Use POP Covers
BF00435 Single-Use Perineal Post Pad
BF00436 Single-Use Traction Boot Liners
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PURIST Overview

Why We Use the PURIST
- Dr. Miranda and Dr. Tsismenakis

PURIST Surgical Functions

PURIST In-Service
(Product & Patient Setup)

PURIST Typical Leg Positions
During Direct Anterior THA

Perineal Operative Post

Opposite Leg Holder

Boot Liner and Traction Boot - Patient Setup

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Training Certification Program

Are you interested in becoming certified to use the ARCH or even becoming a trainer of other users? Welcome to the ARCH Training Certification Program. We are glad you want to become our equipment's certified user or trainer. STERIS’ certification program for users and trainers is divided into the three tiers below.

Level 1: PURIST Users

This refers to medical professionals who operate the device in the operating room. Level 1 equipment users should know all the information in the following documents. The Level 1 Certification Form can be used if necessary but is not required.

  1. PURIST In-Service Video
  2. PURIST In-Service Summary
  3. PURIST Pre-op Checklist
  4. DAA Top 360 In-Service Summary (if applicable)

Level 2: Trainers

This level is for advanced users, STERIS employees, and third-party representatives who will be in-servicing Level 1 users on the proper use of the ARCH. Level 2 trainers must meet all Level 2 Certification Form requirements.

Level 3: Advanced Trainers

This level is for STERIS employees and third-party representatives ONLY with the certification to train Level 2 trainers. In addition to all requirements necessary to achieve Level 2 certification, Level 3 trainers must also meet the requirements outlined in the Level 3 Certification Form.

Please click the CONTACT link below and send us a request to start your certification training today.


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Q: Do the ARCH and/or PURIST systems use a femur hook with a powered lift to elevate the femur?

A: No. Both the ARCH and PURIST systems use femoral support under the patient’s thigh, which acts as a fulcrum to elevate the proximal end of the femur during leg extension.

The Perineal Operative Post and Direct Anterior Approach (DAA) Top 360 accessories have femoral supports with variable heights. Increasing the height of the femoral support will increase the anterior movement of the proximal end of the femur during leg extension. The DAA Top 360 tabletop accessory offers the widest range of femoral support height adjustment, and the height can be changed intraoperatively through the drape.

Q: ARCH vs. PURIST, which product is best for me?

A: It depends on the surgeon's preference and OR setting. We have PURIST and ARCH users who are very satisfied with the performance of their leg positioning system of choice. The PURIST is designed specifically for anterior hip replacement, and the ARCH can be used for anterior hip replacement and femoral fractures.

ARCH Advantages

  • Fully constrains the leg during extension and adduction
  • More total rotation and adduction available
  • Easily accessible flexion movements
  • Adduction and abduction are possible at neutral extension

PURIST Advantages

  • Automatic traction release during extension
  • Fast Track Hybrid System™ for simultaneous traction and rotation control, simplifying hip reduction and dislocation
  • Smaller footprint
  • Increased mobility
  • Built-in drape holder
  • The PURIST operator can complete all surgical functions in a standing position.

For surgeons who currently use full-size fracture tables and are looking for firm, sturdy control of the leg, we usually recommend the ARCH. For surgeons looking for a light, ergonomic, staff-friendly device, we usually recommend the PURIST. However, this is highly variable and depends on individual surgeon preferences, staff familiarity with the anterior approach, surgical volume, geographic location, facility size, etc. Contact us for more information.

Q: Can the ARCH or PURIST be used for hip arthroscopy?

A: Neither the ARCH nor the PURIST is designed for hip arthroscopy.

Q: Are the ARCH and the PURIST compatible with any surgical table?

A: Yes, ARCH and PURIST are compatible with most general surgical tables. Over the last 10+ years, we have had very few situations in which our accessories did not fit!

Both our ARCH and PURIST systems are free-standing devices, and the accessories attach to the OR table siderails. Siderail dimensions can vary depending on the country, but this is not a problem. We offer various siderail attachments to fit different types of siderails. Our accessories are currently used in markets with different sizes of siderails, such as the USA, Europe, Australia, and Japan.

There is no need to pair our systems with a traction table. More basic OR tables, such as the STERIS 5095 or AMSCO 3085 SP, are preferred because they have fewer metal structures that could interfere with intraoperative imaging.

Q: What is the best way to set up the OR table using the ARCH or PURIST?

A: Follow all requirements of the OR table used. We recommend orienting the table when possible so the long portion of the table base will be situated under the patient’s center of gravity and pointing toward the ARCH or PURIST. This usually provides increased stability. Ensure there is adequate clearance for the C-arm to maneuver into place. Watch the ARCH In-Service Video or PURIST In-Service Video for more info.

Q: How are the ARCH and the PURIST classified in my country?

A: According to FDA and MDR regulations, ARCH and PURIST are classified as class I medical devices.

Q: What is the maximum patient weight for these devices?

A: The ARCH, PURIST, DAA Top 360, OLH, and POP are all designed for patient weights up to 500 lb. (227 kg). However, if the patient weight limit of the OR table is lower than this, the table weight limit takes priority. Ensure to check the orientation of the OR table, as different orientations often have different weight limits. Refer to the OR table user manual to ensure you operate within their specifications.

Q: Does the PURIST have patient height requirements?

A: No, the PURIST does not have patient height requirements.

Q: What maximum patient height can the Opposite Leg Holder accommodate?

A: About 7’5” (226cm). As leg length and total height are not perfectly correlated, this is an estimated maximum height.

Q: Do you have different traction boot sizes?

A: Yes. The ARCH, PURIST, and Opposite Leg Holder (OLH) all have a size medium boot in their standard configurations. We also offer a size small boot that can be purchased separately.

Q: What is the footprint of the PURIST?

A: 61 cm (2’) x 91 cm (3’)

Q: Is the black perineal post pad (of the POP or DAA Top 360) reusable?

A: Yes, the black perineal post pad is designed to be reusable. Its closed-pore design allows the sealed surface to be easily cleaned. However, we recommend replacement after every 10 cases.

Q: Are single-use accessories required with ARCH and PURIST?

A: No. However, we offer a variety of single-use products that increase patient safety and efficiency, especially in Direct Anterior THA cases.

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